The latest CaHRU Implementation Science and Research Methods seminar was given on 1 September 2017 by guest lecturer and statistician, StellaMay Gwini of Monash University, Melbourne, Australia. StellaMay is a Research Fellow (Biostatistician) with the Department of Epidemiology and Preventive Medicine at Monash . She has a background in applied medical research having commenced her career with the Lincolnshire National Health Service in the UK with Professor Siriwardena where she worked primarily on a case-control and self-controlled case series study funded by the NIHR Research for Patient Benefit programme exploring the relationship between flu vaccination and protection against heart attack (acute myocardial infarction) using GPRD data. The studies were published in the Canadian Medical Association Journal and Vaccine. Her main interests are in appropriate use of both statistical methods and research techniques for health service/technology use, epidemiology and public health research.
StellaMay spoke on the topic of multilevel modelling. She described how multilevel modelling, also called hierarchical or nested modelling can be used where subjects are clustered into groups giving rise to the possibility that measured outcomes might be correlated. Usual regression techniques assume that data points are independent hence these methods are not appropriate for hierarchical data or repeated measurements (data collected multiple times for the same subject) where independence cannot be assumed.
Hence multilevel modelling allows for correct inferences to be drawn from data, without making the assumption of independence. Stellamay concluded by describing a recent study which she has conducted on efficacy of raloxifene therapy for schizophrenia treatment, the presentation highlight the usefulness of multilevel modelling in medical research. Her talk was informative and very well received.
Members of the Scaling up PINCER project team (PINCER is a pharmacist-led information technology intervention for reducing clinically important errors in medication management in general practice), Prof Niro Siriwardena, Janice Wiseman, Dr Sarah Rodgers, Chris Rye and Despina Laparidou, recently attended (on June 29th) the Scaling-Up Improvement Programme Mid-point Event in London. The event was organised by the Health Foundation, the main funder for the six participating projects. The focus of the meeting was on evaluation and sustainability of improvement.
The day was designed to be as interactive as possible and teams were asked to bring materials with them, such as information, pictures, posters, leaflets, data, etc., to put up on a pin board, with the purpose of giving a visual story of their project for other teams to view during and between sessions. This created a wonderful opportunity for teams to learn about each other’s projects and discuss issues (such as successes and challenges) around their progress.
A number of interesting talks were presented around evaluating and sustaining scaling-up improvements, such as the sessions facilitated by Tom Ling/Bryn Garrod (RAND Europe) and Kathy Elliott (NCAT) respectively. One of the most stimulating and thought-provoking sessions, “Influencing for sustainability”, asked delegates to split into two large groups and have one person from each project team ‘make a case’ for their project, facilitated by Carl Smith (Frontline) and Jamie Ripman (Practive). At the end of each brief presentation, the rest of the delegates provided feedback on their performance and suggestions on how to improve their style and adjust the context of the presentation to better fit the target audience’s agenda.
At the end of the day, Sally Williams (Frontline) and Valentina Karas (the Health Foundation) brought the event to its close by reflecting on the day and discussing future actions.
By Despina Laparidou
As part of the CaHRU Improvement Science and Research Methods seminar series, Fiona Togher presented a fascinating seminar on the use of cognitive interviews on 28 June 2016. Fiona eloquently described how cognitive interviews can and indeed should be used as an integral part of questionnaire design. She explained how some of the potential problems found in data collected by questionnaires can be directly apportioned to participants understanding and perception of the questions along with issues of memory retrieval and the response process. Traditional field testing of questionnaires does not highlight these issues as this type of testing will only analyse whether a participant answers a question or not. It does not assess the thought process behind the participant’s decision to answer the question in that way.
Cognitive interviews are an in-depth question by question discussion with typical participants designed to assess their comprehension, retrieval, judgement and response process. From this it is possible to determine the suitability and relevance of questions to the target audience, thereby producing clear questionnaires that will themselves produce more robust data. Fiona was able to show practical application of this technique through her own experiences whilst developing a Patient Reported Experience Measure (PREM) for use in Ambulance Services in England. Her personal experience of using cognitive interviews and relaxed and engaging presentation style made this an interesting, informative and enjoyable seminar.
Fiona recommended the following book as a good starting place for understanding this method: Willis, G. B. (2004) Cognitive Interviewing: A Tool for Improving Questionnaire Design Sage Publications, Inc. There is also a follow on book: Willis, G.B. (2015) Analysis of the Cognitive Interview in Questionnaire Design (Understanding Qualitative Research) OUP, USA. The next Improvement Science and Methods seminar will take place on 13th September, 2016 where Prof Chris Bridle, director of the Lincoln Institute for Health, will be discussing accumulative evidence synthesis.
By Dr Stephanie Armstrong
On Wednesday 27th April, Professor Siriwardena, Viet-Hai Phung and Fiona Togher attended the launch event of the National Institute for Health Research (NIHR) themed review of prehospital care. This was held at Firth Court, University of Sheffield. The session was action-packed and included four presentations from senior prehospital care researchers whose work had been included as part the review. Within these presentations Professor Siriwardena spoke about patient outcomes and experience in relation to the ambulance service and detailed some of the work that has been undertaken within CaHRU and collaboratively with EMAS and the University of Sheffield. This included the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme – focussing particularly on the qualitative work we did to explore what was of value to patients that needed to access emergency ambulance care. Professor Siriwardena’s presentation was informative, insightful and particularly well received by the patient and public involvement group members that were in the audience.
Professor Tom Quinn also gave a fascinating presentation about the work undertaken by Kingston University and the University of London around the effectiveness of introducing a mechanical chest compression device into front-line emergency response vehicles. They hypothesis was that the use of mechanical devices (rather than administering manual resuscitation) should improve survival from out of hospital cardiac arrests. Interestingly though, the research team concluded from the evidence that adopting these devices routinely would not improve patient outcomes.
Following the research presentations the session continued with Daniel Mason, a member of the National Ambulance Commissioners Network sharing some of his thoughts on the research presented in the review in relation to the provider-commissioner relationship. One of the key points he highlighted was a need to include commissioners in the dissemination of key research findings that could have an impact on policy and practice. Finally, Derek Prentice, the chair of the lay group of the Royal College of Emergency Medicine reminded the delegates that ultimately the purpose of undertaking any healthcare research, not just prehospital research, is to improve the quality of care and the quality of experience provided to patients. It is patients that must remain at the centre of everything that we as researchers do.
Overall the event was a wonderful opportunity to hear about some of the major prehospital care research projects that have been undertaken with the support of NIHR funding during the last ten years. As the official event due to a close the delegates gathered over lunch and networking with colleagues with similar interests resumed. Upon reflection it was exciting to get a glimpse of the progress that has been made in the field of prehospital care research and to look forward to the contribution that CaHRU will continue to make in this area of healthcare research.
By Fiona Togher
PhD student Jolien Vos was awarded the Best PhD Project Award for her paper, ‘Care Navigation in Older People with Multimorbidity – Feasibility and Acceptability of using ICT’ at this year’s International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AWE). The conference brought together experts in Computer Science and Health Sciences in Rome (Italy) on 21st and 22nd April 2016.
The conference included keynotes on ‘Can ICT Assist Learning and Living’ (by Prof. Margaret Ross) and ‘Senior Homo Digitalis’ (by Prof. Hubert Österle), together with oral sessions and poster presentations on topics such as: Telemedicine and e-Health; Monitoring, Accessibility and User Interfaces; Robotics and Devices for Independent Living and HCI for Ageing Populations. The conference addressed current challenges such as the lack of integrated systems, ethical considerations of technology in health and social care and the risks and dangers of technology in this setting.
Jolien’s PhD takes place in the area of Digital Health and Social Care and her full paper on care navigation in older people with multimorbidity was accepted for the Doctoral Consortium. Papers and presentations for the Consortium were reviewed and scored by the independent advisory board. At the end of the presentation, a general discussion and reflection was held with the doctoral student and the members of the advisory board. Having constructive discussion with senior leaders in the field and receiving their feedback provided a wonderful and invaluable opportunity for Jolien and other doctoral candidates. The paper will be included in the list of conference best papers and invited for an extended and revised version publication in a book or journal of the Institute for Systems and Technologies of Information Control and Communication (INSTICC).
By Jolien Vos