scholarly journals Can changes in spending on health and social care explain the recent mortality trends in Scotland? A protocol for an observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e036025
Author(s):  
Christina Wraw ◽  
Jon Minton ◽  
Rory Mitchell ◽  
Grant M A Wyper ◽  
Clare Campbell ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Social Care ◽  
Linear Regression Analysis ◽  
Mortality Rates ◽  
Secondary Outcome ◽  
Service Research ◽  
Mortality Trends ◽  
Data Set ◽  
Health And Social Care ◽  
The Absolute

IntroductionThere have been steady reductions in mortality rates in the majority of high-income countries, including Scotland, since 1945. However, reductions in mortality rates have slowed down since 2012–2014 in these nations; and have reversed in some cases. Deaths among those aged 55+ explain a large amount of these changing mortality trends in Scotland. Increased pressures on health and social care services have been suggested as one factor explaining these changes. This paper outlines a protocol for the approach to testing the extent to which health and social care pressures can explain recent mortality trends in Scotland. Although a slower rate of mortality improvements have affected people of all ages, certain ages have been more negatively affected than the others. The current analyses will be run by age-band to test if the service pressure-mortality link varies across age-group.Methods and analysisThis will be an observational ecological study based on the Scottish population. The exposures of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in real terms per capita spending on social and healthcare services between 2011 and 2017. The outcome of interest will be the absolute (primary outcome) and percentage (secondary outcome) change in age-standardised mortality rate between 2012 and 2018 for men and women separately. The units of analysis will be the 32 local authorities and the 14 territorial health boards. The analyses will be run for both all age-groups combined and for the following age bands: <1, 1–15, 16–44, 45–64, 65–74, 75–84 and 85+.A series of descriptive analyses will summarise the distribution of health and social care expenditure and mortality trends between 2011 and 2018. Linear regression analysis will be used to investigate the direct association between health care spending and mortality rates.Ethics and disseminationThe data used in this study will be publicly available and aggregated and will not be individually identifiable; therefore, ethical committee approval is not needed. This work will not result in the creation of a new data set. On completion, the study will be stored within the National Health Service research governance system. All of the results will be published once they have been shared with partner agencies.

scholarly journals Rapid evaluation for health and social care innovations: challenges for “quick wins” using interrupted time series

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrew McCarthy ◽  
Peter McMeekin ◽  
Shona Haining ◽  
Lesley Bainbridge ◽  
Claire Laing ◽  
...  
Keyword(s):  
Social Care ◽  
Interrupted Time Series ◽  
Models Of Care ◽  
Short Term ◽  
Data Set ◽  
Monthly Cost ◽  
Cost Increase ◽  
Term Model ◽  
Health And Social Care ◽  
Quasi Experimental

Abstract Background Rapid evaluation was at the heart of National Health Service England’s evaluation strategy of the new models of care vanguard programme. This was to facilitate the scale and spread of successful models of care throughout the health & social care system. The aim of this paper is to compare the findings of the two evaluations of the Enhanced health in Care Homes (EHCH) vanguard in Gateshead, one using a smaller data set for rapidity and one using a larger longitudinal data set and to investigate the implications of the use of rapid evaluations using interrupted time series (ITS) methods. Methods A quasi-experimental design study in the form of an ITS was used to evaluate the impact of the vanguard on secondary care use. Two different models are presented differing by timeframes only. The short-term model consisted of data for 11 months data pre and 20 months post vanguard. The long-term model consisted of data for 23 months pre and 34 months post vanguard. Results The cost consequences, including the cost of running the EHCH vanguard, were estimated using both a single tariff non-elective admissions methodology and a tariff per bed day methodology. The short-term model estimated a monthly cost increase of £73,408 using a single tariff methodology. When using a tariff per bed day, there was an estimated monthly cost increase of £14,315. The long-term model had, using a single tariff for non-elective admissions, an overall cost increase of £7576 per month. However, when using a tariff per bed-days, there was an estimated monthly cost reduction of £57,168. Conclusions Although it is acknowledged that there is often a need for rapid evaluations in order to identify “quick wins” and to expedite learning within health and social care systems, we conclude that this may not be appropriate for quasi-experimental designs estimating effect using ITS for complex interventions. Our analyses suggests that care must be taken when conducting and interpreting the results of short-term evaluations using ITS methods, as they may produce misleading results and may lead to a misallocation of resources.

scholarly journals Changing mortality trends in countries and cities of the UK: a population-based trend analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038135
Author(s):  
David Walsh ◽  
Gerry McCartney ◽  
Jon Minton ◽  
Jane Parkinson ◽  
Deborah Shipton ◽  
...  
Keyword(s):  
Trend Analysis ◽  
Causes Of Death ◽  
Age Groups ◽  
Mortality Rates ◽  
Population Based ◽  
Secondary Outcome ◽  
Mortality Trends ◽  
Relative Index ◽  
Index Of Inequality ◽  
The Uk

ObjectivesPreviously improving life expectancy and all-cause mortality in the UK has stalled since the early 2010s. National analyses have demonstrated changes in mortality rates for most age groups and causes of death, and with deprived populations most affected. The aims here were to establish whether similar changes have occurred across different parts of the UK (countries, cities), and to examine cause-specific trends in more detail.DesignPopulation-based trend analysis.Participants/settingWhole populations of countries and selected cities of the UK.Primary and secondary outcome measuresEuropean age-standardised mortality rates (calculated by cause of death, country, city, year (1981–2017), age group, sex and—for all countries and Scottish cities—deprivation quintiles); changes in rates between 5-year periods; summary measures of both relative (relative index of inequality) and absolute (slope index of inequality) inequalities.ResultsChanges in mortality from around 2011/2013 were observed throughout the UK for all adult age groups. For example, all-age female rates decreased by approximately 4%–6% during the 1980s and 1990s, approximately 7%–9% during the 2000s, but by <1% between 2011/2013 and 2015/2017. Equivalent figures for men were 4%–7%, 8%–12% and 1%–3%, respectively. This later period saw increased mortality among the most deprived populations, something observed in all countries and cities analysed, and for most causes of death: absolute and relative inequalities therefore increased. Although similar trends were seen across all parts of the UK, particular issues apply in Scotland, for example, higher and increasing drug-related mortality (with the highest rates observed in Dundee and Glasgow).ConclusionsThe study presents further evidence of changing mortality in the UK. The timing, geography and socioeconomic gradients associated with the changes appear to support suggestions that they may result, at least in part, from UK Government ‘austerity’ measures which have disproportionately affected the poorest.

scholarly journals Is austerity responsible for the recent change in mortality trends across high-income nations? A protocol for an observational study

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e034832 ◽  
Author(s):  
Gerry McCartney ◽  
Lynda Fenton ◽  
Jon Minton ◽  
Colin Fischbacher ◽  
Martin Taulbut ◽  
...  
Keyword(s):  
Government Expenditure ◽  
Mortality Rates ◽  
Recent Change ◽  
High Income ◽  
Sensitivity Analyses ◽  
Service Research ◽  
Social Spending ◽  
Governance System ◽  
Mortality Trends ◽  
Lifespan Variation

IntroductionMortality rates in many high-income countries have changed from their long-term trends since around 2011. This paper sets out a protocol for testing the extent to which economic austerity can explain the variance in recent mortality trends across high-income countries.Methods and analysisThis is an ecological natural experiment study, which will use regression adjustment to account for differences in exposure, outcomes and confounding. All high-income countries with available data will be included in the sample. The timing of any changes in the trends for four measures of austerity (the Alesina-Ardagna Fiscal Index, real per capita government expenditure, public social spending and the cyclically adjusted primary balance) will be identified and the cumulative difference in exposure to these measures thereafter will be calculated. These will be regressed against the difference in the mean annual change in life expectancy, mortality rates and lifespan variation compared with the previous trends, with an initial lag of 2 years after the identified change point in the exposure measure. The role of underemployment and individual incomes as outcomes in their own right and as mediating any relationship between austerity and mortality will also be considered. Sensitivity analyses varying the lag period to 0 and 5 years, and adjusting for recession, will be undertaken.Ethics and disseminationAll of the data used for this study are publicly available, aggregated datasets with no individuals identifiable. There is, therefore, no requirement for ethical committee approval for the study. The study will be lodged within the National Health Service research governance system. All results of the study will be published following sharing with partner agencies. No new datasets will be created as part of this work for deposition or curation.

scholarly journals Nephrotoxicity of concomitant piperacillin/tazobactam and teicoplanin compared with monotherapy

2020 ◽  
Vol 76 (1) ◽  
pp. 212-219
Author(s):  
J D Workum ◽  
C Kramers ◽  
E Kolwijck ◽  
J A Schouten ◽  
S N de Wildt ◽  
...  
Keyword(s):  
Renal Function ◽  
Serum Creatinine ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Linear Regression Analysis ◽  
Kidney Injury ◽  
Secondary Outcome ◽  
Multivariate Linear Regression Analysis ◽  
Single Centre ◽  
Health Records

Abstract Objectives Piperacillin/tazobactam combined with vancomycin has been associated with a decline in renal function when compared with monotherapy. Teicoplanin is a glycopeptide similar to vancomycin. We investigated whether piperacillin/tazobactam combined with teicoplanin is associated with a decline in renal function as well. Methods We conducted a single-centre retrospective cohort study with data from our electronic health records from 9 August 2013 to 15 November 2019, including all adult patients that received either piperacillin/tazobactam, teicoplanin or piperacillin/tazobactam + teicoplanin. The incidence of acute kidney injury (AKI) at 48–72 h served as the primary outcome, whereas change in serum creatinine served as a secondary outcome. Results Of the 4202 included patients, 3188 (75.9%) received piperacillin/tazobactam, 791 (18.8%) received teicoplanin and 223 (5.3%) received piperacillin/tazobactam + teicoplanin. The incidence of AKI at 48–72 h after commencement of antibiotic therapy was 5.4% for piperacillin/tazobactam, 3.4% for teicoplanin and 11.7% for piperacillin/tazobactam + teicoplanin (P &lt; 0.001). However, mean serum creatinine at 48–72 h was slightly higher in the piperacillin/tazobactam + teicoplanin group therapy compared with baseline [+1.61% (95% CI –2.25 to 5.70)], indicating a slight decrease in renal function, and decreased for piperacillin/tazobactam [–1.98% (95% CI –2.73 to –1.22)] and teicoplanin [–8.01% (95% CI –9.54 to –6.45)]. After correcting for significant confounders in a multivariate linear regression analysis, these patterns remained. Conclusions Our study suggests that piperacillin/tazobactam + teicoplanin is associated with a higher prevalence of AKI compared with monotherapy. However, as the overall decline in renal function with piperacillin/tazobactam + teicoplanin is very small, its clinical relevance is likely limited. Therefore, piperacillin/tazobactam + teicoplanin can probably be safely combined.

Abstract 16654: Covid - 19 - Acute Myocardial Infarction and Heart Failure Mortality Trends in a Non-epicenter Region

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mahathi Indaram ◽  
Mark Doyle ◽  
Sarah Wiswall ◽  
Indu G Poornima
Keyword(s):  
Heart Failure ◽  
Mortality Rate ◽  
Hospital Admissions ◽  
Acute Decompensated Heart Failure ◽  
Mortality Rates ◽  
Absolute Number ◽  
Delayed Presentation ◽  
Mortality Trends ◽  
True Incidence ◽  
The Absolute

Introduction: As the novel coronavirus gained acceleration, there are several reports of a decreasing number of hospital admissions for acute myocardial infarctions (AMI) worldwide. It is unclear if this is due to an actual decrease in their incidence or due to patients avoiding hospital visits during the pandemic. We examined the trends in admissions for AMI, acute decompensated heart failure (HF) and their associated mortality in an integrated health system (7 hospitals) in Pittsburgh (Pennsylvania), a non-epicenter region. Hypothesis: If patients are presenting late due to avoiding hospitals, AMI and HF would be associated with increased mortality rates. Methods: We collected data on the total number of admissions and deaths related to AMI (ST and non-ST elevation), HF using ICD-10 codes, during the period of January-April 2020. We compared this with data from the same period in 2018, 2019. Mortality rate was calculated as deaths per 100 admissions. Results: There were 505 AMI admissions in January-April 2020 and 37 died compared to 23 deaths amongst 645 admissions in the same period of 2018 and 2019 (averaged). Similarly, there were 1030 HF admissions in January-April 2020 and 46 died in comparison to 39 deaths amongst 1280 admissions in 2018 and 2019 (averaged). The absolute number of AMI and HF admissions was lower in 2020 (p<0.05, p<0.01). There was no difference in absolute number of deaths attributed to HF or AMI between 2020 and the preceding years (p=0.3). However, mortality rate was higher for HF in 2020 compared to prior 2 years. Conclusions: In this non-epicenter region, there was a significant decrease in admissions for AMI and HF in 2020 compared to 2018-2019 while the absolute number of deaths were similar. Similar mortality rates for AMI across the years suggests that patients were presenting appropriately and that the true incidence was likely low. However, higher mortality rate with HF may suggest a delayed presentation albeit without accounting for confounders.

Vigilance Aid Use and Aircraft Carrier Landing Performance in Pilots of Tactical Aircraft

2020 ◽  
Vol 91 (6) ◽  
pp. 518-524
Author(s):  
Craig S. Schallhorn
Keyword(s):  
Primary Outcome ◽  
Linear Regression Analysis ◽  
Secondary Outcome ◽  
Outcome Analysis ◽  
Multivariate Linear Regression Analysis ◽  
Operational Environment ◽  
Aircraft Carrier ◽  
Mixed Effect ◽  
Flight Operations ◽  
Objective Evidence

BACKGROUND: Fatigue is a well-known hazard in aviation. In military fighter communities, policies have evolved to allow for in-flight use of pharmacological vigilance aids to counteract the negative effects of fatigue. With limited objective evidence supporting the role of these medications in continuous flight operations, the present study seeks to evaluate whether use of modafinil is associated with pilot aircraft carrier landing performance.METHODS: A retrospective, observational study was completed following carrier-based flight operations in support of Operation Inherent Resolve. All graded landing passes were included in the analysis. Mixed-effect multivariate linear regression analysis was utilized for the primary outcome of landing signal officer grade of landing performance following combat sorties for events with reported in-flight use of modafinil.RESULTS: A total of 1122 sorties were flown by 79 different pilots with an average landing pass grade of 3.86. The primary outcome of modafinil use in-flight was not generally associated with landing performance. In a subset analysis of more senior ranked aviators, modafinil use appeared to offer a relative performance improvement back to baseline (+0.19). Secondary outcome analysis revealed landing performance was associated with advanced landing technologies (+0.25), sorties later in deployment (+0.05 per 30 d), total career carrier landings (+0.03 per 100 traps), and longer mission duration (-0.04 per hour).DISCUSSION: In the context of evidence supporting subjective benefits of vigilance aid use by aircrew, the results of this study provide ample objective support to the controlled use of modafinil in the operational environment.Schallhorn CS. Vigilance aid use and aircraft carrier landing performance in pilots of tactical aircraft. Aerosp Med Hum Perform. 2020; 91(6):518–524.

scholarly journals Effects of health and social care spending constraints on mortality in England: a time trend analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e017722 ◽  
Author(s):  
Johnathan Watkins ◽  
Wahyu Wulaningsih ◽  
Charlie Da Zhou ◽  
Dominic C Marshall ◽  
Guia D C Sylianteng ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Time Trend ◽  
Social Care ◽  
Care Home ◽  
Mortality Rates ◽  
Care Homes ◽  
Annual Data ◽  
Macroeconomic Factors ◽  
Health And Social Care ◽  
Per Capita

ObjectiveSince 2010, England has experienced relative constraints in public expenditure on healthcare (PEH) and social care (PES). We sought to determine whether these constraints have affected mortality rates.MethodsWe collected data on health and social care resources and finances for England from 2001 to 2014. Time trend analyses were conducted to compare the actual mortality rates in 2011–2014 with the counterfactual rates expected based on trends before spending constraints. Fixed-effects regression analyses were conducted using annual data on PES and PEH with mortality as the outcome, with further adjustments for macroeconomic factors and resources. Analyses were stratified by age group, place of death and lower-tier local authority (n=325). Mortality rates to 2020 were projected based on recent trends.ResultsSpending constraints between 2010 and 2014 were associated with an estimated 45 368 (95% CI 34 530 to 56 206) higher than expected number of deaths compared with pre-2010 trends. Deaths in those aged ≥60 and in care homes accounted for the majority. PES was more strongly linked with care home and home mortality than PEH, with each £10 per capita decline in real PES associated with an increase of 5.10 (3.65–6.54) (p<0.001) care home deaths per 100 000. These associations persisted in lag analyses and after adjustment for macroeconomic factors. Furthermore, we found that changes in real PES per capita may be linked to mortality mostly via changes in nurse numbers. Projections to 2020 based on 2009-2014 trend was cumulatively linked to an estimated 152 141 (95% CI 134 597 and 169 685) additional deaths.ConclusionsSpending constraints, especially PES, are associated with a substantial mortality gap. We suggest that spending should be targeted on improving care delivered in care homes and at home; and maintaining or increasing nurse numbers.

THE EPIDEMIOLOGY OF HEALTH AND SOCIAL CARE COST AND CAPACITY SHOCKS

2021 ◽  
Author(s):  
Rodney P Jones
Keyword(s):  
Social Care ◽  
Hospital Admissions ◽  
Absolute Number ◽  
Human Pathogens ◽  
Health And Social Care ◽  
The World ◽  
High Utilization ◽  
The Absolute ◽  
Area Health

The financial and capacity pressures experienced by hospitals and social care organisations are far higher than has been realized. End-of-life is a time of high utilization of acute and social care. The absolute number of deaths (and its year-to-year variation) then acts to drive the marginal pressures in both capacity and costs for these organisations. Higher weighted population density is associated with higher year-to-year volatility in deaths, hospital admissions and sickness absence, which seems to work via a multitude of (local) infectious outbreaks from the >2,000 known species of human pathogens. The funding formulae used to distribute money to area health boards and social care organisations around the world do not generally contain any recognition for the role of the absolute number of deaths in the costs incurred by such organisations. A far more nuanced approach is required by governments around the world to equalising these pressures which are beyond the control of the organisations involved in delivering health and social care.

scholarly journals Specialist nursing support for unpaid carers of people with dementia: a mixed-methods feasibility study

2019 ◽  
Vol 7 (12) ◽  
pp. 1-198 ◽  
Author(s):  
Kate Gridley ◽  
Fiona Aspinal ◽  
Gillian Parker ◽  
Helen Weatherly ◽  
Rita Faria ◽  
...  
Keyword(s):  
Data Collection ◽  
Usual Care ◽  
Social Care ◽  
Cross Sectional ◽  
Data Set ◽  
Nursing Support ◽  
Care Services ◽  
People With Dementia ◽  
Health And Social Care ◽  
Collection Methods

Background Unpaid carers are the mainstay of support for people with dementia. Admiral Nursing (AN) is the only specialist nursing service that specifically focuses on supporting such carers, but evidence of its effectiveness, costs and relationships with other health and social care services is limited. This project aimed to address this gap and explore the feasibility of a full-scale formal evaluation. Objectives To explore the relationships between characteristics of carers and people with dementia, service type and input and outcomes; to develop and test data collection methods for subsequent economic evaluation; to explore the effect of AN on outcomes and costs, compared with usual care; to explore the perceived system-wide impact of specialist support for carers of people with dementia, compared with usual care; and to implement new data collection methods in AN, which could also be used by other services, to facilitate evaluation. Design A mixed-methods study, using secondary analysis of an administrative data set, and primary (cross-sectional) quantitative and qualitative data collection. Setting Qualitative research with carers in four areas of England; a survey of carers in 32 local authority areas (16 with and 16 without AN); and qualitative interviews with professionals in four areas. Participants Thirty-five carers of people with dementia and 20 professionals were interviewed qualitatively; 346 carers completed in-scope questionnaires (46% through AN services and 54% from matched non-AN areas). Interventions Specialist nursing support for carers of people with dementia (with AN as an exemplar) compared with usual care. Main outcome measures The Adult Social Care Outcomes Toolkit for Carers; the EuroQol-5 Dimensions, five-level version; and the Caregiver Self-Efficacy for Managing Dementia Scale. Data sources Dementia UK’s AN administrative data set. Results Admiral Nurses are successfully targeting the most complex cases. They work predominantly with older carers who have the main responsibility for the person with dementia, who are heavily involved in caring activity and who may be at risk. Three outcome areas that are important to carers of people with dementia and are potentially affected by receiving support are (1) carer self-efficacy, (2) carer quality of life (3) and carer mental and physical health. The carers in the survey receiving support from AN were older, were more heavily involved in caring and had poorer outcomes than carers not in receipt of such support. When these differences were controlled for, carers supported by AN had better outcomes, although the differences did not reach statistical significance. Health and social care costs were similar in both groups. The perceived system-wide impact of services, such as AN, is not well understood by professional stakeholders. Limitations Challenges were experienced in identifying similar carers in areas with or without an AN service and in the cross-sectional nature of the work. Conclusions Specialist nursing support to carers of people with dementia may enable them to continue providing care to the end or very close to the end of the dementia journey. The outcomes for such carers may be no different from, or even slightly better than, those of similar carers without this support, although the costs to health and social care services are the same in each case. Future work Future research could investigate the impact of specialist support for carers on admission to long-term care. There is also a need for more work to encourage routine use of the selected outcome measures in dementia service delivery. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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