Research Update: Week 4

I have finally completed all of the interviews which totals to 14 patients and roughly 41 responses. I have documented all of the responses and added them to my paper verbatim. The interviews were rather short for each person but finding patients with the patient coordinators was rather time consuming. I planned to do about 2 hospitals each afternoon and succeeded in terms of keeping up with my goal, but travel was rather taxing. 

I interviewed 4 patients in Jericho, 5 in Marston and 5 in Cowley to try and get an even split of patients. The patients participated in answering all the questions, except for one patient who had to leave for his appointment and could not answer 2/3 questions. This meant that although our patient sample size was small, we gained a lot of data and response despite the short amount of time we had to work with. 

Here are some common responses to each question that I had gotten. I will expand more on these responses and try to find trends and correlations. Also, I will publish the entire transcript of the interview in the paper so that readers can also see a wide variety of responses regarding each question. 

Question 1: “How did you choose to come to this clinic today? Through NHS pathways or were you assigned to this clinic?”

Common responses for this question were…

– Patients used NHS pathways

– Patients chose Jericho because it looked like a good facility

– Patients chose Nuffield because it is a reputable clinic affiliated with the University

– Patients chose clinics that were closer to their residence

Question 2: “Have you visited any other clinics in the Oxford area? If so, how do they compare with this clinic?”

Responses:

– Most patients have not visited another clinic

– Some patients transferred from Cowley 

– Some patients prefer Jericho clinic over other clinics

Question 3: “Would you rather go to a clinic in an expensive neighborhood or an economically disadvantaged neighborhood? Why?”

Responses:

– Some patients said that all NHS clinics are the same

– Expensive neighborhood clinics because they have better technology

– Expensive neighborhood clinics because they are newer

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Research Update: Week 3

This week’s focus has mainly been on gathering resources that will aid me in the interview process of the project. The main focus was to prepare the questions for the interviews. But before making the questions, I wanted to understand how other research groups approached patients in a hospital setting. One thing to consider is whom to approach and how to approach them, because patients may be dealing with many problems or may be under immense amounts of stress. In order to understand proper “interview etiquette” in a hospital setting, I took a look at the following books and more in the Bodleian and Radcliffe Science Libraries.

1. Exceptionally good? Positive experiences of NHS care and treatment surprises lymphoma patients: a qualitative interview study. – Ziebland, Evans

2. Methods of data collection and analysis for the economic evaluation alongside a national, multi-centre trial in the UK: conventional ventilation or ECMO for Severe Adult Respiratory Failure (CESAR). – Thalanany, Mugford

Some other points I found regarding interview etiquette were…

– Patient interview cannot be held in the Surgery, ER, ICCU, or Oncology units

– Patient coordinators have to be present during all interviews

– Patients must sign consent forms for the interviews

Thus accordingly the consent form was made and I contacted patients coordinators at all the clinics I plan to visit and interview at. 

After creating some notes about how to approach and communicate with patients, I started to formulate the questions I will be asking. The following are the questions I plan to ask: 

Question 1: “How did you choose to come to this clinic today? Through NHS pathways or were you assigned to this clinic?”

Question 2: “Have you visited any other clinics in the Oxford area? If so, how do they compare with this clinic?”

Question 3: “Would you rather go to a clinic in an expensive neighborhood or an economically disadvantaged neighborhood? Why?”

Unfortunately, I had a minor injury to my ankle on Wednesday evening, and could not conduct interviews as planned. But this extra time gave me the opportunity to contact human resources and physician coordinators based in the following hospitals, in order to further streamline the interview process and eliminate any paperwork or hurdles that may arise the day of.

  1. Jericho Health Centre
  2. John Radcliffe Hospital
  3. Nuffield Health
  4. The Manor Hospital
  5. The Churchill Hospital
  6. Warneford Hospital and Clinic
  7. Bartholomew’s Medical Centre

Finally I did some research on the NHs system itself through a variety of different resources at Radcliffe Science Library including, but not limited to..

“The National Health Service”. HistoryLearningSite.co.uk. 2005. Web.

“The NHS in England.” About the National Health Service (NHS) in England. Department of Health UK, n.d. Web. 20 Aug. 2014.

Millard, Peter H. National Health Service. London: National Pensioners Convention, 2001. Print.

The Impact of the Built Environment on Care within A&E Departments. London: TSO, 2004. Print.

“Health and Social Care Information Centre (hscic).” About NHS Pathways. HSCIC, n.d. Web. 20 Aug. 2014.

“Health and Social Care Information Centre (hscic).” Benefits. Department of Health UK, n.d. Web. 20 Aug. 2014.

These resources gave me a thorough knowledge of the formation of NHS, how it evolved from 1948 to present day, and some of the pro’s and con’s associated with the system. I plan to talk about this framework and evolution of the NHS in my paper as a way to give background about the system itself prior to analyzing the actual system. This way readers have a better knowledge of what I am referring to in my analysis in the latter portions of my research paper. 

Research Update: Week 2

Before I came into Oxford, I had imagined that the bulk of my research will be around finding the faults of the NHS and commenting on them in relation to the faults we have in the Affordable Care Act. But after interviewing Dr. Cheruvu, a bariatric surgeon in Staffordshire, I understood that the purpose of my project is not to take a stance for or against the policies of the NHS but rather paint a holistic image of what the system is, particularly how it address quality of care among patients of different economic backgrounds.

Now I was questioning how do I figure out what metrics would be useful to evaluate “quality of care?” After going through many relevant online articles and books I found at both the Bodleian and Radcliffe Science Library, I found that the most popular metric to use is patient-centered self reports. This can be in the form of interviews, testimonials and anonymous quotes.

Here is a sample of the online articles I had found through the SOLO system in the Bodleian:

Hip Surgery Economic: http://jpubhealth.oxfordjournals.org/content/35/1/115
Equitable Cardio Treatment: http://circoutcomes.ahajournals.org/content/6/2/208
Physician Staffing: http://www.jstor.org/stable/3764146
Distance Travelled: http://hsr.sagepub.com/content/12/3/153.full.pdf+html
Improving NHS: http://www.content.healthaffairs.org/content/19/3/102

In addition, some other useful metrics I found include comparing patient wait times and ratio of public and private NHS clinics in different economic areas of Oxford. The next step is to create a release form that volunteers would sign prior to giving their comments on the system for our project. In this process, we have to bear in mind that patient information and hospital information/records are strictly confidential. Subsequently, I have created the release form that we give to patients. For the creation of this form, I used templates that were from the University of Washington human services department. These templates were good examples of how to not include personal information but still have consent. Now that the form has been created, Aurnee and I will commence interviews next week hoping to find a wide array of patient responses to the NHS.

Apart from that, Aurnee has been using a website called Zoopla to find out the average property values of portions of the city and thus create economically diverse sectors of the city. I will then find the clinics (public and private) in these sectors and go to as many of those clinics as I can with Aurnee and conduct the interviews. More to come on the interviews in next week’s blog posting…

Research Proposal

An Analysis of Quality of Care in the Hierarchy

A. Rahman and P. Mellacheruvu

Introduction

Healthcare is the provision of medical and related services aimed at maintaining good health. The National Health Service (NHS) of the UK strives to provide healthcare from the top-down. In a nutshell, the NHS is the pinnacle of socialized medicine, as the British government pays almost any bill to the extent to which the maximum cost of receiving any prescribed medicine is a mere $12. The NHS was formed in 1948, in the wake of the atrocities of World War II. There was incredible opposition to the plan at the time, especially by the British Medical Association (BMA) stating that it was unsupportable and too ambitious. Today, some citizens of the UK have a similar opinion regarding NHS. Others believe that the NHS has done well, as Britain has a higher average life expectancy, lower infant mortality, and fewer medical and surgical mishaps. But how does this opinion vary among the classes? How related is quality of care with class structure in the UK? These are some of the questions that are to be explored on the ensuing analysis of how quality of care differs among the classes with NHS.

Research Questions

Considering the possible tensions in the healthcare system with respect to the class divisions of the UK, we began questioning how this system of care manifests itself. We wonder if there was a difference in the quality of care experienced by the different classes. Does it vary? Is the variance significant in any way? Considering this, how can we look at healthcare across classes? How can we take more recent immigration into account? To break down these questions even further, we began thinking about how quality of healthcare could possibly be measured. Importantly, we need to be able to somehow quantify quality in a way that is meaningful. We decided that an effective way to measure quality would be to measure time. What are the wait times for people in clinics that are public versus those which are private? Who frequents private clinics as opposed to private clinics? This led us to question the availability of difference clinics. How can we map the number of clinics in a geographical area, like Oxford, in relation to different demographic areas? Is there a correlation between the number of private and public clinics and property value? Also, how does the number of A&E’s factor in? Are they denser in certain locations as opposed to others? Who is more likely to use an A&E, and can this also be mapped and correlated with income distribution and/or property value? We feel that these are questions that we could possibly answer during our time at Oxford.

Methods

The overall approach to this project will be very hands on. A close attention will be on demographics and first-hand opinions of patients and physicians. With regards to demographics, the city of Oxford will be mapped by creating loose socioeconomic sectors of the city based on metrics such as property values. This data will be obtained from the Oxford City Council databases that are free to the public on the web and through other various real estate websites. Thus an analysis of the built environment is vital for the mapping process. Then the number of NHS clinics and private clinics for each sector can be counted. Then there will be a test to see whether there is a correlation between the socioeconomic sectors of the city and the ratio of NHS to private clinics in each sector. An offshoot of this process is the counting of the number of A&E departments in each sector. An A&E department is a clinic that accepts patients with accidents and emergencies requiring urgent care. Here, a similar ratio can be formulated with the A&E clinics. Finally, an integral aspect of the project is communicating with physicians and patients in the NHS clinics and private clinics. One day interviews can be conducted with willing participants at the NHS sponsored John Radcliffe Hospital and another day interviews can be conducted at private clinic: The Manor Hospital. Since there isn’t a way of quantifying “quality of care,” the interviews shed light on patient and physician experiences and opinions on NHS healthcare and private healthcare. Some examples of questions asked with include, “What are waiting times like for [x] procedure?” “How easy is it to pick and choose a particular hospital? A particular physician?” “What is the appointment scheduling process like? Time consuming or painless?” Even though only a small sample size of physicians and patients will speak for the system, through these questions one can get a gist for the overarching thoughts and opinions on the public vs. private sectors of healthcare in the United Kingdom.

Field Research Schedule

            While conducting our research, we will need to consult people, places, and many writer documents. Because they may be somewhat time consuming, we will need to set aside appropriate time to do interviews. Ideally we will be able to interviews the second week we are in Oxford, and we will need to include both doctors and patients. We are still working on figuring out which doctors and which hospitals and when, but hopefully we will be able to get a start on that soon. As for patients, we are looking to interview a few patients at a private clinic and a few at a public clinic. Ideally we will be able to pick patients who will be able to provide us with information we need in terms of wait times. We will need to probably take audio recordings with a device. We will also be able to assess the quality and differences between the clinics when we visit them to conduct interviews. It will be helpful to take pictures of these locations so that we can reference them in our research. We will also need to spend some time looking at maps of the Oxford area (including Oxfordshire). On these maps, we will have to locate all the public clinics, private clinics, and A&E’s. We will probably spend the first week doing this in order to get a feel for the places we will visit at the geographical relationship between the various clinics. We will also need to reference the demographics of the Oxford area and map them, possibly using property values. For this, we will need to utilize real estate information, likely through websites or by speaking to someone directly, for property values and other useful pieces of information. In order to set a basis for our understanding of class structure in the UK and the history of the NHS, we will also need to consult literature about these histories. Web sources will likely be the most helpful with this. Much of this part can be done before we even travel to the UK, and when we are there we can clarify things we hadn’t previously considered to be important to our understanding. If we decided to look into existing research about class and healthcare, we would also consult online publications and journals that contain papers about these topics. By the third week in Oxford, we should be able to analyze all the data we have collected and begin to compile it into a cohesive paper.

Exploring Topics of Research

NHS v. ACA. A comparative analysis of each programme 

I plan to assess, in an unbiased manner, the healthcare systems of the United States and England. The United Kingdom itself does not have an extensive health plan, but individual countries such as England and Scotland have their own respective organizations. The English healthcare system is the National Health Service (NHS). I would like to compare and contrast NHS with the Affordable Care Act health coverage plan recently set in the United States. In the process, I hope to focus in on the positives of both plans and perhaps hybridize them into another plan that may in fact be better than the present plans in place.

Pro’s of the National Health Service: https://www.gov.uk/government/organisations/department-of-health

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Con’s of the National Health Service: http://article.wn.com/view/2014/04/27/Hospitals_in_England_failing_to_provide_safe_care_have_tripl_p/

Pro’s of the Affordable Care Act: http://www.mass.gov/eohhs/feature-story/top-10-reasons-why-the-affordable-care-act-is-good.html

Con’s of the Affordable Care Act: http://www.huffingtonpost.com/dr-john-jackson/why-the-affordable-care-a_b_4082251.html

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More specifically I would like to understand what sort of political maneuvers were employed to pass these plans and to what degree medical science was considered during the respective parliamentary processes. Thereby, I will analyze the conjunction between two fields: politics and medicine. Some of the questions I will consider include: “How were practicing physicians and hospital administrators involved in the legislative process? What medical papers were quoted or cited in the debates leading up to the votes on these measures? How were the small hospital/clinic staff’s voices heard?” Using these questions, I would like to draw on the interplay between the humanities and sciences and understand how the two work hand in hand as well as repel each other. Although this single conjunction may not answer the age old debate between the humanities and sciences, it creates a path for further exploration into the debate.