Spotlight: ROC curves and the forgotten lesson of Pythagoras

pythagoras_ROC

You know the feeling – someone has said something at some point, but you can’t find the reference to back it up. Well according to Wikipedia, no specific attribution of Pythagoras’ theorem to Pythagoras exists in the surviving Greek literature from the five centuries after Pythagoras lived, let alone from the big man himself. So …read more

Conference report: NAPCRG (North American Primary Care Research Group) Annual Meeting 2014

NAPCRG 2014a-630

What were the highlights of the US meeting this year? Apart from cake for breakfast, much was going on as primary care researchers gathered in Times Square from across the world…conference report here

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Multi-morbidity and the Emperor’s New Clothes: a challenge for primary care researchers

Are single disease guidelines and indicators are going out of fashion? Well they are with people interested in multi-morbidity. The argument is straightforward. Single disease guidelines are usually based on trials which exclude people with multiple complex problems. So how does the physician know how a cholesterol guideline developed from trials on 65 year old …read more

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The economics won’t go away: NHS Cancer Drugs Fund to consider cost-effectiveness

This week, NHS England published its revised process for operation of the cancer drugs fund.  Of particular interest is the requirement to take into account both costs and effects of treatments. NICE was set up in 1999 with the remit of considering the value for money, or cost-effectiveness of new and existing treatments. It is …read more

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So does QOF really reduce emergency hospital admissions?

What should you make of our latest paper suggesting that QOF reduced emergency admissions? There have now been over 20 systematic reviews of pay for performance (P4P) and even a systematic review of systematic reviews. A reasonable summary would be that P4P seems to improve the processes of care somewhat (and with the potential for …read more

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When does a ‘poor’ practice mean a ‘poor’ doctor?

Mean communication score (best estimate) by practice and doctor. Practices (n=25) are sorted by their mean communication score.

This was the title of our paper published today in the BMJ when we first submitted it to the journal. However, the BMJ doesn’t allow questions as titles so it became the less sensationalist “Understanding high and low patient experience scores in primary care: analysis of patients’ survey data for general practices and individual doctors”. …read more

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When incentives go wrong – £55 for dementia diagnosis is a dead cert.

People argue a lot about whether it’s a good idea to give financial incentives to doctors to provide good care. There’s an argument that you should when it costs more to provide that care. Then there’s the more contentious issue of whether a cash incentive is a useful addition. The evidence is that incentives do …read more

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Are patient experience surveys for quality assurance or quality improvement?

Patient experience surveys in primary care carry an expectation that they will stimulate change. Our focus group study in 14 practices explores why practice staff struggle to identify and action improvements as a result of patient feedback alone.

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How can we use patient experience surveys to improve care?

One new answer, for cancer patients, comes from our analysis of the National Cancer Patient Experience Survey, published this week in the European Journal of Cancer Care We found strong inequalities in experience between patients with different cancer diagnoses, and these were pretty consistent across the whole patient journey, from pre-diagnosis care to post hospital …read more

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How do people with diabetes describe their experiences in primary care?

Well, actually quite good news here. People with diabetes in England report primary care experiences that are at least as good as those without diabetes for most domains of care. This is one of our conclusions from our analysis of responses to the English national GP Patient Survey from 85,760 patients with self-reported diabetes. However, …read more

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  • The Cambridge Centre for Health Services Research (CCHSR) is a collaboration between the University of Cambridge Health Services Research Group at the Institute of Public Health and the Health and Healthcare Group at RAND Europe. We aim to inform policy through evidence-based research on health services in the UK and internationally.