Projects

The REAL Centre has been established to provide new evidence and analysis that will help health and social care policymakers consider the long term implications of their funding, design and delivery decisions. The HEU are working in partnership with the centre to answer the following questions by analysing regional datasets such as The Kent Integrated Dataset.

Synthetic data has the potential to overcome many data access issues inherent when using patient level data, even when the data has been de-identified. When created with the required level of privacy, it can enable research by a wider range of analysts to create proof of concepts for analysis and tools, software development, and technology evaluations. The NHS will benefit from this by: • Being able to better support the training of its analytical workforce, as analysts will be able to apply their learning on realistic data • Reducing the resources consumed by the processes surrounding information governance, as analysts will be able to test their ideas on the synthetic dataset to either abandon unfruitful projects or create stronger cases for access • Support innovation, as analysts will have lower barriers for experimentation without creating risks to privacy and security.

The aim of the project is to predict elderly patients readmission to the hospitals after being discharged to the home care facilities. According to the existing records the timely interventions can significantly reduce unplanned readmissions for this cohort of patients. Therefore, we aim to develop accurate and precise predictive models to identify possible readmissions, which can further be used for improving the quality of care.

To define the prevalence, incidence and NHS resource use associated with pressure ulceration within a large, representative sample of the UK population, incorporating data from primary, secondary and community care sources. This data will then be used to generate localised estimates for other organisational geographies.

To assess the natural history of patients who undergo major lower limb amputation or lower limb revascularisation (e.g. endovascular intervention, open surgery, hybrid intervention including open and endovascular techniques) for Peripheral Arterial Disease (PAD) and/or Chronic Limb-Threatening Ischemia (CLTI) in the NHS. It will focus the analysis on patients that have had the specified vascular or endovascular operations (including amputations) carried out from 2016 /2017. Each de-identified patient in this cohort will be analysed to include associated activity for a period of 2 years post-procedure.

The Health Economics Unit will initially carry out a feasibility analysis to ascertain the quality of the data in the MND population available. This will determine the number of patients available to analyse by care setting and month. Clinical and demographic characteristics of MND patients will be identified including gender, age, ethnicity and deprivation. The aim of this phase of the project is to understand the potential to quantify the costs of integrated NHS resources in MND patients and ascertain the utility of the data to answer further questions that the MND Association would like to address. The key questions for MND Association include: • Time from first GP consultation with symptoms, to referral and diagnosis • Number of patients with coordinated care, receiving psychological support, referred for genetic counselling, assessed by Continuing Health Care, identified with palliative and EoLC needs and who are assessed and have a care plan • Number of tracheotomies / invasive ventilation procedures, and where those are being done • Typical number of annual health interactions for people with MND (pwMND)

this project will select patients with a diagnosis of leukaemia to understand how these patients are diagnosed and to see what factors such as age, gender, geographic region, ethnicity and social deprivation are associated with a patient being diagnosed as an emergency rather than through their general practitioner. It will then seek to understand how this affects their chances of survival, explore how long it takes for somebody to be diagnosed after first presenting with possible symptoms of leukaemia and what investigations and how many contacts they have with their general practitioner or hospital prior to a diagnosis being made.

Evaluate the performance of the Harvard predictive model for predicting outcomes of interest in selected patients with heart-failure in terms of the following end-points: - 1-year HF-related hospital admissions - 1-year all-cause mortality The model may then be calibrated / adjusted to optimise their performance.

Epistaxis is a common ENT presentation with lifetime prevalence of 60%. Anticoagulation such as warfarin and the new anticoagulation therapies such as rivaroxaban, and apixaban have been commonly used to treat conditions such as AF (atrial fibrillation) and clots including DVT (deep vein thrombosis) or PE (pulmonary embolism). However, the risk of anticoagulation and its impact on epistaxis is poorly understood. The study hopes to understands the risk of epistaxis amongst patients on anticoagulation to better inform patients and healthcare professionals about its impact.

To evaluate the health economic impact of using Toric lenses (designed to correct astigmatism) during cataract surgery i.e. provide patients with lenses. The clinical proponents of this approach suggest that a patients’ quality of like in terms of self-care are greatly improved and the overall burden to the NHS reduces. A detailed protocol will be developed following an initial feasibility assessment of the data quality to ensure a robust and credible methodology including considering the confounding factors associated with patient characteristics by peer matching populations based on age, gender, comorbidities and deprivation.

This project will help to inform an impactibility model that calculates the address a health condition amenable to preventative care, in this case COPD, which calculates a ‘gap analysis’ of those patients, comparing their treatment to NICE Guidance (NG115) on diagnosis and management. This work will then be followed by a risk stratification of the patients look at their risk of progressing to a first co-morbidity and multimorbidity.

This evaluation will assess oral anticoagulants Warfarin and Edoxaban in patients diagnosed with Atrial Fibrillation (AF) at risk of stroke events. It will contribution in providing further real-world evidence for the population of Kent to support the guidance published by NHSE in June 2020 that HCPs should consider switching eligible patients from Warfarin to a DOAC to reduce the impact on NHS resources and reduce the risk of exposure of vulnerable patients attending hospital.

Identification of at-risk drinking and offering brief advice are key components of the Kent Drug and Alcohol Strategy 2022-2027. The findings from this study will provide key information on variability of alcohol screening and variability in the recording of alcohol screening.

Statistical analysis and clinical/academic evaluation will take place to identify the most effective biomarkers from health and care data that are the best predictors for lung cancer for the local Kent and Medway population. KID will be used to undertake these feasibility studies given its maturity and longitudinal dataset over a 5 year period.

To map comorbidity across Kent and Medway by LSOA based on surrogate markers such as prescription diagnosis codes and episodes

To define the prevalence, incidence and NHS resource use associated with pressure ulceration within a large, representative sample of the UK population, incorporating data from primary, secondary and community care sources. This data will then be used to generate localised estimates for other organisational geographies.