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BackgroundRoutinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. ObjectiveThe aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. MethodsWe will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. ResultsThe hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. ConclusionsORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. International Registered Report Identifier (IRRID)DERR1-10.2196/19773

Background: 'Embedded research' (co-locating researchers within non-academic organisations) is advocated as a way of developing more effective services through better creation and application of knowledge. Aims and objectives: The existing literature on embedded initiatives has largely been descriptive. There has been less in the way of analysis, for example, disaggregating the components of such schemes, unpacking underpinning logics, or comparing the diverse ways in which schemes are instantiated. We aimed to explore the nature and organisation of such schemes in health settings in the UK, with the objective of providing a systematised means of understanding their makeup. Methods: This study uses a focused literature review combined with a systematic scoping exercise of extant initiatives. We assembled documentation on each scheme (n=45) and conducted in-depth interviews in twelve of them (n=17). Analytically, we focused on surfacing and articulating the key features of embedded research initiatives in relation to their intent, structure and processes. Findings were then tested and validated during a co-production workshop with embedded researchers and their managers. Findings: We identified 26 'clusters' of peer-reviewed papers detailing specific embedded research initiatives, and we explored 45 extant initiatives. The initiatives were varied in intent, structure and processes, but we were able to surface ten themes representing common features: intended outcomes, power dynamics, scale, involvement, proximity, belonging, functional activities, skill and expertise, relational roles, and learning and reflection. Discussion and conclusion: The themes uncovered can be used as a framework for guiding further systematic and evaluative enquiry on embedded research initiatives.

Background: Embedded research involves co-locating researchers within non-academic organisations to better link research and practice. Embedded research initiatives are often complex and emergent with a range of underlying intents, structures and processes. This can create tensions within initiatives and contributes to ongoing uncertainty about the most suitable designs and the effectiveness of different approaches. Aims and objectives: We aimed to devise a practical framework to support those designing and cultivating embedded research by operationalising findings from an extensive study of existing initiatives. Key conclusions: The underpinning research on embedded initiatives -- a literature review and scoping exercise of initiatives in health settings across the UK -- showed that such initiatives share ten common sets of concerns in relation to their intent, structure and processes. We used these insights during a co-production workshop with embedded researchers and their managers that made use of a range of creative activities. The workshop resulted in a practical framework (and associated web-based tools) that draw on the metaphor of a garden to represent the growing, emergent nature of embedded research initiatives and the active work which individuals and organisations need to put into planning and maintaining such initiatives. Each of the aspects is represented as a separate area within the garden using relevant visual metaphors. Building on this, we also present a series of reflective questions designed to facilitate discussion and debate about design features, and we link these to the wider literature, thereby helping those involved to articulate and discuss their preferences and expectations.

Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.

Improvements in health-care quality can contribute to healthier populations. However, many global and national health strategies are not sufficiently considering the issues of measuring and improving health-care quality in low-resource [...]