Elsevier

Public Health

Volume 157, April 2018, Pages 1-6
Public Health

Original Research
The correlation between National Health Service trusts' clinical trial activity and both mortality rates and care quality commission ratings: a retrospective cross-sectional study

https://doi.org/10.1016/j.puhe.2017.12.022Get rights and content

Highlights

  • Increased National Institute for Health Research–adopted clinical trial activity is associated with reduced mortality.

  • Increased National Institute for Health Research–adopted clinical trial activity is associated with better Care Quality Commission outcomes.

  • Particularly, the number of clinical trial patients correlates with improved hospital performance.

  • The link between clinical trials activity and quality is not Trust-size dependent.

Abstract

Objectives

Evidence supporting the notion that clinical research activity in itself is of benefit to organisations as a whole is inconclusive. In the recent past, a positive association between research activity and reduced mortality has been shown. This study aimed to ascertain if clinical research activity is associated with established organisational outcome measures.

Study design

Retrospective cross-sectional study.

Methods

For 129 English National Health Service hospital Trusts, National Institute for Health Research study activity data, Summary Hospital-level Mortality Indicator (SHMI) scores and Care Quality Commission (CQC) ratings were collected. Research activity was controlled for Trust size by dividing it by clinical staffing levels. Multiple linear regression and Spearman correlation analyses were performed.

Results

Although there is a significant association between the number of studies and participants with both SHMI score and CQC rating, one particular variable is correlated more significantly than others: the number of participants recruited into interventional studies. It shows a significant correlation with better CQC ratings (standardised coefficient beta 0.26, P-value 0.003) and lower SHMI scores (standardised coefficient beta −0.50, P-value 0.001).

Conclusions

The mortality-related results corroborate with other published data showing a correlation between increased research and reduced deaths. Furthermore, there is also a statistically significant association between clinical trials activity and improved CQC ratings. However, these tie-ins are predominantly driven by the number of participants in interventional research rather than observational research activity.

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.

References (26)

  • NIHR Open Data Platform website, https://odp.nihr.ac.uk/ (last accessed 22 September...
  • NHS Digital – Clinical Staffing data for August 2016, https://digital.nhs.uk/catalogue/PUB22340 (last accessed 22...
  • CQC website, http://www.cqc.org.uk/search/ (last accessed 22 September...
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