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CLAHRC projects on methodology 2014-2016

CLAHRC Publications

Study Title Study Lead Health & Social Care
Partner Organisations
Lay Summary
Evaluation of the GP recruitment process in the UK Dr Celia Taylor,
University of Warwick
Health Education England Looking at how the GP recruitment process can be improved in the UK.
The 'beyond synthesis impact chain'. Review methodologies and reporting techniques that maximise impact and uptake in educational policy and practice Dr Celia Taylor,
University of Warwick
University of Essex and
University of Birmingham
Looking at how the use of research findings relating to medical education can be used most effectively.
Publication bias in health services and delivery research Prof Richard Lilford,
University of Warwick
  Looking at what studies are likely to be published and why in health services and delivery research.
Systematic overview of early childhood cognitive Interventions for promoting child development Prof Richard Lilford,
University of Warwick
(Systematic review) Systematic overview of early childhood cognitive interventions for promoting child development.
Literature review for High Intensity Specialist Led Acute Care (HISLAC): systematic review on weekend effects and literature review on consultant effects to facilitate economic modelling Dr Yen-Fun Chen,
University of Warwick
University Hospitals
Birmingham NHS Foundation Trust
Evaluating seven day consultant cover in hospitals.
Horizon of science: the effect of biases with low base rates and small effect sizes Prof Richard Lilford,
University of Warwick
  Sample sizes in randomised controlled trials are increasing as baseline rates of primary outcomes, such as mortality, decrease and effect sizes of new treatments decrease. Increased sample sizes lead to increased precision, but exaggerate the effect of small biases. We investigate the effect of such biases and examine trends in sample sizes and effect sizes in published studies over time.
Improving the health literacy of Lay Community Health Workers in Southern Africa Prof Richard Lilford,
University of Warwick
Sizabuntu, South Africa; St Appolinnaris Hospital;
Underberg clinic
This research project ultimately aims to improve the health literacy of Lay Community Health Workers (LCHWs) in rural Southern Africa to enable women to make better choices about their own and their children’s health.
Identifying medical risk in the criminal justice system – economic evaluation of Liaison and Diversion services Prof Richard Lilford,
University of Warwick
RAND Europe A pilot evaluation of an intervention to improve the identification of people with health (especially mental health) needs as they proceed through the criminal justice system.
Public Health Projects - Housing and Health Data Linkage Mr Gavin Rudge
University of Birmingham
Worcestershire County
Council, Sandwell
Metropolitan Borough Council
Looking at the whether housing improvement in Sandwell has an association with health improvement. Analysing whether people are disadvantaged in rural Worcestshire if they don't own a car with regards to how accessible GP surgeries and pharmacies are. Looking at the association of alcohol retail outlet availability and alcohol specific admissions of young people to hospital in Worcestershire.
Interventions at one remove Prof Richard Lilford,
University of Warwick
Coventry City Council This project is looking at interventions that are designed to stimulate local innovation rather than to adhere to a pre-formed intervention protocol.
Are increases in mortality observed among weekend admissions attrituable to service quality or casemix (HISLAC - Sam Watson) Dr Sam Watson,
University of Warwick
  This project models the potential benefit of 7 day NHS services by estimating preventable excess deaths at the weekend and adverse events
Comparison of passing standards for written finals examinations in UK Medical Schools Dr Celia Taylor,
University of Warwick
MSCAA This project compares the pass mark set for written questions used in examinations at different medical schools in the UK.
A systematic review and meta-analysis to identify the health and economic consequences of adverse events at the patient level Prof Richard Lilford,
University of Warwick
  Identifying the health and economic consequences of undesirable experiences for patients associated with healthcare. The effect of interventions or policies that aim to improve the way health services are delivered, such as hand washing or increasing nurse to patient ratios, on patient health outcomes cannot often be measured in experimental trials. We develop an alternative method of evaluating these policies and interventions that involves incorporating evidence from multiple sources.
Modelling the evidence for stockpiling neuraminidase inhibitors for pandemic usage Dr Sam Watson,
University of Warwick
University of Nottingham Influenza pandemics are rare but may have potentially catastrophic consequences. Governments around the world have to decide whether or not to stockpile anti-influenza medication like neuraminidase inhibitor (NAI) antivirals as a defence against pandemic influenza. However, there has been a lack of conclusive evidence regarding the effectiveness of NAIs. Recent meta-analyses of RCTs of seasonal influenza cases have been unable to confirm or refute an effect of NAIs on important clinical end points such as mortality. A meta-analysis of observational data from pandemic influenza did find evidence of a reduction in the risk of mortality, however, this study has been criticised for being subject to a large degree of bias. The objective of this study was to determine whether NAIs should be stockpiled for treatment of pandemic influenza on the basis of current evidence.
Integrating Multiple Sources of Evidence Dr Sam Watson,
University of Warwick
  In this essay we explore methods for synthesising multiple sources of evidence in health services research. The evaluation of policies or structural interventions in the healthcare system are complicated by the difficulty of linking the intervention to patient level outcomes. Proxy variables are often used in the place of important clinical outcomes such as mortality and quality of life. The researcher must therefore synthesise various forms of evidence from across a causal pathway that links the intervention to the outcomes of interest. We firstly discuss whether the complex nature of a healthcare system hinders understanding of the relevant causal pathways, and whether such systems are amenable to modelling and the synthesis of multiple forms of evidence. An important distinction is drawn between the underlying phenomena that generalise across contexts and the complex data from which they are inferred. We then explore the available methods a researcher might adopt and consider three steps: (i) the design of a causal model; (ii) the identification of the available evidence; and, (iii) the synthesis of multiple forms of evidence including quantitative and qualitative evidence. While many of the methods are well documented, further work is required to develop their use in combination, and understanding how to deal with different study designs, each with their own inherent biases, is still at an early stage. Nevertheless, there exist powerful tools for the synthesis of multiple forms of evidence in health services research.
User fees for access to healthcare in Neno, Malawi Dr Sam Watson,
University of Warwick
  Cost sharing through user fees has been advocated as a way of ensuring the financial sustainability of public health services in low and middle income countries, however previous studies have provided evidence that user fees reduce access to healthcare. This study examines a natural experiment in which 4 out of 13 health centres in Neno District introduced user fees in July 2013, one of which removed user fees in July 2015.
Walking away from gestational diabetes Dr Dr Ponnusamy Saravanan,
University of Warwick
Two centre study
1) East Midlands - University of Leicester and University Hospitals of Leicester NHS Trust. 2) West Midlands - University of Warwick and George Eliot Hospital NHS Trust.

This project represents a collaboration with CLAHRC East Midlands
Background and aim: Women with gestational diabetes are seven times more likely to develop type 2 diabetes within 10 years. The number of cases is growing because of unhealthy lifestyles. The aim of this project is to develop and implement lifestyle education programmes that meet social and cultural needs.
Development: We will ask local women to help us develop face-to-face and online education programmes, including women of South Asian origin.
Implementation: We will identify women with a diagnosis of gestational diabetes 6-36 months ago using hospital databases. Two-hundred-and-fifty volunteers will be randomly allocated to usual care or intervention groups for 12 months. The usual care group will receive usual care plus an information leaflet about healthy lifestyle choices after childbirth. The intervention group will receive usual care plus a referral to the education programmes. In light of feedback we have already received from patients, we will reimburse travel expenses, reimburse childcare expenses, and provide crèches.
Measure of success: Physical activity is the most important measure in this study and participants will wear a physical activity monitor for seven days before, during and after the study. The education programmes will be deemed successful if physical activity increases by around 30 minutes per day.
Impact: An increase in physical activity of around 30 minutes per day is sufficient to reduce type 2 diabetes risk by 30-50%, as part of a healthy lifestyle. We will work with local stakeholders during the study to ensure it is widely implemented if it is successful.
Health Economics and Modelling
  • A systematic review and meta-analysis to identify the health and economic consequences of adverse events at the patient level
  • Identifying medical risk in the criminal justice system – economic evaluation of Liaison and Diversion services
  • Modelling the evidence for stockpiling neuraminidase inhibitors for pandemic usage
  • Walking away from gestational diabetes
 
Methods for Systematic Reviews
  • The 'beyond synthesis impact chain'. Review methodologies and reporting techniques that maximise impact and uptake in educational policy and practice
  • Publication bias in health services and delivery research
  • Systematic overview of early childhood cognitive Interventions for promoting child development
  • Literature review for High Intensity Specialist Led Acute Care (HISLAC): systematic review on weekend effects and literature review on consultant effects to facilitate economic modelling
  • Integrating Multiple Sources of Evidence
   
Data Linkage
  • Public Health Projects -
    Housing and Health Data Linkage
   
Medical Education Selection
  • Evaluation of the GP recruitment process in the UK
  • Comparison of passing standards for written finals examinations in UK Medical Schools
   
Mortality Rates
  • Are increases in mortality observed among weekend admissions attrituable to service quality or casemix (HISLAC - Sam Watson)
   
International
  • Improving the health literacy of Lay Community Health Workers in Southern Africa
  • User fees for access to healthcare in Neno, Malawi