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Henderson A, Shakeshaft A, Allan J, Wallace R, Barker D, Farnbach S. A pilot study examining the impact of a pragmatic process for improving the cultural responsiveness of non-Aboriginal alcohol and other drug treatment services using routinely collected data in Australia. J Health Serv Res Policy 2024:13558196241261800. [PMID: 38870027 DOI: 10.1177/13558196241261800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Objective: Routine health data has the potential to identify changes in patient-related outcomes, in close to real time. This pilot project used routine data to explore and compare the impact of changes to cultural responsiveness on service use by Aboriginal and Torres Strait Islander (hereafter, Aboriginal) clients in Australia.Methods: The New South Wales Minimum Data Set (MDS) for alcohol and other drug use treatment services was provided for 11 services for a period of 30 months from March 2019 to September 2021 (four months prior to two years after the intervention; data were analysed between March 2022 to February 2023). Change in cultural responsiveness was assessed via practice audits of services at baseline and two years. The average change in audit rating was analysed using a linear mixed regression model. Generalised Linear Mixed Models were used to identify changes in service use by Aboriginal clients. Results: All 11 services showed increased audit scores at two years, with a statistically significant mean increase of 18.6 (out of 63 points; b = 18.32, 95% CI 12.42-24.22). No statistically significant pre-to post-changes were identified in: (1) the proportion of episodes delivered to Aboriginal versus non-Aboriginal clients (OR = 1.15, 95% CI = 0.94-1.40), (2) the number of episodes of care provided to Aboriginal clients per month (IRR = 1.01, 95% CI = 0.84-1.23), or (3) the proportion of episodes completed by Aboriginal clients (OR = 0.96, 95% CI = 0.82-1.13). Conclusions: The lack of statistically significant impact on service use outcomes using MDS contrasts to the improvements in cultural responsiveness, suggesting further work is needed to identify appropriate outcome measures. This may include patient-reported experience measures. This project showed that routine data has potential as an efficient method for measuring changes in patient-related outcomes in response to health services improvements.
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Affiliation(s)
- Alexandra Henderson
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, AU-NSW, Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, AU-NSW, Australia
| | - Julaine Allan
- Rural Health Research Institute, Charles Sturt University, Orange, AU-NSW, Australia
| | | | - Daniel Barker
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, AU-NSW, Australia
| | - Sara Farnbach
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, AU-NSW, Australia
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Sydes MR, Murray ML, Ahmed S, Apostolidou S, Bliss JM, Bloomfield C, Cannings-John R, Carpenter J, Clayton T, Clout M, Cosgriff R, Farrin AJ, Gentry-Maharaj A, Gilbert DC, Harper C, James ND, Langley RE, Lessels S, Lugg-Widger F, Mackenzie IS, Mafham M, Menon U, Mintz H, Pinches H, Robling M, Wright-Hughes A, Yorke-Edwards V, Love SB. Getting our ducks in a row: The need for data utility comparisons of healthcare systems data for clinical trials. Contemp Clin Trials 2024; 141:107514. [PMID: 38537901 DOI: 10.1016/j.cct.2024.107514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/23/2024] [Accepted: 03/24/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Better use of healthcare systems data, collected as part of interactions between patients and the healthcare system, could transform planning and conduct of randomised controlled trials. Multiple challenges to widespread use include whether healthcare systems data captures sufficiently well the data traditionally captured on case report forms. "Data Utility Comparison Studies" (DUCkS) assess the utility of healthcare systems data for RCTs by comparison to data collected by the trial. Despite their importance, there are few published UK examples of DUCkS. METHODS-AND-RESULTS Building from ongoing and selected recent examples of UK-led DUCkS in the literature, we set out experience-based considerations for the conduct of future DUCkS. Developed through informal iterative discussions in many forums, considerations are offered for planning, protocol development, data, analysis and reporting, with comparisons at "patient-level" or "trial-level", depending on the item of interest and trial status. DISCUSSION DUCkS could be a valuable tool in assessing where healthcare systems data can be used for trials and in which trial teams can play a leading role. There is a pressing need for trials to be more efficient in their delivery and research waste must be reduced. Trials have been making inconsistent use of healthcare systems data, not least because of an absence of evidence of utility. DUCkS can also help to identify challenges in using healthcare systems data, such as linkage (access and timing) and data quality. We encourage trial teams to incorporate and report DUCkS in trials and funders and data providers to support them.
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Affiliation(s)
- Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; Health Data Research UK (HDR UK), London, UK; BHF Data Science Centre, Health Data Research UK (HDR UK), London, UK.
| | - Macey L Murray
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; Health Data Research UK (HDR UK), London, UK.
| | - Saiam Ahmed
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; UCL Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Sophia Apostolidou
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Judith M Bliss
- Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK.
| | - Claire Bloomfield
- Insitro Inc, San Francisco, CA, USA; NHS Transformation Directorate, NHS England & NHS Improvement, London, UK.
| | | | - James Carpenter
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; London School of Hygiene and Tropical Medicine, London, UK.
| | - Tim Clayton
- Department of Medical Statistics and Clinical Trials Unit, London School of Hygiene and Tropical Medicine (LSHTM), London, UK.
| | | | - Rebecca Cosgriff
- NHS Transformation Directorate, NHS England & NHS Improvement, London, UK.
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Aleksandra Gentry-Maharaj
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; Department of Women's Cancer, UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK.
| | - Duncan C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Charlie Harper
- Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | | | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Sarah Lessels
- BHF Data Science Centre, Health Data Research UK (HDR UK), London, UK.
| | | | - Isla S Mackenzie
- MEMO Research, Division of Molecular and Clinical Medicine, University of Dundee, Dundee, UK.
| | - Marion Mafham
- Health Data Research UK (HDR UK), London, UK; Nuffield Department of Population Health, University of Oxford, Oxford, UK; Clinical Trial Service Unit and Epidemiological Studies Unit (CTSU), NDPH, University of Oxford, Oxford, UK.
| | - Usha Menon
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | - Harriet Mintz
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
| | | | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK.
| | - Alexandra Wright-Hughes
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - Victoria Yorke-Edwards
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK; Centre for Advanced Research Computing, University College London, London, UK.
| | - Sharon B Love
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
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Sathyanarayanan A. The use of routinely collected healthcare records for outcome assessment in clinical trials: a UK perspective. Curr Med Res Opin 2024; 40:887-892. [PMID: 38511976 DOI: 10.1080/03007995.2024.2333441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
The use of routinely collected electronic healthcare records (EHR) for outcome assessment in clinical trials has been described as a 'disruptive' new technique more than a decade ago. Despite this potential, significant methodological issues and regulatory barriers have hampered the progress in this area. This article discusses the key considerations that trialists should take into account when incorporating EHR into their trials. These include considerations of the clinical relevance of the outcome, data timeliness and quality, ethical and regulatory issues, and some practical considerations for clinical trials units. In addition, this article describes the benefits of using EHR which include cost, reduced trial burden for participants and staff, follow up efficiencies, and improved health economic evaluation procedures. We also describe the major regulatory and start up costs of using EHR in clinical trials. This article focuses on the UK specific EHR landscape in clinical trials and would help researchers and trials units considering the use of this method of outcome data collection in their next trial. If the issues described are mitigated, this method will be a formidable tool for conducting pragmatic clinical trials.
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Horner DE, Davis S, Pandor A, Shulver H, Goodacre S, Hind D, Rex S, Gillett M, Bursnall M, Griffin X, Holland M, Hunt BJ, de Wit K, Bennett S, Pierce-Williams R. Evaluation of venous thromboembolism risk assessment models for hospital inpatients: the VTEAM evidence synthesis. Health Technol Assess 2024; 28:1-166. [PMID: 38634415 PMCID: PMC11056814 DOI: 10.3310/awtw6200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Background Pharmacological prophylaxis during hospital admission can reduce the risk of acquired blood clots (venous thromboembolism) but may cause complications, such as bleeding. Using a risk assessment model to predict the risk of blood clots could facilitate selection of patients for prophylaxis and optimise the balance of benefits, risks and costs. Objectives We aimed to identify validated risk assessment models and estimate their prognostic accuracy, evaluate the cost-effectiveness of different strategies for selecting hospitalised patients for prophylaxis, assess the feasibility of using efficient research methods and estimate key parameters for future research. Design We undertook a systematic review, decision-analytic modelling and observational cohort study conducted in accordance with Enhancing the QUAlity and Transparency Of health Research (EQUATOR) guidelines. Setting NHS hospitals, with primary data collection at four sites. Participants Medical and surgical hospital inpatients, excluding paediatric, critical care and pregnancy-related admissions. Interventions Prophylaxis for all patients, none and according to selected risk assessment models. Main outcome measures Model accuracy for predicting blood clots, lifetime costs and quality-adjusted life-years associated with alternative strategies, accuracy of efficient methods for identifying key outcomes and proportion of inpatients recommended prophylaxis using different models. Results We identified 24 validated risk assessment models, but low-quality heterogeneous data suggested weak accuracy for prediction of blood clots and generally high risk of bias in all studies. Decision-analytic modelling showed that pharmacological prophylaxis for all eligible is generally more cost-effective than model-based strategies for both medical and surgical inpatients, when valuing a quality-adjusted life-year at £20,000. The findings were more sensitive to uncertainties in the surgical population; strategies using risk assessment models were more cost-effective if the model was assumed to have a very high sensitivity, or the long-term risks of post-thrombotic complications were lower. Efficient methods using routine data did not accurately identify blood clots or bleeding events and several pre-specified feasibility criteria were not met. Theoretical prophylaxis rates across an inpatient cohort based on existing risk assessment models ranged from 13% to 91%. Limitations Existing studies may underestimate the accuracy of risk assessment models, leading to underestimation of their cost-effectiveness. The cost-effectiveness findings do not apply to patients with an increased risk of bleeding. Mechanical thromboprophylaxis options were excluded from the modelling. Primary data collection was predominately retrospective, risking case ascertainment bias. Conclusions Thromboprophylaxis for all patients appears to be generally more cost-effective than using a risk assessment model, in hospitalised patients at low risk of bleeding. To be cost-effective, any risk assessment model would need to be highly sensitive. Current evidence on risk assessment models is at high risk of bias and our findings should be interpreted in this context. We were unable to demonstrate the feasibility of using efficient methods to accurately detect relevant outcomes for future research. Future work Further research should evaluate routine prophylaxis strategies for all eligible hospitalised patients. Models that could accurately identify individuals at very low risk of blood clots (who could discontinue prophylaxis) warrant further evaluation. Study registration This study is registered as PROSPERO CRD42020165778 and Researchregistry5216. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR127454) and will be published in full in Health Technology Assessment; Vol. 28, No. 20. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Daniel Edward Horner
- Emergency Department, Northern Care Alliance NHS Foundation Trust, Salford, UK
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Oxford Road, Manchester, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah Davis
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Abdullah Pandor
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Helen Shulver
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Daniel Hind
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Saleema Rex
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Michael Gillett
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Matthew Bursnall
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Xavier Griffin
- Barts Bone and Joint Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mark Holland
- School of Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, Bolton, UK
| | - Beverley Jane Hunt
- Thrombosis & Haemophilia Centre, St Thomas' Hospital, King's Healthcare Partners, London, UK
| | - Kerstin de Wit
- Department of Emergency Medicine, Queens University, Kingston, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Shan Bennett
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Dakhil ZA. Routine electronic health record-based clinical trials: what should an early-career trialist know? Eur Heart J 2023; 44:3207-3211. [PMID: 37525523 DOI: 10.1093/eurheartj/ehad437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Affiliation(s)
- Zainab Atiyah Dakhil
- Department of Cardiology, Ibn Al-Bitar Cardiac Centre, Al-Salhiya, Baghdad, Iraq
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Noor NM, Siegel CA. Leveraging Virtual Technology to Conduct Clinical Trials in Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2023; 19:468-474. [PMID: 37772152 PMCID: PMC10524427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Clinical trials have led to major advances in inflammatory bowel disease (IBD) care over the last few decades, yet in that time most clinical trial protocols in IBD have remained markedly the same. Many IBD protocols often still require face-to-face visits and monitoring, hospital-based medication administration, paper-based forms and questionnaires, and short follow-up periods resulting in limited long-term data. These factors have recently been recognized as likely contributors to the low recruitment and lack of diversity of participants across clinical trials in IBD. However, with increasing technological advances, there is now an opportunity for improvement. This article assesses a range of virtual innovations for how they may offer digital solutions to challenges currently encountered in IBD clinical trials. Such solutions include consideration for increasing patient diversity, digital invitation, remote consent and recruitment, virtual visits, remote patient monitoring and data collection, remote medication delivery and administration, remote clinical trial monitoring, and routinely collected health data for long-term follow-up. Adoption of virtual technology may drive the field toward patient centricity and more efficient trial protocols to allow for a new era in IBD clinical trials.
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Affiliation(s)
- Nurulamin M. Noor
- Department of Gastroenterology, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Corey A. Siegel
- Inflammatory Bowel Disease Center, Section of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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Williams ADN, Davies G, Farrin AJ, Mafham M, Robling M, Sydes MR, Lugg-Widger FV. A DELPHI study priority setting the remaining challenges for the use of routinely collected data in trials: COMORANT-UK. Trials 2023; 24:243. [PMID: 36997954 PMCID: PMC10064573 DOI: 10.1186/s13063-023-07251-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Researchers are increasingly seeking to use routinely collected data to support clinical trials. This approach has the potential to transform the way clinical trials are conducted in the future. The availability of routinely collected data for research, whether healthcare or administrative, has increased, and infrastructure funding has enabled much of this. However, challenges remain at all stages of a trial life cycle. This study, COMORANT-UK, aimed to systematically identify, with key stakeholders across the UK, the ongoing challenges related to trials that seek to use routinely collected data. METHODS This three-step Delphi method consisted of two rounds of anonymous web-based surveys and a virtual consensus meeting. Stakeholders included trialists, data infrastructures, funders of trials, regulators, data providers and the public. Stakeholders identified research questions or challenges that they considered were of particular importance and then selected their top 10 in the second survey. The ranked questions were taken forward to the consensus meeting for discussion with representatives invited from the stakeholder groups. RESULTS In the first survey, 66 respondents yielded over 260 questions or challenges. These were thematically grouped and merged into a list of 40 unique questions. Eighty-eight stakeholders then ranked their top ten from the 40 questions in the second survey. The most common 14 questions were brought to the virtual consensus meeting in which stakeholders agreed a top list of seven questions. We report these seven questions which are within the following domains: trial design, Patient and Public Involvement, trial set-up, trial open and trial data. These questions address both evidence gaps (requiring further methodological research) and implementation gaps (requiring training and/or service re-organisation). CONCLUSION This prioritised list of seven questions should inform the direction of future research in this area and should direct efforts to ensure that the benefits in major infrastructure for routinely collected data are achieved and translated. Without this and future work to address these questions, the potential societal benefits of using routinely collected data to help answer important clinical questions will not be realised.
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Affiliation(s)
| | - Gwyneth Davies
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Amanda J Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Marion Mafham
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, UK
- DECIPHer - Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, Cardiff University, Cardiff, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trial and Methodology, University College London, London, UK
- BHF Data Science Centre, Health Data Research UK, London, UK
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8
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Macnair A, Nankivell M, Murray ML, Rosen SD, Appleyard S, Sydes MR, Forcat S, Welland A, Clarke NW, Mangar S, Kynaston H, Kockelbergh R, Al-Hasso A, Deighan J, Marshall J, Parmar M, Langley RE, Gilbert DC. Healthcare systems data in the context of clinical trials - A comparison of cardiovascular data from a clinical trial dataset with routinely collected data. Contemp Clin Trials 2023; 128:107162. [PMID: 36933612 DOI: 10.1016/j.cct.2023.107162] [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: 11/18/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Routinely-collected healthcare systems data (HSD) are proposed to improve the efficiency of clinical trials. A comparison was undertaken between cardiovascular (CVS) data from a clinical trial database with two HSD resources. METHODS Protocol-defined and clinically reviewed CVS events (heart failure (HF), acute coronary syndrome (ACS), thromboembolic stroke, venous and arterial thromboembolism) were identified within the trial data. Data (using pre-specified codes) was obtained from NHS Hospital Episode Statistics (HES) and National Institute for Cardiovascular Outcomes Research (NICOR) HF and myocardial ischaemia audits for trial participants recruited in England between 2010 and 2018 who had provided consent. The primary comparison was trial data versus HES inpatient (APC) main diagnosis (Box-1). Correlations are presented with descriptive statistics and Venn diagrams. Reasons for non-correlation were explored. RESULTS From 1200 eligible participants, 71 protocol-defined clinically reviewed CVS events were recorded in the trial database. 45 resulted in a hospital admission and therefore could have been recorded by either HES APC/ NICOR. Of these, 27/45 (60%) were recorded by HES inpatient (Box-1) with an additional 30 potential events also identified. HF and ACS were potentially recorded in all 3 datasets; trial data recorded 18, HES APC 29 and NICOR 24 events respectively. 12/18 (67%) of the HF/ACS events in the trial dataset were recorded by NICOR. CONCLUSION Concordance between datasets was lower than anticipated and the HSD used could not straightforwardly replace current trial practices, nor directly identify protocol-defined CVS events. Further work is required to improve the quality of HSD and consider event definitions when designing clinical trials incorporating HSD.
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Affiliation(s)
- Archie Macnair
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK; Health Data Research, UK; Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Matthew Nankivell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Macey L Murray
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK; Health Data Research, UK; NHS DigiTrials, NHS Digital, 7 and 8 Wellington Place, Leeds, West Yorkshire LS1 4AP, UK
| | - Stuart D Rosen
- National Heart and Lung Institute, Imperial College, London, UK
| | - Sally Appleyard
- University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK; Health Data Research, UK; BHF Data Science Centre, Health Data Research UK (Central Office), Gibbs Building, 215 Euston Road, London NW1 2BE, UK
| | - Sylvia Forcat
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Andrew Welland
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Noel W Clarke
- The Christie and Salford Royal Hospitals, Manchester, UK
| | - Stephen Mangar
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Howard Kynaston
- Division of Cancer and Genetics, Cardiff University Medical School, Cardiff, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | | | - John Deighan
- Patient representative, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - John Marshall
- Patient representative, MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Mahesh Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Ruth E Langley
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK
| | - Duncan C Gilbert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, 90 High Holborn, London WC1V 6LJ, UK; University Hospitals Sussex NHS Foundation Trust, Royal Sussex County Hospital, Eastern Road, Brighton BN2 5BE, UK.
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Horner D, Rex S, Reynard C, Bursnall M, Bradburn M, de Wit K, Goodacre S, Hunt BJ. Accuracy of efficient data methods to determine the incidence of hospital-acquired thrombosis and major bleeding in medical and surgical inpatients: a multicentre observational cohort study in four UK hospitals. BMJ Open 2023; 13:e069244. [PMID: 36746545 PMCID: PMC9906300 DOI: 10.1136/bmjopen-2022-069244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES We evaluated the accuracy of using routine health service data to identify hospital-acquired thrombosis (HAT) and major bleeding events (MBE) compared with a reference standard of case note review. DESIGN A multicentre observational cohort study. SETTING Four acute hospitals in the UK. PARTICIPANTS A consecutive unselective cohort of general medical and surgical patients requiring hospitalisation for a period of >24 hours during the calendar year 2021. We excluded paediatric, obstetric and critical care patients due to differential risk profiles. INTERVENTIONS We compared preidentified sources of routinely collected information (using hospital coding data and local contractually mandated thrombosis datasets) to data extracted from case notes using a predesigned workflow methodology. PRIMARY AND SECONDARY OUTCOME MEASURES We defined HAT as objectively confirmed venous thromboembolism occurring during hospital stay or within 90 days of discharge and MBE as per international consensus. RESULTS We were able to source all necessary routinely collected outcome data for 87% of 2008 case episodes reviewed. The sensitivity of hospital coding data (International Classification of Diseases 10th Revision, ICD-10) for the diagnosis of HAT and MBE was 62% (95% CI, 54 to 69) and 38% (95% CI, 27 to 50), respectively. Sensitivity improved to 81% (95% CI, 75 to 87) when using local thrombosis data sets. CONCLUSIONS Using routinely collected data appeared to miss a substantial proportion of outcome events, when compared with case note review. Our study suggests that currently available routine data collection methods in the UK are inadequate to support efficient study designs in venous thromboembolism research. TRIAL REGISTRATION NUMBER NIHR127454.
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Affiliation(s)
- Daniel Horner
- Emergency Department, Northern Care Alliance NHS Foundation Trust, Salford, Manchester, UK
- Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, UK
| | - Saleema Rex
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Charles Reynard
- Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
| | - Matthew Bursnall
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- School of Health and Related Research (ScHARR), The University of Sheffield, Sheffield, UK
| | - Kerstin de Wit
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Emergency Department, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Steve Goodacre
- Medical Care Research Unit, University of Sheffield, Sheffield, UK
| | - Beverley J Hunt
- Kings Healthcare Partners & Thrombosis & Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Jefferson E, Cole C, Mumtaz S, Cox S, Giles TC, Adejumo S, Urwin E, Lea D, Macdonald C, Best J, Masood E, Milligan G, Johnston J, Horban S, Birced I, Hall C, Jackson AS, Collins C, Rising S, Dodsley C, Hampton J, Hadfield A, Santos R, Tarr S, Panagi V, Lavagna J, Jackson T, Chuter A, Beggs J, Martinez-Queipo M, Ward H, von Ziegenweidt J, Burns F, Martin J, Sebire N, Morris C, Bradley D, Baxter R, Ahonen-Bishopp A, Smith P, Shoemark A, Valdes AM, Ollivere B, Manisty C, Eyre D, Gallant S, Joy G, McAuley A, Connell D, Northstone K, Jeffery K, Di Angelantonio E, McMahon A, Walker M, Semple MG, Sims JM, Lawrence E, Davies B, Baillie JK, Tang M, Leeming G, Power L, Breeze T, Murray D, Orton C, Pierce I, Hall I, Ladhani S, Gillson N, Whitaker M, Shallcross L, Seymour D, Varma S, Reilly G, Morris A, Hopkins S, Sheikh A, Quinlan P. A Hybrid Architecture (CO-CONNECT) to Facilitate Rapid Discovery and Access to Data Across the United Kingdom in Response to the COVID-19 Pandemic: Development Study. J Med Internet Res 2022; 24:e40035. [PMID: 36322788 PMCID: PMC9822177 DOI: 10.2196/40035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/12/2022] [Accepted: 11/01/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND COVID-19 data have been generated across the United Kingdom as a by-product of clinical care and public health provision, as well as numerous bespoke and repurposed research endeavors. Analysis of these data has underpinned the United Kingdom's response to the pandemic, and informed public health policies and clinical guidelines. However, these data are held by different organizations, and this fragmented landscape has presented challenges for public health agencies and researchers as they struggle to find relevant data to access and interrogate the data they need to inform the pandemic response at pace. OBJECTIVE We aimed to transform UK COVID-19 diagnostic data sets to be findable, accessible, interoperable, and reusable (FAIR). METHODS A federated infrastructure model (COVID - Curated and Open Analysis and Research Platform [CO-CONNECT]) was rapidly built to enable the automated and reproducible mapping of health data partners' pseudonymized data to the Observational Medical Outcomes Partnership Common Data Model without the need for any data to leave the data controllers' secure environments, and to support federated cohort discovery queries and meta-analysis. RESULTS A total of 56 data sets from 19 organizations are being connected to the federated network. The data include research cohorts and COVID-19 data collected through routine health care provision linked to longitudinal health care records and demographics. The infrastructure is live, supporting aggregate-level querying of data across the United Kingdom. CONCLUSIONS CO-CONNECT was developed by a multidisciplinary team. It enables rapid COVID-19 data discovery and instantaneous meta-analysis across data sources, and it is researching streamlined data extraction for use in a Trusted Research Environment for research and public health analysis. CO-CONNECT has the potential to make UK health data more interconnected and better able to answer national-level research questions while maintaining patient confidentiality and local governance procedures.
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Affiliation(s)
- Emily Jefferson
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Christian Cole
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Shahzad Mumtaz
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Samuel Cox
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | | | - Sam Adejumo
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Esmond Urwin
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Daniel Lea
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Calum Macdonald
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Joseph Best
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Erum Masood
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Gordon Milligan
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Jenny Johnston
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Scott Horban
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ipek Birced
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Christopher Hall
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Aaron S Jackson
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Clare Collins
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Sam Rising
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte Dodsley
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Jill Hampton
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Andrew Hadfield
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Roberto Santos
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Simon Tarr
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Vasiliki Panagi
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Joseph Lavagna
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
| | - Tracy Jackson
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Antony Chuter
- Lay Partnership in Healthcare Research, Lindfield, United Kingdom
| | - Jillian Beggs
- Health Informatics Centre, Division of Population and Health Genomics, School of Medicine, University of Dundee, Dundee, United Kingdom
| | | | - Helen Ward
- School of Public Health, Imperial College London, London, United Kingdom
| | - Julie von Ziegenweidt
- Department of Haemotology, University of Cambridge, Cambridge, United Kingdom
- National Institute for Healthcare Research BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Frances Burns
- Centre for Public Health, Belfast Institute of Clinical Science, Queens University Belfast, Belfast, United Kingdom
| | - Joanne Martin
- Blizard Institute, Faculty of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Neil Sebire
- Institute of Child Health, Great Ormond Street Hospital, London, United Kingdom
| | | | - Declan Bradley
- Centre for Public Health, Institute of Clinical Science, Queen's University Belfast, Belfast, United Kingdom
- Public Health Agency, Belfast, United Kingdom
| | - Rob Baxter
- EPCC, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Amelia Shoemark
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Ana M Valdes
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Benjamin Ollivere
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte Manisty
- Institute of Cardiovascular Sciences, University of College London, London, United Kingdom
| | - David Eyre
- Big Data Institute, University of Oxford, Oxford, United Kingdom
| | - Stephanie Gallant
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - George Joy
- Barts Heart Centre, London, United Kingdom
| | - Andrew McAuley
- Clinical and Protecting Health Directorate, Public Health Scotland, Glasgow, United Kingdom
| | - David Connell
- School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Kate Northstone
- Population Health Sciences, Avon Longitudinal Study of Parents and Children, Bristol, United Kingdom
| | - Katie Jeffery
- Radcliffe Department of Medicine, Oxford University, Oxford, United Kingdom
- Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, United Kingdom
| | - Emanuele Di Angelantonio
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- British Heart Foundation Centre of Research Excellence, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
- Health Data Research UK Cambridge, Wellcome Genome Campus, University of Cambridge, Cambridge, United Kingdom
- Health Data Science Research Centre, Human Technopole, Milan, Italy
| | - Amy McMahon
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
| | - Mat Walker
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Behaviour, University of Cambridge, Cambridge, United Kingdom
| | - Malcolm Gracie Semple
- Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infections, University of Liverpool, Liverpool, United Kingdom
- Respiratory Department, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | | | | | - Bethan Davies
- School of Public Health, Imperial College London, London, United Kingdom
| | - John Kenneth Baillie
- Outbreak Data Analysis Platform, University of Edinburgh, Edinburgh, United Kingdom
| | - Ming Tang
- NHS England, Worcestershire, United Kingdom
| | - Gary Leeming
- Civic Data Cooperative, Digital Innovation Facility, University of Liverpool, Liverpool, United Kingdom
| | - Linda Power
- Public Health England, London, United Kingdom
| | - Thomas Breeze
- Avon Longitudinal Study of Parents and Children, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Duncan Murray
- University of Birmingham, Birmingham, United Kingdom
- University Hospital Coventry & Warwickshire NHS Trust, Coventry, United Kingdom
| | - Chris Orton
- Population Data Science, Swansea University Medical School, Swansea, United Kingdom
| | - Iain Pierce
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ian Hall
- Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England Colindale, London, United Kingdom
| | | | - Matthew Whitaker
- School of Public Health, Imperial College London, London, United Kingdom
| | | | | | | | | | | | | | - Aziz Sheikh
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Philip Quinlan
- Digital Research Service, University of Nottingham, Nottingham, United Kingdom
- School of Medicine, University of Nottingham, Nottingham, United Kingdom
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11
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Gardner H, Elfeky A, Pickles D, Dawson A, Gillies K, Warwick V, Treweek S. A good use of time? Providing evidence for how effort is invested in primary and secondary outcome data collection in trials. Trials 2022; 23:1047. [PMID: 36575542 PMCID: PMC9793601 DOI: 10.1186/s13063-022-06973-8] [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: 06/17/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Data collection is a substantial part of trial workload for participants and staff alike. How these hours of work are spent is important because stakeholders are more interested in some outcomes than others. The ORINOCO study compared the time spent collecting primary outcome data to the time spent collecting secondary outcome data in a cohort of trials. METHODS We searched PubMed for phase III trials indexed between 2015 and 2019. From these, we randomly selected 120 trials evaluating a therapeutic intervention plus an additional random selection of 20 trials evaluating a public health intervention. We also added eligible trials from a cohort of 189 trials in rheumatology that had used the same core outcome set. We then obtained the time taken to collect primary and secondary outcomes in each trial. We used a hierarchy of methods that included data in trial reports, contacting the trial team and approaching individuals with experience of using the identified outcome measures. We calculated the primary to secondary data collection time ratio and notional data collection cost for each included trial. RESULTS We included 161 trials (120 phase III; 21 core outcome set; 20 public health), which together collected 230 primary and 688 secondary outcomes. Full primary and secondary timing data were obtained for 134 trials (100 phase III; 17 core outcome set; 17 public health). The median time spent on primaries was 56.1 h (range: 0.0-10,746.7, IQR: 226.89) and the median time spent on secondaries was 190.7 hours (range: 0.0-1,356,832.9, IQR: 617.6). The median primary to secondary data collection time ratio was 1.0:3.0 (i.e. for every minute spent on primary outcomes, 3.0 were spent on secondaries). The ratio varied by trial type: phase III trials were 1.0:3.1, core outcome set 1.0:3.4 and public health trials 1.0:2.2. The median notional overall data collection cost was £8015.73 (range: £52.90-£31,899,140.70, IQR: £20,096.64). CONCLUSIONS Depending on trial type, between two and three times as much time is spent collecting secondary outcome data than collecting primary outcome data. Trial teams should explicitly consider how long it will take to collect the data for an outcome and decide whether that time is worth it given importance of the outcome to the trial.
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Affiliation(s)
- Heidi Gardner
- grid.7107.10000 0004 1936 7291Health Services Research Unit, University of Aberdeen, Health Services Research Unit, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Adel Elfeky
- grid.7107.10000 0004 1936 7291Health Services Research Unit, University of Aberdeen, Health Services Research Unit, Foresterhill, Aberdeen, AB25 2ZD UK ,grid.7372.10000 0000 8809 1613Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - David Pickles
- grid.415967.80000 0000 9965 1030Rheumatology Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Katie Gillies
- grid.7107.10000 0004 1936 7291Health Services Research Unit, University of Aberdeen, Health Services Research Unit, Foresterhill, Aberdeen, AB25 2ZD UK
| | - Violet Warwick
- grid.8241.f0000 0004 0397 2876School of Medicine, University of Dundee, Dundee, UK
| | - Shaun Treweek
- grid.7107.10000 0004 1936 7291Health Services Research Unit, University of Aberdeen, Health Services Research Unit, Foresterhill, Aberdeen, AB25 2ZD UK
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12
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Czwikla J, Herzberg A, Kapp S, Kloep S, Rothgang H, Nitschke I, Haffner C, Hoffmann F. Generalizability and reach of a randomized controlled trial to improve oral health among home care recipients: comparing participants and nonparticipants at baseline and during follow-up. Trials 2022; 23:560. [PMID: 35804423 PMCID: PMC9264743 DOI: 10.1186/s13063-022-06470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background The generalizability of randomized controlled trials (RCTs) with a low response can be limited by systematic differences between participants and nonparticipants. This participation bias, however, is rarely investigated because data on nonparticipants is usually not available. The purpose of this article is to compare all participants and nonparticipants of a RCT to improve oral health among home care recipients at baseline and during follow-up using claims data. Methods Seven German statutory health and long-term care insurance funds invited 9656 home care recipients to participate in the RCT MundPflege. Claims data for all participants (n = 527, 5.5% response) and nonparticipants (n = 9129) were analyzed. Associations between trial participation and sex, age, care dependency, number of Elixhauser diseases, and dementia, as well as nursing, medical, and dental care utilization at baseline, were investigated using multivariable logistic regression. Associations between trial participation and the probability of (a) moving into a nursing home, (b) being hospitalized, and (c) death during 1 year of follow-up were examined via Cox proportional hazards regressions, controlling for baseline variables. Results At baseline, trial participation was positively associated with male sex (odds ratio 1.29 [95% confidence interval 1.08–1.54]), high (vs. low 1.46 [1.15–1.86]) care dependency, receiving occasional in-kind benefits to relieve caring relatives (1.45 [1.15–1.84]), having a referral by a general practitioner to a medical specialist (1.62 [1.21–2.18]), and dental care utilization (2.02 [1.67–2.45]). It was negatively associated with being 75–84 (vs. < 60 0.67 [0.50–0.90]) and 85 + (0.50 [0.37–0.69]) years old. For morbidity, hospitalizations, and formal, respite, short-term, and day or night care, no associations were found. During follow-up, participants were less likely to move into a nursing home than nonparticipants (hazard ratio 0.50 [0.32–0.79]). For hospitalizations and mortality, no associations were found. Conclusions For half of the comparisons, differences between participants and nonparticipants were observed. The RCT’s generalizability is limited, but to a smaller extent than one would expect because of the low response. Routine data provide a valuable source for investigating potential differences between trial participants and nonparticipants, which might be used by future RCTs to evaluate the generalizability of their findings. Trial registration German Clinical Trials Register DRKS00013517. Retrospectively registered on June 11, 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06470-y.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany. .,Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany. .,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.
| | - Alexandra Herzberg
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Sonja Kapp
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany.,Competence Center for Clinical Trials, University of Bremen, Linzer Straße 4, 28359, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Mary-Somerville-Straße 5, 28359, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bibliothekstraße 1, 28359, Bremen, Germany
| | - Ina Nitschke
- Division of Gerodontology, Clinic of Prosthetic Dentistry and Dental Materials Science, University Medical Center, Liebigstraße 10-14, 04103, Leipzig, Germany.,Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Plattenstraße 11, CH-8032, Zurich, Switzerland
| | - Cornelius Haffner
- Special Care- and Geriatric Dentistry, Städtisches Klinikum Harlaching München, Sanatoriumsplatz 2, 81545, Munich, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstraße 114-118, 26129, Oldenburg, Germany
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13
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Wray N, Miller K, Irvine K, Moore E, Crisp A, Bapaume K, Taylor C, Smetak R, Wiggins N, Dombrovskaya M, Flack F. Development and implementation of a national online application system for cross-jurisdictional linked data. Int J Popul Data Sci 2022; 7:1732. [PMID: 35520098 PMCID: PMC9052959 DOI: 10.23889/ijpds.v6i1.1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
The Population Health Research Network (PHRN) is an Australian national data linkage infrastructure that links a wide range of health and human services data in privacy-preserving ways. The data linkage infrastructure enables researchers to apply for access to routinely collected, linked, administrative data from the six states and two territories which make up the Commonwealth of Australia, as well as data collected by the Australian Government. The PHRN is a distributed network where data is collected and managed at the respective jurisdictional and/or cross-jurisdictional levels. As a result, access to linked data from multiple jurisdictions requires complex approval processes. This paper describes Australia's approach to enabling access to linked data from multiple jurisdictions. It covers the identification of, and agreement to, a minimum set of data items to be included in a unified national application form, the development and implementation of a national online application system and the harmonisation of business processes for cross-jurisdictional research projects. Utilisation of the online application system and the ongoing challenges of data linkage across jurisdictions are discussed. Changes to the data custodian and ethics committee approval criteria were out of scope for this project.
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Affiliation(s)
- Natalie Wray
- Population Health Research Network, University of Western Australia, Perth 6009, Australia
| | - Kate Miller
- Telethon Kids Institute, Perth 6009, Australia
| | | | | | - Alice Crisp
- Australian Institute of Health and Welfare, Canberra 2601, Australia
| | | | | | - Rob Smetak
- SA NT DataLink, University of South Australia, Adelaide 5000, Australia
| | - Nadine Wiggins
- Menzies Institute for Medical Research, Hobart 7000, Australia
| | - Mikhalina Dombrovskaya
- Population Health Research Network, University of Western Australia, Perth 6009, Australia
| | - Felicity Flack
- Population Health Research Network, University of Western Australia, Perth 6009, Australia
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14
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Lugg-Widger F, Munnery K, Townson J, Trubey R, Robling M. Identifying researcher learning needs to develop online training for UK researchers working with administrative data: CENTRIC training. Int J Popul Data Sci 2022; 7:1712. [PMID: 35310556 PMCID: PMC8900594 DOI: 10.23889/ijpds.v6i1.1712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The use of administrative data in health and social science research continues to expand, with increased availability of data and interest from funders. Researchers, however, continue to experience delays in access, storage and sharing of administrative data. Training opportunities are limited and typically specific to individual data providers or focussed on the analytical aspects of working with administrative data. The CENTRIC study was funded by the Information Commissioners Office, with the aim of developing a broader training curriculum for researchers working with administrative data in the UK. METHODS A mixed-methods design informed curriculum content, including surveys with researchers, focus group discussions with data providers and workshops with members of the public. Researchers were identified from relevant administrative data networks and invited to participate in an online survey identifying training needs. Data providers were approached with a request to input to a face-to-face or online meeting with two members of the research team about their experiences of working with researchers. Data were analysed within the broad framework of the interview schedule, free text responses in the survey were analysed thematically. RESULTS 107 researchers responded to the online survey and four data providers participated in the focus groups. We identified five main themes, relating to research training needs for UK researchers working with administrative data: communication; timelines; changes & amendments; future-proofing applications; and, the availability of training and support. Data providers either provided additional evidence on these learning needs or ways to address identified challenges. Six modules were developed addressing these training needs. Quotes from the survey and focus groups are used anonymously in the online training modules. CONCLUSION The CENTRIC online training curriculum was launched in September 2020 and is available, free of charge for UK researchers. CENTRIC specifically addresses commonly identified training needs of researchers working with administrative data.
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Affiliation(s)
| | - Kim Munnery
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS
| | - Rob Trubey
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Cardiff, CF14 4YS,DECIPHer - Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement, 1-3 Museum Place, Cardiff. CF10 3BD
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15
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Hemkens LG, Juszczak E, Thombs BD. Reporting transparency and completeness in trials: Paper 1: Introduction - Better reporting for disruptive clinical trials using routinely collected data. J Clin Epidemiol 2021; 141:172-174. [PMID: 34525407 DOI: 10.1016/j.jclinepi.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Lars G Hemkens
- Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland; Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA; Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
| | - Edmund Juszczak
- Nottingham Clinical Trials Unit, University of Nottingham, University Park, Nottingham, UK; National Perinatal Epidemiology Unit Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Brett D Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Quebec, Canada; Department of Psychiatry, McGill University, Montreal, Quebec, Canada; Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, McGill University, Montreal, Quebec, Canada; Department of Psychology, McGill University, Montreal, Quebec, Canada; Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada; Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
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16
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Taylor JA, Crowe S, Espuny Pujol F, Franklin RC, Feltbower RG, Norman LJ, Doidge J, Gould DW, Pagel C. The road to hell is paved with good intentions: the experience of applying for national data for linkage and suggestions for improvement. BMJ Open 2021; 11:e047575. [PMID: 34413101 PMCID: PMC8378388 DOI: 10.1136/bmjopen-2020-047575] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We can improve healthcare services by better understanding current provision. One way to understand this is by linking data sets from clinical and national audits, national registries and other National Health Service (NHS) encounter data. However, getting to the point of having linked national data sets is challenging. OBJECTIVE We describe our experience of the data application and linkage process for our study 'LAUNCHES QI', and the time, processes and resource requirements involved. To help others planning similar projects, we highlight challenges encountered and advice for applications in the current system as well as suggestions for system improvements. FINDINGS The study set up for LAUNCHES QI began in March 2018, and the process through to data acquisition took 2.5 years. Several challenges were encountered, including the amount of information required (often duplicate information in different formats across applications), lack of clarity on processes, resource constraints that limit an audit's capacity to fulfil requests and the unexpected amount of time required from the study team. It is incredibly difficult to estimate the resources needed ahead of time, and yet necessary to do so as early on as funding applications. Early decisions can have a significant impact during latter stages and be hard to change, yet it is difficult to get specific information at the beginning of the process. CONCLUSIONS The current system is incredibly complex, arduous and slow, stifling innovation and delaying scientific progress. NHS data can inform and improve health services and we believe there is an ethical responsibility to use it to do so. Streamlining the number of applications required for accessing data for health services research and providing clarity to data controllers could facilitate the maintenance of stringent governance, while accelerating scientific studies and progress, leading to swifter application of findings and improvements in healthcare.
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Affiliation(s)
- Julie A Taylor
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Sonya Crowe
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Ferran Espuny Pujol
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
| | - Rodney C Franklin
- Paediatric Cardiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | | | - Lee J Norman
- Paediatric Intensive Care Audit Network, University of Leeds, Leeds, UK
| | - James Doidge
- Intensive Care National Audit and Research Centre, London, UK
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Christina Pagel
- Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK
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