The close partnership with NHS Cheshire and Merseyside (C&M) Data into Action programme is a crucial part of DART, which aims to ensure that data is translated into impactful action, realising clear benefits for C&M patients, communities, key stakeholder organisations and wider partners through measurable change across the system.
Weekly meetings provide a forum for health care professionals, analysts, data scientists and population health researchers to present their work, to share knowledge and enable mobilisation across academia, NHS, local authorities, and the wider health and care system. This provides a unique ability for C&M to respond to urgent health and care priorities in a timely and evidenced based manner.
The DART comprises representatives from the University of Liverpool and strategic partner organisations. This includes, but is not limited to:
| Name | Organisation |
|---|---|
| Ben Barr | University of Liverpool |
| Roberta Piroddi | University of Liverpool |
| Liz Camancho | University of Liverpool |
| Richard Jackson | University of Liverpool |
| Phil McHale | University of Liverpool |
| Iain Buchan | University of Liverpool |
| Claire Smith | University of Liverpool |
| Gary Leeming | University of Liverpool |
| Sarah Rodgers | University of Liverpool |
| Marta Garcia-Finana | University of Liverpool |
| Ruwanthi Kolamunnage-Dona | University of Liverpool |
| Mark Green | University of Liverpool |
| Hayley Jones | University of Liverpool |
| Carmen Cabrera-Arnau | University of Liverpool |
| Chris Kypridemos | University of Liverpool |
| Michael Abaho | University of Liverpool |
| David Hughes | University of Liverpool |
| Olly Butters | University of Liverpool |
| Nina Zhang | University of Liverpool |
| Yang Yu | University of Liverpool |
| Konstantinos Daras | University of Liverpool |
| Roberto Villegas-Diaz | University of Liverpool |
| Kukatharmini Tharmaratnam | University of Liverpool |
| Christopher Cheyne | University of Liverpool |
| Pieta Scholfield | University of Liverpool |
| Hannah Burnett | University of Liverpool |
| Alice Varley | University of Liverpool |
| Brendan Colllins | University of Liverpool |
| Hui Hui Song | University of Liverpool |
| Tom Butterworth | NHS Cheshire and Merseyside ICB |
| Julia Barber | University of Liverpool |
| Wes Baker | NHS Merseycare Foundation Trust |
| Alice Lee | Alder Hey |
| Luis Filipe | Lancaster University |
| Gwen Cowley | Alder Hey |
| Bethan Reeves | Merseycare |
| Elspeth Anwar | Liverpool City Council |
| Chris Buckels | ICB |
| Nicolaos Koukkoulli | ICB |
| Gashirai Mbizvo | Walton Hospital |
DART Projects
Households with complex needs
We have developed a tool for identifying and supporting the households with children with the most complex needs in Cheshire and Merseyside. Using whole population individual level linked data from primary, secondary, community health, mental health and social care services we identify complex patterns on need within households. Using anonymized households identifiers we analyzed how risks cluster within households. This is being used in a case finding tool to help services to plan and target integrated care family interventions and decide on resource allocation.
Evaluating Liverpool’s Citizens Advice on Prescription (CAP)
Citizens Advice on Prescription (CAP) provides advice and support to reduce financial insecurity and improve living conditions for people in Liverpool. Using data linkage between Citizens Advice Liverpool’s Case Management system and electronic health records, we estimated the impact on mental health and health care use of CAP and estimated cost-effectiveness. We find consistent evidence using different methods that Citizens Advice on Prescription improved mental health and wellbeing and it is likely it saves the NHS money.
Predicting the risk of children entering care
Using linked data between children’s social care and electronic health records, we are developing predictive models to identify which children are most at risk of being taken into care, learning where and when it is most effective to intervene. This will support the targeting and redesign of services within and beyond children’s social care.
Anticholinergic Medicines Index (ACMI)
Many medications have anticholinergic properties, increase risk of falls and delirium. This risk can be reduced by reviewing and modifying the medications people receive. We used linked primary and secondary care data to calculate people risk of hospital admissions attributable to Anticholinergic Medications using ACMI, and found that high risk patient in deprived areas were less likely to be reviewed that more affluent patients with similar risks. We are working with medicines management teams to use this tool to better target medicine review to reduce these risks.
Evaluating the risks and benefits of medicine optimization reviews for anti-coagulants
Direct Oral Anticoagulants (DOACS) are important drugs prescribed to reduce risks of blood clotting disorders in patients with Atrial Fibrillation. They are however very expensive and a significant cost to the NHS and can increase risks of bleeding complications. Medicine Optimization reviews can be used to ensure patients are receiving the most appropriate version of these drugs, switching them to less expensive versions when safe to do so. We investigated whether medicine optimization reviews and switching DOACs increased bleeding risks and found that the structured approach used in Sefton did not increase risks and could save the NHS money.
DIAPHRAM: Evaluating whether parent champions reduce risk of hospitalisation of young children with bronchiolitis
The Parent Champions in the Community Project, developed by Liverpool City Council and Alder Hey, provides peer support for families in deprived areas of Liverpool where babies are most at risk of having severe bronchiolitis. Using linked primary care and hospital data we are evaluating this and have found it is effective at reducing risk of hospitalization.
Developing a need prediction model for district nursing teams
We developed a novel whole population district nurse needs-assessment model to inform staffing levels for neighbourhood teams so that they better reflect patterns of need. Using linked data from GPs, community services, social care and hospitals, we have produced and index of of district nurse need for each neighbourhoods, showing how staff should be shifted to better reflect patterns of need. Mersey care NHS Trust are now using this model to inform district nurse staffing patterns.
Evaluating the use of mobile vaccination units
Following the national rollout of the COVID-19 vaccine program in 2020, there were concerns with low vaccine uptake in some areas. Local Authorities across Cheshire and Merseyside introduced Vaccine Buses to take the vaccines into the hearts of local communities. We evaluated whether this approach increased uptake in these communities, and found that it did, but was more effective amongst the least deprived groups in those communities.
Evaluating the impact of an integrated care intervention on mortality and unplanned hospital admissions
In 2017 Liverpool introduced integrated care teams, bringing together existing community teams, with a new clinical care-coordinator role. We investigated whether this reduced emergency admissions or increased survival. We found that there was actually an increase in admissions amongst those receiving the service, as additional need were identified, and mortality risk did not change.
Impact of community asymptomatic rapid antigen testing on covid-19 related hospital admissions
During the COVID-19 pandemic we established UK’s first Civic Data Cooperative as CIPHA (Combined Intelligence for Public Health Action), bringing together diverse linked population health data, tracking testing, uptake and impact across 2.5 million. This delivered and evaluated the world’s first public health evaluation of voluntary open-access SARS-CoV-2 rapid antigen testing, demonstrating how it led to lower hospital admissions in Liverpool than would have otherwise been the case.
Evaluation of the health impact of COVID-19 shielding programme
Early in the pandemic Liverpool used CIPHA (Combined Intelligence for Public Health Action) to provide and enhanced shielding and response programme. We assessed the effect of this on COVID-19 mortality indicating that it reduced mortality risk of the clinically vulnerable population by 35%.
DART is supported by colleagues funded through the NIHR Applied Research Collaboration (ARC) NWC.
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