Spatio-temporal modelling of referrals to outpatient respiratory clinics in the integrated care system of the Morecambe Bay area, England.

Publication date: Feb 22, 2024

Promoting integrated care is a key goal of the NHS Long Term Plan to improve population respiratory health, yet there is limited data-driven evidence of its effectiveness. The Morecambe Bay Respiratory Network is an integrated care initiative operating in the North-West of England since 2017. A key target area has been reducing referrals to outpatient respiratory clinics by upskilling primary care teams. This study aims to explore space-time patterns in referrals from general practice in the Morecambe Bay area to evaluate the impact of the initiative. Data on referrals to outpatient clinics and chronic respiratory disease patient counts between 2012-2020 were obtained from the Morecambe Bay Community Data Warehouse, a large store of routinely collected healthcare data. For analysis, the data is aggregated by year and small area geography. The methodology comprises of two parts. The first explores the issues that can arise when using routinely collected primary care data for space-time analysis and applies spatio-temporal conditional autoregressive modelling to adjust for data complexities. The second part models the rate of outpatient referral via a Poisson generalised linear mixed model that adjusts for changes in demographic factors and number of respiratory disease patients. The first year of the Morecambe Bay Respiratory Network was not associated with a significant difference in referral rate. However, the second and third years saw significant reductions in areas that had received intervention, with full intervention associated with a 31. 8% (95% CI 17. 0-43. 9) and 40. 5% (95% CI 27. 5-50. 9) decrease in referral rate in 2018 and 2019, respectively. Routinely collected data can be used to robustly evaluate key outcome measures of integrated care. The results demonstrate that effective integrated care has real potential to ease the burden on respiratory outpatient services by reducing the need for an onward referral. This is of great relevance given the current pressure on outpatient services globally, particularly long waiting lists following the COVID-19 pandemic and the need for more innovative models of care.

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Concepts Keywords
Covid Chronic respiratory disease
Healthcare Integrated care
Outpatient Outpatient referrals
Upskilling Routinely collected data


Type Source Name
disease VO population
disease VO effectiveness
disease VO time
disease IDO intervention
disease VO effective
disease MESH COVID-19 pandemic
pathway REACTOME Reproduction
drug DRUGBANK Fenamole
disease MESH morbidity
disease IDO history
disease MESH death
drug DRUGBANK Medical air
disease MESH asthma
pathway KEGG Asthma
disease MESH COPD
disease VO efficient
drug DRUGBANK Spinosad
disease IDO country
drug DRUGBANK Indoleacetic acid
disease VO efficiency
drug DRUGBANK Stavudine
drug DRUGBANK Serine
disease VO monthly
drug DRUGBANK Tretamine
drug DRUGBANK Oxygen
disease MESH cancer
drug DRUGBANK Ranitidine
disease IDO process
drug DRUGBANK Esomeprazole
drug DRUGBANK Imidacloprid
disease IDO algorithm
disease MESH uncertainty
drug DRUGBANK Trestolone
drug DRUGBANK Coenzyme M
drug DRUGBANK Methionine
drug DRUGBANK Etoperidone
disease VO Gap
disease IDO facility
drug DRUGBANK Methyl isocyanate
disease VO report
disease MESH chronic diseases
drug DRUGBANK L-Phenylalanine
drug DRUGBANK Gold
drug DRUGBANK Isoxaflutole
disease VO Equity
disease VO Canada
drug DRUGBANK Flunarizine
disease VO ReCOV
drug DRUGBANK Tropicamide

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