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Research and Projects

Health Care Quality for an Active Later Life

Who is involved?

Theme: CLAHRC - Person-Centred Care
Status: Complete

Background

These are the questions underlying a programme of work on the treatment of older people. 

The objective of this study was to bring together health data from diverse sources to address two aims. The aim for the initial phase of the project was to examine the current state of health of the older population, explore the evidence on how the NHS is meeting the needs of the older population and examine whether the current healthcare reforms improve health outcomes for older people.

The aim for the second phase was to utilise Clinical Practice Research Datalink (CPRD) and hospital episode statistics (HES) datasets to explore potentially inappropriate prescribing and polypharmacy in older people. American Geriatrics Society prescribing standards were compared to prescriptions actually received by a sample of 50,000 older people in England.

Grant funding

1. Health Care Quality in Later Life: Trends for the UK 2011 to 2014.Programme grant: Melzer D (PI) Suzanne Richards, Paul Dieppe, William Henley and Iain Lang: Age UK (2011 - 2014)

2. Quality of Healthcare in the English Longitudinal Study of Ageing - Project grant:Steel N, Bachmann M, Clarke A, Campbell J, Henley W, Richards S and Melzer D (Melzer PI of Exeter half of study); UK National Institute for Health Research (07/2012 - 06/2014)

3. Fair Comparisons of Interventions: Extending the Prior Event Rate Ratio method (EPERR study). Methodology project grant: William Henley (PI), Chris Hyde, Iain Lang, Dave Wright and David Melzer; (UK) Medical Research Council (10/2010 - 09/2013)

4. National School of Public Health Research: Programme / infrastructure funding: Melzer D (PI), Charles Abraham, Ken Stein, Lora Fleming. UK National Institute for Health Research (2011 - 2016)

Projects

Project 1. Age UK programme on health care quality

The University of Exeter Medical School (UEMS) Ageing Research Group was been funded by Age UK to bring together recent health data from diverse sources to shed light on the first two questions posed above.

The aim for the initial phase (2011/2012) was to examine the current state of health of the older population, explore the evidence on how the NHS is meeting the needs of the older population and examine whether the current healthcare reforms improve health outcomes for older people. We published a ‘chart book’ of key information on the health and medical treatment of older people. This was very well received, with the Department of Health’s then clinical lead for older people using this report widely, including in evidence to a House of Lords committee.

The second phase (2012/2013) aimed to utilise the Clinical Practice Research Datalink (CPRD) and hospital episode statistics (HES) datasets in order to explore the potentially inappropriate prescribing and polypharmacyin older people. We used the American Geriatrics Society prescribing standards and comparing them to the prescriptions actually received by a sample of 50,000 older people in England.

Project 2. NIHR study of quality of treatment for diabetes, cardiovascular disease and osteoarthritis in older people

In a sister project funded by the NIHR, we explored quality of care received in the English Longitudinal Study of Ageing. Using the Assessing the Care of the Vulnerable Elderly (ACOVE) evidence and consensus based treatment standards, we estimated achievement of indicators of quality healthcare for diabetes, cardio-vascular disease, depression and osteoarthritis. Additionally, we examined correlates of receiving indicated care, to help guide efforts to improve treatment quality for older people.

Emerging projects

In collaboration with the Henley group, we are examining quasi-experimental approaches to estimate the impact of interventions in the elderly, using CPRD general practice and hospital electronic records. Professor Melzer is the national co-lead for the ageing theme in the NIHR National School for Public Health Research, which will allow further development of this programme of work.

References

 

Others Involved

Professor David Melzer, Dr Suzanne Richards, Professor Paul Dieppe, Professor William Henley, Dr Behrooz Tavakoly, Ms Rachel Winder, Dr Luke Mounce, Mr Adam Streeter, Dr Jane Foster