Category Archives: Events

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CAHRU/LIH improvement science and research methods seminar: Mixed methods

QIlogoThe first of this year’s series of CaHRU/LIH (Community and Health Research Unit/Lincoln Institute for Health) improvement science and research methods seminars was given by Prof Siriwardena on mixed methods on 16 February 2016. Improvement and implementation science benefits from the use of mixed research designs which combine quantitative and qualitative methods to show not only what happened but also why and how this might have occurred. Mixed methods approaches are a subset of multiple methods which involve more than one type of qualitative or quantitative method.

ascqilogoThe seminar covered principles such as definitions, theoretical approaches (such as pragmatism and transformation), basic and advanced (including case study) designs and approaches to data integration and transformation. This was then applied to examples of mixed methods designs used by CaHRU in a previous programme of research: the Ambulance Services Cardiovascular Quality Initiative (ASCQI). ASCQI was a national project, led by CaHRU and East Midlands Ambulance Service NHS Trust, designed to improve care for people presenting to ambulance services with heart attack or stroke using a large-scale quality improvement collaborative (QIC), evaluated using a multiple case-study design.

NWASami170112ASCQI involved gathering quantitative and qualitative data to describe what effect the QIC had, and how improvements, if they did occur, were brought about. Integration of data was carried out using techniques such annotated control charts showing time series data together with what was implemented, pattern matching comparing what services did and whether improvements occurred (doi:  10.1186/1748-5908-9-17), and comparison of quantitative and qualitative data from an online questionnaire (doi: 10.1111/jep.12438). Attendees were finally asked to consider a mixed methods question and think about research designs which they might use to answer it.

Thank you to all those staff and students who attended. Details of future seminars will be posted on the CaHRU and the LIH sites shortly.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2016/02/Mixed-methods_Siriwardena.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

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Presentation at GP educator conference and bursary award for doctoral study on early cancer diagnosis

BJoseph Akanuwe, doctoral student at CaHRU, was recently invited to present a workshop with Dr Sharon Black (both pictured below) at a regional primary educator’s conference organised by Health Education East Midlands at the Eastgate Hotel on 14 January 2016. Joseph who is a full time PhD student with CaHRU, continues to work as a nurse to support his studies which are supervised by Prof Niro Siriwardena, Dr Black and Prof Sara Owen.

joseph and sharon 1The workshop entitled ‘Estimating and Communicating Cancer risk in the GP Consultation’ was based on his work reviewing the literature around use of cancer risk assessment tools and a series of interviews of primary care practitioners and service users on their perceptions of risk assessment using a novel risk tool (Qcancer) and how this might be used in the primary care consultation. Participants discussed the implications for GPs of using Qcancer to quantify cancer risk; the potential uses of QCancer in the consultation; what communication issues might arise when using Qcancer; and the potential challenges to using QCancer in routine general practice. The workshop raised issues about communicating risk in general practice participants found the discussion of potential advantages and disadvantages of using Qcancer.

BJoseph also presented findings of a qualitative study involving semi-structured interviews and focus groups of 19 service users and 17 practitioners on cancer risk estimation and communication. The results of the workshop will contribute to validation of the research findings. Joseph has also been invited to present his most recent study, ‘Patient and practitioner perspectives of QCancer use in primary care consultations’ at the Trent Regional SAPC conference in Leicester in March 2016. His work was recently recognised through a bursary awarded by a member of the University Court to support his studies.

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CaHRU research on measuring quality presented at the Larrey Society’s Future of EMS Conference

niro2Professor Niro Siriwardena recently presented on ‘Developing new ways of measuring the quality of emergency medical services’ on 21 January 2016 at the Larrey Society’s inaugural conference on the Future of EMS in London. The Larrey Society, the brainchild of its founder David Davis, is an international organisation of paramedics and NHS, independent and voluntary ambulance services with leaders from health and academic communities, formed a year ago. The society is named after Dominque Jean Larrey, an army surgeon in Napoloen’s army who developed field medicine and ambulances.

NThe meeting was chaired by Sue Noyes, chief executive of East Midlands Ambulance Services NHS Trust and included keynote lectures from Prof Andy Newton, president of the society, Prof Jonathan Benger, professor of emergency medicine at the University of West of England, Prof Siriwardena, director of CAHRU, and Prof Kevin Mackway-Jones, professor of emergency medicine. Prof Newton talked about the current state of ambulance services and the urgent need to innovate to improve care quality. Prof Benger described an innovative method of ambulance dispatch currently being introduced and evaluated in the South West. Prof Mackway-Jones discussed the causes of and potential solutions to emergency department blocking.

photo2italiccolourWORDSProf Siriwardena described work done by ambulance services in England over the past eight years developing new quality measures of ambulance service care and improving care for conditions such as heart attack, stroke, diabetes and asthma using methods such as largescale quality improvement collaboratives. He went onto describe the new indicators being developed through research programmes such as Prehospital Outcomes for Evidence Based Evaluation using method such systematic literature reviews, interviews of ambulance staff and patients, consensus methods and data linkage to derive risk adjustment measures, which provide potential for better measurement and improvement of ambulance service care.

 

 

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CaHRU team reflects on past and plans future

The CaHRU team spent a December awayday at Lincolnshire’s Branston Hall, reflecting on past and ongoing work, discussing current challenges and exploring future opportunities for the research centre. Over the past year the centre has continued to build on its strong collaborations with health service and academic partners (both internal and external to the university), which has led to increasing success in attracting external funding, achieving publications and securing research funding.

In the next year CaHRU will begin new projects on the ethics of ambulance trials (funded by the Wellcome Trust), cahru_awaydaypain management in ambulance services (funded by the Falck Foundation, Denmark) and evaluation of a new pathway for care of people with diabetes presenting with low blood sugar (hypoglycaemia) to ambulance services (funded by the East Midlands Collaboration for Leadership in Applied Health Research and Care). The centre will continue its work on ambulance trials (RIGHT2 funded by the British Heart Foundation) and service delivery (Variation in Ambulance Non-conveyance funded by the NIHR), prescribing safety in primary care (Scaling up PINCER funded by the Health Foundation) and regional networks such as the East Midlands Network for Quality Improvement Research and Education (ENQuIRE, funded by the East Midlands Academic Health Science Network and Health Foundation).

The awayday provided an important opportunity for CaHRU staff to have their say on future developments. Next year the centre will continue to expand with the appointment of two postdoctoral staff who will join the team including a qualitative researcher and health economist. The awayday was supported by funding from the University of Lincoln team achievement award for research which CaHRU won in 2015 for a consecutive year.

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CaHRU hosts second East Midlands Research into Ageing Network regional seminar at University of Lincoln

Emran-png-250The Community and Health Research Unit, as part of the work of the centre’s Healthier Aging programme of research, recently hosted the second East Midlands Research into Ageing Network (EMRAN) seminar that took place at the University of Lincoln on 25 November 2015 and which focused on the care of older people in the community. The seminar started with a brief presentation by Professor John Gladman and Chris Craig on EMRAN’s purpose to facilitate collaborative applied research into ageing and older people research across the East Midlands and a brief update on EMRAN’s progress, including recent publications and projects which are being developed thanks to EMRAN’s intervention.

jo1The first part of the seminar included four ‘Elevator Pitches’. Dr Carlos Rodriguez Pascual (University of Lincoln; Lincoln County Hospital) presented his project on frailty and cardiovascular disease, exploring how a combination of a comprehensive geriatric assessment (CGA) score and frailty is a predictor of cardiovascular disease in an older person. The second pitch, presented by Dr Jo Middlemass (CaHRU, University of Lincoln), outlined findings from the ‘CArers of people with Dementia: Empowerment and Efficacy via Education’ (CAD: E3) project that aims to improve carer and patient well-being by offering carers of people with dementia a multicomponent intervention (focusing on education and skill-building). The third pitch, presented by Dr Fiona Marshall (University of Nottingham), looked at a project aimed at creating more dementia friendly areas, by gathering local information (through geo-spatial mapping) of what health, social, religious groups, community and voluntary services (amongst others) there are for older people living in the Peak District of Derbyshire. Finally, Dr Gill Garden (United Lincolnshire Hospitals NHS Trust) presented the very successful Bromhead Care Home service, which involved training care home staff so they can more confidently and effectively deliver care in care homes and reduce admissions to hospitals.

EMAS - PTS 7Professor Niro Siriwardena (Director of CaHRU, University of Lincoln) delivered the second part of the seminar, presenting the work of CaHRU and ideas for developing new projects involving ambulance services: ‘Pathways for Older People from Ambulance Services to Safe Community Care’. The aim of the presentation was to show that paramedics, apart from safely transporting patients, can also offer important treatment and refer patients who don’t require hospitalisation to community services that are often more adequately equipped to care or support them. After the successful SAFER-2 trial (Support and Assessment for Fall and Emergency Referrals), exploring how ambulance staff could assess and divert older people who had suffered a fall to appropriate community-based services, Prof Siriwardena and his colleagues at the East Midlands Ambulance Service (EMAS) are currently interested in exploring other conditions, such as hypoglycaemia, epilepsy and COPD (chronic obstructive pulmonary disease) which may also be amenable to community pathways.

After a quick recess for some much needed tea and coffee, the attendees split into small groups to discuss the projects presented earlier, focusing on possible challenges and solutions to the design and conduct of each study, and consider ideas for further research and exciting collaborations. The seminar came to a close with Chris Craig and Prof John Gladman thanking everyone for their participation and with a promise for more similar events and innovative seminars.

Despina Laparidou