Socio-economic inequalities in access to planned hospital care: causes and consequences

Socio-economic inequalities in access to planned hospital care: causes and consequences
The Strategy Unit 13 May 2021

• This report explores socio-economic inequalities in access to planned hospital care in terms of socio-economic inequalities in access, where in the patient pathways these inequalities in access emerge, potential drivers of these inequalities and whether poor access to planned care in some communities leads to increased demand for unplanned care.

Predicting future state for adaptive clinical pathway management

Predicting future state for adaptive clinical pathway management. 

J Biomed Inform. 2021 May;117:103750. doi: 10.1016/j.jbi.2021.103750. Epub 2021 Mar 25. 

• This paper introduces weighted state transition logic, a logic to model state changes based on actions planned in clinical pathways. Weighted state transition logic extends linear logic by taking weights – numerical values indicating the quality of an action or an entire clinical pathway – into account. It allows us to predict the future states of a patient and it enables adaptive clinical pathway management based on these predictions.

Improving flow along care pathways: Learning from the Flow Coaching Academy programme

Improving flow along care pathways: Learning from the Flow Coaching Academy programme
Health Foundation November 2020

• The Flow Coaching Academy (FCA) programme is based on a co-coaching model combined with elements of improvement science. It aims to support establishing multiple FCAs across the UK, to scale up the approach and to build a community of practice to share learning. The training focuses on both the technical and relationship skills required to deliver continuous and sustainable improvement.

National Cardiac Audit Programme COVID-19 report - rapid cardiovascular data

Rapid cardiovascular data: We need it now (and in the future)
HQIP 10 September 2020

• A report from the National Cardiac Audit Programme describing how the collaborative approach led by the National Institute for Cardiovascular Outcomes Research (NICOR) to countering the impact of COVID-19 demonstrates the value of rapid analysis of national data in helping to improve outcomes for patients with cardiovascular disease.

Understanding the link between health systems and cancer survival

Understanding the link between health systems and cancer survival: A novel methodological approach using a system-level conceptual model
Journal of Cancer Policy v25, September 2020, 100233

• Health system contribution to variation in cancer outcomes remains largely unexplained. This paper presents a conceptual model which depicts the complex interactions along the cancer care pathway. Possible ‘breakpoints’ are highlighted which may have adverse impacts on outcomes. The model provides a novel way to identify where health services could be adapted.

Clinical pathways on a mobile device

Clinical pathways on a mobile device
BMJ Evidence-Based Medicine 2020;25:131-137

• This quality improvement project evaluated the potential use of digital clinical pathways in the primary care setting delivered on a mobile platform. Three new-to-practice [USA] primary care nurse practitioners participated in three plan-do-study-act cycles using these pathways installed on mobile devices to determine if they were a feasible, efficient and useful method to implement evidence.  

Abstract

National COVID-19 Chest Imaging Database (NCCID)

National COVID-19 Chest Imaging Database (NCCID)
NHSX

• The National COVID-19 Chest Imaging Database (NCCID) is a centralised UK database containing X-Ray, CT and MRI images from hospital patients across the country. This is to support a better understanding of the COVID-19 virus and develop technology which will enable the best care for patients hospitalised with a severe infection. It is a joint initiative established by NHSX, the British Society of Thoracic Imaging, Royal Surrey NHS Foundation Trust and Faculty. It is being made available to all those wanting to investigate the disease and develop solutions that can support the COVID-19 patient care pathway.
• A database of chest scans that could lay the groundwork for AI-powered assessments of coronavirus patients is being built by Faculty, which is also involved in the development of a data store to assess and predict demand on the NHS.

Innovative use of AI and digital communication in acute stroke pathway in response to COVID-19

Innovative use of artificial intelligence and digital communication in acute stroke pathway in response to COVID-19
Future Healthcare Journal June 2020 DOI: https://doi.org/10.7861/fhj.2020-0034

• Case study of reconfiguring hyperacute stroke pathways in response to COVID-19 using artificial intelligence and digital communication support (Brainomix).

Abstract

Channel management in virtual care

Channel management in virtual care
npj Digital Medicine volume 3, 44 (2020), 25 March 2020

• With multiple modalities now available for use in virtual care, the central problem is to direct patient-provider interactions to the channels generating the most value. Marketers call this channel management and use sophisticated approaches to implement it. This article proposes an adaptation of channel management to virtual care and discuss anticipated challenges to its implementation.

Effects of lean healthcare on patient flow: A systematic review.

Effects of lean healthcare on patient flow: A systematic review.
Value in Health. 2020;23(2):260-273

• Analysis of 40 studies of the impact of Lean Healthcare (LH) on patient flow in ambulatory care. LH was found to help to reduce waiting time and length of stay in ambulatory care, mainly owing to its focus on identifying and minimizing non-value added activities. Evidence of the impact of LH on patient/staff satisfaction and the translation of the obtained benefits into savings is scarce among studies.

Abstract

Paediatrics 2040

Forecasting the future for paediatrics in the UK [News]
Royal College of Paediatrics and Child Health 4 February 2020

• A description of the Paediatrics 2040 programme of work to help to deliver "a healthier future for children and young people across the UK".
• Work streams include Data and evidence (forecasting burden of disease and healthcare activity trends), Impact of innovation (develop an understanding of how innovation and technology will impact the delivery of paediatric services in the future), Models of care (scenarios for future) and Working lives (future workforce requirements and training).

RightCare Information briefs

RightCare Information briefs

• A series of Information briefs detail how RightCare has worked with local systems to identify innovative practice and share learning. Topics include:
• Changing the Diuretic Intravenous (IV) pathway for heart failure patients 
• Non-ST Elevation Myocardial Infarction pathway redesign
• MSK service development
• upper and lower endoscopy pathways
• Virtual Fracture Clinic

Clinical pathways on a mobile device

Clinical pathways on a mobile device
BMJ Evidence-Based Medicine 12 November 2019. doi: 10.1136/bmjebm-2019-111234

• 106 digital clinical pathways were developed for mobile devices (iPad) used over 3 months by three providers working in different primary care clinics (northeastern USA).
• Both quantitative and qualitative analyses showed that participants wanted to continue using the pathways. The participants all felt the pathways helped them apply the latest clinical evidence into practice better than other methods available and the pathways decreased time spent making clinical decisions. 
• Limitations related to the lack of chart integration coupled with time constraints which made full integration challenging and the need for a variety of delivery systems.

Children & Young People's Health Partnership , London

Children & Young People's Health Partnership (CYPHP)

• The CYPHP, working in London (Lambeth and Southwark) is a cross-organisational, system-wide, transformative and academically rigorous approach to improving child health services.
• The programme aims to produce:
• An evidence‐based, clinically effective and cost effective, comprehensive day-to-day healthcare model for children and young people that meets current and evolving health needs.
• A learning healthcare system so that continuous improvement becomes part of everyday practice.
• Rigorous evaluation that builds the evidence base for improving children's healthcare and strengthening health systems. 

Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care

Negotiating commissioning pathways for the successful implementation of innovative health technology in primary care
BMC Health Services Research (2019) 19:648

• A case study exploring the commissioning considerations for a new photoplethysmography-based diagnostic technology for peripheral arterial disease in primary care in the UK. The evidence illustrates how reconfigurations of inter-organisational relations, and of clinical and related work practices required for the successful implementation of a new technology could become the major challenge in commissioning negotiations.

Abstract

Accessing sexual health testing online

Accessing sexual health testing online
PHE 21 August 019

• Description of a new sexual health testing service in London which makes it simpler and more convenient for people - including those in the groups more at risk of sexually transmitted infections (STIs) - to get tested regularly, encouraging early identification of STIs and avoiding onward transmission. Clients access the service directly through the web or via clinic websites.
• Supporting resources.

Optimising complex care pathways for inflammatory rheumatic disease using a practical simulation tool

Optimising complex care pathways for inflammatory rheumatic disease using a practical simulation tool
Heath Foundation with Norfolk and Norwich University Hospitals NHS Foundation Trust

• An ongoing project aimed at improving understanding of where improvements can be made to care pathways for people with musculoskeletal conditions, and what changes are effective.
• A user-friendly, web-based simulation tool will be developed that combines epidemiological data with local care pathway information to model the effect of system changes.

Digitally enhanced care pathway development using DeepMind

Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions
npj Digital Medicine V2(67) 31 July 2019

• Development of a digitally enabled care pathway for acute kidney injury (AKI) management incorporating a mobile detection application (Streams, DeepMind Technologies Ltd, London, UK see below) specialist clinical response team and care protocol at the Royal Free Hospital, London.
• The care pathway improved the timeliness and reliability of key aspects of AKI care, but definitive conclusions regarding the clinical impact of the pathway cannot be made at this stage and are limited by the scope and nature of the evaluation.

For a description of Streams see:
Using AI to give doctors a 48-hour head start on life-threatening illness
DeepMind 31 July 2019

• "Streams doesn’t use artificial intelligence at the moment, but the team now intends to find ways to safely integrate predictive AI models into Streams in order to provide clinicians with intelligent insights into patient deterioration. "

Streams in NHS hospitals "Streams is a secure mobile phone app that aims to address what clinicians call “failure to rescue” – when the right nurse or doctor doesn’t get to the right patient in time."

Mapping the Patient Journey Across the Continuum: Lessons Learned From One Patient’s Experience

Mapping the Patient Journey Across the Continuum: Lessons Learned From One Patient’s Experience
J Patient Exp. 2019 Jun; 6(2): 103–107 doi: 10.1177/2374373518783763

• This case report draws on a longitudinal journey map for a patient with multiple chronic conditions who needed a hip replacement. 
• An analysis of the patient journey revealed 3 critical needs for a more patient-centered process: (1) making the patient health goal visible; (2) instigating transparent, shared decision-making; and (3) using a closed-loop communication process.

Abstract

Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme

Using a 10-step framework to support the implementation of an evidence-based clinical pathways programme
BMJ Quality & Safety 2019;28:476-485

• Description of a 10-step framework to support pathway development and dissemination across a large academic healthcare system (University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA), including facilitating clinical owner and stakeholder engagement, developing pathway prototypes based on rapid reviews of the existing literature, and developing tools for dissemination and impact assessment. 
• A cloud-based technology platform (Dorsata, Washington, DC) was used to assist with development and dissemination across geographically distributed care settings and providers. Content is viewable through desktop and mobile applications.
• A total of 202 pathways were disseminated. Programme adoption and penetration, mobile application use and pathway views were measured.