Background: It is well established that there are significant disparities in healthcare delivery and utilisation. These differences cannot be explained by differences in disease prevalence, evidenced based medicine or patient preference. Similarly, it is acknowledged that there is significant variation in healthcare outcomes for which our understanding is limited. This thesis details the variation in structures and processes of care between, acute NHS hospital trusts in England and studies the association of these factors with healthcare outcomes. Methods: Publicly available data sets largely provided by the Health Social Care Information Centre, were examined to describe the variation in hospital trust level structures and processes. Patient level data on a variety of diagnostic or procedural cohorts was obtained from the Hospital Episode Statistics administrative database. The cohorts studied included all hospital admissions, emergency admissions or procedures, general surgical emergencies, ruptured abdominal aortic aneurysm (AAA) repair and all A A A repairs. Outcomes included mortality, complications and failure to rescue from complications. Resource provision or utilisation between risk adjusted outliers for a given outcome were compared. Multilevel hierarchical binary logistic regression models were used to identify the associations of structure and processes of care with risk adjusted outcomes. Results: There is significant variation in structures and processes of care between hospital trusts. Trusts with the most favourable outcomes had significantly greater levels of staffing, critical care and radiodiagnostic utilisation. Greater medical and nurse staffing levels, radiodiagnostic utilisation, research activity and procedural volume were associated with better healthcare outcomes for a variety of cohorts. Conclusions: This thesis demonstrates that hospital trust level variation in structures and processes of care is associated with the outcome for a broad range of patients. Further research should examine the underlying mechanisms for these associations and, the clinical and cost-effectiveness of resource modification at the trust level.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:753989 |
| Date | January 2017 |
| Creators | Ozdemir, Baris Ata |
| Publisher | St George's, University of London |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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