Original ResearchThe correlation between National Health Service trusts' clinical trial activity and both mortality rates and care quality commission ratings: a retrospective cross-sectional study
Introduction
Since its inception in 2006, the UK National Institute for Health Research (NIHR) has transformed the clinical research landscape in the United Kingdom. Its mission, ‘To provide a health research system in which the National Health Service (NHS) supports outstanding individuals working in world-class facilities, conducting leading-edge research focused on the needs of patients and the public’, is backed by expenditure of more than 1 billion British pounds.1 Money is primarily spent on provision of research grants for projects and also delivery staff based in NHS Trusts to deliver both NIHR-funded and other peer-reviewed and funded studies. The sizeable amount of money spent on clinical research in the United Kingdom by the NIHR has not increased the number of studies appraising the effect it may have on the overall functioning of the NHS Trusts hosting and conducting its research.2 Reduced mortality rates have been linked with increased NIHR-adopted clinical research activity and academic output within NHS Trusts.3, 4 Furthermore, one study demonstrated that colorectal patients participating in NIHR-adopted oncology trials survived longer and were at lower risk of death after surgery.5 Other cohort studies investigating the potential associations between research activity and other patient and organisational outcome measures, including hospital length of stay and adherence to clinical guidelines, have produced more mixed results.6 A more recent review of literature, led to Boaz et al., concluded that there is a positive association between engagement in research by healthcare organisations and improvements in healthcare performance; a caveat being that all 33 source articles in that review involved different specialities rather than whole organisations.7
In this study, we test the hypothesis that NIHR-adopted clinical research activity in NHS Trusts is associated with improved mortality rates, represented by the Summary Hospital-level Mortality Indicator (SHMI), and better organisational performance, represented by Care Quality Commission (CQC) ratings.
Section snippets
Ethics statement and data sources
This concerns a retrospective cross-sectional study of English NHS hospital Trusts. All data used in this study are readily available to the public via NHS and NIHR electronic depositories. The NIHR research activity data have been published in the past by the Guardian newspaper's website. No personal identifiable information has been used as part of this study. Therefore, from an ethics point of view, this is classed as a service evaluation and no formal ethics clearance is required.
NIHR
Results
SHMI and CQC data were available for 129 English NHS Hospital Trust that have existed for the collated five years of NIHR research activity. Speciality NHS Trusts, such as children's, ophthalmology and orthopaedic hospitals, were not included because they do not offer the gamma of services provided in an average acute hospital. First, individual variables were correlated with the SHMI score and CQC rating (see Table 1). Apart from the number of participants recruited into observational studies
Discussion
Ozdemir et al.4 showed a significant association between NIHR clinical research activity and reduced mortality, with a focus on research funding per Trust to represent research activity. Our results are in agreement with their findings despite some variations in source data and methodology. In their article, NIHR activity data from one year, 2010–11, were used, and Trust size was corrected using more than just Trust staff levels; they calculated mortality rates themselves, whereas we used the
Ethical approval
This is classed as a service evaluation and no formal ethics clearance is required.
Funding
None declared.
Competing interests
Both L. Jonker and S.J. Fisher are in receipt of National Institute for Health Research funding through their regional Clinical Research Network for delivery of National Institute for Health Research national portfolio studies.
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