Ethnicity and Outcomes from COVID-19: The ISARIC CCP-UK Prospective Observational Cohort Study of Hospitalised Patients #covid19rftlks

Harrison, E. M. et al (2020). Ethnicity and Outcomes from COVID-19: The ISARIC CCP-UK Prospective Observational Cohort Study of Hospitalised Patients.

This study has been published ahead of print

Abstract

Background: Reports of ethnic inequalities in COVID-19 outcomes are conflicting and the reasons for any differences in outcomes are unclear. We investigated ethnic inequalities in critical care admission patterns, the need for invasive mechanical ventilation (IMV), and in-hospital mortality, among hospitalised patients with COVID-19.

Methods: We undertook a prospective cohort study in which dedicated research staff recruited hospitalised patients with suspected/confirmed COVID-19 from 260 hospitals across England, Scotland and Wales, collecting data directly and from records between 6th February and 8th May 2020 with follow-up until 22nd May 2020. Analysis used hierarchical regression models accounting for confounding, competing risks, and clustering of patients in hospitals. Potential mediators for death were explored with a three-way decomposition mediation analysis.

Findings: Of 34,986 patients enrolled, 30,693 (88%) had ethnicity recorded: South Asian (1,388, 5%), East Asian (266, 1%), Black (1,094, 4%), Other Ethnic Minority (2,398, 8%) (collectively Ethnic Minorities), and White groups (25,547, 83%). Ethnic Minorities were younger and more likely to have diabetes (type 1/type 2) but had fewer other comorbidities such as chronic heart disease or dementia than the White group. No difference was seen between ethnic groups in the time from symptom onset to hospital admission, nor in illness severity at admission. Critical care admission was more common in South Asian (odds ratio 1.28, 95% confidence interval 1.09 to 1.52), Black (1.36, 1.14 to 1.62), and Other Ethnic Minority (1.29, 1.13 to 1.47) groups compared to the White group, after adjusting for age, sex and location. This was broadly unchanged after adjustment for deprivation and comorbidities. Patterns were similar for IMV. Higher adjusted mortality was seen in the South Asian (hazard ratio 1.19, 1.05 to 1.36), but not East Asian (1.00, 0.74 to 1.35), Black (1.05, 0.91 to 1.26) or Other Ethnic Minority (0.99, 0.89 to 1.10) groups, compared to the White group. 18% (95% CI, 9% to 56%) of the excess mortality in South Asians was mediated by pre-existing diabetes.

Interpretation: Ethnic Minorities in hospital with COVID-19 were more likely to be admitted to critical care and receive IMV than Whites, despite similar disease severity on admission, similar duration of symptoms, and being younger with fewer comorbidities. South Asians are at greater risk of dying, due at least in part to a higher prevalence of pre-existing diabetes.

You can download the paper from SSRN

In the news:

BBC News:  Coronavirus: South Asian people most likely to die in hospital

The state of care in urgent primary care services

This report presents findings from the Care Quality Commission’s programme of comprehensive inspections of urgent care centres, NHS 111 services and GP out-of-hours services.

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Image source: http://www.cqc.org.uk

Urgent primary care services play a vital role in England’s healthcare system. They are the first step to ensure that people are seen by the professional best suited to deliver the right care and in the most appropriate setting.  A quick, safe and effective response from these services provides a good outcome for patients and takes pressure off other parts of the urgent care system.

This report presents some common themes and characteristics that the Care Quality Commission (CQC) have found from their inspections.

The report found:

  • Urgent care services are an essential part of the healthcare system, particularly in taking pressure off other parts of the NHS at times of peak demand.
  • Urgent primary care services have been able to improve. Overall, the quality is good – although one in 10 services still require some improvement, particularly in initial assessment of people and timeliness of response to urgent needs.
  • Urgent care providers face pressures with staffing and workforce planning. This is compounded by the reality of unsocial working hours and high reliance on self-employed clinicians
  • Many providers experience difficulties in accessing people’s medical records.
  • NHS 111 in particular has the potential to take pressure off the NHS – and provide a better experience for people by giving advice and treatment in one place. However, to achieve this it must be adequately resourced. Commissioners need to support providers, take action if they are not meeting their contracts and integrate services more closely.
  • Many people are not aware of the range of urgent care services available. There is a need for more public information – and consistency of service provision.

Full report: The state of care in urgent primary care services. Findings from CQC’s programme of comprehensive inspections in England

Digital change in health and social care

This Kings Fund report aims to support  local organisations looking to undertake large-scale digital change. The document states that the future is bright for technology in health and social care, with local care providers digitising under their own steam and initiative.

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The report shares the lessons from five varied case study sites that have made significant progress towards their digital aims. It sets out the lessons learnt and tips for other organisations that are looking to progress their own digital change.

Overview

  • The use of digital technology in health and social care can improve quality, efficiency and patient experience as well as supporting more integrated care and improving the health of a population.
  • Large-scale change involving digital technology, such as adopting electronic patient records (EPRs) and shared care records, is complex and necessitates attention to particular aspects of the change.
  • This report shares practical learning from a series of case studies where significant largescale digital change is happening.
  • Key barriers to successful digital change include the constraints care organisations face in their workforce, tight budgets, organisations’ attitudes towards risk and the relationships that exist between care providers and key stakeholders.
  • Most of the barriers can be mitigated through time and effort and by treating digital projects as change projects, not IT projects. Effective and consistent staff engagement and resource allocation to the project are key factors in success.

The Kings Fund have also produced an interactive map which brings together case studies from across England, highlighting some of the places that are experimenting with and implementing new technologies to achieve better health outcomes or more efficient care.

Full report: Digital change in health and social care

A summary of the report is available here

The learning disability improvement standards for NHS trusts

NHS Improvement | June 2018 | The learning disability improvement standards for NHS trusts

NHS Improvement have developed new standards which have been developed with a number of outcomes created by people and families — which clearly state what they expect from the NHS. By taking this approach to quality improvement, it places patient and carer experience as the primary objective, as well as recognising the importance of how the NHS listens, learns and responds in order to improve care.

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Image source: improvement.nhs.uk

There are four standards, which include:

  • respecting and protecting rights
  • inclusion and engagement
  • workforce
  • learning disability services standard (aimed solely at specialist mental health trusts providing care to people with learning disabilities, autism or both)

Source: NHS Improvement 
The learning  disability improvement standards for NHS trusts

Easy read version: the learning disability improvement standards for NHS trusts

 

Statistics on care of people with learning disabilities

NHS Digital | June 2018 | Statistics on care of people with learning disabilities

As this week (18-24 June 2018) is Learning Disability Week, NHS Digital have released some key statistics associated with the health and care of people with learning disabilities.

  • 49.7% of patients with a learning disability registered at a GP practice received an annual learning disabilities health check in 2016-17, an increase from 43.2% in 2014-15.
  • 41.9% of patients with a learning disability registered at a GP practice received a seasonal influenza immunisation in 2016-17, an increase from 40.8% in 2014-15.
  • 79.5% of eligible patients with a learning disability registered at a GP practice aged 60-69 received screening for colorectal cancer, less than the 86.0% of those eligible patients without a learning disability.
  • On average, females with learning disabilities had around an 18-year shorter life expectancy than the general population, and males had around a 14-year shorter life expectancy than the general population.

(Source: NHS Digital)

The figures have been compiled into an easy to read format available here 

 

Banning phones in schools could give children ‘space to focus’, says RCGP

Royal College of General Practitioners | June 2018 | Banning phones in schools could give children ‘space to focus’, says RCGP

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Writing in The Telegraph earlier this week,  the Culture Secretary Matt Hancock argued mobile phones should be confiscated at the beginning of the school day. Now the Chair of the Royal College of GPs, Helena Stokes- Lampard has responded to this in a statement.

“Children are under so much pressure to conform to social norms around how to look and what to do in order to be popular, and this can certainly impact on their mental, and physical, health and wellbeing. Whilst pressure to conform might always have existed, these days it is relentless through social media and other such channels and smartphones are often the gateway to this. Considering taking measures to ban the use of mobile phones in schools during lessons – either physically or by blocking 4G signals – would be a welcome move, and one that we hope will give children more space to focus on their studies, and have some respite from the pressures they face online (via RCGP).”

In the news:

The Telegraph Exclusive: Teachers should ban mobile phones in classrooms, says minister

 

BBC News To ban or not to ban: Should phones be allowed in schools?

Multi-disciplinary diagnostic centre at University College London Hospital delivers faster diagnosis

NHS England | June 2018 | Multi-disciplinary diagnostic centre at University College London Hospital delivers faster diagnosis

A new case study published by NHS England shows how the multidisciplinary diagnostic centre (MDC) at University College London Hospital (UCLH), delivers faster diagnosis and improved patient journeys, to patients presenting with complex or vague abdominal symptoms.

It is available from NHS England

Blood signature could improve early TB diagnosis

University of Leicester | June 2018 | Blood signature could improve early TB diagnosis

A gene signature (genes that are either more or less active during active TB, representing the body’s response to the infection)  in the bloodstream could reveal whether someone is going to develop active tuberculosis (TB) disease months before symptoms begin. Now it has been developed by a team led by the Francis Crick Institute, the University of Leicester, and international collaborators. The study is the first-of -its kind to link the presence of signature and the onset of early TB before the patient has developed symptoms.

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The team behind the research studied 53 TB patients in Leicester and followed over 100 of their closest associates during a two-year period to see who developed active TB. The patients who remained healthy showed no sustained gene signature, while two-thirds (6 out of 9) of those who on to develop active TB showed a strong, sustained signature (Source: University of Leicester).

The full news item is available from the University of Leicester

A press release provided by the Francis Crick Institute is also available from their website 

 

Measles and summer travel to Europe

Public Health England | June 2018 | Measles and summer travel to Europe

Public Health England is urging Public young people to check they’ve had both doses of the MMR vaccine before travelling to Europe, where there are large outbreaks of measles. 

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Dr Mary Ramsay, Head of Immunisation at Public Health England (PHE), said:

“In the early 2000s there was a fall in MMR vaccination coverage in children and as a consequence, we are now seeing measles cases in young adults. Measles can be more serious in adults with a higher likelihood of hospitalisation and complications arising.

Measles is circulating in England and the rest of Europe. We often think about what travel-related vaccines we might need before going on holiday, but it’s also important to check that we are up to date with routine vaccinations like MMR.

If you are unsure if you have had 2 doses of MMR call your GP practice to check and catch up if needed. ” (Source:Public Health England)

More details are available from Public Health England 

Number of elderly diagnosed with cancer set to rocket by 80% in less than 20 years

Cancer Research UK | June 2018 | Number of elderly diagnosed with cancer set to rocket by 80% in less than 20 years

Data released by Cancer Research UK indicates that the number of cancer diagnoses in older people will rise by 80% in less than two decades time. Currently, 30,000 people aged 75 and over in the UK develop cancer.  By 2035 this is projected to rise to around 234,000, which is attributed to an ageing population.

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In a new report published today (21 June 2018) Cancer Research UK is calling on the health service to act now, to make sure they are prepared for the rising numbers of older patients with more complex needs (Source: Cancer Research UK).

The report Advancing Care, Advancing Years: Improving cancer treatment and care for an ageing population can be accessed here 

A policy briefing of the report is also here 

Related:

Cancer Research UK Age: the biggest cancer risk factor

 

In the media:

BBC News Cases of cancer in elderly to surge by 2035, report says