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Aims:

  • Establish the proportion of patients dying over the course of a year in Oxfordshire who are assessed by the Oxfordshire Out of Hours service in the four weeks prior to their death.
  • Evaluate whether there are features which could help distinguish patient subgroups at higher risk of death within 4 weeks of contact with the out of hours service.

Why this is important:

The contract between general practices and the government requires GP surgeries to be open from 08:00 to 18:30 on weekdays. Care outside this period is provided by out of hours services (OOH). In recent years the challenges faced in the provision of safe OOH care have been well documented, both in the media and by the Royal College of General Practitioners and the Urgent Care Commission.

We are interested in making out of hours services safer, and improving the experience of patients who use them. To help us understand how to make services safer we need to understand how they are currently working. This study aims to answer quite a simple question: how many people who die in Oxfordshire in a year contacted the OOH service shortly before they died? We will then look in more detail at the records of the people who died shortly after contact with the OOH service to see whether we can identify any patterns that might help us to identify who is at high risk of dying.

This work is important because it will help us to understand how sick the patients are who contact OOH services. It may also allow us to make some early theories about which patients are ‘more likely’ to die. Eventually this might help us become better at preventing some deaths. As far as we are aware this work has not been done before in the UK. 

Methods:

We have worked with Oxford Health NHS Foundation Trust (who run Oxfordshire OOH services) to create a database of all patient contacts with the OOH service over a 13 month period.

We have applied to the HSCIC/ONS to get the NHS number, date of birth, date of death, post code (first part only) and cause of death of everyone who died in Oxfordshire in that same 1 year period (1st Jan 2015 – 31st December 2015).

We will then combine those 2 datasets to find the group of people we are interested in – those who died within four weeks of seeing the Oxfordshire OOH service. We will look at this group in more detail to understand why they needed to see the OOH service, their age/sex/deprivation score etc. Personally identifiable data will be kept for the minimum possible duration of time necessary for completion of the study, and will be held securely at Oxford Health NHS Foundation Trust.

Because this study involves using data from deceased people (who cannot give us their permission to use that data) we have gained permission to do the study from the Confidentiality Advisory Group. We have also obtained Ethics Approval. The study was designed in collaboration with our departmental patient participation group. 

How could this benefit patients?

This research uses the data of patients who have already died and so is not of any direct benefit to their ongoing care. It is our hope that this study will make a significant contribution to understanding ‘risk’ around out of hours primary care. We hope that using data in this way will help us contribute to making out of hours services safer for current and future patients. 

For further information, or to ask the researchers anything about this study please contact Dr Rebecca Fisher at rebecca.fisher@phc.ox.ac.uk

Further information

Full project title:
Understanding patient mortality in the month following contact with the out of hours service: a data-linkage study.

Length of project:
October 2015 - December 2016

Funder:
Oxfordshire Health Services Research Committee OHSRC

External collaborators:
Oxford Health NHS Foundation Trust

CAG Approval: 15/CAG/0211
REC Reference: 15/SC/0754