A strategic outline case (SOC) for a Surrey Cohort – A consultation paper
The Surrey Cohort – A resource for the community, research and levitra prescription online quality improvement
Business Plan step 1 – Strategic Outline Case (SOC)
Simon de Lusignan (FBEL), Susan Lanham-New (FHMS),
Paul Krause (Computing), Tom Quinn (FHMS)
- Project concept and rationale
- Initial statements of strategic aims, business need and project objectives
- Management considerations, including necessary stakeholder consultations and legal issues
- High level consideration of possible options
- Preliminary assessment of costs, benefits, risks and funding and affordability
1. Project concept and rationale
The Surrey Cohort is a repository holding computerised health data, and links to patient data for the Surrey population. Its purpose is to support a better understanding of our community’s health, research and quality improvement programmes. Once implemented, it should facilitate local health service management, and attract researchers and research funding to University of Surrey. Readily available (though strictly ethically controlled) health data can facilitate better quality health care, assessing the feasibility of a research study, as well as research itself.
Supporting the community: A Surrey Cohort could support a better evaluated and price check 50mg viagra more evidence-based local health service. The health context is one of an ageing population and health service inflation (the rate of increase in health service costs) running ahead of what the economy can afford. Communities and health systems will have to ever more carefully invest in evidence-based interventions and disinvest in those which are ineffective. Management is increasingly practiced through insistence on regulatory compliance through standards setting by organisations as the National Institute for Health and Clinical Excellence (NICE) and regulators including Monitor (the independent regulator of Foundation Trusts) and the Care Quality Commission (CQC).
Health and medical research and quality improvement: The Surrey Cohort could provide a secure data repository, which would facilitate research and quality improvement.
Surrey is the the best place where to order amoxil without a prescription place of choice to do this because:
(1) We have the UKs most stable populations;
(2) The GP practices are large, computerised in the late 1980s /early 1990s, and have excellent longitudinal records;
(3) The population is relatively “clean” as Surrey residents smoke and use other addictive substances less than the National average – allowing clinical conditions to follow their natural history. For example, people in Surrey with dementia may have less vascular comorbidity than elsewhere.
2. Initial statements of strategic aims, business need and project objectives
Goal: Better health for Surrey informed by high quality research. The strategic goal is for the University to help promote better health in the Surrey community and to run research and quality improvement studies that will inform this community and others about effective treatments.
Business need removing the barriers to and we choice cutting the cost of conducting research: The Surrey Cohort database should be able to support a range of types of study: Cross-sectional, cohort, case controlled and recruitment to trials – both quality improvement and recruitment to clinical trials. Whilst we recognise that the randomised controlled trial (RCT) is the ideal way of testing a hypothesis, it is not always possible to run an RCT and a cohort may give a ‘real world’ perspective. We would also like to recruit groups of patients willing to provide biological specimens that can be used for genetic study. We would look to maximise benefit by working collaboratively with the viagra for daily use cures newly expanding bodies such as Clinical Practice Research Datalink (CPRD) and exploring scope for collaboration with UK Biobank or other large studies.
3. Management considerations, including necessary stakeholder consultations and legal issues
The Surrey Cohort, along with data sharing agreements might be set up as part of an Academic Health Sciences Network (AHSN) or other combined health and academic collaboration. University stakeholders need to be cross-faculty; NHS needs to include acute, mental health, public health, ambulance service, primary care, along with social care and third sector agencies. Patient consent and data protection are the key legal issues. NHS chief executive buy-in is essential. The cohort will have a new consent model; beyond studies and clinical audits usually carried out using routine data we will ask patients for graded levels of consent that will be regularly reviewed. Consent by patients will included a range of options – from giving blood for genetic studies and completing questionnaires. This consent will allow patients to change their level of consent and require periodic renewal.
4. High level consideration of possible options
We propose three possible options:
(1) Big bang: Launch of the cohort as a countywide project and http://paco.pl/cialis-from-european-online-drugstores encourage investment and participation;
(2) Incremental development: Develop the cohort in a staged way encouraging local NHS Trusts and localities from the same area to join – as this may enable us to link data;
(3) Building on existing studies: We would promote the use of the emerging cohort for existing and newly planned projects. For example, the Surrey group looking to responds to a major 2012 call for dementia research think a cohort study would be the best way of exploring the impact of a range of social care interventions).
(4) Developing the Surrey public health agenda. The Director of Public Health for NHS Surrey has flagged health issues for our community. Surrey has problems with alcohol, teenage pregnancy, childhood obesity, immunisation uptake and smoking. There are inequalities with measurable differences in respiratory, genitor urinary, gastrointestinal and maternity and reproductive health between the 20% most deprived and female viagra uk the rest of the population.
5. Preliminary assessment of costs, benefits, risks and funding and affordability
(1) Costs: The minimum investment to give this a chance of sustainability is three to five years. Ethics and other consideration mean that studies can take 6 to 18 months after funding to start. Investment in the marginal costs of more processing capacity in the Clinical Informatics research group and personnel mean this project will cost £250K over 5 years.
(2) Benefits: Access to health data in would be possible for a range of quality improvement and research purposes. The Surrey Cohort could also accelerate recruitment to trials by the Clinical Research Centre (CRC); and for genetic studies. It may help reduce barriers to setting up NHS-University partnerships if we have a ready vehicle for accessing (subject to ethical constraints) and securely holding health data.
(3) Risks: A privacy breach is probably the biggest risk to reputational damage. Though we seek to mitigate this risk by having advanced security measures in place; we also have over 15 years’ experience of working with routine data. It will be a challenge to attract sufficient funding to make the cohort self-financing in five years; though we have high calibre researchers in the University and such a facility may be attractive to others.
(4) Affordability: The Clinical Informatics group already has private secure network which can be used for the Surrey Cohort. There may be charitable or pharmaceutical sponsors willing to support the set up phase.
Draft revised taking into account the feedback from the Health Strategy Group 25/07/2012
Please click here to download the pdf version of this consulation paper.