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Mellor J, Christie R, Overton CE, Paton RS, Leslie R, Tang M, Deeny S, Ward T. Forecasting influenza hospital admissions within English sub-regions using hierarchical generalised additive models. COMMUNICATIONS MEDICINE 2023; 3:190. [PMID: 38123630 PMCID: PMC10733380 DOI: 10.1038/s43856-023-00424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Seasonal influenza places a substantial burden annually on healthcare services. Policies during the COVID-19 pandemic limited the transmission of seasonal influenza, making the timing and magnitude of a potential resurgence difficult to ascertain and its impact important to forecast. METHODS We have developed a hierarchical generalised additive model (GAM) for the short-term forecasting of hospital admissions with a positive test for the influenza virus sub-regionally across England. The model incorporates a multi-level structure of spatio-temporal splines, weekly cycles in admissions, and spatial correlation. Using multiple performance metrics including interval score, coverage, bias, and median absolute error, the predictive performance is evaluated for the 2022-2023 seasonal wave. Performance is measured against autoregressive integrated moving average (ARIMA) and Prophet time series models. RESULTS Across the epidemic phases the hierarchical GAM shows improved performance, at all geographic scales relative to the ARIMA and Prophet models. Temporally, the hierarchical GAM has overall an improved performance at 7 and 14 day time horizons. The performance of the GAM is most sensitive to the flexibility of the smoothing function that measures the national epidemic trend. CONCLUSIONS This study introduces an approach to short-term forecasting of hospital admissions for the influenza virus using hierarchical, spatial, and temporal components. The methodology was designed for the real time forecasting of epidemics. This modelling framework was used across the 2022-2023 winter for healthcare operational planning by the UK Health Security Agency and the National Health Service in England.
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Affiliation(s)
- Jonathon Mellor
- UK Health Security Agency, Data Analytics and Surveillance, 10 South Colonnade, London, United Kingdom.
| | - Rachel Christie
- UK Health Security Agency, Data Analytics and Surveillance, 10 South Colonnade, London, United Kingdom
| | - Christopher E Overton
- UK Health Security Agency, Data Analytics and Surveillance, 10 South Colonnade, London, United Kingdom
- University of Liverpool, Department of Mathematical Sciences, Liverpool, United Kingdom
| | - Robert S Paton
- UK Health Security Agency, Data Analytics and Surveillance, 10 South Colonnade, London, United Kingdom
| | - Rhianna Leslie
- UK Health Security Agency, Data Analytics and Surveillance, 10 South Colonnade, London, United Kingdom
| | - Maria Tang
- UK Health Security Agency, Data Analytics and Surveillance, 10 South Colonnade, London, United Kingdom
| | - Sarah Deeny
- UK Health Security Agency, Data Analytics and Surveillance, 10 South Colonnade, London, United Kingdom
| | - Thomas Ward
- UK Health Security Agency, Data Analytics and Surveillance, 10 South Colonnade, London, United Kingdom
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Comparing registered and resident populations in Primary Care Networks in England: an observational study. BJGP Open 2022; 6:BJGPO.2022.0037. [PMID: 35977734 PMCID: PMC9904774 DOI: 10.3399/bjgpo.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/02/2022] [Accepted: 07/13/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Primary Care Networks (PCNs) were established in England in 2019 and will play a key role in providing care at a neighbourhood level within integrated care systems (ICSs). AIM To identify PCN 'catchment' areas and compare the overlap between registered and resident populations of PCNs. DESIGN & SETTING Observational study using publicly available data on the number of people within each Lower layer Super Output Area (LSOA) registered to each general practice in England in April 2021. METHOD LSOAs were assigned to the PCN to which the majority of residents were registered. The PCN catchment population was defined as the total number of people resident in all LSOAs assigned to that PCN. The PCN catchment populations were compared with the population of people registered to a GP practice in each PCN. RESULTS In April 2021, 6506 GP practices were part of 1251 PCNs, with 56.1% of PCNs having 30 000-50 000 registered patients. There was a strong correlation (0.91) between the total registered population size and catchment population size. Significant variation was found in the percentage of residents in each LSOA registered to a GP practice within the same PCN catchment, and strong associations were found with both urban and rural status, and socioeconomic deprivation. CONCLUSION There exists significant variation across England in the overlap between registered and resident (catchment) populations in PCNs, which may impact on integration of care in some areas. There was less overlap in urban and more deprived areas, which could exacerbate existing health inequalities.
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Beaney T, Clarke JM, Grundy E, Coronini-Cronberg S. A picture of health: determining the core population served by an urban NHS hospital trust and understanding the key health needs. BMC Public Health 2022; 22:75. [PMID: 35022003 PMCID: PMC8753015 DOI: 10.1186/s12889-021-12373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 12/02/2021] [Indexed: 11/11/2022] Open
Abstract
Background NHS hospitals do not have clearly defined geographic populations to whom they provide care, with patients able to attend any hospital. Identifying a core population for a hospital trust, particularly those in urban areas where there are multiple providers and high population churn, is essential to understanding local key health needs especially given the move to integrated care systems. This can enable effective planning and delivery of preventive interventions and community engagement, rather than simply treating those presenting to services. In this article we describe a practical method for identifying a hospital’s catchment population based on where potential patients are most likely to reside, and describe that population’s size, demographic and social profile, and the key health needs. Methods A 30% proportional flow method was used to identify a catchment population using an acute hospital trust in West London as an example. Records of all hospital attendances between 1st April 2017 and 31st March 2018 were analysed using Hospital Episode Statistics. Any Lower Layer Super Output Areas where 30% or more of residents who attended any hospital for care did so at the example trust were assigned to the catchment area. Publicly available local and national datasets were then applied to identify and describe the population’s key health needs. Results A catchment comprising 617,709 people, of an equal gender-split (50.4% male) and predominantly working age (15 to 64 years) population was identified. Thirty nine point six percent of residents identified as being from Black and Minority Ethnic (BAME) groups, a similar proportion that reported being born abroad, with over 85 languages spoken. Health indicators were estimated, including: a healthy life expectancy difference of over twenty years; bowel cancer screening coverage of 48.8%; chlamydia diagnosis rates of 2,136 per 100,000; prevalence of visible dental decay among five-year-olds of 27.9%. Conclusions We define a blueprint by which a catchment can be defined for a hospital trust and demonstrate the value a hospital-view of the local population could provide in understanding local health needs and enabling population-level health improvement interventions. While an individual approach allows tailoring to local context and need, there could be an efficiency saving were such public health information made routinely and regularly available for every NHS hospital. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12373-5.
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Watson G, Pickard L, Williams B, Hargreaves D, Blair M. 'Do I, don't I?' A qualitative study addressing parental perceptions about seeking healthcare during the COVID-19 pandemic. Arch Dis Child 2021; 106:1118-1124. [PMID: 33692082 PMCID: PMC7948150 DOI: 10.1136/archdischild-2020-321260] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND Paediatric emergency departments have seen reduced attendance during the COVID-19 pandemic. Late paediatric presentations may lead to severe illness and even death. Maintaining provision of healthcare through a pandemic is essential. This qualitative study aims to identify changing care-seeking behaviours in child health during the pandemic and ascertain parental views around barriers to care. METHODS Semistructured interviews were conducted with caregivers of children accessing acute paediatric services in a hospital in North-West London. Thematic content analysis was used to derive themes from the data, using a deductive approach. RESULTS From interviews with 15 caregivers an understanding was gained of care-seeking behaviours during the pandemic. Themes identified were; influencers of decision to seek care, experience of primary care, other perceived barriers, experiences of secondary care, advice to others following lived experience. Where delays in decision to seek care occurred this was influenced predominantly by fear, driven by community perception and experience and media portrayal. Delays in reaching care were focused on access to primary care and availability of services. Caregivers were happy with the quality of care received in secondary care and would advise friends to seek care without hesitation, not to allow fear to delay them. CONCLUSION A pandemic involving a novel virus is always a challenging prospect in terms of organisation of healthcare provision. This study has highlighted parental perspectives around access to care and care-seeking behaviours which can inform us how to better improve service functioning during such a pandemic and beyond into the recovery period.
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Affiliation(s)
- Gabriella Watson
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Lucy Pickard
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Bhanu Williams
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
| | - Dougal Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Mitch Blair
- Department of Paediatrics, London North West Healthcare NHS Trust, Harrow, London, UK
- Paediatrics, Imperial College London, Harrow, UK
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Olsen F, Balteskard L, Uleberg B, Jacobsen BK, Heuch I, Moen A. Impact of parents' education on variation in hospital admissions for children: a population-based cohort study. BMJ Open 2021; 11:e046656. [PMID: 34158300 PMCID: PMC8220478 DOI: 10.1136/bmjopen-2020-046656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assess the impact of parental educational level on hospital admissions for children, and to evaluate whether differences in parents' educational level can explain geographic variation in admission rates. DESIGN National cohort study. SETTING The 18 hospital referral areas for children in Norway. PARTICIPANTS All Norwegian children aged 1-16 years in the period 2008-2016 and their parents. MAIN OUTCOME MEASURES Age- and gender-adjusted admission rates and probability of admission. RESULTS Of 1 538 189 children, 156 087 (10.2%) had at least one admission in the study period. There was a nearly twofold (1.9) variation in admission rates between the hospital referral areas (3113 per 100 000 children, 95% CI: 3056 to 3169 vs 1627, 95% CI: 1599 to 1654). Area level variances in multilevel analysis did not change after adjusting for parental level of education. Children of parents with low level of education (maternal level of education, low vs high) had the highest admission rates (2016: 2587, 95% CI: 2512 to 2662 vs 1810, 95% CI: 1770 to 1849), the highest probability of being admitted (OR: 1.18, 95% CI: 1.16 to 1.20), the highest number of admissions (incidence rate ratio: 1.05, 95% CI: 1.01 to 1.10) and admissions with lower cost (-0.5%, 95% CI: -1.2% to 0.3%). CONCLUSIONS Substantial geographic variation in hospital admission rates for children was found, but was not explained by parental educational level. Children of parents with low educational level had the highest admission probability, and the highest number of admissions, but the lowest cost of admissions. Our results suggest that the variation between the educational groups is not due to differences in medical needs, and may be characterised as unwarranted. However, the manner in which health professionals communicate and interact with parents with different educational levels might play an important role.
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Affiliation(s)
- Frank Olsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Lise Balteskard
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bård Uleberg
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
| | - Bjarne K Jacobsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Centre for Clinical Documentation and Evaluation (SKDE), Northern Norway Regional Health Authority, Tromsø, Norway
- Centre for Sami Health Research, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ivar Heuch
- Department of Mathematics, University of Bergen, Bergen, Norway
| | - Atle Moen
- Department of Neonatology, Oslo University Hospital, Oslo, Norway
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Neale FK, Armstrong EJ, Cohen JM, Segal TY, Hargreaves DS. How fair is our service? Evaluating access to specialist paediatric care. Arch Dis Child 2019; 104:1105-1107. [PMID: 31300409 DOI: 10.1136/archdischild-2019-317254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/18/2019] [Accepted: 07/05/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess equity of access to paediatric outpatient clinics in our hospital. DESIGN/SETTING Retrospective analysis of consecutive accepted referrals to allergy, asthma, epilepsy, general paediatrics, rapid access, chronic fatigue syndrome, diabetes and endocrine outpatient clinics. PATIENTS 32 369 new patients, April 2007 to June 2018. RESULTS Among local patients (58.1%) 0.2%-2.5% of patients referred to each clinic lived in the least deprived quintile, and 43.5%-48.4% in the most deprived quintile-similar to inpatient admissions and the local population. Tertiary clinics showed a much higher proportion of patients from the least deprived quintiles (15.9%-26.2%). CONCLUSIONS Local outpatient referrals broadly reflected the socioeconomic distribution, although not necessarily the distribution of need, of our local population. A relatively high proportion of patients in tertiary clinics were from more affluent postcodes, highlighting the need for referral inequalities to be evaluated across networks or regions.
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Affiliation(s)
| | | | - Jonathan M Cohen
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK.,Population, Policy and Practice, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Terry Y Segal
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Hargreaves DS, Arora S, Viveiro C, Hale DR, Ward JL, Sherlaw-Johnson C, Viner RM, Dunkley C, Cross JH. Association of quality of paediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England: a national longitudinal data linkage study. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:627-635. [PMID: 31281027 DOI: 10.1016/s2352-4642(19)30201-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/28/2019] [Accepted: 05/03/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Concerns have been raised about variation in care quality and outcomes among children and young people with epilepsies in England. We aimed to investigate the association between quality of paediatric care, hospital admissions, and all-cause deaths among epilepsy patients. METHODS In this longitudinal data linkage study of paediatric epilepsy services in England, we linked unit-level data from round 1 (2009-11) and round 2 (2013-14) of the Epilepsy12 national clinical audit, with death registrations from the UK Office for National Statistics and data for unplanned hospital admissions from Hospital Episode Statistics. We investigated the association between unit-level performance in involving a paediatrician with epilepsy expertise, an epilepsy specialist nurse, and a paediatric neurologist (where appropriate) in round 1 and the proportion of adolescents (aged 10-18 years) with epilepsy admitted to each unit who subsequently died during the study period (April 1, 2009, to March 31, 2015). We also investigated whether change in Epilepsy12 performance between the two audit rounds was associated with changes in the standardised ratio of observed-to-expected unplanned epilepsy admissions over the same period. FINDINGS In 99 units with data for the analyses relating to paediatricians with epilepsy expertise and epilepsy specialist nurses, 134 (7%) of 1795 patients died during the study period, 88 (5%) of whom died after the transition to adult service. In 55 units with data for the analyses relating to paediatric neurologists, 79 (7%) of 1164 patients died, 54 (5%) of whom did so after the transition. In regression models adjusting for population, unit, and hospital activity characteristics, absolute reductions in total mortality risk (6·4 percentage points, 95% CI 0·1-12·7) and mortality risk after transition (5·7 percentage points, 0·6-10·8) were found when comparing units where all versus no eligible patients were seen by a paediatric neurologist. Units where all eligible patients were seen by a paediatric neurologist were estimated to have absolute reductions of 4·6 percentage points (0·3-8·9) in total mortality and of 4·6 percentage points (1·2-8·0) in post-transition mortality, compared with units where no or some eligible patients were seen by a paediatric neurologist. There was no significant association between performance on being seen by an epilepsy specialist nurse or by a paediatrician with epilepsy expertise and mortality. In units where access to an epilepsy specialist nurse decreased, the standardised ratio of epilepsy admissions increased by a mean of 0·21 (0·01-0·42). INTERPRETATION Among adolescents with epilepsy, greater involvement of tertiary specialists in paediatric care is associated with decreased all-cause mortality in the period after transition to adult services. Reduced access to an epilepsy specialist nurse was associated with an increase in paediatric epilepsy admissions. FUNDING The Health Foundation.
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Affiliation(s)
- Dougal S Hargreaves
- Department of Primary Care & Public Health, Imperial College London, London, UK; Nuffield Trust, London, UK.
| | - Sandeepa Arora
- Department of Primary Care & Public Health, Imperial College London, London, UK; Nuffield Trust, London, UK
| | | | - Daniel R Hale
- Department of Psychology, Heriot Watt University, Edinburgh, UK
| | - Joseph L Ward
- UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Russell M Viner
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Colin Dunkley
- Sherwood Forest Hospitals NHS Foundation Trust, Sutton In Ashfield, UK
| | - J Helen Cross
- UCL Great Ormond Street Institute of Child Health, London, UK
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