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Driving progress in healthcare through NHS research
This document provides summaries from several presentations about driving progress in health care through research supported by the National Institute for Health Research (NIHR) in the UK. The first presentation introduces the NIHR and its role in supporting different types of health care research. The second presentation describes a clinical academic fellowship funded by the NIHR and the research and career development it enabled. The third presentation summarizes a large clinical trial called DRAFFT that compared wire fixation and plate fixation for distal radius fractures and found wires to be as effective and cost less, leading to a change in practice. The last presentation discusses the experience of patients who participate in research and how it can benefit the NHS.
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Driving progress in healthcare through NHS research
- 1. Driving progress inhealth care through NHS research National Institute for Health Research
- 2. Introduction William van’t Hoff,Clinical Director for NHS Engagement, NIHR Clinical Research Network
- 3. • Provide aflavour of the many different ways in which the NIHR is driving progress in healthcare • Share our experiences of the NIHR, but also provide a wider national view • This will be followed by a Q&A panel session
- 4. Come talk tous about how the NIHR can help your NHS improve through research – stand 119
- 5. The benefits andimpact of clinical academics and NIHR trainees Gilly Howard-Jones, Lymphoma Clinical Nurse Specialist, University of Southampton NHS Foundation Trust and NIHR Clinical Doctoral Research Fellow
- 6. Overview • My background •My research • Clinical development during the fellowship • Outcomes so far • Looking to the future
- 7. My background • RGNDiploma 1993 • Cancer nursing • BSc. Nursing 1996 • MSc. Medical Anthropology 2000 • NIHR MRes 2012, NIHR Internship 2013 • NIHR Clinical Academic Fellowship 2014
- 8. My Research :The influence of social networks on self-management support in cancer survivors: A mixed methods Study Quantitative postal survey Qualitative interviews Invited to participate from survey Interpretation based on Quantitative (qualitative ) results
- 9. Undertaking clinical development •Planning the application with clinical staff - Member of NICE Guidance Development Group for NHL - Patient Triggered Follow Up - Advanced Nurse Practitioner role development • Engagement with Lymphoma Association - Supporting development of survivorship services
- 10. Outcomes so far….. •Patient experience • Team • Hospital Trust • University • National influence
- 11. Looking to thefuture •Completing my PhD ! •Creating a new clinical academic post •Clinical Lectureship application- TIME and RESOURCES
- 12. Thank you Email: ghhj1e11@soton.ac.uk Twitter: @GillyhjJones
- 13. How DRAFFT improvedcare, made cost savings and achieved consistency across the NHS Mike Reed, Consultant Trauma and Orthopaedic Surgeon, Northumbria Healthcare NHS Foundation Trust
- 15. About Me Trauma andorthopaedic surgeon Full time clinician I just do regular trauma on call I’ve run some clinical trials No involvement in this study (although I did do some surgery) “So why are you here?”
- 16. Background In the WesternWorld, 6% of women will have sustained a fracture of the distal radius by the age of 80 and 9% by the age of 90
- 17. Most common interventionsin the UK • Wires • Volar fixed-angle plates
- 18. Most common interventionsin the UK.... VS
- 19. Funding • National Institutefor Health Research Health Technology Assessment • Why? • Clinical and cost-effectiveness
- 20.
- 21. Outcome Measures Primary • PatientReported Wrist Evaluation (PRWE) Secondary • Disability of the Arm, Shoulder and Hand (DASH) • Radiographic changes • Complications • Health Economics (EQ-5D, resource use)
- 22.
- 23. Numbers • Screened: 12,000patients with a distal radius fracture • Eligible: 639 patients • Recruited: 461patients (more than anticipated) • Follow-up: over 90% at each time-point
- 24. Patient-rated wrist evaluation Lowerscore = better outcome
- 25. The result This large,multi-centre, pragmatic clinical trial shows that there is no difference in patient-reported wrist evaluation in the twelve months following Wire fixation versus locking-plate fixation. Confidence intervals exclude a clinically relevant effect (95% CI; -4.5 to 1.7)
- 26. The result: sub-groups Nodifference in under 50 years versus over 50 years No difference in those with intra-articular extension versus extra-articular
- 27. Result: further surgery •5 patients in the wire group and 2 in the plate group required revision surgery for loss of reduction • 9 patients in the plate group required removal of symptomatic metalwork (4 for screw penetration of the joint) and 1 patient with a buried K-wire required removal in theatre
- 28. The result: HealthEconomics Economic evaluation completely driven by the choice of implant Wires were cheaper: £54 vs £854 No difference in Quality of Life in the 12 months after surgery Therefore, wires are cost saving
- 29. So what happenednext? • Did anyone take any notice? • Did anyone get upset? • And, did anyone change their practice?
- 30. National/international presentations: • TraumaTrials Meeting • OTS • BSSH • BOA • EFORT • OTA • NZOA
- 31. Local presentations/meetings • Manysite visits • Local presentations by the Principal Investigators • Teaching courses
- 32. Papers • British MedicalJournal • NIHR-HTA Monograph • Bone and Joint Journal • Patient newsletters
- 33. Modern stuff… • Podcasts •Journal Blogs • ‘Tweeting’…
- 34. So did anyoneget upset about DRAFFT?
- 35. Yes …mostly the handsurgeons…!
- 36. Reaction… • “…in myhands…” • “I’m not a statistician, but I have concerns about the statistics”
- 37. So people heardthe results, but did they take any notice?
- 38. English Hospital Episode Statistics: surgery for fracture ofthe distal radius
- 40. Cool! • But surelynot everyone changed their practice… • Surely not the hand surgeons…
- 41. 0 10 20 30 40 50 60 70 80 90 Time 0 Pretrial Pre results Post results hand units plate hand units wire non-hand units plate non-hand units wire
- 42. So everyone ischanging?
- 43.
- 44. Conclusions • Use morewires. Save lots of money. • UK Orthopaedic Trauma Surgeons can deliver multi- centre clinical trials • They really do change clinical practice!
- 45. How the moneystacks up… DRAFFT cost the taxpayer about £1.5 million The 25% shift in practice has already saved £1.6 million Will continue to save year on year.
- 46. NIHR Musculoskeletal TraumaTrials P R O F H E R
- 47.
- 48. Patient experience ofparticipating in research Vee Mapunde, Associate Consumer Lead National Cancer Research Institute
- 49. The NCRI ConsumerForum – Background Formed in April 2015, funded by NCRI (with NIHR support), follows CLG (funded by NIHR Clinical Research Cancer Specialty Group) Objective: To create a professional, focussed and committed constituency of consumer research partners, who can help NCRI achieve its aims Nine specific points, including: To provide a pool of well-trained consumers to input into NCRI and partner research activities, committees and groups, as equal and valued partners
- 50. How I gotinvolved Diabetes • Why him? And why now? • Could I have stopped this? Prostate Cancer • Why is it that some people can “live” with this condition? • Why is it more aggressive in some ethnic groups? • How does this affect patient outcomes? • What impact can I make?
- 51. How patient involvementbenefits the NHS • Patient experiences can drive service improvements and promote research • Patients get involved in finding solutions when researchers bring ideas or problems to them • Taking part in research is associated with better experience of care – 88% of all cancer patients are satisfied/v satisfied with care; increases to 93% for participants • Increase our understanding of challenges associated with hard-to-reach groups, geographical inequalities of access to research opportunities, gaps in clinical trial portfolios, matching patient priorities • We can change practice faster – working with the NIHR, NICE and MRC CTU
- 52.
- 53. Remember, we’re onstand 119 if you would like to find out more
- 54. Thank you allfor attending and taking part
Editor's Notes
- #17 Firstly a bit of background to the reason this study came about. Apparently a huge number of people will sustain a dr#, 6% of women will have by the age of 80 and 9% by the age of 90 and a cochrane review exposed a serious deficiency in the evidence available for their treatment
- #19 So the trial is comparing Kirschner wires with volar locking plates for the fixation of dorsally displaced distal radius fractures in adult patients.
- #21 The 18 centres as you can see from this slide are spread across England
- #22 Our primary outcome is the PRWE taken at 12 months and we are collecting a number of secondary outcomes including DASH, x-rays, complications and health economics.
- #23 Here is what our recruitment graph. This was an incredibly successful phase of the trial and as you can see our actual line exceeds the target the whole duration of the trial and we actually recruited 461 patients in total which will help improve the power of the study (this is 71 over our original target). This was due to a number of factors not only the enthusiasm and commitment from all of our 18 centres but we managed to open a few centres earlier than intended. We had a bad winter in 2010, and due to lots of interest from centres we opened at more centres than originally planned. So these lessons will help when putting future applications together. But a big thank you to everyone involved for making this happen.
- #24 One huge part of the study was collecting the screening data on all patients with a dr# across all 18 centres. You all have a copy of this consort diagram in your delegate packs and as you can see we screened a over 11,000 pts which is a huge number and of whom 638 were eligible and 461 consented which is 72%. As expected not all patients received their allocated interventions.
- #50 Additional background notes: Same members initially, but new Terms of Reference
- #52 Patient experiences of research opportunities can drive service improvements and promote research awareness Patients get involved in finding appropriate and relevant solutions when researchers bring ideas or problems to them Taking part in research is associated with better experience of care; 88% of all cancer patients are satisfied/v satisfied with care; increases to 93% for participants We increase our understanding of challenges associated with hard-to-reach groups, geographical inequalities of access to research opportunities, gaps in clinical trial portfolios, matching patient priorities We can change practice faster – working with NIHR CRN & NICE, with NIHR’s Dissemination Centre and with MRC CTU