Background
Methods
Oxford BRC Research Theme/Working Group (RT/WG) lead interviews
BRC Research theme/Working group | Oxford BRC projects with potential impact on patient care | Potential impact on patient care at OUH |
---|---|---|
Biomedical Informatics and Technology | Gestational diabetes smartphone application | Processes and/or service organisation |
New alerting score based on patients’ vital signs (CALMS-3 Study – Computer Alerting Monitoring System) | Processes and/or service organisation | |
Maintenance of database of samples and consent management for Oxford Biobank | Processes and/or service organisation | |
System for Electronic Notes Documentation (SEND) project (electronic track and trigger and patient alerting) | Processes and/or service organisation | |
Blood | Training and hiring staff and improving infrastructure for clinical programme to do stem cell transplants and run more clinical trials in this area | Treatments |
Cancer | Multi-gene testing service with rapid (1 week) turnaround | Diagnostics, testing, screening |
BRC-funded clinical research posts specialising in sarcoma, gynaecological cancers and melanoma | Staffing for specialist services | |
Cardiovascular | MRI diagnostic tools for patients with intermittent angina | Diagnostics, testing, screening |
Clinical Informatics | Upgrade for cancer informatics in OUH (enabled by Genomic Medicine Centre (GMC) designation) | Diagnostics, testing, screening |
Molecular diagnostics and genome sequencing services (enabled by GMC designation) | Diagnostics, testing, screening | |
Development of integrated logical record for each cancer patient (in progress) | Processes and/or service organisation | |
True colours technology for mental health patients across Oxfordshire to aid self-management | Processes and/or service organisation | |
Streamlining management of notes/records from multidisciplinary cancer meetings (in progress) | Processes and/or service organisation | |
Clinical decision support dialogue to make blood orders more efficient | Processes and/or service organisation | |
Dementia and Cerebrovascular Disease | New screening process for acute confusion in medical admissions | Diagnostics, testing, screening |
Fast track carotid surgery | Treatments | |
Telemetric home blood pressure monitoring | Processes and/or service organisation | |
The first transient ischaemic attack (TIA) and minor stroke clinic in the United Kingdom | Processes and/or service organisation | |
Diabetes | Diagnostic programme to identify patients with a genetic basis for their diabetes | Diagnostics, testing, screening |
Pancreatic islet extraction unit | Treatments | |
Pancreatic transplants | Treatments | |
Functional Neuroscience and Imaging | Imaging protocols (epilepsy) | Diagnostics, testing, screening |
Functional neurosurgery team (part of the BRC) provides a clinical service, including pain deep brain stimulation | Treatments | |
Specialist clinic in epilepsy, Parkinson’s disease, motor neurone disease, supported by BRC-funded research fellows | Staffing for specialist services | |
Genomic Medicine | Targeted next generation sequencing | Diagnostics, testing, screening |
Whole exome or whole genome sequencing | Diagnostics, testing, screening | |
Immunology and Inflammation | Non-invasive tests for liver disease | Diagnostics, testing, screening |
Patient stratification for biologic therapies | Diagnostics, testing, screening | |
Tests to diagnose encephalitis (brain inflammation) | Diagnostics, testing, screening | |
Trials on treatment of inflammation in eczema | Treatments | |
Infection | Work linking care to outcomes with big data approaches | Processes and/or service organisation |
Genomic testing to support infection monitoring (provided informally) | Processes and/or service organisation | |
Molecular Diagnostics | Oxford designated as GMC for Genomics England’s 100,000 Genomes Project | Diagnostics, testing, screening |
Multi-gene testing for cancer patients | Diagnostics, testing, screening | |
Diagnostic tests for children with rare blood conditions | Diagnostics, testing, screening | |
Response prediction in leukaemia | Diagnostics, testing, screening | |
Prevention and Population Care | The first TIA and minor stroke clinic in the United Kingdom | Processes and/or service organisation |
Surgical Innovation and Evaluation | Chemotherapy (device targeted therapy): liposomes developed to carry the treatment to the organ of interest | Treatments |
Image-guided surgery using fluorescents | Treatments | |
Organ transplantation/reconditioning | Treatments | |
Restoring vision through an electronic implant | Treatments | |
Restoring vision through gene therapy | Treatments | |
Training and Education | No projects identified | |
Translational Physiology | No projects identified | |
Vaccines | Respiratory syncytial virus, trialling a new vaccine | Treatments (national) |
Meningitis, looking at trials of schedules for baby vaccines, booster doses, meningitis B vaccine trials | Processes and/or service organisation (national) | |
Multiple research themes/Working groups | Better infrastructure for clinical trials and other studies (e.g. better pharmacovigilance, biobanking) | Processes and/or service organisation |
OUH senior clinician interviews
Part 1
Part 2
Part 3
Cross-analysis of results
Results
Results of the RT/WG leader interviews
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Direct impacts of Oxford BRC research on patient care
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Indirect impacts:
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○ Absorptive capacity: infrastructure
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○ Absorptive capacity: developing human capital
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○ Improvements related to clinical trials (enabling more trials or closer monitoring and support)
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○ Collaborative working and participatory research
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Direct impacts
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Diagnostics, testing or patient screening
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Treatments available
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Processes for delivering patient care and/or organising hospital services
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Staffing for specialist services
Indirect impacts
Absorptive capacity: infrastructure
Absorptive capacity: developing human capital
Improvements related to clinical trials
Collaborative working and participatory research
Results of the OUH senior clinician interviews
Themes from the interviews with OUH clinicians
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Staff are better and more informed or interested (37%), which maps to the ‘absorptive capacity’ and ‘participatory research’ headings in the Hanney framework
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Patients receive more monitoring and staff contact/communication (37%), which overlaps with the Hanney framework’s ‘improvement in the processes of care related to conducting a specific trial’
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Patients get access to new treatments (21%), which is part of the ‘absorptive capacity’ and ‘participatory research’ categories in the Hanney framework
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Patients evidently appreciate that staff are interested in the condition they have presented with (21%), again part of the ‘absorptive capacity’ item in the Hanney list of mechanisms;
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It seems that patients are themselves better informed (16%), which can be seen as part of ‘participatory research’ in the Hanney framework
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Patients appear to enjoy contributing (11%), which is a spin-off from involving more patients in clinical trials and is not mentioned in the Hanney framework. (One interviewee commented that low drop-out rates from clinical trials at OUH (described as less than 5%) indicate high patient satisfaction. An illustrative example was given by another interviewee of a recent research project which involved comprehensive interviews with patients and families. Even the experience of undergoing the interview was thought likely to have had a positive psychological impact on the patients interviewed.
Individual projects
BRC Research theme/Working group | Oxford BRC projects with potential impact on patient care | Potential impact on patient care at OUH | OUH senior clinician mentioned impact unprompted?a
| OUH senior clinician confirmed impact after prompting?a
|
---|---|---|---|---|
Biomedical Informatics and Technology | Gestational diabetes smartphone application | Processes and/or service organisation | YES | n.a. |
New alerting score based on patients’ vital signs (CALMS-3 Study – Computer Alerting Monitoring System) | Processes and/or service organisation | NO | NO | |
Maintenance of database of samples and consent management for Oxford Biobank | Processes and/or service organisation | NO | YES | |
System for Electronic Notes Documentation (SEND) project (electronic track and trigger and patient alerting) | Processes and/or service organisation | YES | n.a. | |
Blood | Training and hiring staff and improving infrastructure for clinical programme to do stem cell transplants and run more clinical trials in this area | Treatments | NO | NO |
Cancer | Multi-gene testing service with rapid (1 week) turnaround | Diagnostics, testing, screening | NO | YES |
BRC-funded clinical research posts specialising in sarcoma, gynaecological cancers and melanoma | Staffing for specialist services | NO | NO | |
Cardiovascular | MRI diagnostic tools for patients with intermittent angina | Diagnostics, testing, screening | NO | YES |
Clinical Informatics | Upgrade for cancer informatics in OUH (enabled by Genomic Medicine Centre (GMC) designation) | Diagnostics, testing, screening | NO | NO |
Molecular diagnostics and genome sequencing services (enabled by GMC designation) | Diagnostics, testing, screening | NO | NO | |
Development of integrated logical record for each cancer patient (in progress) | Processes and/or service organisation | NO | YES | |
True colours technology for mental health patients across Oxfordshire to aid self-management | Processes and/or service organisation | NO | YES | |
Streamlining management of notes/records from multidisciplinary cancer meetings (in progress) | Processes and/or service organisation | NO | YES | |
Clinical decision support dialogue to make blood orders more efficient | Processes and/or service organisation | NO | NO | |
Dementia and Cerebrovascular Disease | New screening process for acute confusion in medical admissions | Diagnostics, testing, screening | NO | YES |
Fast track carotid surgery | Treatments | NO | NO | |
Telemetric home blood pressure monitoring | Processes and/or service organisation | NO | NO | |
The first transient ischaemic attack (TIA) and minor stroke clinic in the United Kingdom | Processes and/or service organisation | YES | n.a. | |
Diabetes | Diagnostic programme to identify patients with a genetic basis for their diabetes | Diagnostics, testing, screening | NO | NO |
Pancreatic islet extraction unit | Treatments | NO | NO | |
Pancreatic transplants | Treatments | NO | NO | |
Functional Neuroscience and Imaging | Imaging protocols (epilepsy) | Diagnostics, testing, screening | NO | NO |
Functional neurosurgery team (part of the BRC) provides a clinical service, including pain deep brain stimulation | Treatments | NO | NO | |
Specialist clinic in epilepsy, Parkinson’s disease, motor neurone disease, supported by BRC-funded research fellows | Staffing for specialist services | NO | NO | |
Genomic Medicine | Targeted next generation sequencing | Diagnostics, testing, screening | NO | NO |
Whole exome or whole genome sequencing | Diagnostics, testing, screening | NO | NO | |
Immunology and Inflammation | Non-invasive tests for liver disease | Diagnostics, testing, screening | YES | n.a. |
Patient stratification for biologic therapies | Diagnostics, testing, screening | NO | YES | |
Tests to diagnose encephalitis (brain inflammation) | Diagnostics, testing, screening | NO | NO | |
Trials on treatment of inflammation in eczema | Treatments | NO | NO | |
Infection | Work linking care to outcomes with big data approaches | Processes and/or service organisation | NO | NO |
Genomic testing to support infection monitoring (provided informally) | Processes and/or service organisation | NO | NO | |
Molecular Diagnostics | Oxford designated as GMC for Genomics England’s 100,000 Genomes Project | Diagnostics, testing, screening | YES | n.a. |
Multi-gene testing for cancer patients | Diagnostics, testing, screening | NO | YES | |
Diagnostic tests for children with rare blood conditions | Diagnostics, testing, screening | NO | NO | |
Response prediction in leukaemia | Diagnostics, testing, screening | NO | YES | |
Prevention and Population Care | The first TIA and minor stroke clinic in the United Kingdom | Processes and/or service organisation | YES | n.a. |
Surgical Innovation and Evaluation | Chemotherapy (device targeted therapy): liposomes developed to carry the treatment to the organ of interest | Treatments | NO | NO |
Image-guided surgery using fluorescents | Treatments | YES | n.a. | |
Organ transplantation/reconditioning | Treatments | NO | NO | |
Restoring vision through an electronic implant | Treatments | YES | n.a. | |
Restoring vision through gene therapy | Treatments | YES | n.a. | |
Training and Education | No projects identified | |||
Translational Physiology | No projects identified | Diagnostics, testing, screening | YES | n.a. |
Vaccines | Respiratory syncytial virus, trialling a new vaccineb
| Treatments (national) | YES | n.a. |
Meningitis, looking at trials of schedules for baby vaccines, booster doses, meningitis B vaccine trialsb
| Processes and/or service organisation (national) | YES | n.a. | |
Multiple Research themes/Working groups | Better infrastructure for clinical trials and other studies (e.g. better pharmacovigilance, biobanking) | Processes and/or service organisation | NO | YES |
Cross-analysis of results from RT/WG interviews and senior clinician interviews
Theme | Positive changes mentioned (interviewee type) | Challenges and risks mentioned (interviewee type) |
---|---|---|
1. Research activity | Research activity has increased over time (SC and RT/WG) The Oxford BRC plays an important role in enabling research to happen and helps attract additional research funding (RT/WG) | For some, it is unclear how decisions are made about which clinical areas receive Oxford BRC support (SC) The types and topics of research taking place may not fully align with OUH clinical needs (SC) |
2. Formalisation of research roles | There has been an increase in the number of medical and non-medical clinical research staff (SC and RT/WG) More clinical staff have time protected for research, which better enables them to engage in research (SC and RT/WG) | The fixed-term, part-time nature of Oxford BRC research posts can create tension for OUH staff organisation and planning (SC) |
3. Communication and awareness of research | Staff awareness of ongoing research and associated opportunities has increased in some clinical areas (SC) Oxford BRC has increased the profile of patient engagement in research through multiple initiatives (RT/WG) | Clinical staff should be better informed about research taking place, opportunities to get involved and findings (SC) External communications could be improved (SC) |
4. Reputation | Oxford BRC improves the reputation and profile of OUH (SC and RT/WG) | None mentioned |
5. Staff recruitment and retention | Staff are attracted to the OUH because they believe the Oxford BRC and links to the University of Oxford will create opportunities for research and career development (SC and RT/WG) Research opportunities may encourage staff not to leave the OUH (SC) | High quality staff (especially non-medical staff) move into research posts and out of clinical work (SC mainly, but also RT/WG) |
6. Patient benefits from staff involvement in research | Staff are better informed about developments in treatments (SC) Staff reflect more on clinical decisions and how to deliver care (SC and RT/WG) Patients interact with staff more; they may receive better care and feel better cared for (SC) Patients gain access to new treatments (SC) Patients report that they enjoy being involved in research and feel they are contributing to the public good (SC and RT/WG) | Patients may feel inconvenienced or overburdened, particularly if study design and communication to patients are poor (SC) |
7. Access to infrastructure | Additional, improved or lower-priced infrastructure has become available in some areas because of research (SC and RT/WG) | In other areas, there may be opportunities to share infrastructure which are not being realised (SC) Research activity can put additional pressure on clinical infrastructure (SC) |
8. Novel treatments and technologies | Many patients have had access (or earlier access) to novel treatments and technologies because of research (SC and RT/WG) | None mentioned |
9. Attitudes to research | In some areas staff have become more interested, motivated and willing to use research findings (SC)a
| Some perceive a split between the University and NHS; some staff never engage with research and may feel ‘outside’ of research (SC and RT/WG) |
10. Collaboration | Oxford BRC brought more collaboration between Oxford University and the OUH; it made research more clinically relevant and raised the profile of research in the OUH (RT/WG mainly, but also SC) | None mentioned |
Fit with the Hanney framework
Discussion
Limitations
Conclusions
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Patients have had earlier access to novel treatments and technologies as a result of research activity locally
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Research activity has become more formalised in recent years, bringing advantages from funded research time for OUH’s NHS staff, but tensions with those staff who are not so funded
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NHS staff awareness of research appears to be increasing, though there is still work to be done to improve communication about research that is going on, opportunities to get involved, and the findings that emerge
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The Oxford BRC adds positively to the reputation of OUH
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Staff recruitment and retention may be improved in aggregate, though there are local issues with experienced staff being drawn into research and away from patient care
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Patient involvement has increased over time, associated with a major increase in clinical trial activity at OUH
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Additional physical infrastructure has become available in some areas, although this is constrained by Oxford BRC funds not being allowed to be used for capital equipment purchases; against that there were comments to the effect that the demands of extra research activity involving patients can increase pressure on NHS care facilities such as space for outpatient clinics
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In some areas, staff have become more interested in and receptive to research findings, although in some areas such interest and receptiveness have been high for many years