Through access to 2.5 million de-identified patient records in North-West London (NWL), the Hub combines robust data infrastructure and access through its Trusted Research Environment, with the analytical capability and technical expertise to offer the following services (Figure 1) to clinicians, researchers and scientists:
Since inception, Discover-NOW has developed close partnership arrangements with AstraZeneca, with the aim of working across healthcare systems and industry to provide deeper insights into the delivery of care, target key interventions and improve value-based and personalised care at scale.
Through the partnership health data is collected in real world settings, such as routine appointments or through mobile phones, and is used by pathway designers to target and model changes as a result of specific clinical interventions. This can be evaluated using RWE through the Discover-NOW Hub and team of analysts, economists and health implementation experts to develop the evidence base for efficacy and cost-effectiveness of the intervention.
“The Hub’s role as a facilitator between the NHS, academia and industry partners to provide a level playing field and a safe environment to experiment is critical to the success of innovative and transformational work.”
Ross Stone, Global Programme Director, Healthcare, AstraZeneca
AstraZeneca and the Discover-NOW team have partnered on several projects since 2020, including:
- The NWL type 2 Diabetes remote care model, using digital technologies to support high risk patients self-manage their own care.
- The development of remote monitoring support for NHSX during the COVID-19 pandemic.
- Imperial College Healthcare NHS Trust heart failure (HF) pathway redesign.
A further project has been kicked off with the London Kidney Network (LKN) to develop an integrated pathway in relation to chronic kidney disease (CKD), that optimises early identification and management across NWL. This case study outlines these four areas of work and the impact this is having on the delivery of care.
“We hope that this collaboration will demonstrate a new partnership model for working with healthcare systems, providing deeper insight into the delivery of care, and therefore improving value-based and personalised care. It will also give deeper insight into patient journeys, disease progression and new possibilities to improve care at scale”
Ross Stone, Global Programme Director, Healthcare, AstraZeneca
NWL Type 2 Diabetes (T2D) remote care model
NWL Clinical Commissioning Group, teams from primary and secondary care, patients and Hub partners HUMA and AstraZeneca
This was an exemplar project funded through HDRUK to demonstrate value in this type of collaboration around real world data, with real world care systems and industry. It was supported through an in-kind contribution from Hub partners AstraZeneca and HUMA.
- Diabetes care in NWL annually costs approximately £600m.
- Many patients are only seen once or twice a year.
- Therefore, it is difficult for healthcare professionals (HCPs) to know if care plans are being followed and are effective.
- Consequently, treatment outcomes and patient experience can be sub-optimal, leading to complications and increased levels of need.
- The programme began in January 2020. The Discover-NOW and AstraZeneca team worked with HUMA to assess how innovative technologies such as a patient platform and remote monitoring could be used to identify and improve care for high-risk patients in an initial pilot with local primary care networks (PCNs).
- Through this partnership, the team were able to address the multiple challenges of working at scale, improve patient experience and outcome, integrate clinical pathways, commission care across multiple providers, and maximise support for self-care for patients from diverse backgrounds.
- Implemented a new risk stratification model (approved by NWL Clinical Reference Group).
Created and deployed a new 12-week intensification of care service, “Fresh Start” (Figure 2). This includes an App-based remote monitoring programme, virtual group consultations with peers and health care professionals, and a structured education campaign – all of which is delivered to the patient in their own home.
Working with the AZ team on the group consultations study has been an excellent collaboration has and brought together people with diverse skills, knowledge and experience. This has given us the opportunity to learn from each other, tap into the positive contributions that a wider section collaboration can bring and use learning to support more effective delivery as we start to scale up group consultations across the NW London footprint
Matthew Harmer, Head of Programme – Diabetes, NHS North West
Outcome: A new model of personalised, remote care enabling HCPs to identify and manage more high-risk patients effectively in group environments, maximise clinician efficiency and improve patients’ ability to self-manage. The model is currently being rolled-out across NWL.
Evaluation: An economic and outcomes-based evaluation of the new pathway is underway. This includes onboarding 300 patients using Discover-NOW’s patient identification and recruitment service.
Supporting NHSX during COVID-19
The partnership with AstraZeneca, and the work on the T2D pathway, meant that the hub was able to respond rapidly to a request from NHSX to support the national roll-out of COVID-19 remote monitoring and development of ‘Hot Hubs’ across NWL. These hubs were designed to diagnose and advise COVID-19 patients not in hospital. They would not have been possible without the infrastructure, digital platforms and partnerships already developed as part of the Discover-NOW programme and the T2D exemplar project.
Within two weeks of launch, this service had over 150 patients on a virtual ward and 96% of patients using the service as prescribed. Over four months of implementation (April-July 2020) 100% of patients using the HUMA app in primary care were able to recover across the pilot sites, with an average three minutes saved per Hot-Hub patient per day (NHSX, 2020), as reported in the evaluation of the hot hubs.
Imperial College Healthcare NHS Trust heart failure (HF) pathway redesign
Patients, Eko Health, GPs, Cardiologists, Pharmacists, HF specialist nurses.
- Most cases of HF are diagnosed too late, with 80% of patients in the UK receiving a diagnosis in secondary care and emergency services.
- More than 40% of these patients had shown symptoms earlier in the care pathway, presenting in general practice or primary care consultations as far back as five years before admission to secondary care/emergency services.
- Early identification of these patients would allow for better treatment, improved quality of life and a reduction in hospital admissions.
- New GP referral templates were created within GP systems, using existing information.
- This in turn supported the development of improved, integrated (primary and secondary care) care plans.
- Eko Duo trial for earlier diagnosis in primary care.
- New remote monitoring programme for outpatients and primary care via Luscii platform and home monitoring technology to improve 30-day hospital readmission rates.
Evaluation: Pragmatic health economic evaluation of 100+ patients experiencing improved pathway vs standard of care (Figure 4 below).
- Created a more integrated care pathway across primary and secondary care.
- Demonstrably reduced unplanned hospital admissions.
- Improved efficiency of the service, allowing more time for specialists to spend on other clinical priorities.
- Increased referrals to specialist HF services.
- Improved system coding of HF patients, so they receive better care.
- Ultimately, improved patient experience and, hopefully, better long-term outcomes, as described in the video link.
NWL chronic kidney disease pathway
Patients, GPs, Nephrologists, Public health consultants, LKN, NWL’s Applied Research Collaborative (ARC)
The partnership with AstraZeneca continues to develop robust programmes of work, building on the success and learnings from the three previous projects. In November 2021, we kicked off a project to optimise early identification and management of chronic kidney disease with NWL patients and clinicians, the LKN and NWL’s Applied Research Collaborative (ARC).
Many patients are only diagnosed with chronic kidney disease (CKD) when they reach end-stage disease, require dialysis or transplant surgery, or have resultant cardiovascular complications. We now have effective treatments that delay the progression of CKD. The earlier we intervene, the greater the benefit to that individual and the health economy.
- This work attracted £200k funding from the NHS Insights Prioritisation Programme (NIPP).
- The work has dedicated patient and public involvement and engagement (PPIE) and health inequalities workstreams to ensure maximum impact.
- It is expected that with LKN involvement, the work will be scaled across London and Surrey and the NIPP programme will result in national dissemination. Also, because of this work, LKN is commissioning a health economic evaluation from Discover-NOW to support wider work.
Moreover, the Discover-NOW/AstraZeneca partnership is looking at ways to ensure the sustainability of the CKD pathway improvements, so that it is embedded in clinical practice and can be scaled nationally at a later date.
Working with the AZ team on CKD transformation alongside supporting the NWL ICS COVID-19 virtual wards has meant I can bring concepts such as minimal viable products and fast pace iterative changes to a rapidly changing environment, to help the NHS system in NWL cope with the evolving pandemic
Matthew Wyatt, Senior Innovation Manager, ICHP
Impact of the partnership
The investment of HDRUK funding and in-kind support from AstraZeneca has enabled the Hub to position itself at the forefront of research and clinical interventions for treating disease. The duration of the funding has allowed the partners to build up expertise and collaborative ways of working over three years – capitalising on the multi-disciplinary approach across the organisations. This, in turn, has led to an enhanced health implementation service offer, which brings design thinking and agile ways of working to the implementation of evidence-based innovations within NWL ICS. This has gone on to improve clinical effectiveness and address the gap between national policies and clinical practice.
The partnership continues to grow from strength to strength, with a confirmed commitment from AstraZeneca to extend the Discover-NOW consortium agreement. This enables sustainable implementation of the integrated CKD pathway across NWL.
Discover-NOW has also delivered a series of feasibility, retrospective and health economic evaluation studies for AstraZeneca using the Trusted Research Environment (detailed in Figure 5 above). This amounts to over £300k of additional income for Discover-NOW. Moreover, we are in the process of producing several peer-reviewed journal articles and a conference presentation that will be available to clinical teams, networks, researchers, commissioners and other stakeholders during 2022.
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