Introduction to Epidemiology and Research

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Introduction to Epidemiology and Research

• Richard Thomson
• Director of Epidemiology and Research
• NPSA
• 28 September 2005

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Department of Epidemiology and Research
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Todays overview

• The Department
• Prioritisation
• RD and Evaluation
• The Patient Safety Observatory (PSO)

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Objectives

• To develop, manage and keep under review the NPSA
  RD Strategy
• To set up, manage and deliver a surveillance and
  monitoring system (the Patient Safety
  Observatory) in order to underpin the NPSA work
  programme.
• To oversee a programme of evaluation of the
  NPSAs role in order to quantify the
  organisations impact and review work programmes
  and priorities.
• To develop, implement and apply a process of
  prioritisation for the NPSAs work programme

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Prioritisation
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Prioritisation background

• Need to target resources
• Need to decide where NPSA adds (national) value
• Multiple demands limited resources
• OPM workshops and consultation document and
  process (NewChurch)
• Support for open and transparent process
• Clarify objectives
• Clarify process

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Prioritisation where next

• Key points - Adapt HTA model
• A means of capturing proposals and topics for
  consideration
• A set of criteria that will help us choose
  between options
• A process by which these criteria can be applied
  in a consistent, objective and transparent
  fashion.
• Also need fast track system

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Process

• Objectives
• to seek and identify patient safety concerns for
  subsequent solutions development
• to prioritise these in order to make best use of
  NPSA resources such as to produce cost-effective
  impact on patient safety

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RD and Evaluation
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R D Strategy

• Draft to Board March 2004
• Targeted external consultation ended June 4th
  2004 and public/patient workshop
• Consultation included government agencies,
  professional bodies including the Royal Colleges,
  patients and the public, health care
  professionals, equipment manufacturers, academic
  institutions and research funding councils, and
  leading academics and health care professionals
  involved in patient safety research

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Results of targeted external consultation

• 61/139 contacts response rate 44
• Key points included
• Not enough on evaluation
• Need to be clear about NPSA role and role of
  others (E.g. Patient Safety Research Programme)

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R D Strategy Aim

• The aim of the NPSAs research and development
  strategy is to promote RD to inform the work of
  the NPSA and to support the pursuit of patient
  safety within the NHS
• To create a research literate, evaluative
  organisation

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Objectives

• To identify gaps in our knowledge about patient
  safety by assimilating information from many
  different sources in order to define and reveal
  priorities.
• To work with others in the UK and internationally
  to develop capacity and sustainability of
  research into patient safety and to avoid
  duplication of effort.
• To access, interpret and apply relevant research
  evidence and advice to ensure that the NPSAs
  work is based on available research evidence.
• To understand and improve the impact of NPSA work
  on the NHS, by carrying out or commissioning
  evaluations of the effectiveness of the NPSA work
  programme, including safety solutions and
  guidance.
• To ensure that all research in which the NPSA is
  involved follows appropriate ethical and research
  governance principles and practice.

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NPSA approach to using evidence

• The NPSA is committed to exploring solutions to
  identified patient safety issues by
• Reviewing and critically appraising the available
  evidence from published and grey literature
• Identifying potential solutions from the field
• Where necessary, developing theoretically
  grounded solutions, based on effective root cause
  analysis, in collaboration with relevant experts,
  practitioners and patients
• Risk assessing and prioritising potential
  solutions
• Piloting, refining and evaluating promising
  solutions using both quantitative and qualitative
  methods as appropriate, before proceeding to
  dissemination and implementation
• Evaluating the effectiveness of fully developed
  solutions using appropriate analytical and
  observational studies

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Main challenges RDThe research literate,
evaluative organisation

• Evidence based approach to work
• Evaluation embed this across organisation
• What is the impact of the NPSA
• Skills analysis and development
• To strengthen the organisations ability to meet
  RD and evaluation goals
• Influence PSRP and other key funding
  organisations

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Patient Safety Observatory
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Why do we need a PSO?

• Many agencies already involved in collecting and
  using information relevant to patient safety
• information not always used to full potential
• No one source of information can tell us
  everything that we need to know
• different data sources designed for different
  purposes
• National incident reporting data valuable and
  will help to generate hypotheses
• will need help in interpretation and implementing
  change

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• PRIORITISATION
• Criteria/methods
• (rapid response)
• Topic selection

• Research by NPSA
• With others
• Lit review

Patient Safety Research
OTHER ORGANISATIONS CHAI, DoH etc
NRLS
Surveillance Monitoring OBSERVATORY
Other bodies Their views SHAs NICE DoH/Ministers
CMO CPPIH VOs/Charities
Public/Patient e-form
EVALUATION
Other confidential reporting systems
RD
Other dataset relevant to patient safety e.g.
MHRA NCAA CHAI Reviews HES RCGP Database NHS
Direct
NHS Feedback Bounceback

• Sources of Intelligence/Knowledge
• POMH
• CSAs, PSMs Expert Groups
• PEPI Patient/Public Views
• Individual Patients
• Interest Groups etc.

PATIENTS/ PUBLIC
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What is the PSO?
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What do we hope the PSO will achieve?

• Build a network of interested information
  partners
• Operationalise the PSO test processes
• Establish right support arrangements
• Eg stats/analysis, RD skills
• Produce major annual report with actionable
  learning
• Develop data compendium
• Produce regular (NRLS) reports
• Agree and set future directions mutual benefit

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What do we hope the PSO will achieve?

• Over the next three to five years
• Make regularly available authoritative and
  actionable national information
• Help to set priorities for action
• Regular feedback to NHS organisations
• Earlier warning of emerging problems
• Build a network of interested information
  partners
• National and international recognition

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Main challenges PSO/NRLS

• Use of data to make a difference
• Feedback, prioritisation, safer practice,
  PSM/CSA, data mining
• Examples of PSO model in practice
• Data sources and partners
• Report(s) variety of
• Policies and procedures
• E.g. Data analysis and disclosure publication
  policy
• Data Quality

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Summary

• Department supports whole organisation
• Prioritisation
• RD and Evaluation
• PSO and analysis of data (NRLS)
• Many challenges!