Log in
Events in the UK NHS have shown the need for a robust understanding of hospital mortality rates.
Surrey's research produced "a unique web-enabled pattern analysis system that is specifically designed to enable clinicians and their teams to view in detail their in-house mortality patterns in the national context" (a).
Launched on a national scale in Ireland in 2013, it has already identified `mortality outliers' and been described as a `game changer' for improving service quality at national level. The tool's impact stems from its ability to translate statistical patterns into a form readily usable by health professionals to improve care quality and sharing best practice.
Imperial College researchers have developed methods and indicators for highlighting potential variations in healthcare performance and safety using routinely collected health data. Analytical tools based on our methodological research are used by managers and clinicians in over two thirds of NHS hospital trusts, and hospitals throughout the world. The results of our analyses helped detect problems at Mid Staffordshire NHS Foundation Trust and triggered the initial investigation and subsequent public inquiry with wide ranging recommendations based on the recognition of their value and their use in enhancing the safety of healthcare.
Statistical analysis and methodological development carried out by Imperial College London on data from the Bristol Royal Infirmary Inquiry and the Shipman Inquiry have led to new monitoring systems in healthcare. Using routinely collected healthcare information, we have highlighted variations in performance and safety, impacting the NHS through direct interventions and/or policy change. For example: (i) findings and recommendations arising from our research for the Bristol Inquiry were reflected in the final inquiry outputs, which highlighted the importance of routinely collected hospital data to be used to undertake the monitoring of a range of healthcare outcomes, (ii) a range of monitoring recommendations have arisen as a direct result of the research on data from the Shipman Inquiry, (iii) analytical tools based on our methodological research are used by managers and clinicians in over two thirds of NHS hospital trusts, (iv) Imperial's monthly mortality alerts to the Care Quality Commission were major triggers leading to the Healthcare Commission investigation into the Mid Staffordshire NHS Trust.
The Variable Life-Adjusted Display (VLAD) is a graphical tool for monitoring clinical outcomes. It has been widely adopted by UK cardiac surgery centres, and has helped a shift in culture towards more open outcome assessment in adult cardiac surgery, which has been credited with reduced mortality rates. VLAD is also being used for a broad range of other clinical outcomes by regulatory bodies worldwide. For example, Queensland Health uses VLAD as a major part of its Patient Safety and Quality Improvement Service to monitor 34 outcomes across 64 public hospitals, and NHS Blood and Transplant uses VLAD to monitor early outcomes of all UK transplants.
Research carried out from 2003 by Currie (Maxwell Institute) and his PhD students Djeundje, Kirkby and Richards (also Longevitas), and international collaborators Eilers and Durban, created new, flexible smoothing and forecasting methods. These methods are now widely used by insurance and pension providers to forecast mortality when determining pricing and reserving strategy for pensions. The methods were incorporated by the SME Longevitas in its forecasting package Projections Toolkit launched in 2009. This generated impact in the form of £400K turnover for Longevitas in licensing and consultancy fees, with further impact on the pricing and reserving strategies on Longevitas's customers. Since 2010 the methods have been adopted by the Office for National Statistics (ONS) to make the forecasts required to underpin public policy in pensions, social care and health and by The Continuous Mortality Investigation (CMI) to model and provide forecasts on mortality to the pensions and insurance industries. As a result, the research has changed practices in these advisory agencies and in the insurance industry.
Graduated period life tables for men and women, based on the mortality experience of the population of England and Wales, have been published by the Office for National Statistics (ONS) using data from the 2001 Census. These tables are the sixteenth in a series known as the English Life Tables which are associated with decennial population censuses, beginning with the Census of 1841. Errors in crude census data owing to the small numbers of deaths involved, particularly in childhood and at very advanced ages, can be reduced by a statistical process of smoothing. A smoothing methodology developed at Cass Business School, City University London has been used in the latest ONS Decennial Life Tables. The tables show the increasing longevity of the population of England and Wales over a long period. The impact of this research is broad as life tables are used extensively in pensions planning, demography, insurance, economics and medicine. Life tables using this statistical smoothing methodology have also been prepared for Scotland, Northern Ireland, the Republic of Ireland and Canada.
Our research has used epidemiological insights, data and methods to enable Legal & General (L&G), a major pensions and annuity provider, to understand the drivers of long-term trends in the annual rates of improvement in mortality in older ages. Our first-ever analysis of inequalities in mortality trends by cause of death over 25 years in England, and future projections of these, has resulted in better informed pricing and risk management (capital reserving) practices at L&G. We also modelled how much of the decline in coronary heart disease, the main contributor to improving life expectancy, was due to improved healthcare versus healthier lifestyles. Projections of these, based on plausible scenarios of evolution of risk factors and disease management, helped strengthen the evidence base for L&G's assumptions of mortality improvements for the UK financial regulators.
LSHTM research led to the development of a computer-based tool known as the Lives Saved Tool (LiST), which has been made available to international organisations, governments and NGOs free of charge. It allows policy-makers and programme managers in the 75 countries with the highest number of child deaths to identify which policy and programme choices are likely to have the greatest impact in cutting neonatal and child mortality. Since its 2008 launch, LiST has been used widely by international agencies, foundations, bilateral agencies, large NGOs and individual countries to determine investment priorities and programme choices.
Every year over 5,000 children and young people in the UK die. Previous research suggests that 20-25% of these deaths may be preventable, and in comparison to many other European countries, the UK has higher child mortality rates. Child Death Review processes, introduced in the USA in the 1970s have been proposed as a means of learning from child deaths and driving prevention initiatives. Prior to 2008, the UK had no national system for reviewing and learning from children's deaths.
From 2006 to 2007, a team from Warwick Medical School led by Dr Peter Sidebotham undertook government-funded research examining a number of Local Authorities across England who had set up pilot Child Death Overview Panels (CDOPs). The findings from this research were instrumental in developing national policy and procedures for child death reviews. The Warwick research emphasised the importance of a multi-agency approach to reviewing all child deaths, with a strong public health focus on learning lessons for prevention, and robust systems for notification and gathering information. This, together with other research by Warwick Medical School on fatal child maltreatment published between 2009 and 2011, has contributed to updated national policy and interagency practice to safeguard children.
Although it is too early in the process to demonstrate any impact on the ultimate goal of reducing preventable child deaths, CDOPs have now been established in every Local Authority in England, as well as an all-Wales panel, and current work in Scotland and Northern Ireland is considering how best to implement such reviews. These panels are reviewing all child deaths in England, resulting in local prevention initiatives, and national returns enabling a clearer picture of the nature of preventable child deaths.