Projects Delivered

The use of hospital data has significantly expanded in the past years to better understand treatment patterns and patients’ characteristics. Comparing treatment and outcomes between hospitals is an important method of ensuring good standards of care.

Undertaking studies that compare between hospitals, particularly between countries, remains a significant challenge due to data privacy concerns. “Federated” analysis, where hospitals can work together to complete the same analysis and share aggregate results while data never leaves the hospitals’ servers, allows robust multi-centre data-analysis to be undertaken without any need for data sharing.

In an effort to facilitate the above process, the OHDSI network has developed the Observational Medical Outcomes Partnership (OMOP) common data model (CDM). Once hospitals have formatted their data to this common, standardised CDM, an algorithm can be run by each hospital and share the report with other sites. This means than no individual patient data is leaving the hospitals, and the reports contain summaries only which means that the patients cannot be identified. The results are additionally checked by each sites’ disclosure guidelines before being shared.

This project is led from the UK by the National Institute for Care Excellence (NICE). It is looking at the example of how cancer survival differs between different European hospitals. Participation will allow us, NHS Lothian, as part of the DataLoch initiative to test our recently mapped breast cancer data and test our local processes needed to support federated analysis in a safe manner.

Asthma affects more than 1 in 10 people in the UK. If untreated, asthma attacks can lead to unease and at worst death. In the UK alone, every 10 seconds, someone has an asthma attack. The main method of treating asthma is using regular preventer medication. This comes in the form of an inhaler, and patients are asked to take their inhaler daily to lessen the risk of an asthma attack. However, there are many reasons why patients don’t take their inhaler, which can vary between adults and children. This study will explore which groups of patients are not taking their inhaler regularly and whether this has changed over time. Using this information can improve the education we offer around medication use and reduce the number of asthma attacks.

The aim of this project is to establish the impact of the recent COVID-19 pandemic on the management approach to emergency surgical conditions. As a model condition, we will use one of the most common emergency surgical conditions; acute appendicitis. Appendicitis can be managed definitively with surgical operation, or conservatively with antibiotic administration alone. The latter poses the risk of recurrent appendicitis and is often elected by patients as an alternative to admission and operative management. We aim to compare recurrence rates of acute appendicitis in patients managed without surgery before and during the COVID-19 pandemic. Any occurring significant differences will provide evidence that the pandemic has had an impact on physicians’ treatment approach, and patient views regarding the fear of hospitalization. Part of the project is to identify individual risk factors for the election of surgical versus non-operative management of appendicitis during the pandemic.

People with two or more long-term conditions at the same time (multimorbidity) can have complex care needs. The number of people in our community with multimorbidity is increasing. People with multimorbidity may be less likely to benefit from treatments, because they may be more likely to experience side-effects of treatment than people without multimorbidity. This can be even more challenging in emergency situations, such as in hospital emergency departments.

Very few researchers have looked at the care of people with multimorbidity in emergency departments, despite how common it now is in our communities. This research study will look into this issue.

We will firstly find out how common multimorbidity is in people attending emergency departments in Lothian. We will then look at different ways of measuring multimorbidity, as well as frailty, to see whether this affects how common it is. We will then look into how these measures affect how likely it is that someone dies within 30 days of attending the emergency department, along with other outcomes. We will then use statistical methods to try and find groups of people who are more likely to experience poor outcomes. We hope our study will provide important information to help researchers, clinicians and the wider public to better understand what happens to people with multimorbidity when they need emergency care, with a longer-term aim of improving care for them.

More people are living with dementia. This can be a devastating and life-limiting condition that is of clear importance for the public, NHS and social care services. Having an idea of which people are at higher risk of developing dementia could help address known risk factors earlier in life, like smoking and obesity. We want to see how effective routinely entered health data from GP and hospital visits can be used to predict the future risk of developing dementia. This might include information like blood pressure measurements, other health diagnoses and blood test results. We will also see if other tools developed elsewhere can be used successfully in a Scottish population. If our approach is successful, we would provide some evidence for the use of dementia prediction tools to find people at higher risk. Future work could then test interventions in this group.

Energy poverty (when a household must spend a large amount of their income to keep their home warm) is a growing problem. Cold, damp and badly ventilated housing is made worse by energy poverty and is linked to chest infections, particularly in children. However, we don’t have a good idea of how much energy poverty is affecting child health or particular groups of children (for example those with asthma or born early).

To really look after children, we need to know how big the problem is, which children are most at risk and which actions by the government will make the most difference.

To prepare for a larger project, I will first do a smaller study bringing healthcare and energy poverty information together for the first time to look at how living in energy poverty affects the risk of chest infections in different groups of children across NHS Lothian.

Background: Delirium is a common and serious problem for older people. It is a form of confusion which starts suddenly. Around one in four older people who go to hospital as an emergency are affected. Illness, medicines, and surgery can all cause delirium. It is more common in people with multiple long-term conditions (MLTCs) and in people who are frail.

Approach: We will look at links between delirium, MLTCs, and being frail. We will study information for thousands of patients admitted to hospital with a hip fracture or an emergency medical problem. This information is collected in health records from GPs and hospitals. Information will not identify people and will be stored securely.

Impact: We are aiming to find out why some people have delirium when they come to hospital, and why some have more problems after being in hospital with delirium. Findings could help to understand the causes of delirium. This study may allow healthcare practitioners to spot the condition earlier and it may help to reduce the bad consequences following a hospital admission with delirium.

Heart disease is the leading cause of death worldwide. Secondary prevention is focused on patients with known heart disease to prevent a second heart event. This includes prescribing medications like cholesterol lowering medication or life style advice such a quitting smoking or losing weight.

Trends in the prescription of preventative medications and life style changes in patients with known heart disease in Scotland is unclear. It also unknown whether there are differences between important patient groups (like sex or age). More insight on risk assessment and management of therapy in secondary prevention of heart disease in current practice is important to identify the gaps and where we can improve the adoption of prevention treatment to improve outcomes.

In this study we aim to conduct an evaluation on trends and inequalities in risk assessment, treatment and outcomes of patients with heart disease by sex, age, ethnicity, and deprivation status.