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Journal articleGoiana-da-Silva F, Severo M, Cruz-E-Silva D, et al., 2020,
Projected impact of the Portuguese sugar-sweetened beverages tax on obesity incidence across different age groups: a modelling study
, PLoS Medicine, Vol: 17, Pages: 1-17, ISSN: 1549-1277BackgroundExcessive consumption of sugar has a well-established link with obesity. Preliminary results show that a tax levied on sugar-sweetened beverages (SSBs) by the Portuguese government in 2017 led to a drop in sales and reformulation of these products. This study models the impact the market changes triggered by the tax levied on SSBs had on obesity incidence across various age groups in Portugal.Methods and findingsWe performed a national market analysis and population-wide modelling study using market data for the years 2014–2018 from the Portuguese Association of Non-Alcoholic Drinks (GlobalData and Nielsen Consumer Panel), dietary data from a national survey (IAN-AF 2015–2016), and obesity incidence data from several cohort studies. Dietary energy density from SSBs was calculated by dividing the energy content (kcal/gram) of all SSBs by the total food consumption (in grams). We used the potential impact fraction (PIF) equation to model the projected impact of the tax-triggered change in sugar consumption on obesity incidence, through both volume reduction and reformulation. Results showed a reduction of 6.6 million litres of SSBs sold per year. Product reformulation led to a decrease in the average energy density of SSBs by 3.1 kcal/100 ml. This is estimated to have prevented around 40–78 cases of obesity per year between 2016 and 2018, with the biggest projected impact observed in adolescents 10 to <18 years old. The model shows that the implementation of this tax allowed for a 4 to 8 times larger projected impact against obesity than would be achieved though reformulation alone. The main limitation of this study is that the model we used includes data from various sources, which can result in biases—despite our efforts to mitigate them—related to the methodological differences between these sources.ConclusionsThe tax triggered both a reduction in demand and product reformulation. These, together, can reduce obesity levels
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Journal articleMazzucato M, Li HL, Darzi A, 2020,
Is it time to nationalise the pharmaceutical industry?
, BMJ: British Medical Journal, Vol: 368, Pages: 1-3, ISSN: 0959-535X -
ReportGhafur S, Fontana G, Halligan J, et al., 2020,
NHS data: Maximising its impact on the health and wealth of the United Kingdom
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Journal articleFontana G, Ghafur S, Torne L, et al., 2020,
Ensuring that the NHS realises fair financial value from its data
, The Lancet Digital Health, Vol: 2, Pages: e10-e12, ISSN: 2589-7500 -
Journal articleFeather C, Appelbaum N, Clarke J, et al., 2019,
Medication errors during simulated paediatric resuscitations: a prospective, observational human reliability analysis
, BMJ Open, Vol: 9, Pages: 1-13, ISSN: 2044-6055Introduction: Medication errors during paediatric resuscitation are thought to be common. However, there is little evidence about the individual process steps that contribute to such medication errors in this context.Objectives: To describe the incidence, nature and severity of medication errors in simulated paediatric resuscitations, and to employ human reliability analysis to understand the contribution of discrepancies in individual process steps to the occurrence of these errors.Methods: We conducted a prospective observational study of simulated resuscitations subjected to video micro-analysis, identification of medication errors, severity assessment and human reliability analysis in a large English teaching hospital. Fifteen resuscitation teams of two doctors and two nurses each conducted one of two simulated paediatric resuscitation scenarios. Results: At least one medication error was observed in every simulated case, and a large magnitude (>25% discrepant) or clinically significant error in 11 of 15 cases. Medication errors were observed in 29% of 180 simulated medication administrations, 40% of which considered to be moderate or severe. These errors were the result of 884 observed discrepancies at a number of steps in the drug ordering, preparation and administration stages of medication use, 8% of which made a major contribution to a resultant medication error. Most errors were introduced by discrepancies during drug preparation and administration. Conclusions: Medication errors were common with a considerable proportion likely to result in patient harm. There is an urgent need to optimise existing systems and to commission research into new approaches to increase the reliability of human interactions during administration of medication in the paediatric emergency setting.
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Journal articleGhafur S, Kristensen S, honeyford K, et al., 2019,
A retrospective impact analysis of the WannaCry cyber-attack on the NHS
, npj Digital Medicine, Vol: 2, ISSN: 2398-6352A systematic analysis of Hospital Episodes Statistics (HES) data was done to determine the effects of the 2017 WannaCry attack on the National Health Service (NHS) by identifying the missed appointments, deaths, and fiscal costs attributable to the ransomware attack. The main outcomes measured were: outpatient appointments cancelled, elective and emergency admissions to hospitals, Accident & Emergency (A&E) attendances, and deaths in A&E. Compared with the baseline, there was no significant difference in the total activity across all trusts during the week of the WannaCry attack. Trusts had 1% more emergency admissions and 1% fewer A&E attendances per day during the WannaCry week compared with baseline. Hospitals directly infected with the ransomware, however, had significantly fewer emergency and elective admissions: a decrease of about 6% in total admissions per infected hospital per day was observed, with 4% fewer emergency admissions and 9% fewer elective admissions. No difference in mortality was noted. The total economic value of the lower activity at the infected trusts during this time was £5.9m including £4m in lost inpatient admissions, £0.6m from lost A&E activity, and £1.3m from cancelled outpatient appointments. Among hospitals infected with WannaCry ransomware, there was a significant decrease in the number of attendances and admissions, which corresponded to £5.9m in lost hospital activity. There was no increase in mortality reported, though this is a crude measure of patient harm. Further work is needed to appreciate the impact of a a cyber attack or IT failure on care delivery and patient safety.
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Journal articleFontana G, Flott K, Dhingra-Kumar N, et al., 2019,
Five reasons for optimism on World Patient Safety Day
, The Lancet, Vol: 394, Pages: 993-995, ISSN: 0140-6736 -
Journal articleSymons J, Ashrafian H, Dunscombe R, et al., 2019,
From EHR to PHR: Let’s get the UK record straight
, BMJ Open, Vol: 9, Pages: 1-5, ISSN: 2044-6055This article reflects on the changing nature of health information access and the transition of focus from electronic health records (EHRs) to personal health records (PHRs) along with the challenges and need for alignment of national initiatives for EHR and PHR in the National Health Service (NHS) of the United Kingdom (UK).The importance of implementing integrated EHRs as a route to enhance the quality of health delivery has been increasingly understood. EHRs however carry several limitations that include major fragmentation through multiple providers and protocols throughout the NHS. Questions over ownership and control of data further complicate the potential for fully utilising records. Analysing the previous initiatives and the current landscape, we identify that adopting a patient health record system can empower patients and allow better harmonisation of clinical data at a national level. We propose regional PHR “hubs” to provide a universal interface that integrates digital heath data at a regional level with further integration at a national level.We propose that these PHR “hubs” will reduce the complexity of connections, decrease governance challenges and interoperability issues while also providing a safe platform for high-quality scalable and sustainable digital solutions, including artificial intelligence (AI) across the UK NHS, serving as an exemplar for other countries which wish to realise the full value of healthcare records.
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Journal articleGaras G, Cingolani I, Patel V, et al., 2019,
Evaluating the implications of Brexit for research collaboration and policy: A network analysis and simulation study
, BMJ Open, Vol: 9, Pages: 1-11, ISSN: 2044-6055Objective To evaluate the role of the European Union (EU) as a research collaborator in the United Kingdom (UK)’s success as a global leader in healthcare research and innovation and quantify the impact that Brexit may have. Design Network and regression analysis of scientific collaboration, followed by simulation models based on alternative scenarios. Setting International real world collaboration network among all countries involved in robotic surgical research and innovation.Participants 772 organisations from industry and academia nested within 56 countries and connected through 2,397 collaboration links.Main outcome measures Research impact measured through citations, innovation value measured through the innovation index, and an array of attributes of social networks to measure brokerage and geographical entropy at national and international levels.Results Globally, the UK ranks third in robotic surgical innovation, and the EU constitutes its prime collaborator. Brokerage opportunities and collaborators’ geographical diversity are associated with a country’s research impact (c=211.320 and 244.527, respectively;p-value<0·01) and innovation (c=18.819 and 30.850, respectively;p-value<0·01). Replacing EU collaborators with United States (US)’ ones is the only strategy that could benefit the UK, but on the condition that US collaborators are chosen among the top-performing ones, which is likely to be very difficult and costly, at least in the short term. Conclusions This study suggests what has long been argued, namely that the UK-EU research partnership has been mutually beneficial and that its continuation represents the best possible outcome for both negotiating parties. However, the uncertainties raised by Brexit necessitate looking beyond the EU for potential research partners. In the short-term, the UK’s best strategy might be to try and maintain its academic links with the EU. In the longer-term, strategic r
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Journal articleMiraldo M, Goiana-da-Silva F, Cruz-e-Silva D, et al., 2019,
Disrupting the landscape: how the Portuguese National Health Service built an omnichannel communication platfor
, Public Health Panorama, Vol: 5, Pages: 314-323, ISSN: 2412-544XNoncommunicable diseases (NCDs) are the leading causes of death, disease and disability in the WHO European Region and are largely preventable. The private sector has long been using marketing to influence and change people’s lifestyles. In some cases, particularly the food sector, health-compromising content is prioritized over health-promoting content. However, this case study aims to illustrate how governments working on tight budgets can partner with private media companies to their own advantage in order to increase the impact of health messages and thus improve the health literacy of the population. The omnichannel communication platform and associated campaigns initiated by the Portuguese government and described in this case study serve as a practical example of a national health literacy initiative successfully reaching a wide audience. Indeed, the Portuguese National Health Service entered high on the list of the most impactful communication campaigns in Portugal.This might have implications for other countries as although further progress is required to analyse any impact of the campaigns, this example showcases the potential advantages of partnering with the media in that by using the same communication channels as multinational food and tobacco companies, governments may be able to level the playing field in terms of influence through marketing and communication, which might help to reverse unhealthy lifestyles among their populations.
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Journal articleVlaev I, King D, Darzi A, et al., 2019,
Changing health behaviors using financial incentives: a review from behavioral economics
, BMC Public Health, Vol: 19, ISSN: 1471-2458BackgroundIncentives are central to economics and are used across the public and private sectors to influence behavior. Recent interest has been shown in using financial incentives to promote desirable health behaviors and discourage unhealthy ones.Main textIf we are going to use incentive schemes to influence health behaviors, then it is important that we give them the best chance of working. Behavioral economics integrates insights from psychology with the laws of economics and provides a number of robust psychological phenomena that help to better explain human behavior. Individuals’ decisions in relation to incentives may be shaped by more subtle features – such as loss aversion, overweighting of small probabilities, hyperbolic discounting, increasing payoffs, reference points – many of which have been identified through research in behavioral economics. If incentives are shown to be a useful strategy to influence health behavior, a wider discussion will need to be had about the ethical dimensions of incentives before their wider implementation in different health programmes.ConclusionsPolicy makers across the world are increasingly taking note of lessons from behavioral economics and this paper explores how key principles could help public health practitioners design effective interventions both in relation to incentive designs and more widely.
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Journal articleEspinosa-González AB, Delaney BC, Marti J, et al., 2019,
The impact of governance in primary health care delivery: a systems thinking approach with a European panel
, Health Research Policy and Systems, Vol: 17, Pages: 1-16, ISSN: 1478-4505Enhancing primary health care (PHC) is considered a policy priority for health systems strengthening due to PHC’s ability to provide accessible and continuous care and manage multimorbidity. Research in PHC often focuses on the effects of specific interventions (e.g. physicians’ contracts) in health care outcomes. This informs narrowly designed policies that disregard the interactions between the health functions (e.g. financing and regulation) and actors involved (i.e. public, professional, private), and their impact in care delivery and outcomes. The purpose of this study is to analyse the interactions between PHC functions and their impact in PHC delivery, particularly in providers’ behaviour and practice organisation.
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Journal articleGoiana-da-Silva F, Cruz-E-Silva D, Allen L, et al., 2019,
Modelling impacts of food industry co-regulation on noncommunicable disease mortality, Portugal
, Bulletin of the World Health Organization, Vol: 97, Pages: 450-459, ISSN: 0042-9686Objective: To model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met. Methods: The 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015-2016 and on population structure and deaths from four major noncommunicable diseases over 1990-2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030. Findings: If reformulation targets were met, we projected reductions in intake in 2015-2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021. Conclusion: The co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets.
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Journal articleArcher SA, Pinto A, Vuik S, et al., 2019,
Surgery, complications and quality of life: a longitudinal cohort study exploring the role of psychosocial factors
, Annals of Surgery, Vol: 270, Pages: 95-101, ISSN: 0003-4932Objective:To determine if psychosocial factors moderate the relationship between surgical complications and quality of life (QoL).Summary Background:Patients who experience surgical complications have significantly worse post-operative QoL than patients with an uncomplicated recovery. Psychosocial factors, such as coping style and level of social support influence how people deal with stressful events, but it is unclear if they impact on QoL following a surgical complication. These findings can inform the development of appropriate interventions that support patients post-operatively. Methods:This is a longitudinal cohort study; data were collected at pre-op, 1 month post-op, 4 months post-op and 12 months post-op. A total of 785 patients undergoing major elective gastro-intestinal, vascular or cardio-thoracic surgery were recruited from 28 National Health Service (NHS) sites in England and Scotland took part in the study.Results:Patients who experience major surgical complications report significantly reduced levels of physical and mental QoL (p<0.05) but they make a full recovery over time. Findings indicate that a range of psychosocial factors such as the use of humor as a coping style and the level of health care professional support may moderate the impact of surgical complications on QoL.Conclusion:Surgical complications alongside other socio-demographic and psychosocial factors contribute to changes in QoL; the results from this exploratory study suggest that interventions that increase the availability of healthcare professional support and promote more effective coping strategies prior to surgery may be useful, particularly in the earlier stages of recovery where QoL is most severely compromised. However, these relationships should be further explored in longitudinal studies that include other types of surgery and employ rigorous recruitment and follow up procedures.
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Journal articleAufegger L, Bicknell C, Soane E, et al., 2019,
Understanding health management and safety decisions using signal processing and machine learning
, BMC Medical Research Methodology, Vol: 19, ISSN: 1471-2288BackgroundSmall group research in healthcare is important because it deals with interaction and decision-making processes that can help to identify and improve safer patient treatment and care. However, the number of studies is limited due to time- and resource-intensive data processing. The aim of this study was to examine the feasibility of using signal processing and machine learning techniques to understand teamwork and behaviour related to healthcare management and patient safety, and to contribute to literature and research of teamwork in healthcare.MethodsClinical and non-clinical healthcare professionals organised into 28 teams took part in a video- and audio-recorded role-play exercise that represented a fictional healthcare system, and included the opportunity to discuss and improve healthcare management and patient safety. Group interactions were analysed using the recurrence quantification analysis (RQA; Knight et al., 2016), a signal processing method that examines stability, determinism, and complexity of group interactions. Data were benchmarked against self-reported quality of team participation and social support. Transcripts of group conversations were explored using the topic modelling approach (Blei et al., 2003), a machine learning method that helps to identify emerging themes within large corpora of qualitative data.ResultsGroups exhibited stable group interactions that were positively correlated with perceived social support, and negatively correlated with predictive behaviour. Data processing of the qualitative data revealed conversations focused on: (1) the management of patient incidents; (2) the responsibilities among team members; (3) the importance of a good internal team environment; and (4) the hospital culture.ConclusionsThis study has shed new light on small group research using signal processing and machine learning methods. Future studies are encouraged to use these methods in the healthcare context, and to conduct further research
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Journal articleCohen D, Vlaev I, Heitmueller A, et al., 2019,
Validation of behavioral simulations: a case study on enhancing collaboration between partnership organizations
, Journal of Public Health, Vol: 27, Pages: 367-378, ISSN: 1741-3842AimThe current article provides a detailed account of a behavioral simulation called Lateral Play. Lateral Play aimed to enhance collaborations and optimize shared decision-making across organizations within a newly formed partnership. The current article aims to enhance appreciation of the behavioral simulation methodology and encourage its use.Subjects and MethodsHealth service leaders from different organizations within a newly formed partnership gathered in the simulated community and took up roles similar to their real-life positions. The simulation presented participants with problems and opportunities similar to those that they would experience in real life, such as the need to consolidate services and create new care pathways. To evaluate Lateral Play’s effectiveness, self-reported and observational data were collected. These data include information about participants’ reactions, learning and behavior, and the newly formed partnership’s organizational results.ResultsLateral Play allowed health leaders to better understand how they could enhance collaborations and optimize shared decision-making across their newly formed partnership. The data suggest that simulations can promote effective collaborations.ConclusionsUse of behavioral simulations should be encouraged to promote policy awareness and understanding, refine implementation strategies and improve outcomes in newly formed partnerships.
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Journal articleHassen YAM, Johnston MJ, Singh P, et al., 2019,
Key components of the safe surgical ward: international Delphi consensus study to identify factors for quality assessment and service improvement
, Annals of Surgery, Vol: 269, Pages: 1064-1072, ISSN: 0003-4932Objective: The aim of this study was to prioritize key factors contributing to safety on the surgical wardBackground: There is a variation in the quality and safety of postoperative care between institutions. These variations may be attributed to a combination of process-related issues and structural factors. The aim of this study is to reach a consensus, by means of Delphi methodology, on the most influential of these components that may determine safety in this environment. Methods: The Delphi questionnaire was delivered via an online questionnaire platform. The panel were blinded. An international panel of safety experts, both clinical and nonclinical, and safety advocates participated. Individuals were selected according to their expertise and extent of involvement in patient safety research, regulation, or patient advocacy. Results: Experts in patient safety from the UK, Europe, North America, and Australia participated. The panel identified the response to a deteriorating patient and the care of outlier patients as error-prone processes. Prioritized structural factors included organizational and environmental considerations such as use of temporary staff, out-of-hours reduction in services, ward cleanliness, and features of layout. The latter includes dedicated areas for medication preparation and adequate space around the patient for care delivery. Potential quality markers for safe care that achieved the highest consensus include leadership, visibility between patients and nurses, and nursing team skill mix and staffing levels. Conclusion: International consensus was achieved for a number of factors across process-related and structural themes that may influence safety in the postoperative environment. These should be championed and prioritized for future improvements in patient safety at the ward-level.
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Journal articleMartin G, Clarke J, Liew F, et al., 2019,
Evaluating the impact of organisational digital maturity on clinical outcomes in secondary care in England
, npj Digital Medicine, Vol: 2, ISSN: 2398-6352All healthcare systems are increasingly reliant on health information technology to support the delivery of high-quality, efficient and safe care. Data on its effectiveness are however limited. We therefore sought to examine the impact of organisational digital maturity on clinical outcomes in secondary care within the English National Health Service. We conducted a retrospective analysis of routinely collected administrative data for 13,105,996 admissions across 136 hospitals in England from 2015 to 2016. Data from the 2016 NHS Clinical Digital Maturity Index were used to characterise organisational digital maturity. A multivariable regression model including 12 institutional covariates was utilised to examine the relationship between one measure of organisational digital maturity and five key clinical outcome measures. There was no significant relationship between organisational digital maturity and risk-adjusted 30-day mortality, 28-day readmission rates or complications of care. In multivariable analysis risk-adjusted long length of stay and harm-free care were significantly related to aspects of organisational digital maturity; digitally mature hospitals may not only deliver more harm-free care episodes but also may have a significantly increased risk of patients experiencing a long length of stay. Organisational digital maturity is to some extent related to selected clinical outcomes in secondary care in England. Digital maturity is, however, also strongly linked to other institutional factors that likely play a greater role in influencing clinical outcomes. There is a need to better understand how health IT impacts care delivery and supports other drivers of hospital quality.
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Journal articleWarren L, Clarke J, Arora S, et al., 2019,
Transitions of care across hospital settings in patients with inflammatory bowel disease
, World Journal of Gastroenterology, Vol: 25, Pages: 2122-2132, ISSN: 1007-9327BACKGROUNDInflammatory bowel disease (IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group.AIMTo determine the type and location of hospital services accessed by IBD patients in England.METHODSThis was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England. Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their ‘home provider’. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters.RESULTSOf 95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD ‘home provider’ was 73.3%, 87.8% and 83.1% for accident and emergency, inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their ‘home provider’ for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology.CONCLUSIONTransitions of care between secondary care sett
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Journal articleGhafur S, Grass E, Jennings N, et al., 2019,
The challenges of cybersecurity in health care: the UK National Health Service as a case study
, The Lancet Digital Health, Vol: 1, Pages: e10-e12, ISSN: 2589-7500
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