Update on Current Update on Current Vascular ResearchVascular Research

Christi DeatonChristi DeatonProfessor of NursingProfessor of Nursing

University Hospital of South Manchester NHS FTUniversity Hospital of South Manchester NHS FTSchool of Nursing, Midwifery & Social WorkSchool of Nursing, Midwifery & Social Work

The University of ManchesterThe University of Manchester

Vascular ResearchVascular Research

Broad area of researchBroad area of researchHeart diseaseHeart diseaseDiabetesDiabetesStrokeStrokeKidney diseaseKidney disease

Focus on:Focus on:CLAHRC (implementation)CLAHRC (implementation)Examples of nurse-led cardiovascular Examples of nurse-led cardiovascular

researchresearch

CLAHRCCLAHRC

Collaborations for Leadership in Applied Collaborations for Leadership in Applied Health Research and Care Health Research and Care Innovative programme from NIHRInnovative programme from NIHR

The NIHR CLAHRC for Greater Manchester is The NIHR CLAHRC for Greater Manchester is a collaboration of Greater Manchester NHS a collaboration of Greater Manchester NHS Trusts and the University of ManchesterTrusts and the University of Manchester Conduct high quality health services researchConduct high quality health services research Ensure knowledge gained from the research is Ensure knowledge gained from the research is

translated into improved health care in the NHStranslated into improved health care in the NHS

““Knowledge Transformation”Knowledge Transformation”

Greater Manchester

Why CLAHRCs?Why CLAHRCs?

Aim to provide high quality research Aim to provide high quality research and apply it!and apply it!

Addressing Cooksey’s second Addressing Cooksey’s second translational gaptranslational gap

Major problem in the health service Major problem in the health service re “know how”re “know how”

Evaluative componentEvaluative component

Greater Manchester

CLAHRC in UKCLAHRC in UK

• Nine approved CLAHRCs in EnglandNine approved CLAHRCs in England• Manchester, Birmingham, Manchester, Birmingham,

Leeds/York, Leicester, Exeter/Peninsula, Leeds/York, Leicester, Exeter/Peninsula, London-Imperial, Sheffield, Nottingham, London-Imperial, Sheffield, Nottingham, Cambridge.Cambridge.

• Each receives £10 million over 5 Each receives £10 million over 5 years from the NIHR alongside £10 years from the NIHR alongside £10 million in ‘matched funds’million in ‘matched funds’

• Began in October 2008Began in October 2008

NIHR CLAHRCNIHR CLAHRC

Director Bonnie SibbaldDirector Bonnie Sibbald Deputy Director Ruth BoadenDeputy Director Ruth Boaden Vascular disease focusVascular disease focus

Major health problem in GMMajor health problem in GM Expertise in the UniversityExpertise in the University Stroke, Kidney, Heart, DiabetesStroke, Kidney, Heart, Diabetes

Aims to improve the quality of Aims to improve the quality of care and the health of citizens care and the health of citizens suffering from these conditionssuffering from these conditions

The WISE ApproachThe WISE Approach

LevelLevel StrategyStrategy MethodMethod

People with People with long term long term conditionsconditions

Improve Improve informationinformation

Develop information Develop information resources that resources that combine lay with combine lay with professional professional knowledgeknowledge

PractitionerPractitionerss

Change Change professional professional responseresponse

Introduce patient-Introduce patient-centred care with centred care with negotiated self-negotiated self-managementmanagement plans plans

ServicesServices Improve access to Improve access to servicesservices

Promote patient-led Promote patient-led follow upfollow up through through service redesignservice redesign

Greater Manchester

WISE: Whole-system Informing Self-management Engagement

People with Long Term ConditionsPeople with Long Term ConditionsResearch Theme 1. Anne Rogers, Carolyn Chew-GrahamResearch Theme 1. Anne Rogers, Carolyn Chew-Graham

Develop new information resources Develop new information resources to support patient self-managementto support patient self-management in diabetes, kidney and heart in diabetes, kidney and heart disease.disease.

Adapt these resources to the needs Adapt these resources to the needs of people living in poverty.of people living in poverty.

Assess cost and effectiveness Assess cost and effectiveness through randomised controlled trials.through randomised controlled trials.

Health Care PractitionersHealth Care PractitionersResearch Theme 2. Linda Gask, Christine Bundy & Chris Research Theme 2. Linda Gask, Christine Bundy & Chris

DickensDickens

Develop better approach to the Develop better approach to the management of depression in management of depression in patientspatients with diabetes and heart with diabetes and heart disease.disease.

Adapt this approach to meet the Adapt this approach to meet the needs of people from ethnic minority needs of people from ethnic minority groups. groups.

Assess cost and effectiveness through Assess cost and effectiveness through randomised controlled trials. randomised controlled trials.

Health Care ServicesHealth Care ServicesResearch Theme 3. Kinta BeaverResearch Theme 3. Kinta Beaver

Develop patient-led access to Develop patient-led access to specialist carespecialist care for people with for people with diabetes and kidney disease. diabetes and kidney disease.

Adapt these to the needs of people Adapt these to the needs of people from ethnic minority groups. from ethnic minority groups.

Assess cost and effectiveness Assess cost and effectiveness through randomised controlled through randomised controlled trials.trials.

Health Information Health Information SystemsSystems

Research Theme 4. Iain BuchanResearch Theme 4. Iain Buchan

Use existing NHS information Use existing NHS information systems to- systems to- • Map clinical care pathwaysMap clinical care pathways• Measure inequalitiesMeasure inequalities

Develop simulation models to Develop simulation models to assess impacts of planned assess impacts of planned interventions on cost and quality of interventions on cost and quality of care.care.

CLAHRC ImplementationCLAHRC Implementation

Stroke – Pippa Tyrrell (Salford)Stroke – Pippa Tyrrell (Salford)Diabetes – Martin Gibson (Salford)Diabetes – Martin Gibson (Salford)Chronic Kidney Disease – Donal Chronic Kidney Disease – Donal

O’Donoghue/Janet Hegarty O’Donoghue/Janet Hegarty (Salford)(Salford)

Heart Disease – Christi Deaton Heart Disease – Christi Deaton (UHSM/UoM)(UHSM/UoM)

Academic PartnersAcademic Partners

Prof. Ruth BoadenProf. Ruth Boaden Professor of Service Professor of Service Operations ManagementOperations Management

quality frameworks and quality frameworks and assessmentassessment

Dr Gill HarveyDr Gill Harvey Senior Lecturer in Senior Lecturer in Healthcare and Public Healthcare and Public Sector ManagementSector Management

evaluation of changeevaluation of change

Dr Anne McBrideDr Anne McBride Senior Lecturer in Senior Lecturer in Employment StudiesEmployment Studies

workforceworkforce

Dr David BamfordDr David Bamford Senior Lecturer in Senior Lecturer in Operations ManagementOperations Management

leadership and the leadership and the knowledge transfer knowledge transfer processprocess

Prof. Louise FitzgeraldProf. Louise Fitzgerald Visiting Professor and Visiting Professor and Professor of HRM at de Professor of HRM at de Montfort University, Montfort University, Leicester. Leicester.

change in change in professionalised professionalised organisations and the organisations and the spread of changespread of change

Prof. Heather WatermanProf. Heather Waterman Professor of Nursing and Professor of Nursing and Ophthalmology, SNMSWOphthalmology, SNMSW

action research action research methodologymethodology

Implementation StrategyImplementation Strategy

Evidence-based framework* for changeEvidence-based framework* for change1)1) Agree the goals of changeAgree the goals of change2)2) Determine how attainment of these Determine how attainment of these

goals will be measured goals will be measured 3)3) Identify what changes should be made Identify what changes should be made

to attain the goals to attain the goals 4)4) Implement change using Plan-Do-Study-Implement change using Plan-Do-Study-

Act cyclesAct cycles5)5) Sustain and spread the changeSustain and spread the change

Model for Improvement and Promoting Action on Research Implementation in Health Services” (PARiHS) framework*

Implement Research Theme Implement Research Theme outputoutput

Research ThemeResearch Theme Improvement InterventionImprovement Intervention

1. People with long 1. People with long term conditionsterm conditions

Information resources that combine lay with Information resources that combine lay with professional knowledge; guidebooks for professional knowledge; guidebooks for patients, training for professionalspatients, training for professionals

2. Practitioners2. Practitioners

Training to support negotiated patient self-Training to support negotiated patient self-management.management.

Better treatments for depression in people with Better treatments for depression in people with long term conditions.long term conditions.

3. Services3. Services Patient-led models of access to specialist care.Patient-led models of access to specialist care.

4. Systems4. Systems Information systems to plan and monitor the Information systems to plan and monitor the impact of interventions.impact of interventions.

StrokeStroke

Implementation of national Implementation of national stroke strategystroke strategy

Work with emergency services to Work with emergency services to ensure people with acute symptoms ensure people with acute symptoms are triaged without delay to specialist are triaged without delay to specialist stroke centres stroke centres

Develop patient-centred management Develop patient-centred management plans to support people through the plans to support people through the sequelae of stroke / TIA, and prevent sequelae of stroke / TIA, and prevent future vascular injury and deathfuture vascular injury and death..

DiabetesDiabetes

Improve access and quality of Improve access and quality of carecare

Nurse-led call centre management Nurse-led call centre management with regular proactive telephone with regular proactive telephone advice advice

Nurse-led specialist ambulatory care Nurse-led specialist ambulatory care clinic for people with hypertension and clinic for people with hypertension and hyperlipidemia.hyperlipidemia.

Greater Manchester

Chronic Kidney DiseaseChronic Kidney Disease

Improve general practice Improve general practice managementmanagement

Local adaptation of national clinical Local adaptation of national clinical guidelines, including referral guidelines, including referral protocols to specialist careprotocols to specialist care

Training for nurses and GPs in Training for nurses and GPs in chronic kidney disease managementchronic kidney disease management

Educational outreachEducational outreach by hospital by hospital specialistsspecialists

Heart DiseaseHeart Disease

Improve access and quality Improve access and quality of care of care

Decrease stroke risk in AF through Decrease stroke risk in AF through early diagnosis (pulse checks) and early diagnosis (pulse checks) and anti-coagulation management anti-coagulation management

Improve MDT management of chronic Improve MDT management of chronic heart failure (CHF)heart failure (CHF) Optimal doses ACEI/ARB and BBOptimal doses ACEI/ARB and BB Discharge planning and follow-upDischarge planning and follow-up

Implementation SitesImplementation Sites

Stroke

Diabetes

Kidney Disease

Heart Disease

Diabetes

Diabetes Stroke

StrokeStroke

Stroke

Kidney Disease

Kidney Disease

Diabetes

Stroke

Patient and Public EngagementPatient and Public Engagement Research themesResearch themes

• Patient consultation and participationPatient consultation and participation

Implementation themesImplementation themes• Patient consultation through new/existing Patient consultation through new/existing

patient engagement networkspatient engagement networks

GovernanceGovernance• Patient representation on Steering GroupPatient representation on Steering Group

Wider engagementWider engagement• Public dissemination of findingsPublic dissemination of findings• Public debate/scrutiny:- use of NHS Public debate/scrutiny:- use of NHS

information resources for researchinformation resources for research

Step ChangeStep Change

ImplementationImplementation Large-scale sustained knowledge Large-scale sustained knowledge

transfer between University and transfer between University and NHS. NHS.

Increased capacity in the NHS to Increased capacity in the NHS to plan and implement evidence-based plan and implement evidence-based changes to service deliverychanges to service delivery

Inputting into commissioningInputting into commissioning

Other Vascular Research….

Examples of Nurse-Led Research Examples of Nurse-Led Research in Cardiovascularin Cardiovascular

Predictors of Impaired health related QoL in Predictors of Impaired health related QoL in patients receiving thrombolysis or primary patients receiving thrombolysis or primary PCI PCI Linda McGowan, Chris Dickens, Heather Iles-Linda McGowan, Chris Dickens, Heather Iles-

Smith, Cat Rogers, F. Fath-OrdoubadiSmith, Cat Rogers, F. Fath-Ordoubadi 6 Month Interim Findings6 Month Interim Findings

Winner of best poster abstract at 9Winner of best poster abstract at 9thth Annual Annual Spring Meeting on Cardiovascular Nursing, Spring Meeting on Cardiovascular Nursing, Dublin, April 2009 (presented by Cat Rogers)Dublin, April 2009 (presented by Cat Rogers)

Council on Cardiovascular Nursing and Allied Council on Cardiovascular Nursing and Allied Professions (CCNAP) of the European Society of Professions (CCNAP) of the European Society of CardiologyCardiology

Doctoral Student ResearchDoctoral Student Research

An investigation of the role of anxiety An investigation of the role of anxiety and depression on representation and depression on representation rates post Primary PCI for STEMIrates post Primary PCI for STEMIHeather Iles-Smith Heather Iles-Smith

The impact of anxiety on health The impact of anxiety on health status and quality of life of patients status and quality of life of patients with heart failurewith heart failureKatherine Easton Katherine Easton

Doctoral Student ResearchDoctoral Student Research

The relationship between self-care The relationship between self-care and health related QoL in adult and health related QoL in adult patients with dilated cardiomyopathypatients with dilated cardiomyopathyMaria KapranaMaria Kaprana

An investigation into the factors that An investigation into the factors that facilitate early help-seeking facilitate early help-seeking behaviour for CHD related conditions behaviour for CHD related conditions among Chinese Elders in NW Englandamong Chinese Elders in NW EnglandZhenmi LiuZhenmi Liu

ConclusionsConclusions

Number of ongoing and developing Number of ongoing and developing projectsprojects

Opportunities for research Opportunities for research development and involvement development and involvement connected to the CLAHRC connected to the CLAHRC programme and other studiesprogramme and other studies