Investigating innovations in outpatient services: a mixed-methods rapid evaluation.

Background: Within outpatient services, a broad range of innovations are being pursued to better manage care and reduce unnecessary appointments. One of the least-studied innovations is Patient-Initiated Follow-Up, which allows patients to book appointments if and when they need them, rather than follow a standard schedule.

Objectives: To use routine national hospital data to identify innovations in outpatient services implemented, in recent years, within the National Health Service in England.

Patient Characteristics Associated With Disparities in Engagement With and Experience of COVID-19 Remote Home Monitoring Services: A Mixed-Methods Evaluation.

Introduction: The adoption of remote healthcare methods has been accelerated by the COVID-19 pandemic, but evidence suggests that some patients need additional support to engage remotely, potentially increasing health disparities if needs are not met. This study of COVID-19 remote home monitoring services across England explores experiences of and engagement with the service across different patient groups.

Methods: This was a mixed-methods study with survey and interview data collected from 28 services across England between February and June 2021.

A Cost Evaluation of COVID-19 Remote Home Monitoring Services in England.

Background: Remote home monitoring services emerged as critical components of health care delivery from NHS England during the COVID-19 pandemic, aiming to provide timely interventions and reduce health care system burden. Two types of service were offered: referral by community health services to home-based care to ensure the right people were admitted to the hospital at the right time (called COVID Oximetry@home, CO@h); and referral by hospital to support patients' transition from hospital to home (called COVID-19 Virtual Ward, CVW). The information collected for the oxygen levels and other symptoms was provided via digital means (technology-enabled) or over the phone (analogue-only submission mode).

A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England.

Background: Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g.

Patient and staff experiences of using technology-enabled and analogue models of remote home monitoring for COVID-19 in England: A mixed-method evaluation.

Objective: To evaluate patient and staff experiences of using technology-enabled ('tech-enabled') and analogue remote home monitoring models for COVID-19, implemented in England during the pandemic.

Methods: Twenty-eight sites were selected for diversity in a range of criteria (e.g.

Youth violence intervention programme for vulnerable young people attending emergency departments in London: a rapid evaluation.

Background: Youth violence intervention programmes involving the embedding of youth workers in NHS emergency departments to help young people (broadly aged between 11 and 24 years) improve the quality of their lives following their attendance at an emergency department as a result of violent assault or associated trauma are increasing across the NHS. This study evaluates one such initiative run by the charity Redthread in partnership with a NHS trust.

Objectives: To evaluate the implementation and impact of a new youth violence intervention programme at University College London Hospital NHS Trust and delivered by the charity Redthread: (1) literature review of studies of hospital-based violent crime interventions; (2) evaluation of local implementation and of University College London Hospital staff and relevant local stakeholders concerning the intervention and its impact; (3) assessment of the feasibility of using routine secondary care data to evaluate the impact of the Redthread intervention; and (4) cost-effectiveness analysis of the Redthread intervention from the perspective of the NHS.

Undertaking rapid evaluations during the COVID-19 pandemic: Lessons from evaluating COVID-19 remote home monitoring services in England.

Introduction: Rapid evaluations can offer evidence on innovations in health and social care that can be used to inform fast-moving policy and practise, and support their scale-up according to previous research. However, there are few comprehensive accounts of how to plan and conduct large-scale rapid evaluations, ensure scientific rigour, and achieve stakeholder engagement within compressed timeframes.

Methods: Using a case study of a national mixed-methods rapid evaluation of COVID-19 remote home monitoring services in England, conducted during the COVID-19 pandemic, this manuscript examines the process of conducting a large-scale rapid evaluation from design to dissemination and impact, and reflects on the key lessons for conducting future large-scale rapid evaluations.

The impact of post-hospital remote monitoring of COVID-19 patients using pulse oximetry: A national observational study using hospital activity data.

Background: There was a national roll out of 'COVID Virtual Wards' (CVW) during England's second COVID-19 wave (Autumn 2020 - Spring 2021). These services used remote pulse oximetry monitoring for COVID-19 patients following discharge from hospital. A key aim was to enable rapid detection of patient deterioration.

The impact of remote home monitoring of people with COVID-19 using pulse oximetry: A national population and observational study.

Background: Remote home monitoring of people testing positive for COVID-19 using pulse oximetry was implemented across England during the Winter of 2020/21 to identify falling blood oxygen saturation levels at an early stage. This was hypothesised to enable earlier hospital admission, reduce the need for intensive care and improve survival. This study is an evaluation of the clinical effectiveness of the pre-hospital monitoring programme, COVID oximetry @home (CO@h).

Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review.

Background: the aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt.

Methods: we carried out a rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK). The main outcomes included in the review were: impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality.

The implementation of remote home monitoring models during the COVID-19 pandemic in England.

Background: There is a paucity of evidence for the implementation of remote home monitoring for COVID-19 infection. The aims of this study were to identify the key characteristics of remote home monitoring models for COVID-19 infection, explore the experiences of staff implementing these models, understand the use of data for monitoring progress against outcomes, and document variability in staffing and resource allocation.

Methods: This was a multi-site mixed methods study conducted between July and August 2020 that combined qualitative and quantitative approaches to analyse the implementation and impact of remote home monitoring models developed during the first wave of the COVID-19 pandemic in England.

Safe working in a 7-day service. Experience of hip fracture care as documented by the UK National Hip Fracture Database.

Objective: to describe differences in care and 30-day mortality of patients admitted with hip fracture on weekends (Saturday-Sunday) compared to weekdays (Monday-Friday), and their relationship to the organisation of care.

Methods: data came from the National Hip Fracture Database (NHFD) linked to ONS mortality data on 52,599 patients presenting to 162 units in England between 1 January and 31 December 2014. This was combined with information on geriatrician staffing and major trauma centre (MTC) status.

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).

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.

Development of a predictive model to identify inpatients at risk of re-admission within 30 days of discharge (PARR-30).

Objectives: To develop an algorithm for identifying inpatients at high risk of re-admission to a National Health Service (NHS) hospital in England within 30 days of discharge using information that can either be obtained from hospital information systems or from the patient and their notes.

Design: Multivariate statistical analysis of routinely collected hospital episode statistics (HES) data using logistic regression to build the predictive model. The model's performance was calculated using bootstrapping.

Overlap of hospital use and social care in older people in England.

Objectives: To link pseudonymous health and social care use data in order to determine what proportion of older people access hospital and social care services.

Methods: Retrospective analysis of linked, pseudonymous, routine service use data of people aged 75 and over (n = 133,055) drawn from the operational systems of four primary care trusts and their corresponding local authorities in England.

Results: Fourteen percent of older people received local authority-funded social care in one year, 59% accessed NHS hospital care and 10% accessed both types of service.

The role of matched controls in building an evidence base for hospital-avoidance schemes: a retrospective evaluation.

Objective: To test whether two hospital-avoidance interventions altered rates of hospital use: "intermediate care" and "integrated care teams."

Data Sources/study Setting: Linked administrative data for England covering the period 2004 to 2009.

Study Design: This study was commissioned after the interventions had been in place for several years.

A person based formula for allocating commissioning funds to general practices in England: development of a statistical model.

Objectives: To develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practice

Design: Multivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices.

Do 'virtual wards' reduce rates of unplanned hospital admissions, and at what cost? A research protocol using propensity matched controls.

Background: This retrospective study will assess the extent to which multidisciplinary case management in the form of virtual wards (VWs) leads to changes in the use of health care and social care by patients at high risk of future unplanned hospital admission. VWs use the staffing, systems and daily routines of a hospital ward to deliver coordinated care to patients in their own homes. Admission to a VW is offered to patients identified by a predictive risk model as being at high risk of unplanned hospital admission in the coming 12 months.

Predicting who will use intensive social care: case finding tools based on linked health and social care data.

Background: the costs of delivering health and social care services are rising as the population ages and more people live with chronic diseases.

Objectives: to determine whether predictive risk models can be built that use routine health and social care data to predict which older people will begin receiving intensive social care.

Design: analysis of pseudonymous, person-level, data extracted from the administrative data systems of local health and social care organisations.

Stable sonoluminescence within a water hammer tube.

The sonoluminescence (SL) from the collapse of a single gas bubble within a liquid can be produced repetitively using an acoustic resonator. An alternative technique using a water hammer tube, producing SL from bubbles of greater size, is described here. A sealed vertical tube partly filled with a liquid and a gas at low pressure is subjected to vertical vibrations.