Category Archives: Events

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Prof Siriwardena gives invited lecture at North American EMS conference, San Diego

Prof Niro Siriwardena of CaHRU attended the North American Emergency Medical Services Physicians (NAEMSP) annual conference in San Diego, California from 10-12 January 2018 to deliver an invited lecture on ambulance quality measures and improvement.

SD2The conference opened with a keynote address, ‘The patient as a mission with a very critical outcome, how to get that right – the first time and every time’ given by Dr Story Musgrave, child labourer, mechanic, farmer, scientist, doctor, pilot, astronaut, artist and university professor. This was followed by Dr Dave Williams of the Institute for Health Improvement in the US who spoke on ‘Improvement science and safety in EMS’ including an example from CaHRU of development of prehospital indicators and their use for quality improvement.

SD6The following day included session on the Canadian Prehospital Evidence-Based Practice Project, National Model EMS Clinical Guidelines and Ethical Challenges in EMS, simulation, cognitive bias and medical error. The afternoon sessions focussed in quality included ‘Mission: Quality – Can Mission Lifeline Help Your Performance Improvement Program?’ presented by Dr Jeremy Cushman MD. He described how a the programme Mission: Lifeline is designed to transform care for patients with myocardial infarction, stroke, and cardiac arrest using national performance benchmarks, and sharing best practices to enhance provider feedback through hospital outcome information.

Niro_EMAS4Prof Siriwardena then spoke on how new quality measures for ambulance services have been developed and implemented over the past decade in England in his lecture entitled ‘Developing Ambulance Quality & Performance Measures that Make a Difference to Patients’. This was based on research conducted by Prof Siriwardena with UK ambulance services and academic institutions as part of the Ambulance Services Cardiovascular Quality Initiative (ASCQI) and the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) program. There was discussion of the successes as well as the barriers to development of new quality measures, and the underpinning research and quality improvement initiatives that have been vital to progress in this field.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/01/NAEMSP2018_Siriwardenav3.pdf” width=”640″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

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CaHRU contributes to international EMS quality & safety programme

Professor Niro Siriwardena recently contributed to ‘Safer, Better and Stronger: Quality Improvement for EMS Leaders’ a one-day preconference course at the North American Emergency Medical Services Physicians (NAEMSP) Annual Conference in San Diego, on January 10, 2018.

SD1Around 60 EMS physicians attended the day to learn about quality improvement methods from experts based in the US and UK led by Dr Michael Redlener, EMS and Emergency Department physician based in New York city and chair of the NAEMSP Quality and Safety Committee together with Dr Scott Bourn, president of the National Association of EMS Educators, supported by Mike Taignan, Associate Professor in the Emergency Health Services Management graduate program at the University of Maryland Baltimore County, Dr David Williams, Executive Director at the US Institute for Health Improvement, and Prof Siriwardena from CaHRU.

SD4The preconference course began with an overview of the day by Dr Scott Bourn. This was followed by Dave Williams leading a session on the science of improvement including the ‘red bead experiment’ and an outline of Deming’s theory of profound knowledge. Niro Siriwardena led a session on understanding the model for improvement and Mike Taigman helped delegates get to grips with the plan-do-study-act cycle using the coin-spinning game. The later sessions were focussed on application of these ideas to selecting a good project, identifying measures, developing a measurement strategy, managing change and understanding what changes will result in an improvement faciltated by other faculty members including  Joseph Grover MD, Jeffrey L. Jarvis, MD, MS, EMT-P, Kevin Mackey, MD, FACEP, Kim D McKenna, PhD, RN, EMT-P, and James “Tripp” Winslow, MD, MPH.

SD3The day will be followed by a year-long course for around 25 delegates from the US and Canada who will take part in monthly moderated online educational sessions on key aspects of quality improvement, read relevant articles and conduct a ‘capstone project to implement quality improvement methods to a problem in their agency or system, supported by a mentor from the course faculty to help guide their progress. Participants will present their work to colleagues and members of the NAEMSP community to share the impact of quality improvement.

The preconference has been summarised by Dr Catherine Counts, one of the delegates in a blog entitled: ‘Quick take: Quality and safety gain prominence at NAEMSP‘.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2018/01/FLYER-QI-2018.pdf” width=”640″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

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CaHRU receives university team award for achievement in research

CaHRU2017webThis year members of the Community and Health Research Unit received the University of Lincoln team award for Achievement in Research at the Individual Merit and Team Achievement Awards 2017. This was the team’s fifth team award over the past 6 years and the fourth time the team have received the team award for achievement in research. Members of the team include Prof Niro Siriwardena (director), Prof Graham Law, Dr Murray Smith, Dr Zahid Asghar, Dr Coral Sirdifield, Dr Stephanie Armstrong, Dr Julie Pattinson, Dr Rebecca Marples, Viet-Hai Phung, Despina Laparidou, Michael Toze, Laura Simmons, Joseph Akanuwe, Dr Nadeeka Chandraratne, Dr Ravindra Pathirathna and Sue Bowler (administrator).

ResearchTeamAward2017CertificateThe CaHRU team are striving to conduct research which will make a difference to patients and healthcare delivery. The group conducts basic and translational interdisciplinary research in collaboration with health service and academic partners.  It currently has over 30 active projects in progress across a range of research methods from systematic reviews (e.g. role of community first responders, ethics of ambulance trials), major clinical trials (investigating conditions such as hyper-acute care of stroke, prehospital pain management, ambulance hypoglycaemia pathways and primary care for insomnia), observational studies (investigating prehospital pain and seizure management), qualitative designs (community first responders, dementia carers, ethics of ambulance trials, fairness of medical licensing exams), consensus methods (ambulance indicators), and surveys (healthcare for offenders on community sentences) to quality improvement programmes (prescribing safety) and international research networks (ethics of ambulance trials). Details of current studies are available on the CaHRU website (http://cahru.org.uk/research/).

CaHRU_logotypeThis has led to over 20 publications in the past year covering research on development of new pathways and indicators for ambulance services, assessment and treatment for insomnia and use of health technology innovations, in major journals such as Resuscitation, Annals of Emergency medicine, Health Technology Assessment, Health Expectations and Lancet Psychiatry. The team have  received several major grants over the past year, particularly from the National Institute for Health Research, as well as continuing to work on studies funded by the Wellcome Trust, Health Foundation and Falck Foundation. This year we have also welcomed international fellows from the University of Colombo to the team for the first time.

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CaHRU/LIH seminar: Economic methods used in Health Technology Assessment

murraysmith1This month’s CaHRU/LIH Improvement Science and Research Methods seminar was presented by Dr. Murray Smith, senior research fellow in econometrics and health economics based in CaHRU on 28 November 2017. His topic was a general introduction to health technology assessment, with the overall aim of seeking to establish whether or not a new health technology is cost effective relative to its comparator.

Murray gave a backround to the principles of health economics and the main approaches to evaluation including cost minimisation, cost effectiveness, cost utility and cost benefit analysis. He described the concept of the incremental economic analysis, demonstrated how to calculate an incremental cost effectiveness ratio (ICER) and described the role that incremental economic methods provide in helping to answer the question of whether or not a new treatment is cost effective relative existing health technologies.

CaHRU_logotypeIn the second half of the presentation, Murray gave examples of assessments undertaken by the National Institute for Health and Care Excellence (NICE), the UK health assessment agency, contrasting their regulatory decisions arrived at through cost effectiveness considerations with other management approaches taken by key stakeholder agencies such as NHS England and the now defunct Cancer Drugs Fund.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2017/12/CaHRU-Seminar_MDSmith_28Nov2017.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

By Dr. Murray Smith

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CaHRU/LIH Research methods seminar: Realist evaluation with Dr Paul Leighton

WP_20170124_12_05_46_RichThe latest in the CAHRU/LIH research methods seminars was given by Dr Paul Leighton on 24 October 2017 on the subject of ‘Realist evaluation in health services research’. Paul Leighton is a senior research fellow at the University of Nottingham, deputy director of the NIHR Research Design Service for the East Midlands and an expert in health services research, qualitative methods and process evaluation. The presentation covered the philosophy of critical realism and how this related to realist methods, described a practical example of a realist evaluation and finished with concluding thoughts and comment on the method.

Critical realism was described as a philosophical approach developed by Roy Bhaskar that adopts an ontological position of being in which: the actual world is independent of the human mind and the mind is capable of perceiving the empirical world, but unable to directly perceive unseen forces in the real world. Gravity and social class were cited as examples of unseen forces in the real world.

WordItOut-word-cloud-2565294“Realist” or “realistic evaluation” was described as a form of primary research methodology derived from critical realist philosophy, by Ray Pawson and Nick Tilley, which acknowledges the potential for unseen forces and accepts that interventions will not always work or work in the same way because of local contextual factors will influence how an intervention works and the impact it has. Realistic evaluation was summed up as “What works, for whom, in what circumstances?”

The process of realistic evaluation involves developing a programme theory, which theorises what should happen and how it might happen. This so-called mid-range theory is tested using qualitative and/or quantitative methods to explore the context, mechanisms (often hidden) and outcomes (C+M=O), revised iteratively and tested again, leading to a refined mid-range theory.

This was illustrated using the Falls in Care Homes (FinCH) study and summarised by concluding that interventions will not work all the time in all settings, but will work differently in different contexts.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2017/11/lincoln-realist-oct17.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

A. N. Siriwardena