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Candelaria D, Redfern J, O'Neil A, Brieger D, Clark RA, Briffa T, Bauman A, Hyun K, Cunich M, Figtree GA, Cartledge S, Gallagher R. Data-driven collaborative QUality improvement in Cardiac Rehabilitation (QUICR) to increase program completion: protocol for a cluster randomized controlled trial. BMC Cardiovasc Disord 2024; 24:302. [PMID: 38877422 DOI: 10.1186/s12872-024-03971-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is the leading cause of deaths and disability worldwide. Cardiac rehabilitation (CR) effectively reduces the risk of future cardiac events and is strongly recommended in international clinical guidelines. However, CR program quality is highly variable with divergent data systems, which, when combined, potentially contribute to persistently low completion rates. The QUality Improvement in Cardiac Rehabilitation (QUICR) trial aims to determine whether a data-driven collaborative quality improvement intervention delivered at the program level over 12 months: (1) increases CR program completion in eligible patients with CHD (primary outcome), (2) reduces hospital admissions, emergency department presentations and deaths, and costs, (3) improves the proportion of patients receiving guideline-indicated CR according to national and international benchmarks, and (4) is feasible and sustainable for CR staff to implement routinely. METHODS QUICR is a multi-centre, type-2, hybrid effectiveness-implementation cluster-randomized controlled trial (cRCT) with 12-month follow-up. Eligible CR programs (n = 40) and the individual patient data within them (n ~ 2,000) recruited from two Australian states (New South Wales and Victoria) are randomized 1:1 to the intervention (collaborative quality improvement intervention that uses data to identify and manage gaps in care) or control (usual care with data collection only). This sample size is required to achieve 80% power to detect a difference in completion rate of 22%. Outcomes will be assessed using intention-to-treat principles. Mixed-effects linear and logistic regression models accounting for clusters within allocated groupings will be applied to analyse primary and secondary outcomes. DISCUSSION Addressing poor participation in CR by patients with CHD has been a longstanding challenge that needs innovative strategies to change the status-quo. This trial will harness the collaborative power of CR programs working simultaneously on common problem areas and using local data to drive performance. The use of data linkage for collection of outcomes offers an efficient way to evaluate this intervention and support the improvement of health service delivery. ETHICS Primary ethical approval was obtained from the Northern Sydney Local Health District Human Research Ethics Committee (2023/ETH01093), along with site-specific governance approvals. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001239651 (30/11/2023) ( https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386540&isReview=true ).
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Affiliation(s)
- Dion Candelaria
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia.
| | - Julie Redfern
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Adrienne O'Neil
- IMPACT - the Institute for Mental and Physical Health and Clinical Translation, Food & Mood Centre, School of Medicine, Deakin University, Barwon Health, Geelong, VIC, Australia
| | - David Brieger
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
- Cardiology Department, Concord Hospital, ANZAC Research Institute, Sydney, NSW, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Adrian Bauman
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Karice Hyun
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, NSW, Australia
- Cardiology Department, Concord Hospital, ANZAC Research Institute, Sydney, NSW, Australia
| | - Michelle Cunich
- Faculty of Medicine and Health, Central Clinical School, Charles Perkins Centre, The University of Sydney, Boden Initiative, Sydney, NSW, Australia
- Sydney Local Health District, Camperdown, NSW, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Susie Cartledge
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, The University of Sydney, Sydney, NSW, Australia
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Alghamdi S, Dixon N, Al-Senani F, Al Aseri Z, Al Saif S, AlTahan T. Effects of a team Quality Improvement method in a national clinical audit programme of four clinical specialties in Ministry of Health hospitals in Saudi Arabia. Int J Qual Health Care 2024; 36:mzad107. [PMID: 38153764 PMCID: PMC10842466 DOI: 10.1093/intqhc/mzad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/29/2023] [Accepted: 12/24/2023] [Indexed: 12/29/2023] Open
Abstract
In 2018, the Ministry of Health (MoH) in Saudi Arabia developed a clinical excellence strategy. An objective was to reduce variation in clinical practices in MoH hospitals, particularly for conditions with high mortality in Saudi Arabia, by applying best practice clinical standards and using the clinical audit process to measure clinical practice. The strategy included working with multiprofessional teams in hospitals to implement improvements needed in clinical practice. To test the feasibility of carrying out national clinical audits in MoH hospitals, audits were carried out in 16 MoH hospitals on four clinical subjects-acute myocardial infarction, major trauma, sepsis, and stroke. Clinical expert groups, including Saudi clinicians and an international clinical expert, developed clinical care standards for the four conditions from analyses of international and Saudi clinical guidelines. The audits were designed with the expert groups. Multiprofessional teams were appointed to carry out the audits in designated MoH hospitals. Data collectors in each hospital were trained to collect data. Workshops were held with the teams on the clinical care standards and how data would be collected for the audits, and later, on the findings of data collection and how to use the improvement process to implement changes to improve compliance with the standards. After 4 months, data collection was repeated to determine if compliance with the clinical care standards had improved. Data collected from each hospital for both cycles of data collection were independently reliably tested. All designated hospitals participated in the audits, collecting and submitting data for two rounds of data collection and implementing improvement plans after the first round of data collection. All hospitals made substantial improvements in clinical practices. Of a total of 84 measures used to assess compliance with a total of 52 clinical care standards for the four clinical conditions, improvements were made by hospital teams in 58 (69.1%) measures. Improvements were statistically significant for 34 (40.5%) measures. The project demonstrated that well-designed and executed audits using evidence-based clinical care standards can result in substantial improvements in clinical practices in MoH hospitals in Saudi Arabia. Keys to success were the improvement methodology built into the audit process and the requirement for hospitals to appoint multiprofessional teams to carry out the audits. The approach adds to evidence on the effectiveness of clinical audits in achieving improvements in clinical quality and can be replicated in national audit programmes.
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Affiliation(s)
- Saleh Alghamdi
- Clinical Excellence General Directorate, Ministry of Health, Riyadh 14726, Saudi Arabia
| | - Nancy Dixon
- Healthcare Quality Quest, Shelley Farm, Shelley Lane, Ower, Romsey, Hampshire SO51 6AS, United Kingdom
| | - Fahmi Al-Senani
- Stroke Saudi Clinical Expert Group, Model of Care Programme, Ministry of Health, Riyadh 11525, Saudi Arabia
| | - Zohair Al Aseri
- Sepsis Saudi Clinical Expert Group, Departments of Emergency and Critical Care, College of Medicine, King Saud University and Department of Clinical Sciences, College of Medicine, Riyadh Hospital, Dar Al Uloom University, Adult ICU services, Ministry of Health, Riyadh 145111, Saudi Arabia
| | - Shukri Al Saif
- Myocardial Infarction Saudi Clinical Expert Group, Eastern Health Cluster, Saudi Al-Babtain Cardiac Centre, Qatif, Dammam 32632, Saudi Arabia
| | - Talal AlTahan
- Major Trauma Saudi Clinical Expert Group, Prince Mohammed Bin Abdulaziz Hospital, Riyadh 14214, Saudi Arabia
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Pate K, Belin L, Layell J. Auditing to support quality improvement: Recommendations for nurse leaders. Nurs Manag (Harrow) 2023; 54:12-19. [PMID: 37527647 DOI: 10.1097/nmg.0000000000000035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Affiliation(s)
- Kimberly Pate
- In Charlotte, N.C., Kimberly Pate is the director of policy and professional development at Atrium Health's Carolinas Medical Center, Latasia Belin is an orthopedic/specialty surgery clinical nurse specialist at Atrium Health Mercy, and Jessica Layell is the director of infection prevention at Atrium Health's Carolinas Medical Center
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Antonacci G, Whitney J, Harris M, Reed JE. How do healthcare providers use national audit data for improvement? BMC Health Serv Res 2023; 23:393. [PMID: 37095495 PMCID: PMC10123973 DOI: 10.1186/s12913-023-09334-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/23/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Substantial resources are invested by Health Departments worldwide in introducing National Clinical Audits (NCAs). Yet, there is variable evidence on the NCAs' effectiveness and little is known on factors underlying the successful use of NCAs to improve local practice. This study will focus on a single NCA (the National Audit of Inpatient Falls -NAIF 2017) to explore: (i) participants' perspectives on the NCA reports, local feedback characteristics and actions undertaken following the feedback underpinning the effective use of the NCA feedback to improve local practice; (ii) reported changes in local practice following the NCA feedback in England and Wales. METHODS Front-line staff perspectives were gathered through interviews. An inductive qualitative approach was used. Eighteen participants were purposefully sampled from 7 of the 85 participating hospitals in England and Wales. Analysis was guided by constant comparative techniques. RESULTS Regarding the NAIF annual report, interviewees valued performance benchmarking with other hospitals, the use of visual representations and the inclusion of case studies and recommendations. Participants stated that feedback should target front-line healthcare professionals, be straightforward and focused, and be delivered through an encouraging and honest discussion. Interviewees highlighted the value of using other relevant data sources alongside NAIF feedback and the importance of continuous data monitoring. Participants reported that engagement of front-line staff in the NAIF and following improvement activities was critical. Leadership, ownership, management support and communication at different organisational levels were perceived as enablers, while staffing level and turnover, and poor quality improvement (QI) skills, were perceived as barriers to improvement. Reported changes in practice included increased awareness and attention to patient safety issues and greater involvement of patients and staff in falls prevention activities. CONCLUSIONS There is scope to improve the use of NCAs by front-line staff. NCAs should not be seen as isolated interventions but should be fully embedded and integrated into the QI strategic and operational plans of NHS trusts. The use of NCAs could be optimised, but knowledge of them is poor and distributed unevenly across different disciplines. More research is needed to provide guidance on key elements to consider throughout the whole improvement process at different organisational levels.
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Affiliation(s)
- Grazia Antonacci
- Department of Primary Care and Public Health, Imperial College London, National Institute of Health Research (NIHR) Applied Research Collaboration (ARC) Northwest London, London, UK
- Business School, Centre for Health Economics and Policy Innovation (CHEPI), Imperial College London, London, UK
| | - Julie Whitney
- Department of Physiotherapy, King's College London, London, UK
| | - Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, South Kensington, UK
| | - Julie E Reed
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Julie Reed Consultancy Ltd, London, UK
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Donnelly C, Janssen A, Vinod S, Stone E, Harnett P, Shaw T. A Systematic Review of Electronic Medical Record Driven Quality Measurement and Feedback Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010200. [PMID: 36612522 PMCID: PMC9819986 DOI: 10.3390/ijerph20010200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 06/09/2023]
Abstract
Historically, quality measurement analyses utilize manual chart abstraction from data collected primarily for administrative purposes. These methods are resource-intensive, time-delayed, and often lack clinical relevance. Electronic Medical Records (EMRs) have increased data availability and opportunities for quality measurement. However, little is known about the effectiveness of Measurement Feedback Systems (MFSs) in utilizing EMR data. This study explores the effectiveness and characteristics of EMR-enabled MFSs in tertiary care. The search strategy guided by the PICO Framework was executed in four databases. Two reviewers screened abstracts and manuscripts. Data on effect and intervention characteristics were extracted using a tailored version of the Cochrane EPOC abstraction tool. Due to study heterogeneity, a narrative synthesis was conducted and reported according to PRISMA guidelines. A total of 14 unique MFS studies were extracted and synthesized, of which 12 had positive effects on outcomes. Findings indicate that quality measurement using EMR data is feasible in certain contexts and successful MFSs often incorporated electronic feedback methods, supported by clinical leadership and action planning. EMR-enabled MFSs have the potential to reduce the burden of data collection for quality measurement but further research is needed to evaluate EMR-enabled MFSs to translate and scale findings to broader implementation contexts.
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Affiliation(s)
- Candice Donnelly
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Anna Janssen
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
| | - Shalini Vinod
- Liverpool Cancer Therapy Centre, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
- South West Sydney Clinical Campuses, University of New South Wales, Liverpool, NSW 2170, Australia
| | - Emily Stone
- Department of Thoracic Medicine and Lung Transplantation, St Vincent’s Hospital, Darlinghurst, NSW 2010, Australia
- School of Clinical Medicine, University of New South Wales, Randwick, NSW 2031, Australia
| | - Paul Harnett
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
- Crown Princess Mary Cancer Centre, Western Sydney Local Health District, Westmead, NSW 2145, Australia
| | - Tim Shaw
- Faculty of Medicine and Health, University of Sydney, Camperdown, NSW 2006, Australia
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Shunmuga Sundaram C, Campbell R, Ju A, King MT, Rutherford C. Patient and healthcare provider perceptions on using patient-reported experience measures (PREMs) in routine clinical care: a systematic review of qualitative studies. J Patient Rep Outcomes 2022; 6:122. [PMID: 36459251 PMCID: PMC9718906 DOI: 10.1186/s41687-022-00524-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/01/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patient-reported experience measures (PREMs) assess quality-of-care from patients' perspectives. PREMs can be used to enhance patient-centered care and facilitate patient engagement in care. With increasing quality improvement studies in clinical practice, the use of PREMs has surged. As a result, knowledge about stakeholder experiences of using PREMs to assess quality of care across diverse clinical settings is needed to inform PREM implementation efforts. To address this, this review examines the qualitative literature on patient and healthcare provider experiences of using PREMs in clinical practice. METHODS Medline, Embase and PsycInfo were systematically searched from inception to May 2021. Additional searching of reference lists for all included articles and relevant review articles were performed. Retrieved articles were screened for eligibility by one reviewer and 25% cross-checked by a second reviewer across all stages of the review. Full texts meeting eligibility criteria were appraised against the COREQ checklist for quality assessment and thematic analysis was used to analyze textual data extracted from the results. RESULTS Electronic searches identified 2683 records, of which 20 studies met eligibility criteria. Extracted data were synthesized into six themes: facilitators to PREM implementation; barriers to PREM implementation; healthcare providers' perspectives towards using PREMs; patients' perspectives towards using PREMs; advantages of using PREMs in clinical practice; limitations and practical considerations to reduce resistance of PREM usage. The primary factors facilitating and impeding the use of PREMs include organizational-, staff- and patient-related factors. CONCLUSION Results can be used to guide the usage and implementation of PREMs in clinical settings by addressing the identified barriers and building on the perceived benefits to encourage adoption of PREMs. Results around facilitators to PREM implementation and practical considerations could also promote appropriate use of PREMs by healthcare providers, helping to improve practice and the quality of care based on patient feedback.
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Affiliation(s)
- Chindhu Shunmuga Sundaram
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Rachel Campbell
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Angela Ju
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Madeleine T King
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia
| | - Claudia Rutherford
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney, Level 6 North, Chris O'Brien Lifehouse (C39Z), Sydney, NSW, 2006, Australia. .,Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney, Sydney, Australia. .,The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia.
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Alvarado N, McVey L, Elshehaly M, Greenhalgh J, Dowding D, Ruddle R, Gale CP, Mamas M, Doherty P, West R, Feltbower R, Randell R. Analysis of a Web-Based Dashboard to Support the Use of National Audit Data in Quality Improvement: Realist Evaluation. J Med Internet Res 2021; 23:e28854. [PMID: 34817384 PMCID: PMC8663683 DOI: 10.2196/28854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/15/2021] [Accepted: 10/05/2021] [Indexed: 11/30/2022] Open
Abstract
Background Dashboards can support data-driven quality improvements in health care. They visualize data in ways intended to ease cognitive load and support data comprehension, but how they are best integrated into working practices needs further investigation. Objective This paper reports the findings of a realist evaluation of a web-based quality dashboard (QualDash) developed to support the use of national audit data in quality improvement. Methods QualDash was co-designed with data users and installed in 8 clinical services (3 pediatric intensive care units and 5 cardiology services) across 5 health care organizations (sites A-E) in England between July and December 2019. Champions were identified to support adoption. Data to evaluate QualDash were collected between July 2019 and August 2021 and consisted of 148.5 hours of observations including hospital wards and clinical governance meetings, log files that captured the extent of use of QualDash over 12 months, and a questionnaire designed to assess the dashboard’s perceived usefulness and ease of use. Guided by the principles of realist evaluation, data were analyzed to understand how, why, and in what circumstances QualDash supported the use of national audit data in quality improvement. Results The observations revealed that variation across sites in the amount and type of resources available to support data use, alongside staff interactions with QualDash, shaped its use and impact. Sites resourced with skilled audit support staff and established reporting systems (sites A and C) continued to use existing processes to report data. A number of constraints influenced use of QualDash in these sites including that some dashboard metrics were not configured in line with user expectations and staff were not fully aware how QualDash could be used to facilitate their work. In less well-resourced services, QualDash automated parts of their reporting process, streamlining the work of audit support staff (site B), and, in some cases, highlighted issues with data completeness that the service worked to address (site E). Questionnaire responses received from 23 participants indicated that QualDash was perceived as useful and easy to use despite its variable use in practice. Conclusions Web-based dashboards have the potential to support data-driven improvement, providing access to visualizations that can help users address key questions about care quality. Findings from this study point to ways in which dashboard design might be improved to optimize use and impact in different contexts; this includes using data meaningful to stakeholders in the co-design process and actively engaging staff knowledgeable about current data use and routines in the scrutiny of the dashboard metrics and functions. In addition, consideration should be given to the processes of data collection and upload that underpin the quality of the data visualized and consequently its potential to stimulate quality improvement. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2019-033208
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Affiliation(s)
- Natasha Alvarado
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Lynn McVey
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
| | - Mai Elshehaly
- Wolfson Centre for Applied Health Research, Bradford, United Kingdom.,Faculty of Engineering and Informatics, University of Bradford, Bradford, United Kingdom
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, United Kingdom
| | - Dawn Dowding
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Roy Ruddle
- School of Computing, University of Leeds, Leeds, United Kingdom.,Leeds Institute for Data Analytics, Leeds, United Kingdom
| | - Chris P Gale
- Leeds Institute for Data Analytics, Leeds, United Kingdom.,Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Mamas Mamas
- Keele Cardiovascular Group, School of Medicine, Keele University, Keele, United Kingdom
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, United Kingdom
| | - Robert West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Richard Feltbower
- Leeds Institute for Data Analytics, Leeds, United Kingdom.,School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom.,Wolfson Centre for Applied Health Research, Bradford, United Kingdom
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