The association between cancer outcomes and time intervals to diagnosis and treatment

The association between cancer outcomes and time intervals to diagnosis and treatment
Healthcare Improvement Scotland, SHTG team, updated October 2019

• A review of the evidence around the association between cancer outcomes and time intervals to diagnosis and treatment was inconclusive due to heterogeneity across the evidence base. Well conducted systematic reviews were identified for head and neck cancers, colon cancer and prostate cancer

MRI for patients with CIEDs: simplifying complexity with a ‘one-stop’ service model

MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model
BMJ Quality & Safety 2019;28:853-858, 19 September 2019

• MRI scanning for patients with cardiac implantable electronic devices (CIEDs) requires some additional steps to be taken both prior to imaging and on attendance. 
• A one stop service model [Barts Hospital NHS Trust, London] whereby CIEDs could be reprogrammed and scans acquired at a single location on a single visit is described, including workforce impact, and development of a standard booking protocol. No additional equipment or other fixed costs were needed. After 2 years, scan volume was over 20 times the national average with a lower waiting time, and while maintaining total departmental activity.

How can we best incentivise world class cancer services in England?

How can we best incentivise world class cancer services in England?
Incisive Health for Cancer Research UK, September 2019

• This paper explores how to best use financial levers and incentives to support the delivery of the NHS Long Term Plan (LTP) cancer ambitions, summarising findings and recommendations developed through consultation with experts. 
• The report explores how funding and commissioning of services currently operates in the NHS in England and assesses what opportunities exist to deliver the ambitions of the NHS LTP. The conclusion reflects on the opportunity that exists, with the NHS LTP and accompanying funding settlement, to ensure funding for cancer services is optimally delivered to improve outcomes 
• Box 1 - Principles that should guide decisions on cancer funding:
• Funding should take into account predicted increases in incidence, survival and comorbidity, ensuring that resources keep pace with need and are sufficient to deliver the ambitions of the Long Term Plan.
• Funding should be prioritised for the areas of cancer services where evidence shows it can deliver the biggest improvement in outcomes.
• Financial incentives should be used to support improvements in quality and service transformation, and to incentivise innovation, not just as a measure to stabilise current performance.
• Funding should also be used to encourage all those involved in cancer services to come together to design, test and implement radical new approaches to improved cancer outcomes.
• Funding should be allocated in a way which enables the NHS, at both a national and a local level, to track how money is used and to account for the progress delivered.

Hospital-level evaluation of the effect of a national quality improvement programme: time-series analysis of registry data

Hospital-level evaluation of the effect of a national quality improvement programme: time-series analysis of registry data
BMJ Quality & Safety 12 September 2019. doi: 10.1136/bmjqs-2019-009537

• Analysis using data from the Enhanced Peri-Operative Care for High-risk patients trial (a quality improvement programme for emergency abdominal surgery across 92 NHS hospitals) demonstrated a large variation in implementation approaches but no mortality reduction.  
• Hospital level evaluation indicated that only a small number of hospitals in the trial improved more than half of the 10 measured care processes, more often when at least five of six implementation strategies were used.

Abstract

Risk factors for dislocation after primary total hip replacement

Risk factors for dislocation after primary total hip replacement: a systematic review and meta-analysis of 125 studies involving approximately five million hip replacements
The Lancet Rheumatology, 9 September 2019 DOI:https://doi.org/10.1016/S2665-9913(19)30045-1

• Analysis of data on dislocations following primary total hip replacements found incidence of dislocation ranged from 0·12% to 16·13%, with an overall pooled incidence of 2·10% over 6 year follow up. 
• The report identifies a number of significant factors associated with risk of dislocation including sociodemographics, BMI, comorbidity, and surgical/implant factors.

Implementing changes to the eligibility criteria for cochlear implants in NHS Scotland

Implementing changes to the eligibility criteria for cochlear implants in NHS Scotland
Healthcare Improvement Scotland, SHTG team, 4 September 2019

• An estimate of the potential budget impact of changing the eligibility criteria for cochlear implants in Scotland. This follows a change to NICE guidance in England, which includes modifications to the clinical criteria for what constitutes severe or profoundly deaf, and how ‘adequate benefit’ from hearing aids is measured.
• Key findings
• Cochlear implants are deemed to be clinically and cost effective based on pre-existing NICE technology appraisal guidance (TA566).
• Changes to the assessment of eligibility for cochlear implants is expected to increase the number of people eligible to receive a cochlear implant in Scotland.

National Cancer Patient Experience Survey 2018 reports

National Cancer Patient Experience Survey 2018 reports
NCPES 4th September 2019

• Survey reports by CCG, Cancer Alliance, Trusts and national data.

Graft Rejection Prediction Following Kidney Transplantation Using Machine Learning Techniques: A Systematic Review and Meta-Analysis

Graft Rejection Prediction Following Kidney Transplantation Using Machine Learning Techniques: A Systematic Review and Meta-Analysis
MEDINFO 2019: Health and Wellbeing e-Networks for All, Studies in Health Technology and Informatics Volume 264: p10 - 14. DOI 10.3233/SHTI190173

• Analysis of the literature around the role of machine learning (ML) in predicting graft rejection following kidney transplantation identified 14 studies and five different algorithms.

Abstract

Changes in colorectal cancer incidence in seven high-income countries

Changes in colorectal cancer incidence in seven high-income countries: a population-based study
The Lancet Gastroenterology & Hepatology, 16 May 2019 DOI:https://doi.org/10.1016/S2468-1253(19)30147-5

• Analysis of longitudinal and generational changes in seven high-income countries noted an overall decline or stabilisation in the incidence of colon and rectal cancer in all studied countries. However analysis of UK data by age showed significant increases in the incidence in people younger than 50 years for colon cancer (1.8% pa), and rectal cancer (1.4% pa), and a significant decrease in the incidence of rectal cancer  (1.2% pa) for people aged 50–74 years.

Abstract

Development and evaluation of a renal learning health system across inner east London

Development and evaluation of a renal learning health system across inner east London
Health Foundation December 2018

• The east London community kidney service was conceived as a renal learning health system, extending across primary and secondary care, with data providing feedback to improve the delivery of care and clinical performance.
• The two innovative components include:
• A virtual CKD clinic, in which nephrologists can see the entire GP patient record (with consent) and enter management suggestions.
• A suite of IT tools for practices to improve identification and management of CKD. A novel ‘trigger tool’ alerts GPs to cases of possible CKD progression.
• Major impacts include: 
• A reduction in wait time for a specialist opinion from 64 to 5-10 days 
• Only 20% of patients referred to the virtual clinic require a hospital appointment 
• Significant improvements to GP identification and management of CKD. 
• Nurse led self-management education for patients 
• See also NHS ENgland case study New virtual clinic designed by doctors gives renal patients more specialist consultant time