Use this URL to cite or link to this record in EThOS: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.780733
Title: Identifying and prioritising interventions to reduce emergency hospital admissions
Author: Bobrovitz, Niklas
ISNI:       0000 0004 7966 3738
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2019
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Abstract:
The aim of this thesis was to identify and prioritise evidence-based interventions that reduce emergency hospital admissions and explore their implementation in clinical practice. To achieve its aim, this thesis first identified evidence-based interventions that reduce emergency admissions using a systematic review of systematic reviews. Second, it determined which of the evidence-based interventions had been recommended in national clinical guidelines, developed into quality of care indicators, and featured in national audits in England. Thirdly, it explored the extent to which evidence- and guideline-based interventions were being optimally utilised in primary care in the United Kingdom. Fourthly, it evaluated an innovative access to care initiative implemented in primary care to reduce hospital admissions. Fifthly, it explored the use of evidence by decision makers when designing and implementing local interventions as part of national campaigns to reduce admissions. Overall, the findings showed that there are a variety of evidence-based interventions that reduce emergency hospital admission rates. However, the thesis showed gaps in the promotion and use of these interventions in clinical practice in the United Kingdom. It also demonstrated that increasing access to primary care using innovative interventions may not be an effective or evidence-based approach to reducing hospitalisations. Stakeholders seeking to reduce admission rates may consider optimising use of the evidence- and guideline-based interventions prioritised in this thesis. This may be done using existing quality improvement infrastructure or by developing or expanding health care services that feature the interventions. Furthermore, efforts should be made to robustly evaluate novel interventions implemented in clinical practice to reduce hospital admissions. The results of such evaluations should be systematically disseminated to facilitate peer-peer learning, avoid duplicated efforts, and promote use of evidence-based interventions.
Supervisor: Heneghan, Carl ; Mahtani, Kamal Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.780733  DOI: Not available
Keywords: Systematic reviews (Medical research) ; Emergency management ; Clinical epidemiology ; Time series analysis ; Public health ; Emergency medical services ; Health services administration ; Medical Care
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