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Millier A, Horváth M, Ma F, Kóczián K, Götze A, Toumi M. Healthcare resource use in schizophrenia, EuroSC findings. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2017; 5:1372027. [PMID: 29081923 PMCID: PMC5645906 DOI: 10.1080/20016689.2017.1372027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/22/2017] [Indexed: 05/16/2023]
Abstract
Background: It is unclear if the burden associated with schizophrenia is affected by the type and severity of patient's symptoms. Objective: This study aims to quantify healthcare resource use associated with different profiles of schizophrenia symptoms. Study design: Post-hoc analysis of data from a naturalistic follow-up study. Setting: Secondary psychiatric services in France, Germany and the UK. Patients: EuroSC cohort:, representative sample of 1,208 schizophrenia patients Main outcome measure: We classified patients into eight health states, according to the Lenert classification (HS1-HS8), and estimated 6-month healthcare resource use (outpatient and day clinic visits, and hospitalisations) across the health states. Results: Approximately half of the patients were classed as having mild symptoms (HS1), with around 20% experiencing moderate, predominantly negative symptoms (HS2). The remaining health states were represented by <10% of patients each. Very few patients experienced extremely severe symptoms (HS8). No health state was associated with excess utilisation across all resource types. In terms of outpatient visits, patients were estimated to see a psychiatrist most often (3.01-4.15 visits over 6 months). Hospital admission was needed in 11%(HS1) - 35%(HS8) of patients and inpatient stays were generally prolonged for all health states (39-57 days). The average number of inpatient days was highest for patients in HS8 (18.17 days), followed by patients with severe negative symptoms (HS4; 13.37 days). In other health states characterised by severe symptoms (HS5-HS7), the average number of inpatient days was approximately half of those seen for HS4 (6.09-7.66). Conclusion: While none of the symptom profiles was associated with excess resource usage, hospitalization days were highest for HS with severe, predominantly negative or extremely severe symptoms. Patients with predominantly negative, moderate or severe symptoms appeared to have a high number of psychologist visits - an interesting finding that may reflect a specific therapeutic approach to the treatment of these patients.
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Affiliation(s)
- A. Millier
- Health Economics and Outcomes Research, Creativ-Ceutical, Paris, France
- CONTACT A. Millier Creativ-Ceutical, 215 rue du Faubourg Saint Honoré, Paris75008, France
| | - M. Horváth
- Market Access, Medical & Marketing, Gedeon Richter Plc, Budapest, Hungary
| | - F. Ma
- Health Economics and Outcomes Research, Creativ-Ceutical, Beijing, China
| | - K. Kóczián
- Market Access, Medical & Marketing, Gedeon Richter Plc, Budapest, Hungary
| | - A. Götze
- Market Access, Medical & Marketing, Gedeon Richter Plc, Budapest, Hungary
| | - M. Toumi
- Public Health Department, Aix-Marseille University, France
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McIntosh AM, Stewart R, John A, Smith DJ, Davis K, Sudlow C, Corvin A, Nicodemus KK, Kingdon D, Hassan L, Hotopf M, Lawrie SM, Russ TC, Geddes JR, Wolpert M, Wölbert E, Porteous DJ. Data science for mental health: a UK perspective on a global challenge. Lancet Psychiatry 2016; 3:993-998. [PMID: 27692269 DOI: 10.1016/s2215-0366(16)30089-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 02/01/2023]
Abstract
Data science uses computer science and statistics to extract new knowledge from high-dimensional datasets (ie, those with many different variables and data types). Mental health research, diagnosis, and treatment could benefit from data science that uses cohort studies, genomics, and routine health-care and administrative data. The UK is well placed to trial these approaches through robust NHS-linked data science projects, such as the UK Biobank, Generation Scotland, and the Clinical Record Interactive Search (CRIS) programme. Data science has great potential as a low-cost, high-return catalyst for improved mental health recognition, understanding, support, and outcomes. Lessons learnt from such studies could have global implications.
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Affiliation(s)
- Andrew M McIntosh
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK.
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Katrina Davis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Cathie Sudlow
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Aiden Corvin
- Department of Psychiatry & Psychosis Research Group, Trinity College Dublin, Dublin, Ireland
| | - Kristin K Nicodemus
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - David Kingdon
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lamiece Hassan
- Health eResearch Centre, University of Manchester, Manchester, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen M Lawrie
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - Tom C Russ
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, UK
| | - John R Geddes
- Department of Psychiatry, University of Oxford, Oxford UK
| | - Miranda Wolpert
- Child Outcomes Research Consortium (CORC) and Evidence Based Practice Unit, University College London, and Anna Freud Centre, London, UK
| | | | - David J Porteous
- Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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53
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Stewart R, Davis K. 'Big data' in mental health research: current status and emerging possibilities. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1055-72. [PMID: 27465245 PMCID: PMC4977335 DOI: 10.1007/s00127-016-1266-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 07/08/2016] [Indexed: 01/24/2023]
Abstract
PURPOSE 'Big data' are accumulating in a multitude of domains and offer novel opportunities for research. The role of these resources in mental health investigations remains relatively unexplored, although a number of datasets are in use and supporting a range of projects. We sought to review big data resources and their use in mental health research to characterise applications to date and consider directions for innovation in future. METHODS A narrative review. RESULTS Clear disparities were evident in geographic regions covered and in the disorders and interventions receiving most attention. DISCUSSION We discuss the strengths and weaknesses of the use of different types of data and the challenges of big data in general. Current research output from big data is still predominantly determined by the information and resources available and there is a need to reverse the situation so that big data platforms are more driven by the needs of clinical services and service users.
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Affiliation(s)
- Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK.
| | - Katrina Davis
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Box 63, De Crespigny Park, London, SE5 8AF, UK
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54
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Patel R, Chesney E, Cullen AE, Tulloch AD, Broadbent M, Stewart R, McGuire P. Clinical outcomes and mortality associated with weekend admission to psychiatric hospital. Br J Psychiatry 2016; 209:29-34. [PMID: 27103681 PMCID: PMC4929405 DOI: 10.1192/bjp.bp.115.180307] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies indicate that risk of mortality is higher for patients admitted to acute hospitals at the weekend. However, less is known about clinical outcomes among patients admitted to psychiatric hospitals. AIMS To investigate whether weekend admission to a psychiatric hospital is associated with worse clinical outcomes. METHOD Data were obtained from 45 264 consecutive psychiatric hospital admissions. The association of weekend admission with in-patient mortality, duration of hospital admission and risk of readmission was investigated using multivariable regression analyses. Secondary analyses were performed to investigate the distribution of admissions, discharges, in-patient mortality, episodes of seclusion and violent incidents on different days of the week. RESULTS There were 7303 weekend admissions (16.1%). Patients who were aged between 26 and 35 years, female or from a minority ethnic group were more likely to be admitted at the weekend. Patients admitted at the weekend were more likely to present via acute hospital services, other psychiatric hospitals and the criminal justice system than to be admitted directly from their own home. Weekend admission was associated with a shorter duration of admission (B coefficient -21.1 days, 95% CI -24.6 to -17.6, P<0.001) and an increased risk of readmission in the 12 months following index admission (incidence rate ratio 1.13, 95% CI 1.08 to 1.18, P<0.001), but in-patient mortality (odds ratio (OR) = 0.79, 95% CI 0.51 to 1.23, P = 0.30) was not greater than for weekday admission. Fewer episodes of seclusion occurred at the weekend but there was no significant variation in deaths during hospital admission or violent incidents on different days of the week. CONCLUSIONS Being admitted at the weekend was not associated with an increased risk of in-patient mortality. However, patients admitted at the weekend had shorter admissions and were more likely to be readmitted, suggesting that they may represent a different clinical population to those admitted during the week. This is an important consideration if mental healthcare services are to be implemented across a 7-day week.
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Affiliation(s)
- Rashmi Patel
- Rashmi Patel, BM BCh, Edward Chesney, BM BCh, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alexis E. Cullen, PhD, Department of Psychosis Studies and Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Alex D. Tulloch, PhD, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Matthew Broadbent, BSc, Biomedical Research Centre Nucleus, South London and Maudsley NHS Foundation Trust, London; Robert Stewart, MD, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London; Philip McGuire, PhD, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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55
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Torous J, Kiang MV, Lorme J, Onnela JP. New Tools for New Research in Psychiatry: A Scalable and Customizable Platform to Empower Data Driven Smartphone Research. JMIR Ment Health 2016; 3:e16. [PMID: 27150677 PMCID: PMC4873624 DOI: 10.2196/mental.5165] [Citation(s) in RCA: 299] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/22/2015] [Accepted: 01/21/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A longstanding barrier to progress in psychiatry, both in clinical settings and research trials, has been the persistent difficulty of accurately and reliably quantifying disease phenotypes. Mobile phone technology combined with data science has the potential to offer medicine a wealth of additional information on disease phenotypes, but the large majority of existing smartphone apps are not intended for use as biomedical research platforms and, as such, do not generate research-quality data. OBJECTIVE Our aim is not the creation of yet another app per se but rather the establishment of a platform to collect research-quality smartphone raw sensor and usage pattern data. Our ultimate goal is to develop statistical, mathematical, and computational methodology to enable us and others to extract biomedical and clinical insights from smartphone data. METHODS We report on the development and early testing of Beiwe, a research platform featuring a study portal, smartphone app, database, and data modeling and analysis tools designed and developed specifically for transparent, customizable, and reproducible biomedical research use, in particular for the study of psychiatric and neurological disorders. We also outline a proposed study using the platform for patients with schizophrenia. RESULTS We demonstrate the passive data capabilities of the Beiwe platform and early results of its analytical capabilities. CONCLUSIONS Smartphone sensors and phone usage patterns, when coupled with appropriate statistical learning tools, are able to capture various social and behavioral manifestations of illnesses, in naturalistic settings, as lived and experienced by patients. The ubiquity of smartphones makes this type of moment-by-moment quantification of disease phenotypes highly scalable and, when integrated within a transparent research platform, presents tremendous opportunities for research, discovery, and patient health.
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Affiliation(s)
- John Torous
- Brigham and Women's Hospital, Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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56
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Perera G, Broadbent M, Callard F, Chang CK, Downs J, Dutta R, Fernandes A, Hayes RD, Henderson M, Jackson R, Jewell A, Kadra G, Little R, Pritchard M, Shetty H, Tulloch A, Stewart R. Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register: current status and recent enhancement of an Electronic Mental Health Record-derived data resource. BMJ Open 2016; 6:e008721. [PMID: 26932138 PMCID: PMC4785292 DOI: 10.1136/bmjopen-2015-008721] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE The South London and Maudsley National Health Service (NHS) Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register and its Clinical Record Interactive Search (CRIS) application were developed in 2008, generating a research repository of real-time, anonymised, structured and open-text data derived from the electronic health record system used by SLaM, a large mental healthcare provider in southeast London. In this paper, we update this register's descriptive data, and describe the substantial expansion and extension of the data resource since its original development. PARTICIPANTS Descriptive data were generated from the SLaM BRC Case Register on 31 December 2014. Currently, there are over 250,000 patient records accessed through CRIS. FINDINGS TO DATE Since 2008, the most significant developments in the SLaM BRC Case Register have been the introduction of natural language processing to extract structured data from open-text fields, linkages to external sources of data, and the addition of a parallel relational database (Structured Query Language) output. Natural language processing applications to date have brought in new and hitherto inaccessible data on cognitive function, education, social care receipt, smoking, diagnostic statements and pharmacotherapy. In addition, through external data linkages, large volumes of supplementary information have been accessed on mortality, hospital attendances and cancer registrations. FUTURE PLANS Coupled with robust data security and governance structures, electronic health records provide potentially transformative information on mental disorders and outcomes in routine clinical care. The SLaM BRC Case Register continues to grow as a database, with approximately 20,000 new cases added each year, in addition to extension of follow-up for existing cases. Data linkages and natural language processing present important opportunities to enhance this type of research resource further, achieving both volume and depth of data. However, research projects still need to be carefully tailored, so that they take into account the nature and quality of the source information.
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Affiliation(s)
- Gayan Perera
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | | | | | - Chin-Kuo Chang
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Johnny Downs
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Rina Dutta
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Andrea Fernandes
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Richard D Hayes
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Max Henderson
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Richard Jackson
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Amelia Jewell
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Giouliana Kadra
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Ryan Little
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Megan Pritchard
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alex Tulloch
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - Robert Stewart
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
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57
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Das-Munshi J, Ashworth M, Gaughran F, Hull S, Morgan C, Nazroo J, Roberts A, Rose D, Schofield P, Stewart R, Thornicroft G, Prince MJ. Ethnicity and cardiovascular health inequalities in people with severe mental illnesses: protocol for the E-CHASM study. Soc Psychiatry Psychiatr Epidemiol 2016; 51:627-38. [PMID: 26846127 PMCID: PMC4823321 DOI: 10.1007/s00127-016-1185-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE People with severe mental illnesses (SMI) experience a 17- to 20-year reduction in life expectancy. One-third of deaths are due to cardiovascular disease. This study will establish the relationship of SMI with cardiovascular disease in ethnic minority groups (Indian, Pakistani, Bangladeshi, black Caribbean, black African and Irish), in the UK. METHODS E-CHASM is a mixed methods study utilising data from 1.25 million electronic patient records. Secondary analysis of routine patient records will establish if differences in cause-specific mortality, cardiovascular disease prevalence and disparities in accessing healthcare for ethnic minority people living with SMI exist. A nested qualitative study will be used to assess barriers to accessing healthcare, both from the perspectives of service users and providers. RESULTS In primary care, 993,116 individuals, aged 18+, provided data from 186/189 (98 %) practices in four inner-city boroughs (local government areas) in London. Prevalence of SMI according to primary care records, ranged from 1.3-1.7 %, across boroughs. The primary care sample included Bangladeshi [n = 94,643 (10 %)], Indian [n = 6086 (6 %)], Pakistani [n = 35,596 (4 %)], black Caribbean [n = 45,013 (5 %)], black African [n = 75,454 (8 %)] and Irish people [n = 13,745 (1 %)]. In the secondary care database, 12,432 individuals with SMI over 2007-2013 contributed information; prevalent diagnoses were schizophrenia [n = 6805 (55 %)], schizoaffective disorders [n = 1438 (12 %)] and bipolar affective disorder [n = 4112 (33 %)]. Largest ethnic minority groups in this sample were black Caribbean [1432 (12 %)] and black African (1393 (11 %)). CONCLUSIONS There is a dearth of research examining cardiovascular disease in minority ethnic groups with severe mental illnesses. The E-CHASM study will address this knowledge gap.
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Affiliation(s)
- J Das-Munshi
- Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, PO 33, London, SE5 8AF, UK.
| | - M Ashworth
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, 3rd Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - F Gaughran
- South London and Maudsley Trust and King's College London, London, UK
| | - S Hull
- Centre for Primary Care and Public Health, Blizard Institute, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK
| | - C Morgan
- Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, PO 33, London, SE5 8AF, UK
| | - J Nazroo
- University of Manchester, Manchester, England
| | - A Roberts
- Natural Language Processing Group, Department of Computer Science, University of Sheffield, Sheffield, England
| | - D Rose
- Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, PO 33, London, SE5 8AF, UK
| | - P Schofield
- Division of Health and Social Care Research, Department of Primary Care and Public Health Sciences, King's College London, 3rd Floor, Addison House, Guy's Campus, London, SE1 1UL, UK
| | - R Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Room M1.06, De Crespigny Park, London, SE5 8AF, UK
| | - G Thornicroft
- Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, PO 33, London, SE5 8AF, UK
| | - M J Prince
- Department of Health Service and Population Research, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, PO 33, London, SE5 8AF, UK
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