What are the determinants of variations in emergency readmission rates and one-year mortality in patients hospitalized with heart failure or chronic obstructive pulmonary disease?

Record ID 32015000891
Authors' objectives: Chronic diseases affect patients quality of life and health service budgets. Two conditions, heart failure and chronic lung disease, already affect around two million people in the UK and are becoming commoner. International comparisons show that we lag behind other countries in the treatment of these conditions. There are differences between hospitals in terms of their performance using measures such as how well they manage their patients medications and also outcome measures such as emergency readmissions and survival. Some progress has been made in understanding what drives these variations, but much remains unclear. England s NHS is well placed to answer this due to its wealth of accessible and comprehensive hospital administrative databases that now cover A&E attendances as well as inpatient and outpatient activity. We plan to combine the databases with publically available survey results of patient experiences of their time in different parts of the hospital, staff experiences of working in the hospital, and the quality of and access to general practices and community services. The proposal has had input from two patient representatives from the British Heart Foundation. We have these research questions to answer: What are the most important factors associated with variation between hospitals in readmission and mortality rates? Should A&E attendance data be considered alongside readmission metrics when measuring hospital performance? If so, how? Are the results for chronic lung disease similar to those for heart failure? The two-year project will be conducted by the academic group at Imperial College London. The project team has considerable expertise in handling these large, complicated hospital databases and producing useful information for NHS staff and patients on the quality and safety of services. We already hold these databases in our unit and have ethical permission to use them for research. For the statistical analysis, we will require funding for a research associate for two years and one day per week for the lead investigator. An administrator will be needed for two months to collect information on community services such as heart failure nurses and lung rehabilitation services. To help communicate our findings, we have asked for funding for conferences and publications.
Project Status: Completed
Year Published: 2015
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Emergency Service, Hospital
  • Patient Readmission
  • Pulmonary Disease, Chronic Obstructive
Organisation Name: NIHR Health Services and Delivery Research programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name: journals.library@nihr.ac.uk
Contact Email: journals.library@nihr.ac.uk
Copyright: Queen's Printer and Controller of HMSO
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