Re-admission patterns in England and the Netherlands: a comparison based on administrative data of all hospitals.

Background: Examining variation in patterns of re-admissions between countries can be valuable for mutual learning in order to reduce unnecessary re-admissions. The aim of this study was to compare re-admission rates and reasons for re-admissions between England and the Netherlands.

Methods: We used data from 85 Dutch hospitals (1 355 947 admissions) and 451 English hospitals (5 260 227 admissions) in 2014 (96% of all Dutch hospitals and 100% of all English NHS hospitals).

Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study.

Background: Older people are increasing users of health care globally. We aimed to establish whether older people with characteristics of frailty and who are at risk of adverse health-care outcomes could be identified using routinely collected data.

Methods: A three-step approach was used to develop and validate a Hospital Frailty Risk Score from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes.

The impact of alcohol care teams on emergency secondary care use following a diagnosis of alcoholic liver disease - a national cohort study.

Background: The increasing mortality rates from alcohol-related liver disease (ARLD) are a public health concern. To address this, alcohol care teams (ACT) case-find and lead management of alcohol issues for these patients. Local assessments of ACTs have shown reductions in emergency admissions and emergency department attendances.

Factors associated with variation in hospital use at the end of life in England.

Objective: To identify the relative importance of factors influencing hospital use at the end of life.

Design: Retrospective cohort study of person and health system effects on hospital use in the past 12 months modelling differences in admissions, bed days and whether a person died in hospital.

Setting: Residents in England for the period 2009/2010 to 2011/2012 using Hospital Episodes Statistics (HES) data from all acute care hospitals in England funded by the National Health Service (NHS).

Effect of telehealth on hospital utilisation and mortality in routine clinical practice: a matched control cohort study in an early adopter site.

Objectives: To assess the effects of a home-based telehealth intervention on the use of secondary healthcare and mortality.

Design: Observational study of a mainstream telehealth service, using person-level administrative data. Time to event analysis (Cox regression) was performed comparing telehealth patients with controls who were matched using a machine-learning algorithm.

Continuous monitoring of emergency admissions of older care home residents to hospital.

Background: evidence from inspection programmes suggest that the quality of care provided by individual care homes for older people is very variable. Aside from periodic inspection, there is limited information that is routinely collected and can be used to monitor quality.

Objectives: to describe a method for using routine hospital data on admissions of older people as means for monitoring quality of care within a care home.

An Approach to Assess Generalizability in Comparative Effectiveness Research: A Case Study of the Whole Systems Demonstrator Cluster Randomized Trial Comparing Telehealth with Usual Care for Patients with Chronic Health Conditions.

Background: Policy makers require estimates of comparative effectiveness that apply to the population of interest, but there has been little research on quantitative approaches to assess and extend the generalizability of randomized controlled trial (RCT)-based evaluations. We illustrate an approach using observational data.

Methods: Our example is the Whole Systems Demonstrator (WSD) trial, in which 3230 adults with chronic conditions were assigned to receive telehealth or usual care.

Pre-dialysis hospital use and late referrals in incident dialysis patients in England: a retrospective cohort study.

Background: Timely referral to specialist kidney care can improve outcomes for patients and delay the onset of dialysis, yet late referral (LR) remains a problem in many countries. We aimed to estimate the proportion of LRs that could potentially have been detected earlier because of increases in patients' general hospital activity.

Methods: A cohort of patients starting dialysis in the English NHS (National Health Service) during 2010/11 was approximated using hospital administrative data.

Effect of telehealth on glycaemic control: analysis of patients with type 2 diabetes in the Whole Systems Demonstrator cluster randomised trial.

Background: The Whole Systems Demonstrator was a large, pragmatic, cluster randomised trial that compared telehealth with usual care among 3,230 patients with long-term conditions in three areas of England. Telehealth involved the regular transmission of physiological information such as blood glucose to health professionals working remotely. We examined whether telehealth led to changes in glycosylated haemoglobin (HbA1c) among the subset of patients with type 2 diabetes.

Effect of a telephonic alert system (Healthy outlook) for patients with chronic obstructive pulmonary disease: a cohort study with matched controls.

Background: Healthy Outlook was a telephonic alert system for patients with chronic obstructive pulmonary disease (COPD) in the UK. It used routine meteorological and communicable disease reports to identify times of increased risk to health. We tested its effect on hospital use and mortality.

Experiences of front-line health professionals in the delivery of telehealth: a qualitative study.

Background: Telehealth is an emerging field of clinical practice but current UK health policy has not taken account of the perceptions of front-line healthcare professionals expected to implement it.

Aim: To investigate telehealth care for people with long-term conditions from the perspective of the front-line health professional.

Design And Setting: A qualitative study in three sites within the UK (Kent, Cornwall, and the London Borough of Newham) and embedded in the Whole Systems Demonstrator evaluation, a large cluster randomised controlled trial of telehealth and telecare for patients with long-term and complex conditions.

Cost-effectiveness of telecare for people with social care needs: the Whole Systems Demonstrator cluster randomised trial.

Purpose Of The Study: to examine the costs and cost-effectiveness of 'second-generation' telecare, in addition to standard support and care that could include 'first-generation' forms of telecare, compared with standard support and care that could include 'first-generation' forms of telecare.

Design And Methods: a pragmatic cluster-randomised controlled trial with nested economic evaluation. A total of 2,600 people with social care needs participated in a trial of community-based telecare in three English local authority areas.

Classifying emergency 30-day readmissions in England using routine hospital data 2004-2010: what is the scope for reduction?

Background: Many health systems across the globe have introduced arrangements to deny payment for patients readmitted to hospital as an emergency. The purpose of this study was to develop an exploratory categorisation based on likely causes of readmission, and then to assess the prevalence of these different types.

Methods: Retrospective analysis of 82 million routinely collected National Health Service hospital records in England (2004-2010) was undertaken using anonymised linkage of records at person-level.

Reflections from the NHS in England.

This paper describes the approach taken to "high-risk patients" in England. It provides an overview of the use of risk stratification to identify those at high risk and policy innovations designed to provide preventive care, including the community matron and virtual ward initiatives. We review how such initiatives have been evaluated and discuss the findings of those evaluations.

The effect of telecare on the quality of life and psychological well-being of elderly recipients of social care over a 12-month period: the Whole Systems Demonstrator cluster randomised trial.

Background: home-based telecare (TC) is utilised to manage risks of independent living and provide prompt emergency responses. This study examined the effect of TC on health-related quality of life (HRQoL), anxiety and depressive symptoms over 12 months in patients receiving social care.

Design: a study of participant-reported outcomes [the Whole Systems Demonstrator (WSD) Telecare Questionnaire Study; baseline n = 1,189] was nested in a pragmatic cluster-randomised trial of TC (the WSD Telecare trial), held across three English Local Authorities.

Integrating care for high-risk patients in England using the virtual ward model: lessons in the process of care integration from three case sites.

Background: Patients at high risk of emergency hospitalisation are particularly likely to experience fragmentation in care. The virtual ward model attempts to integrate health and social care by offering multidisciplinary case management to people at high predicted risk of unplanned hospitalisation.

Objective: To describe the care practice in three virtual ward sites in England and to explore how well each site had achieved meaningful integration.

Integrated care pilot in north-west London: a mixed methods evaluation.

Introduction: This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support.

Methods: The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study).

Impact of telehealth on general practice contacts: findings from the whole systems demonstrator cluster randomised trial.

Background: Telehealth is increasingly used in the care of people with long term conditions. Whilst many studies look at the impacts of the technology on hospital use, few look at how it changes contacts with primary care professionals. The aim of this paper was to assess the impacts of home-based telehealth interventions on general practice contacts.

Choosing a model to predict hospital admission: an observational study of new variants of predictive models for case finding.

Objectives: To test the performance of new variants of models to identify people at risk of an emergency hospital admission. We compared (1) the impact of using alternative data sources (hospital inpatient, A&E, outpatient and general practitioner (GP) electronic medical records) (2) the effects of local calibration on the performance of the models and (3) the choice of population denominators.

Design: Multivariate logistic regressions using person-level data adding each data set sequentially to test value of additional variables and denominators.

Effect of telephone health coaching (Birmingham OwnHealth) on hospital use and associated costs: cohort study with matched controls.

Objectives: To test the effect of a telephone health coaching service (Birmingham OwnHealth) on hospital use and associated costs.

Design: Analysis of person level administrative data. Difference-in-difference analysis was done relative to matched controls.

Evaluation of complex integrated care programmes: the approach in North West London.

Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing.