Improving lives, saving lives – identifying research challenges
The purpose of this Fellowship was to help fill in the gaps in the research on the best interventions to enable the effective implementation of the eleven pledges as set out in ‘Towards the best together’.
Roy Marsh worked alongside the pledge leads and their team to identify and categorise the research evidence required to support interventions, and to develop research questions and areas for innovation where the evidence is weak. The Fellowship aimed to enable the team to produce publications for peer reviewed journals where NHS data can support arguments for interventions in pledge areas.
Fellowship Progress Report, Roy Marsh, July 2010
I am a Research Fellow with the NHS East of England (formerly known as the Strategic Health Authority), attached to the Public Health Directorate in Cambridge.
The first fifty percent of my work is fairly conventional, consisting of doing rapid evidence assessments on key health issues facing the regional public health strategy. The aim is to help the Clinical Programme Managers to make sure their decisions are based on complete and reliable information. The reviews I have done (some completed, some ongoing) are:
- The impact of Point of Care Testing devices and community-diagnostics on health service delivery, patterns of use and patient experience.
- The impacts of introducing Personal Health Plans (a key element of the ‘patient choice’ agenda), focusing on health outcomes for patients with long term conditions.
- The reasons for parent and child attendance at A & E with non-urgent conditions.
- How to promote 'healthy behaviour' in physical activity, nutrition, smoking, drinking.
- How care home residents can become more involved in decision-making about their own care.
- The cost-effectiveness of psychological treatment for somatically-affected conditions and for MUS (medically unexplained symptoms).
- How to improve the engagement with the health care services of eight marginalised social groups.
The body of evidence is vast, covering systematic reviews, controlled trials, focus groups, audits, service evaluations, cost-effectiveness studies, retrospective data analyses, and so on. Partly it’s a matter of assessing and interpreting what is already highly visible in the academic world of peer-reviewed publications and partly, it’s a matter of networking and fact-finding in the under-reported world of ‘grey literature’ (Primary Care Trusts reports, conference proceedings, etc.). The finished reviews will, of course, be publicly available.
However, the real challenge is the other fifty percent of my work. This is not just finding the evidence, but making sure it is both useful and usable. For example, systematic reviews are fairly static documents, whose applicabililty to front-line health service managers is difficult to gauge. How can the information in them be presented more dynamically and interactively, empowering information-users to both use and contribute to a pool of ‘validated common knowledge?’
Putting this another way – what kind of rapid evidence-assessment is of genuine help in health service decision-suppport? What changes could be made to the review process to enable this? And how in practice can the academic and health service worlds be helped to share their different experience and expertise?
What would it take for the health services to genuinely lead on applied research studies, instead of simply signing off studies that originate in academia? Is it all a case of treading familiar tracks, setting up yet another professional network or web bulletin board in the hope that this time someone will actually use it? The answers – I hope – will emerge in the next three months.