Kamlesh Khunti, Director, NIHR CLAHRC East Midlands

CLAHRC East Midlands is hosted by

Nottinghamshire Healthcare

Introduction to

NIHR CLAHRC East Midlands

East Midlands

Prevalance of Long Term Conditions • 15 million with LTC• 70% NHS Budget

NHS Outcomes Framework 5 Domains

 • Preventing people from dying prematurely • Enhancing quality of life for people with long-term conditions• Helping people to recover from episodes of ill-health or following injury• Ensuring that people have a positive experience of care; and• Treating and caring for people in a safe environment; and protecting them from avoidable

harm

 

Public Health England Priorities 2013/4

 • Reducing preventable deaths• Reducing the burden of disease• Protecting the country's health• Giving children and young people the best start in life• Improving health in the workplace

 

Department of Health Priorities for the East Midlands (Set out in the East Midlands Health Strategy 2009)

 

“The priorities for the East Midlands are to address health inequalities, levels of tobacco use, harmful alcohol use, obesity, physical activity, avoidable injury and death, affordable warmth and the health of children and young people.”

Key National and Local Priorities

CLAHRC Interview 3rd July 2013

CLAHRC LNR & NDL

BITEs & Evidence summaries

Implementing Evidence Based Stroke Early Supported Discharge Services

Dr Rebecca Fisher & Professor Marion Walker

On behalf of the ESD research team, CLAHRC NDL

CLAHRC East Midlands is hosted by

Nottinghamshire Healthcare

• ESD - multidisciplinary intervention providing transfer of care from hospital to home and early, specialist rehabilitation in the home

• Clinical trial data and meta-analyses show ESD is effective

• Yet, wide levels of variation in the accessibility and quality of care and support provided to people after they have been transferred home (Care Quality Commission: Supporting Life after Stroke 2011)

Objectives

• Knowledge Creation: International ESD consensus document2 that defined core components of an evidence based ESD service and national consensus document on implementation of evidence based community stroke services3

• Knowledge Use: Identified and addressed contextual factors associated with implementation of ESD based on perspectives of patients, carers4, service providers and commissioners5

Outputs

Knowledge to Action Model Graham et al 2006

2. Fisher RJ et al. Stroke 2011; 3. Fisher RJ et al. Clinical Rehabilitation 2013; 4. Cobley CS et al. Clinical Rehabilitation 2013; 5. Chouliara N et al. Clinical Rehabilitation 2013

• Implementation interventions: Designed and delivered interactive workshops focused on ‘Eligibility for ESD’ and ‘Effective Data handling’ to facilitate evidence based practice

Impact

…. has led to the hospital team routinely recording accurate data and robust information on patient discharge destination, rehab potential and improved ability to analyze patient flow. Stroke database manager

• Evaluated outcomes: measured the effectiveness of evidence based ESD services in practice

• ESD group (n=135) had significantly shorter length of hospital stay and accelerated improvement in activities of daily living compared to Non ESD group (n=158) (Paper in prep)

• Collaborative working with the East Midlands Strategic Clinical Network has been formally established as a strategic partnership within the EMAHSN (workstream 2: service improvement)

• Community Stroke Service specification development to inform commissioning of a whole pathway of community services for stroke survivors in the East Midlands

• Mapping exercise to identify gaps and inequity in service provision; conducting dedicated workshops with commissioners to support service improvement

• Educational programme to be delivered to community stroke teams across the East Midlands to support the implementation of services and sustain evidence based practice

Platform for EMAHSN Stroke Theme

Development of a self assessed risk score for diabetes and those

at risk of diabetes Laura Grey, Kamlesh Khunti, Melanie Davies

CLAHRC LNR

CLAHRC East Midlands is hosted by

Nottinghamshire Healthcare

Leicester Diabetes Risk Score

Gray L.J, et al Diabetic Med 2010

NICE PDG 38

Implementation

Where can I complete the assessment?

AHSN Implementation

Adaptation

Contributions from Matched Funding

• Improve patient outcomes through applied health research • Build on the substantial achievements of the LNR and NDL

CLAHRCs • Bring together health providers, commissioners, patient

groups, health and research networks, life science industries and academic institutions to support the NHS to meet locally identified priorities

• Develop a understanding of the necessary and desirable conditions for the uptake of research findings and spread of evidence-based practices

• Increase capacity

CLAHRC EM Objectives

• All CLAHRC EM projects selected using the following criteria:– Have strong interest and engagement from services and commissioners

across EM– Involve co-production between researchers and those expected to use or

benefit from the findings– Address important issues in chronic disease and public health– Deliver significant reductions in service demand, improved service quality

and/or efficiency gains– Include plans for the adoption of findings, in collaboration with the EM AHSN.

• All CLAHRC EM projects will be disseminated in partnership with EM AHSN to CCGs and trusts with a view to wider implementation.

Our Offer to Partners

• Research and implementation achievements• Collaborations with other CLAHRCs• Impact on healthcare provision• Patient and Public Involvement• Links with the NIHR Infrastructure including

external funding awards• Links with Industry including external funding

awards• No of Projects• No of subjects recruited to projects• No and list of publications• Training carried out and formal qualifications

awarded

NIHR Requirements for CLAHRC EM

As well as our projects we will also offer :• Host 30+ NHS staff on placements• Support 30-40 full or part time PhD studentships for both clinical and non-

clinical researchers• Offer a range of direct and online learning courses for NHS Staff in areas

such as using evidence and PPI• Responsive model for evaluations• CLAHRC EM’s partners will be involved in the organisation’s

management through its Governance Board, Executive and Patient and Public Partners Board.

• Generic Partnership support to NHS Partners e.g. Keogh Trusts• Centre for Ethnic Health

Our Offer to Partners

CLAHRC EM Structure

Mission Statement

Thank you for listening

kk22@le.ac.uk

www.clahrc-em.nihr.ac.uk

@CLAHRC_EM

This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care East Midlands (NIHR CLAHRC EM). The views expressed in this

presentation are those of the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.