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Background The PD COMM pilot randomised controlled trial compared Lee Silverman Voice Treatment (LSVT® LOUD) with standard NHS speech and language therapy (SLT) and a control arm in people with Parkinson’s disease (PwPD) with self-reported problems with voice or speech. This analysis compares costs and quality of life outcomes between the trial arms, and considers the validity of the alternative outcome measures for economic evaluations. Methods A comparison of costs and outcomes was undertaken alongside the PD COMM pilot trial involving three arms: LSVT® LOUD treatment (n = 30); standard NHS SLT (n = 30); and a control arm (n = 29) excluded from receiving therapy for at least 6 months after randomisation unless deemed medically necessary. For all trial arms, resource use and NHS, social care and patient costs and quality of life were collected prospectively at baseline, 3, 6, and 12 months. Total economic costs and outcomes (EQ-5D-3L, ICECAP-O) were considered over the 12-month follow-up period from an NHS payer perspective. Quality of life measures for economic evaluation of SLT for people with Parkinson’s disease were compared. Results Whilst there was no difference between arms in voice or quality of life outcomes at 12 months, there were indications of differences at 3 months in favour of SLT, which need to be confirmed in the main trial. The estimated mean cost of NHS care was £3288 per patient per year for the LSVT® LOUD arm, £2033 for NHS SLT, and £1788 for the control arm. EQ-5D-3L was more strongly correlated to voice impairment than ICECAP-O, and was sensitive to differences in voice impairment between arms. Conclusions The pilot did not identify an effect of SLT on disease-specific or economic outcomes for PwPD at 12 months; however, there appeared to be improvements at 3 months. In addition to the sample size not powered to detect difference in cost-consequence analysis, many patients in the control arm started SLT during the 12-month period used for economic analysis, in line with the study protocol. The LSVT® LOUD intervention was more intense and therefore more costly. Early indications suggest that the preferred economic outcome measure for the full trial is EQ-5D-3L; however, the ICECAP-O should still be included to capture a broader measure of wellbeing. Trial registration International Standard Randomised Controlled Trial Number Register: ISRCTN75223808. Registered 22 March 2012.

The NHS was founded on the principle that care should be based on need, not the ability to pay, and the Long Term Plan aims to reduce health inequalities. This article explores how inequalities in the quality of care between the most and least deprived groups have changed over the last decade, and what implications this has on the endeavour to reduce unwarranted variation in care.

Learning health systems (LHS) use digital health and care data to improve care, shorten the timeframe of improvement projects, and ensure these are based on real‐world data. In the United Kingdom, policymakers are depending on digital innovation, driven by better use of data about current health service performance, to enable service transformation and a more sustainable health system. This paper examines what would be needed to develop LHS in the United Kingdom, considering national policy implications and actions, which local organisations and health systems could take. The paper draws on a seminar attended by academics, policymakers, and practitioners, a brief literature review, and feedback from policy experts and National Health Service (NHS) stakeholders. Although there are examples of some aspects of LHS in the UK NHS, it is hard to find examples where there is a continuous cycle of improvement driven by information and where analysis of data and implementing improvements is part of usual ways of working. The seminar and literature identified a number of barriers. Incentives and capacity to develop LHS are limited, and requires a shift in analytic capacity from regulation and performance, to quality improvement and transformation. The balance in priority given to research compared with implementation also needs to change. Policy initiatives are underway which address some barriers, including building analytical capacity, developing infrastructure, and data standards. The NHS and research partners are investing in infrastructure which could support LHS, although clinical buy in is needed to bring about improvement or address operational challenges. We identify a number of opportunities for local NHS organisations and systems to make better use of health data, and for ways that national policy could promote the collaboration and greater use of analytics which underpin the LHS concept.

BackgroundMinority ethnic groups in the UK are reported to have a poor experience of mental health services, but comparative information is scarce.AimsTo examine ethnic differences in patients' experience of community mental health services.MethodTrusts providing mental health services in England conducted surveys in 2004 and 2005 of users of community mental health services. Multiple regression was used to examine ethnic differences in responses.ResultsAbout 27 000 patients responded to each of the surveys, of whom 10% were of minority ethnic origin. In the 2004 survey, age, living alone, detention and hospital admissions were stronger predictors of patient experience than ethnicity Self-reported mental health status had the strongest explanatory effect. In the 2005 survey, the main negative differences relative to the White British were for Asians.ConclusionsEthnicity had a smaller effect on patient experience than other variables. Relative to the White British, the Black group did not report negative experiences whereas the Asian group were most likely to respond negatively. However, there is a need for improvements in services for minority ethnic groups, including access to talking therapies and better recording of ethnicity.

The objective of the study was to evaluate health risk factor information recorded by six general practices, in the light of the GP health promotion contract. A comparison of computer and manual notes was undertaken, for a sample of 709 patients aged 15–74; reports on health promotion activity were generated from practice computers; and interviews were conducted with GPs and practice staff asking about the use of information in the practice. All the practices were in inner London, and were using the computer for Band 3 health promotion, prescribing and disease registers. Blood pressure, smoking, alcohol, weight and height were recorded for over 50% of patients aged 15–74, and computerised for 79% (291/370) for height but only 56% (274/488) for blood pressure. Risk factor information was recorded for a higher proportion of women than men, and for older men but younger women. High risk patients (smokers, heavy drinkers and patients with raised blood pressure) were less likely to have this informatio...

Objective To explore the potential for international comparison of patient safety as part of the Health Care Quality Indicators project of the Organization for Economic Co-operation and Development (OECD) by evaluating patient safety indicators originally published by the US Agency for Healthcare Research and Quality (AHRQ). Design A retrospective cross-sectional study. Setting Acute care hospitals in the USA, UK, Sweden, Spain, Germany, Canada and Australia in 2004 and 2005/2006. Data sources Routine hospitalization-related administrative data from seven countries were analyzed. Using algorithms adapted to the diagnosis and procedure coding systems in place in each country, authorities in each of the participating countries reported summaries of the distribution of hospital-level and overall (national) rates for each AHRQ Patient Safety Indicator to the OECD project secretariat. Results Each country's vector of national indicator rates and the vector of American patient safety indicators rates published by AHRQ (and re-estimated as part of this study) were highly correlated (0.821–0.966). However, there was substantial systematic variation in rates across countries. Conclusions This pilot study reveals that AHRQ Patient Safety Indicators can be applied to international hospital data. However, the analyses suggest that certain indicators (e.g. ‘birth trauma’, ‘complications of anesthesia’) may be too unreliable for international comparisons. Data quality varies across countries; undercoding may be a systematic problem in some countries. Efforts at international harmonization of hospital discharge data sets as well as improved accuracy of documentation should facilitate future comparative analyses of routine databases.

Objective To assess the feasibility of deriving patient safety indicators for England from routine hospital data and whether they can indicate adverse outcomes for patients. Design Nine patient safety indicators developed by the United States Agency for Healthcare Research and Quality (AHRQ) were derived using hospital episode statistics for England for 2003-4, 2004-5, and 2005-6. A case-control analysis was undertaken to compare length of stay and mortality between cases (patients experiencing the particular safety event measured by an indicator) and controls matched for age, sex, health resource group (standard groupings of clinically similar treatments that use similar levels of healthcare resource), main specialty, and trust. Comparisons were undertaken with US data. Setting All NHS trusts in England. Participants Inpatients in NHS trusts. Results There was fair consistency in national rates for the nine indicators across three years. For all but one indicator, hospital stays were longer in cases than in matched controls (range 0.2-17.1 days, P

Measurement of safety and quality is fundamental to health care delivery. A variety of measures are needed to fully understand the system; quantitative and qualitative measures are both useful in different ways. Measures need to be valid, reliable, accurate, timely, collectable, meaningful, relevant and important to those who will use them. Clinicians value appropriate measures and respond to them.

Interviews and workshops with the public, health professionals and managers revealed dissatisfaction with the current system of performance indicators. The public were mostly unaware of the star system. Their priorities were; waiting times, treatment experience, staffing and patient environment. Health professionals and the public were concerned about the effects of a poor star-rating on an organisation.

BACKGROUND The development of primary care led commissioning will increase the need for practice-based information on health and morbidity, and the NHS information strategy recommends that routinely collected health and morbidity information held on general practice computer systems should be use to inform local health needs assessment. The aim of this study was to evaluate the quality of information in six computerized practices. METHODS A comparison was carried out of the recording of registration and social information, health risk factors, medication and record on consultations on the computer and in the manual records for a sample of patients, with an audit of morbidity coding by computer. A comparison was made of computerized disease registers with prescribing for diseases. RESULTS Computer disease registers identified over 90 percent of diabetic patients on medication, 67 percent of asthmatics, 61 percent of epileptics, and 48 percent of patients with angina. Computer recording of problems was inconsistent; practices which recorded clinical information from every consultation did not have substantially more complete disease registers. Over 90 percent of encounters and prescriptions were computerized, but there was bias in recording consultation problems. Blood pressure, smoking, alcohol, weight and height were recorded for over 50 percent of patients aged 15-74, and computerized for 79 percent (291/370) for height, but only 56 percent (274/488) for the most recent blood pressure recorded. Limited social information was recorded about patients: 45 percent (410/915) had occupation or employment status and 35 percent (230/915) ethnic group; computerized for 26 percent and 18 percent, respectively. CONCLUSIONS At present, the routine collection of information from practices would not provide reliable information for health care planning. Greater use of information in practices would improve data quality, and practice data could be used to address specific issues, if augmented by additional data, and for practice-based needs assessment.

I came to review this book by chance, having studied spatial epidemiology some years ago. Reviewing the book was an opportunity to update myself in this field, and see what had changed and what was new. The book covers a wide range of material, including a description of data sources and their limitations, and the theoretical basis for the statistical methods that can be …

EDITOR,—John Shanks and colleagues suggest that conventional methods for assessing needs require adaptation for use in primary care.1 They are right that several methods should be used, although this applies in all areas of needs assessment. An important element of needs assessment that they …