The 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.
The 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.
ASCQI 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]
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), pain 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.
An international team of researchers led by Prof Niro Siriwardena with statistician Dr Zahid Asghar from CaHRU has been awarded funding from the Falck Foundation to study prehospital pain management. The study involves collaboration between CaHRU at the University of Lincoln, with East Midlands, East of England and South Central Ambulance Service NHS Trusts, together with the Universities of Swansea, Hertfordshire and the Sunshine Coast (Australia).
The study, ‘Exploring factors increasing Paramedics’ likelihood of administering Analgesia in pre-hospital pain: cross sectional study (ExPLAIN)’ aims to identify how patient factors such as age, gender, ethnicity and the cause of pain together with clinician factors such as sex or role seniority affect pain assessment and use of analgesic drugs by ambulance staff. The study builds on previous research conducted by members of the team in the area of prehospital pain management and the findings will be used to inform recommendations to improve the rate and quality of acute pain relief provided by ambulance staff and to reduce unintended variations in care.
The study is part of CaHRU’s ongoing research as part of its Prehospital and Emergency Quality and Outcomes (PEQO) workstream which involves collaboration with other ambulance services in England and which has already led to new measures and improvements in the quality of ambulance service care provision.
The NIHR commissioned rapid evidence review to assess the nature and quality of the existing evidence on delivery of emergency and urgent care services and to identify gaps for future research was published last week: Phung V-H (2015) Chapter 6 – Delivery of emergency department services in Turner J, Coster J, Chambers D, Cantrell A, Phung V-H, Knowles E, Bradbury D, Goyder (eds.). What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. Health Serv Deliv Res 2015;3(43). The team, from the School of Health And Related Research (ScHARR) at the University of Sheffield with Viet-Hai Phung, research assistant and doctoral researcher at CaHRU, undertook five separate literature reviews linked to themes in the NHS England review in 2013, which latter drove the need for this rapid evidence review. The review, which took six months to complete, incorporated findings from 45 systematic reviews and 102 primary research studies across all five reviews
Viet-Hai Phung wrote the review in Chapter 6 on the Delivery of Emergency Department (ED) services. This review included literature from 2009 to 2015. Nine papers were included in the review: two systematic reviews, which included 28 individual papers, and seven additional papers. Of the 35 included studies, there were only five randomised control trials and many uncontrolled before-and-after studies, which cannot control for other system effects.
There were three themes to this part of the review: Managing ED flow; Workforce; and managing the frail and the elderly in EDs. In the first review, interventions that aimed to increase access to primary care and ED cost-sharing were found to be effective in reducing ED use. For the Workforce review, the evidence suggested that supplementing existing ED staff with NPs can help to manage demand more effectively, especially in high-volume EDs. For the final review, there was mixed evidence about the effectiveness of Comprehensive Geriatric Assessment (CGA): CGA did not have a significant impact on outcomes nor mortality, while other studies suggested that use of CGA to inform interventions could reduce functional decline.
If you have used the ambulance service in the previous 12 months and are happy to take part in an interview for a new study we would like to hear from you.
This study is part of doctoral research being undertaken by Fiona Togher, Graduate Research Assistant at CaHRU, to develop a Patient Reported Experience Measure (PREM), a brief questionnaire for measuring experiences of ambulance service users. This will enable NHS ambulance services and their commissioners to routinely assess differences in patient experiences between and within organisations and to stimulate positive changes to the experiences of ambulance service users through feedback, training and education to clinicians; it could also be an opportunity to identify the strengths of ambulance service care and provide evidence of good practice.
The purpose of this study is to try to understand how people interpret the questions that have been developed so that we can improve them. In order to do this we are conducting interviews with ambulance service users, showing them the latest version of the questionnaire, and asking them to respond to the questions and share their thoughts and opinions of the questions.