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NIHR Signal Ways of integrating care that better coordinate services may benefit patients
New integrated care models can increase patient satisfaction, perceived quality of care and improve access to services. It is less clear whether there may be effects on hospital admissions, appointments or healthcare costs. Strong leadership and patient engagement are among factors influencing successful implementation. The NHS is undergoing reconfiguration to better coordinate services around patients. This NIHR-funded review looked at the international literature to understand how new care mo...
NIHR Signal People with COPD exacerbations prefer early discharge then treatment at home
People with flare-ups of COPD (chronic obstructive pulmonary disease) prefer to be managed at home rather than in hospital. Hospital stay was on average four days shorter when people were discharged early to the hospital at home scheme, and there was no noticeable increase in readmissions in this group. This NIHR-funded trial aimed to establish the costs and outcomes of hospital at home compared with staying in hospital for treatment. The findings support current guidance that hospital at home...
NIHR Signal Partial knee replacements may save costs compared with total knee replacements
Partial knee replacements, when performed by experienced surgeons, can save costs and improve quality of life compared with total knee replacements. Partial replacements for selected patients improve quality of life and savebetween £600 and £2,000 over the patient’s lifetime, depending on age and gender. Knee replacements are commonly performed for people with ongoing pain and poor function. If the damage is limited to one side of the knee, it may be suitable to replace just t...
NIHR Signal Abdominal aortic aneurysm screening for women is unlikely to be a fair use of NHS resources
Nearly 4,000 women would need screening to prevent one death, and a third of aneurysms detected wouldn’t have influenced the individual woman's health or lifespan. Aneurysm rupture is a life-threatening emergency with low survival. Men are known to be at higher risk of an aneurysm and are offered screening at age 65 to allow early diagnosis of aneurysms large enough to warrant surgical repair. However, a third of deaths from rupture are in women. This NIHR-funded study is the first t...
NIHR Signal Closing five emergency departments not linked with increased hospital admissions, though ambulance call-outs increased
Closure of five small emergency departments in England was not associated with change in the number of hospital admissions, urgent care attendances or deaths among the local populations. However, ambulance call-outs increased by 14% relative to comparison areas, with a four-minute increase in the time to reach a hospital with an emergency department. Emergency departments continue to be under high pressure, while staff shortages increase patient safety concerns. One option is to close smaller s...
NIHR Signal Patient-centred care for multimorbidity improves patient experience, but quality of life is unchanged
A patient-centred intervention in general practice for people with multiple chronic conditions, based on recommended best practice, had no effect on patient quality of life or burden of illness and treatment. Patients were, however, more likely to report being satisfied with their care. An increasing number of people in the UK are living with multimorbidity, defined as two or more long-term health conditions. NICE recommends a comprehensive approach to care, tailored to the patient’s need...
NIHR Signal The proportion of patients not transported to emergency departments after an ambulance is called varies across the country
Nationally, around half of people making urgent calls for ambulance services are not then taken to hospital. This is called the non-conveyancing rate. But this rate varies two-fold from region to region. There are differences too in what happens to patients not going to hospital. Some places discharge more patients at the scene, offer telephone advice or send to other non-emergency health services like walk-in centres. This NIHR mixed methods study used observation and analysis of routine ambul...
NIHR Signal Reminders help GPs to find and manage inherited cholesterol disorders
GPs and practice nurses assess more adults with inherited raised cholesterol (familial hypercholesterolaemia) when prompted by reminders. More patients have repeat cholesterol tests and assessments for heart disease, in line with NICE guidelines. This NIHR-funded study used electronic health records from six GP practices to identify patients with total cholesterol greater than 7.5mmol/l. Reminder messages appeared when their records were opened during consultations and prompted GPs to carry out...
NIHR Signal UK-wide study reveals a pattern of delay in referrals to specialist end-of-life care
Referrals to hospice-based specialist palliative care occur closer to death in older than in younger people and in those without cancer. Existing evidence shows that some people near the end of life have a better quality of life and symptom control if they receive specialist palliative care. This research highlights the need to better understand the reasons for any delay. In this large NIHR-funded hospice study people aged under 50 years were referred to hospice specialist palliative care about...
NIHR Signal Outpatient video consultations are feasible but challenging for the NHS
Video consultations may be a useful substitute for face-to-face consultations for some hospital outpatient appointments. This NIHR funded study provided insights into the conditions which made them better. When these practical and clinical conditions are met, video consultations can be safe and effective and are liked by staff and patients. But there are challenges in embedding new technology in routine practice, and these challenges may have been under-estimated. This high-quality implementati...
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