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Nihr collaboration for leadership in applied health research and care oxford

ABOUT THE NIHR CLAHRC OXFORD

The National Institute for Health Research (NIHR) Collaboration for Applied Health Research and Care (CLAHRC) Oxford is a collaboration that spans several boundaries between primary and secondary care, between commissioners and providers, and across the translational continuum.

The NIHR CLAHRC covers Oxford and the Thames Valley and has been awarded £9 million of funding from the NIHR to ensure that the area’s patients benefit from innovative new treatments and techniques.

Additional matched funding from a variety of organisations including the University of Oxford, local Health Trusts, Care Commissioning Group’s (CCG’s), Local Authorities, Charitable Organisations, and Industry, will initially double the amount to make a total of £18 million available to fund research.

With science excellence and strong collaborative leadership, the NIHR CLAHRC Oxford aims to address areas of high importance and relevance for patients as well as key NHS priorities: delivering the most effective and best value services and focussing on those with greatest need – the frail elderly presenting to acute medical services, people with dementia in care homes, and those with chronic enduring illnesses and comorbidities; the highest users of NHS services.

The NIHR CLAHRC Oxford is led by Professor Richard Hobbs, Head of Oxford University’s Nuffield Department of Primary Care Health Sciences with colleagues from the University’s Medical Sciences Division, in particular researchers at the Department of Psychiatry. The collaboration will work closely with the users of research, including clinicians, patients, commissioners, and the public.

The NIHR CLAHRC Oxford is providing funding and support for innovative research into new ways of providing and targeting services; patient self-management; and integrated care across organisational boundaries. We will provide robust evidence of the effectiveness and efficiency of these services and facilitate rapid implementation of evidence-based changes for the benefit of patients. Importantly, the NIHR CLAHRC Oxford also aims to enhance UK applied research training capacity while ensuring that our research is shaped by local priorities and that evidence-based innovation is translated and implemented quickly, both locally and nationally.

Amongst the Oxford University-led projects that the new funding will support will be assessing the impact of the new Emergency Multi Disciplinary Units, aimed at reducing the pressure on hospital A&E Departments, which are planned to open across Oxfordshire. These Units would act as a ‘halfway house’ between GPs surgeries and hospitals, enabling vulnerable, often frail and elderly patients, to be assessed and treated more quickly without needing to go to A&E and have an extended stay in hospital.

The collaboration will also build on many years of Oxford research into how technology can help patients to monitor their health and treatment: a new project will evaluate the impact of increasing patient self-management in chronic lung disease, pregnancy and mental health. This involves using a combination of secure internet connections, tablet computers, and text messaging to support patients so that, for example, people with chronic lung disease (COPD) can use tablet computers to help them manage their own symptoms including both chest problems and other linked issues such as depression.

The collaboration will be in partnership with the Oxford Health NHS Foundation Trust as well as other local Health Trusts and clinical commissioning groups. The £9 million is Oxford’s share of £124 million of government funding going to 13 research teams across the country to help them tackle some of the nation’s most pressing health problems.

NIHR CLAHRC Oxford THEMEs

Early Intervention and Service Redesign across organisational boundaries

The Early Intervention theme will focus on older people presenting to emergency medical units for assessment, people in care homes with dementia and young people with a first episode of psychosis.The aims of this theme are to research and implement new ways of delivering services in partner NHS organisations and social care settings

This theme will use a comprehensive range of expertise in health services research, trials, health economics and statistics to guide the implementation of new service models, collect high quality evidence of effectiveness, and analyse outcomes. The expertise in the theme which covers quantitative and qualitative methodologies will also provide a general resource across the CLAHRC, including training.

Led by: Professor John Geddes

Health Behaviours and Behavioural Interventions

The Health Behaviours theme will initially focus on people with back pain and other long term painful conditions and people with cognitive and physical disabilities who are referred for exercise in primary care.

The interventions will mainly focus on exercise/physical activity, and multiple poor health behaviours. We will develop and implement interventions, and gain understanding of how to integrate the impact of exercise and physical activity advice alongside interventions for other health behaviours (in particular smoking cessation and diet). A multi methods approach will be used including systematic reviewing, randomised controlled trials, observational work and qualitative research.

The aims of this theme are to translate knowledge from Phase II and III trials completed in low back pain, chronic neurological conditions and dementia to provide better evidence, guidance and/or training to the general public, people with physical and/or cognitive disabilities, families and carers and primary care, public health and rehabilitation practitioners and commissioners. We will work closely with the self-management theme to broaden our work on smoking cessation, harm reduction and dietary interventions. 

Led by: Professor Sallie Lamb

Patient Experience and Patient Reported Outcomes: assessment and impact on services

The Patient Experience and Patient Reported Outcomes theme is focused on the spectrum of individuals with long term conditions, with sample patient groups and conditions. The goal of the theme is to improve the responsiveness of services to patients’ reports of experiences and outcomes at the local level. There are 3 early projects in this theme: to design a Patient Reported Outcome Measure (PROM) more relevant than EQ-5D to the goals and aspirations of patients, health professionals, providers and commissioners/regulators; to pilot evaluate the potential impact of feedback from PROMs on services; and conduct a review of the different mechanisms of obtaining evidence of patients’ experiences of services.

This theme will use qualitative interviews and structured survey techniques to develop a PROM for long term conditions; an RCT to test PROMs in primary care; and systematic review of evidence of impact of feedback.

The aims of this theme are to provide more effective methods and mechanisms to capture, process, synthesise and communicate evidence of outcomes and experiences at the level of the local health economy.

Led by: Professor Ray Fitzpatrick

Better Management of Psychiatric Comorbidity in the medically ill: developing integrated care

Better Management of Psychiatric Comorbidity in the Medically Ill will focus on patients with a combination of a long-term medical condition and a psychiatric disorder, specifically: patients with poorly controlled type 2 diabetes and major depression; depression and anxiety in those in the last year of life of a chronic illness; and medical inpatients with distress. Medical-psychiatric comorbidity worsens outcomes for patients, leads to potentially avoidable reduction in quality of life and increases the cost of care.

In each case an intervention will be developed that will integrate psychiatric interventions with medical care. The interventions will be informed by the ‘collaborative care’ model and delivered by existing medical/nursing staff assisted by training, supervision and clinical information support for improved care. Similar techniques have been successful in other settings (cancer, primary care).

The theme will use three main methods: First, the prevalence and nature of the comorbidity and barriers to it being addressed will be identified using descriptive methods including interviews of patients and staff. Second, informed by these data and by systematic reviews of existing literature, interventions will be constructed and piloted iteratively to ensure their feasibility, acceptability and likely efficacy. Third, the effectiveness of the interventions will be evaluated in randomised control trials, funded by further grant applications.

Led by: Professor Michael Sharpe

Optimising the health of people at risk of or with chronic disease through self-management

The Self Management theme will focus on people with obesity, type 2 diabetes, chronic lung disease, gestational hypertension and bipolar disorder.

A series of technology enabled self-management interventions will be developed and tested including an observational study of weight management behaviour; assessing the influence of lifetime cardiovascular risk information on self-management behaviour in type 2 diabetes; evaluating self-management in Chronic Obstructive Pulmonary Disease (COPD) with respect to improving co-morbid mood; and pilot trials of self-management of blood pressure post-delivery in gestational hypertension and bipolar disorder.

A range of methods will be used in this theme, including observational work, randomised controlled trials, economic evaluation and qualitative research techniques.

By year 3 this theme is aims to have developed a new dietary behaviour diary system and collected data on the first group of patients; developed and tested a lifetime risk education intervention; devised and tested an intervention improving the treatment of co-existing mood disorder in chronic lung disease, adapting and piloting self-monitoring and self-titration of antihypertensive medication following delivery in gestational hypertension and a new multidisciplinary intervention in bipolar disease.

Led by: Professor Richard McManus

NEWS

Oxfordshire Researchers receive £9 million of funding from the National Institute for Health Research (NIHR) 

Guardian Healthcare Innovation Award winners 

PUBLICATIONS

NIHR Central Commissioning Facility Publication

THE TEAM 

THEME LEADS 

CONTACT US

For more information on the NIHR CLAHRC Oxford please contact us on:

E: nihrclahrc@phc.ox.ac.uk

T: +44 (0)1865 289300