Children and Young People’s Health Partnership Evelina London Model of Care: economic evaluation protocol of a complex system change

IntroductionThe Children and Young People’s Health Partnership (CYPHP) Evelina London Model of Care is a new approach to integrated care delivery for children and young people (CYP) with common health complaints and chronic conditions. CYPHP includes population health management (services shaped by data-driven understanding of population and individual needs, applied in this case to enable proactive case finding and tailored biopsychosocial care), specialist clinics with multidisciplinary health teams and training resources for professionals working with CYP. This complex health system strengthening programme has been implemented in South London since April 2018 and will be evaluated using a cluster randomised controlled trial with an embedded process evaluation. This protocol describes the within-trial and beyond-trial economic evaluation of CYPHP.Methods and analysisThe economic evaluation will identify, measure and value resources and health outcome impacts of CYPHP compared with enhanced usual care from a National Health Service/Personal Social Service and a broader societal perspective. The study population includes 90 000 CYP under 16 years of age in 23 clusters (groups of general practitioner (GP) practices) to assess health service use and costs, with more detailed cost-effectiveness analysis of a targeted sample of 2138 CYP with asthma, eczema or constipation (tracer conditions). For the cost-effectiveness analysis, health outcomes will be measured using the Paediatric Quality of Life Inventory and quality-adjusted life years (QALYs) using the Child Health Utility 9 Dimensions (CHU-9D) measure. To account for changes in parental well-being, the Warwick-Edinburg Mental Well-being Scale will be integrated with QALYs in a cost–benefit analysis. The within-trial economic evaluation will be complemented by a novel long-term model that expands the analytical horizon to 10 years. Analyses will adhere to good practice guidelines and National Institute for Health and Care Excellence public health reference case.Ethics and disseminationThe study has received ethical approval from South West-Cornwall and Plymouth Research Ethics Committee (REC Reference: 17/SW/0275). Results will be submitted for publication in peer-reviewed journals, made available in briefing papers for local decision-makers, and provided to the local community through website and public events. Findings will be generalisable to community-based models of care, especially in urban settings.Trial registration numberNCT03461848.

Distributed urban drag parameterization in the sub-kilometre scale London Model

<p>Urban environments in numerical weather prediction models are currently parameterised as part of the atmosphere-surface exchange at ground-level. The vertical structure of buildings is represented by the average height, which does not account for heterogeneous building forms at the subgrid-level. The use of city-scale models with sub-kilometre resolutions and growing number of high-rise buildings in cities call for a better vertical representation of urban environments.</p><p>We present the use of a newly developed, height-distributed urban drag parameterization with the London Model, a high-resolution version of the Met Office Unified Model over Greater London and surroundings at approximately 333 m resolution. The distributed drag parameterization requires vertical morphology profiles in form of height-distributed frontal area functions, which capture the full extent and variability of building-heights. These morphology profiles were calculated for Greater London and parameterised by an exponential distribution with the ratio of maximum to mean building-height as parameter.</p><p>A case study with the high-resolution London Model and the new drag parameterization appears to capture more realistic features of the urban boundary layer compared to the standard parameterization. The simulation showed increased horizontal spatial variability in total surface stress, identifying a broad range of morphology features (densely built-up areas, high-rise building clusters, parks and the river). Vertical effects include heterogeneous wind profiles, extended building wakes, and indicate the formation of internal boundary layers. This study demonstrates the potential of height-distributed urban parameterizations to improve urban weather forecasting, albeit research into distribution of heat- and moisture-exchange is necessary for a fully distributed parameterization of urban areas.</p>

A study on the aromaticity and magnetic properties of N-confused porphyrins

In this paper, topological resonance energy (TRE) methods were used to describe the global aromaticity of nitrogen confused porphyrin (NCP) isomers. The TRE results show that all NCP isomers exhibit lower aromaticity than the normal porphyrins, and their aromaticity decreases as the number of confused pyrrole rings in the molecule increases. In the NCPs, global aromaticity decreases as the distance between the nitrogen atoms increases. The bond resonance energy (BRE) and circuit resonance energy (CRE) indices were applied to study local aromaticity and conjugated pathways. Both the BRE and CRE indices revealed that individual pyrrolic subunits maintain their strong aromatic character and are the main source of global aromaticity. Ring currents (RC) were analysed using the Hückel–London model. RC results revealed that the macrocyclic electron conjugation pathway is the main source of diatropicity. As the number of confused pyrrole rings in the molecule increases, its diatropicity gradually decreases. In the confused pyrrole rings of the NCP isomers, the diatropic RC passing through the β -positions is always weaker than that passing through the inner sections. This is unrelated to the location of the protonated or non-protonated nitrogen atom at the periphery of the molecule and must be ascribed to the unique properties of the confused pyrrole rings.

The Children and Young People’s Health Partnership Evelina London Model of Care: process evaluation protocol

IntroductionChildren and young people (CYP) in the UK have poor health outcomes, and there is increasing emergency department and hospital outpatient use. To address these problems in Lambeth and Southwark (two boroughs of London, UK), the local Clinical Commissioning Groups, Local Authorities and Healthcare Providers formed The Children and Young People’s Health Partnership (CYPHP), a clinical-academic programme for improving child health. The Partnership has developed the CYPHP Evelina London model, an integrated healthcare model that aims to deliver effective, coordinated care in primary and community settings and promote better self-management to over approximately 90 000 CYP in Lambeth and Southwark. This protocol is for the process evaluation of this model of care.Methods and analysisAlongside an impact evaluation, an in-depth, mixed-methods process evaluation will be used to understand the barriers and facilitators to implementing the model of care. The data collected mapped onto a logic model of how CYPHP is expected to improve child health outcomes. Data collection and analysis include qualitative interviews and focus groups with stakeholders, a policy review and a quantitative analysis of routine clinical and administrative data and questionnaire data. Information relating to the context of the trial that may affect implementation and/or outcomes of the CYPHP model of care will be documented.Ethics and disseminationThe study has been reviewed by NHS REC Cornwall & Plymouth (17/SW/0275). The findings of this process evaluation will guide the scaling up and implementation of the CYPHP Evelina London Model of Care across the UK. Findings will be disseminated through publications and conferences, and implementation manuals and guidance for others working to improve child health through strengthening health systems.Trial registration numberNCT03461848

Children and Young People’s Health Partnership (CYPHP) Evelina London model of care: protocol for an opportunistic cluster randomised controlled trial (cRCT) to assess child health outcomes, healthcare quality and health service use

IntroductionChildren and young people (CYP) in many high-income settings have poor healthcare outcomes, especially those with long-term conditions (LTCs). Emergency and outpatient hospital service use is increasing unsustainably. To address these problems, the Children and Young People’s Health Partnership (CYPHP) has developed and is evaluating an integrated model of care as part of a health systems strengthening programme across two boroughs of London, UK that are characterised by mixed ethnic populations and varying levels of deprivation. The CYPHP Evelina London model of care comprises proactive case-finding and triage, specialist clinics and transformative education and training for professionals working with CYP. Services are delivered by multidisciplinary health teams with an emphasis on increased coordination across primary, community and hospital settings and integration of physical and mental healthcare that accounts for the CYP’s social context.Methods and analysisThe phased roll out of the CYPHP Evelina London model allows an opportunistic population-based evaluation using a cluster randomised controlled trial design. Seventy general practices across two London boroughs, grouped into 23 clusters, were randomised to provide either the CYPHP model of care (n=11) or enhanced usual care (n=12).The evaluation will measure the impact of the CYPHP Evelina London model of care on child and parent health and well-being, healthcare quality and health service use up to 2 years postimplementation. A population-level evaluation will use routinely collected pseudonymised healthcare data to conduct a service-use analysis for all CYP registered with a participating general practice (n=~90 000) with the rate of non-elective admissions as the primary outcome. We will seek consent from a subset of this population, with specific conditions (target n=2138) to assess the impact on patient-reported outcomes using the Paediatric Quality of Life Inventory (PedsQL) and Warwick-Edinburgh Mental Well-Being Scale (WEBWMS) as, respectively, the child- and parent-related primary outcomes.Ethics and disseminationEthics approval obtained from South West-Cornwall & Plymouth Research Ethics Committee. Results will be submitted for publication in peer-reviewed journals. Findings will be generalisable to community-based models of care, especially in urban settings. Our process evaluation will identify barriers and enablers of implementation and delivery of care salient to the context and condition.Trial registration numberNCT03461848; Pre-results.