Project Details
Layman's description
Funding will be used to prepare three large inter-disciplinary grant bids to incorporate health inequality concerns into the performance monitoring and economic evaluation tools that NHS policy makers and managers use to guide their decision making. The main task will be to demonstrate that it is feasible to monitor the contribution of the NHS to tackling health inequality in one specific “pilot” area of colorectal cancer. The project will assemble a multi-disciplinary team of economists, epidemiologists and public health specialists, drawing together expertise from the Centre for Health Economics, the Department of Health Sciences, the Yorkshire and Humber Public Health Observatory, the Northern and Yorkshire Cancer Registry and Information Service, and Leeds Institute for Molecular Medicine.
Key findings
FINDINGS/RESULTS
Hospital episode statistics were used to examine five outcomes for patients undergoing primary colorectal cancer surgery in the English NHS for twelve financial years 1998/9 to 2009/10. We described unadjusted two-year trends by quintile groups of English small area income deprivation, and estimated absolute and relative inequality gaps between most and least deprived groups after adjusting for age, sex and co-morbidity.
Preliminary findings are as follows; though should be regarded with caution as they have not yet been peer reviewed and published. Inequality reduced for one indicator (abdominoperineal resection in rectal cancer surgery); increased for one indicator (open versus laparoscopic surgery in colorectal cancer surgery); and remained approximately stable for the other three (28-day in-hospital mortality, 30-day emergency re-admission and length of stay for colorectal cancer surgery). Abdominoperineal resection in rectal surgery fell more rapidly among deprived groups (from around 30% to just under 20%), with an initial absolute inequality gap of 10 percentage points falling to 5 by 2004-6. Laparoscopic surgery rates increased more rapidly among affluent groups (from zero to 30%), with an initial inequality gap of zero rising to four percentage points in 2008-10. 28-day in-hospital mortality fell at a similar rate in all groups, with an absolute inequality gap of about one and a half percentage points throughout except for a reduction to a half percentage point gap in the two year period 2000-1. Length of stay fell at similar rates in all social groups, with an absolute gap of approximately two days throughout. 30-day emergency re-admissions increased at a similar rate in all groups, with an absolute gap of about one percentage point throughout.
COLLABORATIONS
This C2D2 project laid the groundwork for future research on developing indicators of NHS performance in a range of cancer services (not just bowel cancer). It helped build inter-disciplinary collaborative links between economists at CHE and cancer epidemology / public health specialists at DOHS and Leeds Institute for Molecular Medicine. It also facilitated new inter-disciplinary and cross-institutional networking between health economists in CHE and public health experts (in particular, at UCL, University of Manchester, and University of Newcastle) in preparation for further grant bids. This networking has already resulted in a successful cross-institutional grant bid to NIHR HSR&D programme for a three year project to develop indicators of NHS equity performance from Jan 2013 to Dec 2015, as well as further proposals under development.
STAFF
PI: Richard Cookson, Centre for Health Economics
Co-PI: Steven Oliver, Department of Health Sciences
Postdoctoral Research Fellow: Aurora Ortiz-Nunez, Centre for Health Economics
Aurora has subsequently taken up a Research Fellow position at the University of Lancaster Division of Health Research, at a more senior research fellow grade.
COMMERCIALISATION/TRANSLATION
This was just a pilot feasiblity study, and so policy impact is only expected to occur a few years down the line as a result of the large scale follow on project to develop NHS performance indicators. Prelimimary findings from this pilot study are being presented as a poster at the National Cancer Intelligence Network Conference in Brighton in June 2013. The intention is to translate future findings into practice by developing "equity dashboards" for NHS decision makers in NHS England and Clinical Commissioning Groups, as part of the follow-on three year project on developing NHS equity performance indicators.
APPLICATIONS SUBMITTED
This C2D2 project contributed to the success of the following external funding application to the NIHR for nearly half a million pounds:
Cookson, R, Raine, R, Laudicella, M, Goddard, M, Ferguson, B, Fleetcroft, R, Goldblatt, P. Jan 2013 to Dec 2015. Developing indicators of change in NHS equity performance. NIHR Health Services and Delivery Research (HS&DR) Programme (project number 11/2004/39), £493,638.
It also contributed to the development of the following cross-institutional bid - not successful at outline stage but we are exploring further avenues.
NIHR HS&DR: Health inequality support for local healthcare commissioners to tackle cardiovascular disease and diabetes in socioeconomically disadvantaged adults - an evaluation of primary care, hospitalisation and mortality outcomes.
Doran, T., Cookson, R. A. & Dusheiko, M. A.
R15104, NIHR-CCF
1/01/14 → 31/03/16
£691,900.
ARTICLES SUBMITTED
A poster showing our preliminary colorectal cancer surgery results is being presented to the National Cancer Intelligence Network Conference in June 2013; the intention is to draft a working paper by November 2013 and thereafter submit to a suitable clinical journal (e.g. Gut).
Hospital episode statistics were used to examine five outcomes for patients undergoing primary colorectal cancer surgery in the English NHS for twelve financial years 1998/9 to 2009/10. We described unadjusted two-year trends by quintile groups of English small area income deprivation, and estimated absolute and relative inequality gaps between most and least deprived groups after adjusting for age, sex and co-morbidity.
Preliminary findings are as follows; though should be regarded with caution as they have not yet been peer reviewed and published. Inequality reduced for one indicator (abdominoperineal resection in rectal cancer surgery); increased for one indicator (open versus laparoscopic surgery in colorectal cancer surgery); and remained approximately stable for the other three (28-day in-hospital mortality, 30-day emergency re-admission and length of stay for colorectal cancer surgery). Abdominoperineal resection in rectal surgery fell more rapidly among deprived groups (from around 30% to just under 20%), with an initial absolute inequality gap of 10 percentage points falling to 5 by 2004-6. Laparoscopic surgery rates increased more rapidly among affluent groups (from zero to 30%), with an initial inequality gap of zero rising to four percentage points in 2008-10. 28-day in-hospital mortality fell at a similar rate in all groups, with an absolute inequality gap of about one and a half percentage points throughout except for a reduction to a half percentage point gap in the two year period 2000-1. Length of stay fell at similar rates in all social groups, with an absolute gap of approximately two days throughout. 30-day emergency re-admissions increased at a similar rate in all groups, with an absolute gap of about one percentage point throughout.
COLLABORATIONS
This C2D2 project laid the groundwork for future research on developing indicators of NHS performance in a range of cancer services (not just bowel cancer). It helped build inter-disciplinary collaborative links between economists at CHE and cancer epidemology / public health specialists at DOHS and Leeds Institute for Molecular Medicine. It also facilitated new inter-disciplinary and cross-institutional networking between health economists in CHE and public health experts (in particular, at UCL, University of Manchester, and University of Newcastle) in preparation for further grant bids. This networking has already resulted in a successful cross-institutional grant bid to NIHR HSR&D programme for a three year project to develop indicators of NHS equity performance from Jan 2013 to Dec 2015, as well as further proposals under development.
STAFF
PI: Richard Cookson, Centre for Health Economics
Co-PI: Steven Oliver, Department of Health Sciences
Postdoctoral Research Fellow: Aurora Ortiz-Nunez, Centre for Health Economics
Aurora has subsequently taken up a Research Fellow position at the University of Lancaster Division of Health Research, at a more senior research fellow grade.
COMMERCIALISATION/TRANSLATION
This was just a pilot feasiblity study, and so policy impact is only expected to occur a few years down the line as a result of the large scale follow on project to develop NHS performance indicators. Prelimimary findings from this pilot study are being presented as a poster at the National Cancer Intelligence Network Conference in Brighton in June 2013. The intention is to translate future findings into practice by developing "equity dashboards" for NHS decision makers in NHS England and Clinical Commissioning Groups, as part of the follow-on three year project on developing NHS equity performance indicators.
APPLICATIONS SUBMITTED
This C2D2 project contributed to the success of the following external funding application to the NIHR for nearly half a million pounds:
Cookson, R, Raine, R, Laudicella, M, Goddard, M, Ferguson, B, Fleetcroft, R, Goldblatt, P. Jan 2013 to Dec 2015. Developing indicators of change in NHS equity performance. NIHR Health Services and Delivery Research (HS&DR) Programme (project number 11/2004/39), £493,638.
It also contributed to the development of the following cross-institutional bid - not successful at outline stage but we are exploring further avenues.
NIHR HS&DR: Health inequality support for local healthcare commissioners to tackle cardiovascular disease and diabetes in socioeconomically disadvantaged adults - an evaluation of primary care, hospitalisation and mortality outcomes.
Doran, T., Cookson, R. A. & Dusheiko, M. A.
R15104, NIHR-CCF
1/01/14 → 31/03/16
£691,900.
ARTICLES SUBMITTED
A poster showing our preliminary colorectal cancer surgery results is being presented to the National Cancer Intelligence Network Conference in June 2013; the intention is to draft a working paper by November 2013 and thereafter submit to a suitable clinical journal (e.g. Gut).
| Status | Finished |
|---|---|
| Effective start/end date | 1/03/12 → 30/09/12 |