Publications by category
Journal articles
Mounce LTA, Williams WH, Harris A, Yates PJ, Llewellyn D (In Press). Deprivation increases risk of head versus orthopaedic injury in children and young people.
Price S, Mounce L, Shephard E, Hamilton W (In Press). Effect of pre-existing conditions on stage of bladder cancer at diagnosis: a cohort study using electronic primary care records. British Journal of General Practice, 1-22.
Price S, Wiering B, Mounce LTA, Hamilton W, Abel G (2023). Examining methodology to identify patterns of consulting in primary care for different groups of patients before a diagnosis of cancer: an exemplar applied to oesophagogastric cancer. Cancer Epidemiology, 82, 102310-102310.
Parsons J, Abel G, Mounce LT, Atherton H (2023). The changing face of missed appointments. The British journal of general practice : the journal of the Royal College of General Practitioners, 73(728), 134-135.
Lamont RA, Calitri R, Mounce LTA, Hollands L, Dean SG, Code C, Sanders A, Tarrant M (2022). Shared social identity and perceived social support among stroke groups during the COVID‐19 pandemic: Relationship with psychosocial health. Applied Psychology: Health and Well-Being, 15(1), 172-192.
Funston G, Mounce LTA, Price S, Rous B, Crosbie EJ, Hamilton W, Walter FM (2021). CA125 test result, test-to-diagnosis interval, and stage in ovarian cancer at diagnosis: a retrospective cohort study using electronic health records.
British Journal of General Practice,
71(707), e465-e472.
Abstract:
CA125 test result, test-to-diagnosis interval, and stage in ovarian cancer at diagnosis: a retrospective cohort study using electronic health records
BackgroundIn the UK, the cancer antigen 125 (CA125) test is recommended as a first-line investigation in women with symptoms of possible ovarian cancer.AimTo compare time between initial primary care CA125 test and diagnosis, tumour morphology, and stage in women with normal (<35 U/ml) and abnormal (≥35 U/ml) CA125 levels prior to ovarian cancer diagnosis.Design and settingRetrospective cohort study using English primary care and cancer registry data.MethodAssociations between CA125 test results and test-to-diagnosis interval, stage, and ovarian cancer morphology were examined.ResultsIn total, 456 women were diagnosed with ovarian cancer in the 12 months after having a CA125 test. of these, 351 (77%) had an abnormal, and 105 (23%) had a normal, CA125 test result. The median test-to-diagnosis interval was 35 days (interquartile range [IQR] 21–53) for those with abnormal CA125 levels, and 64 days (IQR 42–127) for normal CA125 levels. Tumour morphology differed by CA125 result: indolent borderline tumours were less common in those with abnormal CA125 levels (n = 47, 13%) than those with normal CA125 levels (n = 51, 49%) (P<0.001). Staging data were available for 304 women with abnormal, and 77 with normal, CA125 levels. of those with abnormal CA125 levels, 35% (n = 106) were diagnosed at an early stage, compared to 86% (n = 66) of women with normal levels. The odds of being diagnosed with early-stage disease were higher in women with normal as opposed to abnormal CA125 levels (odds ratio 12.2, 95% confidence interval = 5.8 to 25.1, P<0.001).ConclusionDespite longer intervals between testing and diagnosis, women with normal, compared with abnormal, CA125 levels more frequently had indolent tumours and were more commonly diagnosed at an early stage in the course of the disease. Although testing approaches that have greater sensitivity might expedite diagnosis for some women, it is not known if this would translate to earlier-stage diagnosis.
Abstract.
Bradley SH, Bhartia BS, Callister ME, Hamilton WT, Hatton NLF, Kennedy MP, Mounce LT, Shinkins B, Wheatstone P, Neal RD, et al (2021). Chest X-ray sensitivity and lung cancer outcomes: a retrospective observational study.
Br J Gen Pract,
71(712), e862-e868.
Abstract:
Chest X-ray sensitivity and lung cancer outcomes: a retrospective observational study.
BACKGROUND: Chest X-ray (CXR) is the first-line investigation for lung cancer in many healthcare systems. An understanding of the consequences of false-negative CXRs on time to diagnosis, stage, and survival is limited. AIM: to determine the sensitivity of CXR for lung cancer and to compare stage at diagnosis, time to diagnosis, and survival between those with CXR that detected, or did not detect, lung cancer. DESIGN AND SETTING: Retrospective observational study using routinely collected healthcare data. METHOD: all patients diagnosed with lung cancer in Leeds Teaching Hospitals NHS Trust during 2008-2015 who had a GP-requested CXR in the year before diagnosis were categorised based on the result of the earliest CXR performed in that period. The sensitivity of CXR was calculated and analyses were performed with respect to time to diagnosis, survival, and stage at diagnosis. RESULTS: CXR was negative for 17.7% of patients (n = 376/2129). Median time from initial CXR to diagnosis was 43 days for those with a positive CXR and 204 days for those with a negative CXR. of those with a positive CXR, 29.8% (95% confidence interval [CI] = 27.9% to 31.8%) were diagnosed at stage I or II, compared with 33.5% (95% CI = 28.8% to 38.6%) with a negative CXR. CONCLUSION: GPs should consider lung cancer in patients with persistent symptoms even when CXR is negative. Despite longer duration to diagnosis for those with false-negative CXRs, there was no evidence of an adverse impact on stage at diagnosis or survival; however, this comparison is likely to be affected by confounding variables.
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Strain WD, Elyas S, Wedge N, Mounce L, Henley W, James M, Shore AC (2021). Evaluation of microalbuminuria as a prognostic indicator after a TIA or minor stroke in an outpatient setting: the prognostic role of microalbuminuria in TIA evolution (ProMOTE) study.
BMJ Open,
11(9), e043253-e043253.
Abstract:
Evaluation of microalbuminuria as a prognostic indicator after a TIA or minor stroke in an outpatient setting: the prognostic role of microalbuminuria in TIA evolution (ProMOTE) study
ObjectiveTransient ischaemic attacks (TIA) and minor strokes are important risk factors for further vascular events. We explored the role of albumin creatinine ratio (ACR) in improving risk prediction after a first event.SettingRapid access stroke clinics in the UK.Participants2202 patients attending with TIA or minor stroke diagnosed by the attending stroke physician, able to provide a urine sample to evaluate ACR using a near-patient testing device.Primary and secondary outcomesPrimary outcome was major adverse cardiac events (MACE: recurrent stroke, myocardial infarction or cardiovascular death) at 90 days. The key secondary outcome was to determine whether urinary ACR could contribute to a risk prediction tool for use in a clinic setting.Results151 MACE occurred in 144 participants within 90 days. Participants with MACE had higher ACR than those without. A composite score awarding a point each for age >80 years, previous stroke/TIA and presence of microalbuminuria identified those at low risk and high risk. 90% of patients were at low risk (scoring 0 or 1). Their 90-day risk of MACE was 5.7%. of the remaining ‘high-risk’ population (scoring 2 or 3) 12.4% experienced MACE over 90 days (p<0.001 compared with the low-risk population). The need for acute admission in the first 7 days was twofold elevated in the high-risk group compared with the low-risk group (3.23% vs 1.43%; p=0.05). These findings were validated in an independent historic sample.ConclusionA risk score comprising age, previous stroke/TIA and microalbuminuria predicts future MACE while identifying those at low risk of a recurrent event. This tool shows promise in the risk stratification of patients to avoid the admission of low-risk patients.
Abstract.
Ricci-Cabello I, Gangannagaripalli J, Mounce LTA, Valderas JM (2021). Identifying Factors Leading to Harm in English General Practices: a Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis. Journal of Patient Safety, 17(1), e20-e27.
Rodgers LR, Dennis JM, Shields BM, Mounce L, Fisher I, Hattersley AT, Henley WE (2020). Prior event rate ratio adjustment produced estimates consistent with randomized trial: a diabetes case study. Journal of Clinical Epidemiology, 122, 78-86.
Watson J, Mounce L, Bailey SER, Cooper SL, Hamilton W (2019). Blood markers for cancer. BMJ, l5774-l5774.
Watson J, Bailey S, Hamilton F, Mounce LTA, Hamilton W (2019). Clinical implications of increased testing in primary care. BMJ, 364, l175-l175.
Mounce LTA, Campbell JL, Henley WE, Tejerina Arreal MC, Porter I, Valderas JM (2018). Predicting Incident Multimorbidity.
Ann Fam Med,
16(4), 322-329.
Abstract:
Predicting Incident Multimorbidity.
PURPOSE: Multimorbidity is associated with adverse outcomes, yet research on the determinants of its incidence is lacking. We investigated which sociodemographic, health, and individual lifestyle (eg, physical activity, smoking behavior, body mass index) characteristics predict new cases of multimorbidity. METHODS: We used data from 4,564 participants aged 50 years and older in the English Longitudinal Study of Aging that included a 10-year follow-up period. Discrete time-to-event (complementary log-log) models were constructed for exploring the associations of baseline characteristics with outcomes between 2002-2003 and 2012-2013 separately for participants with no initial conditions (n = 1,377) developing multimorbidity, any increase in conditions within 10 years regardless of initial conditions, and the impact of individual conditions on incident multimorbidity. RESULTS: the risks of developing multimorbidity were positively associated with age, and they were greater for the least wealthy, for participants who were obese, and for those who reported the lowest levels of physical activity or an external locus of control (believing that life events are outside of one's control) for all groups regardless of baseline conditions (all linear trends
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Mounce LTA, Price S, Valderas JM, Hamilton W (2017). Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
Br J Cancer,
116(12), 1536-1543.
Abstract:
Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
BACKGROUND: Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis. METHOD: Incident cases (aged ⩾40 years, 2007-2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as 'competing demands' (unrelated to colorectal cancer) or 'alternative explanations' (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means. RESULTS: Out of the 4512 patients included, 72.9% had ⩾1 competing demand and 31.3% had ⩾1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14-39). CONCLUSIONS: the burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged ⩾80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity.
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Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, et al (2017). Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience.
Programme Grants for Applied Research,
5(9), 1-452.
Abstract:
Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Abstract.
Wright C, Davey A, Elmore N, Carter M, Mounce L, Wilson E, Burt J, Roland M, Campbell J (2017). Patients' use and views of real-time feedback technology in general practice.
Health Expect,
20(3), 419-433.
Abstract:
Patients' use and views of real-time feedback technology in general practice.
BACKGROUND: There is growing interest in real-time feedback (RTF), which involves collecting and summarizing information about patient experience at the point of care with the aim of informing service improvement. OBJECTIVE: to investigate the feasibility and acceptability of RTF in UK general practice. DESIGN: Exploratory randomized trial. SETTING/PARTICIPANTS: Ten general practices in south-west England and Cambridgeshire. All patients attending surgeries were eligible to provide RTF. INTERVENTION: Touch screens were installed in waiting areas for 12 weeks with practice staff responsible for encouraging patients to provide RTF. All practices received fortnightly feedback summaries. Four teams attended a facilitated reflection session. OUTCOMES: RTF 'response rates' among consulting patients were estimated, and the representativeness of touch screen users were assessed. The frequency of staff-patient interactions about RTF (direct observation) and patient views of RTF (exit survey) were summarized. Associated costs were collated. RESULTS: About 2.5% consulting patients provided RTF (range 0.7-8.0% across practices), representing a mean of 194 responses per practice. Patients aged above 65 were under-represented among touch screen users. Receptionists rarely encouraged RTF but, when this did occur, 60% patients participated. Patients were largely positive about RTF but identified some barriers. Costs per practice for the twelve-week period ranged from £1125 (unfacilitated team-level feedback) to £1887 (facilitated team ± practitioner-level feedback). The main cost was the provision of touch screens. CONCLUSIONS: Response rates for RTF were lower than those of other survey modes, although the numbers of patients providing feedback to each practice were comparable to those achieved in the English national GP patient survey. More patients might engage with RTF if the opportunity were consistently highlighted to them.
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Mounce LTA, Barry HE, Calitri R, Henley WE, Campbell J, Roland M, Richards S (2016). Establishing the validity of English GP Patient Survey items evaluating out-of-hours care.
BMJ Qual Saf,
25(11), 842-850.
Abstract:
Establishing the validity of English GP Patient Survey items evaluating out-of-hours care.
BACKGROUND: a 2014 national audit used the English General Practice Patient Survey (GPPS) to compare service users' experience of out-of-hours general practitioner (GP) services, yet there is no published evidence on the validity of these GPPS items. OBJECTIVES: Establish the construct and concurrent validity of GPPS items evaluating service users' experience of GP out-of-hours care. METHODS: Cross-sectional postal survey of service users (n=1396) of six English out-of-hours providers. Participants reported on four GPPS items evaluating out-of-hours care (three items modified following cognitive interviews with service users), and 14 evaluative items from the Out-of-hours Patient Questionnaire (OPQ). Construct validity was assessed through correlations between any reliable (Cochran's α>0.7) scales, as suggested by a principal component analysis of the modified GPPS items, with the 'entry access' (four items) and 'consultation satisfaction' (10 items) OPQ subscales. Concurrent validity was determined by investigating whether each modified GPPS item was associated with thematically related items from the OPQ using linear regressions. RESULTS: the modified GPPS item-set formed a single scale (α=0.77), which summarised the two-component structure of the OPQ moderately well; explaining 39.7% of variation in the 'entry access' scores (r=0.63) and 44.0% of variation in the 'consultation satisfaction' scores (r=0.66), demonstrating acceptable construct validity. Concurrent validity was verified as each modified GPPS item was highly associated with a distinct set of related items from the OPQ. CONCLUSIONS: Minor modifications are required for the English GPPS items evaluating out-of-hours care to improve comprehension by service users. A modified question set was demonstrated to comprise a valid measure of service users' overall satisfaction with out-of-hours care received. This demonstrates the potential for the use of as few as four items in benchmarking providers and assisting services in identifying, implementing and assessing quality improvement initiatives.
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Davey AF, Roberts MJ, Mounce L, Maramba I, Campbell JL (2016). Test–retest stability of patient experience items derived from the national GP patient survey.
SpringerPlus,
5(1).
Abstract:
Test–retest stability of patient experience items derived from the national GP patient survey
Purpose: the validity and reliability of various items on the GP Patient Survey (GPPS) survey have been reported, however stability of patient responses over time has not been tested. The purpose of this study was to determine the test–retest reliability of the core items from the GPPS. Methods: Patients who had recently consulted participating GPs in five general practices across the South West England were sent a postal questionnaire comprising of 54 items concerning their experience of their consultation and the care they received from the GP practice. Patients returning the questionnaire within 3 weeks of mail-out were sent a second identical (retest) questionnaire. Stability of responses was assessed by raw agreement rates and Cohen’s kappa (for categorical response items) and intraclass correlation coefficients and means (for ordinal response items). Results: 348 of 597 Patients returned a retest questionnaire (58.3 % response rate). In comparison to the test phase, patients responding to the retest phase were older and more likely to have white British ethnicity. Raw agreement rates for the 33 categorical items ranged from 66 to 100 % (mean 88 %) while the kappa coefficients ranged from 0.00 to 1.00 (mean 0.53). Intraclass correlation coefficients for the 21 ordinal items averaged 0.67 (range 0.44–0.77). Conclusions: Formal testing of items from the national GP patient survey examining patient experience in primary care highlighted their acceptable temporal stability several weeks following a GP consultation.
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Steel N, Hardcastle AC, Bachmann MO, Richards SH, Mounce LTA, Clark A, Lang I, Melzer D, Campbell JL (2015). Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.
BMJ Open,
4(10).
Abstract:
Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.
Objective We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment.Design the English Longitudinal Study of Ageing, a panel study of 12
765 participants aged 50
years and older in four waves from 2004 to 2011, selected using a stratified random sample of households in England. Distribution of illness burden, diagnosis and treatment by wealth was estimated using regression analysis.Outcome measures the main outcome measures were ORs for the illness burden, diagnosis and treatment, respectively, adjusted for age, sex and wealth. We estimated the illness burden for angina with the Rose Angina scale, diabetes with fasting glycosylated haemoglobin, depression with the Centre for Epidemiologic Studies Depression Scale, osteoarthritis with self-reported pain and disability and cataract with self-reported poor vision. Medical diagnoses were self-reported for all conditions. Treatment was defined as β-blocker prescription for angina, surgery for osteoarthritis and cataract, and receipt of predefined effective interventions for diabetes and depression.Results Compared with the wealthiest, the least wealthy participant had substantially higher odds for illness burden from any of the five conditions at all four time points, with ORs ranging from 4.2 (95% CI 2.6 to 6.8) for diabetes to 15.1 (11.4 to 20.0) for osteoarthritis. The ORs for diagnosis and treatment were smaller in all five conditions, and ranged from 0.9 (0.5 to 1.4) for diabetes treatment to 4.5 (3.3 to 6.0) for angina diagnosis.Conclusions the substantially higher illness burden in less wealthy participants was not matched by appropriately higher levels of diagnosis and treatment.
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Ricci-Cabello I, Violán C, Foguet-Boreu Q, Mounce LTA, Valderas JM (2015). Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review.
Eur J Gen Pract,
21(3), 192-202.
Abstract:
Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review.
The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing healthcare systems globally. It potentially threatens the coordination, continuity and safety of care. In this paper, we report the results of a scoping review examining the impact of multi-morbidity on the quality of healthcare. We used its results as a basis for a discussion of the challenges that research in this area is currently facing. In addition, we discuss its implications for health policy and clinical practice. The review identified 37 studies focussing on multi-morbidity but using conceptually different approaches. Studies focusing on 'comorbidity' (i.e. the 'index disease' approach) suggested that quality may be enhanced in the presence of synergistic conditions, and impaired by antagonistic or neutral conditions. Studies on 'multi-morbidity' (i.e. multiplicity of problems) and 'morbidity burden' (i.e. the total severity of conditions) suggested that increasing number of conditions and severity may be associated with better quality of healthcare when measured by process or intermediate outcome indicators, but with worse quality when patient-centred measures are used. However, issues related to the conceptualization and measurement of multi-morbidity (inconsistent across studies) and of healthcare quality (restricted to evaluations for each separate condition without incorporating considerations about multi-morbidity itself and its implications for management) compromised the generalizability of these observations. Until these issues are addressed and robust evidence becomes available, clinicians should apply minimally invasive and patient-centred medicine when delivering care for clinically complex patients. Health systems should focus on enhancing primary care centred coordination and continuity of care.
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Mounce LTA, Steel N, Hardcastle AC, Henley WE, Bachmann MO, Campbell JL, Melzer D, Richards SH (2015). Patient characteristics predicting failure to receive indicated care for type 2 diabetes.
Diabetes Research and Clinical Practice,
107(2), 247-258.
Abstract:
Patient characteristics predicting failure to receive indicated care for type 2 diabetes
Aims
Diabetes complications are potentially avoidable, yet incomplete care is common. Little is known about patient characteristics that predict incomplete care.
Methods
English Longitudinal Study of Ageing participants aged 50 years or older with diabetes reported on four diabetes quality indicators (QIs) in 2008-9 and 2010-11. Annual checks for glycated haemoglobin (HbA1c), proteinuria and foot examination were assessed as a care bundle (n=907). A further QI
assessed whether participants with cardiac risk factors were offered ACE inhibitors/receptor blockers
(n=759). Individual's baseline (2008-9) socio-demographic, lifestyle and health characteristics,
diabetes self-management knowledge and health literacy, and previous QI achievement were assessed
with logistic regressions on outcomes in 2010-11.
Results
A third of participants (2008-9=32.8%; 2010-11=32.2%) did not receive all annual checks in the care
bundle. Nearly half of those eligible were not offered ACE inhibitors/receptor blockers (2008-
9=44.6%; 2010-11=44.5%). Odds of not receiving a complete care bundle were increased for
participants lacking diabetes self-management knowledge (OR=2.05), having poorer cognitive
performance (OR=1.78) or having previously received incomplete care (OR=3.32). Participants who
were single (OR=2.16), had with low health literacy (OR=1.50) and who had received incomplete care
previously (OR=6.94) were less likely to subsequently be offered ACE inhibitors/receptor blockers,
whereas trend test showed that being older (OR=0.76) and increased BMI categorisation (OR=0.70)
improved odds of receiving this aspect of care.
Conclusions
Quality improvement initiatives for diabetes might usefully target patients with characteristics shown
here to predict non-receipt of indicated care, such as poor knowledge of annual diabetes care
processes or previous receipt of incomplete care.
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Hardcastle AC, Mounce LTA, Richards SH, Bachmann MO, Clark A, Henley WE, Campbell JL, Melzer D, Steel N (2015). The dynamics of quality: a national panel study of evidence-based standards.
Health Services and Delivery Research,
3(11), 1-128.
Abstract:
The dynamics of quality: a national panel study of evidence-based standards
BackgroundShortfalls in the receipt of recommended health care have been previously reported in England, leading to preventable poor health.ObjectivesTo assess changes over 6 years in the receipt of effective health-care interventions for people aged 50 years or over in England with cardiovascular disease, depression, diabetes or osteoarthritis; to identify how quality varied with participant characteristics; and to compare the distribution of illness burden in the population with the distributions of diagnosis and treatment.Setting and participantsInformation on health-care quality indicators and participant characteristics was collected using face-to-face structured interviews and nurse visits in participants’ homes by the English Longitudinal Study of Ageing in 2004–5, 2006–7, 2008–9 and 2010–11. A total of 16,773 participants aged 50 years or older were interviewed at least once and 5114 were interviewed in all four waves; 5404 reported diagnosis of one or more of four conditions in 2010–11.Main outcome measuresPercentage of indicated health care received by eligible participants for 19 quality indicators: seven for cardiovascular disease, three for depression, five for diabetes and four for osteoarthritis, and condition-level quality indicator achievement, including achievement of a bundle of three diabetes indicators.AnalysisChanges in quality indicator achievement over time and variations in quality with participant characteristics were tested with Pearson’s chi-squared test and logistic regression models. The size of inequality between the hypothetically wealthiest and poorest participants, for illness burden, diagnosis and treatment, was estimated using slope indices of wealth inequality.ResultsAchievement of indicators for cardiovascular disease was 82.7% [95% confidence interval (CI) 79.9% to 85.5%] in 2004–5 and 84.2% (95% CI 82.1% to 86.2%) in 2010–11, for depression 63.3% (95% CI 57.6% to 69.0%) and 59.8% (95% CI 52.4% to 64.3%), for diabetes 76.0% (95% CI 74.1% to 77.8%) and 76.5% (95% CI 74.8% to 78.1%), and for osteoarthritis 31.2% (95% CI 28.5% to 33.8%) and 35.6% (95% CI 34.2% to 37.1%). Achievement of the diabetes care bundle was 67.8% (95% CI 64.5% to 70.9%) in 2010–11. Variations in quality by participant characteristics were generally small. Diabetes indicator achievement was worse in participants with cognitive impairment [odds ratio (OR) 0.5, 95% CI 0.4 to 0.7] and better in those living alone (OR 1.7, 95% CI 1.3 to 2.0). Hypertension care was better for those aged over 74 years (vs. 50–64 years) (OR 3.2, 95% CI 2.0 to 5.3). Osteoarthritis care was better for those with severe (vs. mild) pain (OR 1.8, 95% CI 1.4 to 2.2), limiting illness (OR 1.8, 95% CI 1.5 to 2.1), and obesity (OR 1.6, 95% CI 1.2 to 2.0). Previous non-achievement of the diabetes care bundle was the biggest predictor of non-achievement 2 years later (OR 3.3, 95% CI 2.2 to 4.7). Poorer participants were always more likely than wealthier participants to have illness burden (statistically significant OR 3.9 to 16.0), but not always more likely to be diagnosed or receive treatment (0.2 to 5.3).ConclusionsShortfalls in quality of care for these four conditions have persisted over 6 years, with only half of the level of indicated health care achieved for osteoarthritis, compared with the other three conditions. Quality for osteoarthritis improved slightly over time but remains poor. The relatively high prevalence of specific illness burden in poorer participants was not matched by an equally high prevalence of diagnosis or treatment, suggesting that barriers to equity may exist at the stage at diagnosis. Further research is needed into the association between quality and health system characteristics at the level of clinicians, general practices or hospitals, and regions. Linkage to routinely collected data could provide information on health service characteristics at the individual patient level.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Hughes N, Williams WH, Chitsabesan P, Walesby RC, Mounce LTA, Clasby B (2015). The prevalence of traumatic brain injury among young offenders in custody: a systematic review.
J Head Trauma Rehabil,
30(2), 94-105.
Abstract:
The prevalence of traumatic brain injury among young offenders in custody: a systematic review.
OBJECTIVES: to examine the prevalence of traumatic brain injury (TBI) among young people in custody and to compare this with estimates within the general youth population. DESIGN: Systematic review of research from various national contexts. Included studies were assessed for the relevance of the definition of TBI and the research population, and the quality of the study design. RESULTS: Ten studies were identified for inclusion in the review. Four of these studies included control groups. No studies examining comorbidity of TBI and other neurodevelopmental disorders among incarcerated young people were identified. CONCLUSION: Reported prevalence rates of brain injury among incarcerated youth range from 16.5% to 72.1%, with a rate of 100% reported among a sample of young people sentenced to death. This suggests considerable levels of need among incarcerated young people. Where control groups or directly comparable studies within the general population exist, there is strong and consistent evidence of a prevalence of TBI among incarcerated youth that is substantially greater than that in the general population. This disparity is seemingly more pronounced as the severity of the injury increases.
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Steel N, Hardcastle AC, Clark A, Mounce LTA, Bachmann MO, Richards SH, Henley WE, Campbell JL, Melzer D (2014). Self-reported quality of care for older adults from 2004 to 2011: a cohort study.
Age Ageing,
43(5), 716-720.
Abstract:
Self-reported quality of care for older adults from 2004 to 2011: a cohort study.
BACKGROUND: little is known about changes in the quality of medical care for older adults over time. OBJECTIVE: to assess changes in technical quality of care over 6 years, and associations with participants' characteristics. DESIGN: a national cohort survey covering RAND Corporation-derived quality indicators (QIs) in face-to-face structured interviews in participants' households. PARTICIPANTS: a total of 5,114 people aged 50 or more in four waves of the English Longitudinal Study of Ageing. METHODS: the percentage achievement of 24 QIs in 10 general medical and geriatric clinical conditions was calculated for each time point, and associations with participants' characteristics were estimated using logistic regression. RESULTS: participants were eligible for 21,220 QIs. QI achievement for geriatric conditions (cataract, falls, osteoarthritis and osteoporosis) was 41% [95% confidence interval (CI): 38-44] in 2004-05 and 38% (36-39) in 2010-11. Achievement for general medical conditions (depression, diabetes mellitus, hypertension, ischaemic heart disease, pain and cerebrovascular disease) improved from 75% (73-77) in 2004-05 to 80% (79-82) in 2010-11. Achievement ranged from 89% for cerebrovascular disease to 34% for osteoarthritis. Overall achievement was lower for participants who were men, wealthier, infrequent alcohol drinkers, not obese and living alone. CONCLUSION: substantial system-level shortfalls in quality of care for geriatric conditions persisted over 6 years, with relatively small and inconsistent variations in quality by participants' characteristics. The relative lack of variation by participants' characteristics suggests that quality improvement interventions may be more effective when directed at healthcare delivery systems rather than individuals.
Abstract.
Author URL.
Hardcastle A, Mounce LT, Steel N (2013). HAS THE QUALITY OF CARE WORSENED FOR GERIATRIC CONDITIONS?.
GERONTOLOGIST,
53, 204-204.
Author URL.
Mounce LTA, Williams WH, Jones JM, Harris A, Haslam SA, Jetten J (2013). Neurogenic and psychogenic acute postconcussion symptoms can be identified after mild traumatic brain injury.
J Head Trauma Rehabil,
28(5), 397-405.
Abstract:
Neurogenic and psychogenic acute postconcussion symptoms can be identified after mild traumatic brain injury.
OBJECTIVES: As provenance of postconcussion symptoms after mild traumatic brain injury (mTBI) is controversial, with similar rates found in other populations, we aimed to identify postconcussion symptoms specific to mTBI compared with controls. We also compared differences between complicated and uncomplicated mTBIs. SETTING: Hospital emergency department. PARTICIPANTS: Adult individuals (34 individuals with complicated mTBI, 76 individuals with uncomplicated mTBI, and 47 orthopedic controls) who sought care in the emergency department and were consecutively recruited by post at 2 weeks postinjury. MAIN MEASURES: Rivermead Postconcussion Symptom Questionnaire. Preinjury factors were used as covariates. RESULTS: Compared with orthopedic controls, complicated mTBI group reported greater severity of headaches, dizziness, and nausea, as well as concentration difficulties, suggesting that these are neurogenic. Severity of other symptoms measured on the Rivermead Postconcussion Symptom Questionnaire was not significantly different between these groups, suggesting that these are psychogenic. Differences were evident between the 2 mTBI samples on the items of dizziness, nausea, fatigue, sleep disturbance, and concentration difficulties. CONCLUSIONS: Neurogenic and psychogenic postconcussion symptoms were identified at the acute-phase postinjury. Findings suggest that treating persons with mTBI as a homogenous sample is not prudent. This should inform prognostic models and follow-up support offered after leaving the emergency department.
Abstract.
Author URL.
Hardcastle A, Mounce LT, Steel N (2013). WHAT PREDICTS QUALITY OF CARE: RESULTS FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING.
GERONTOLOGIST,
53, 205-205.
Author URL.
Mounce L, Williams H (2012). Outcome following Mild Traumatic Brain Injury: the interplay of concussion and post-traumatic stress.
BRAIN INJURY,
26(4-5), 638-639.
Author URL.
Davies RC, Williams WH, Hinder D, Burgess CN, Mounce LT (2012). Self-reported traumatic brain injury and postconcussion symptoms in incarcerated youth.
J Head Trauma Rehabil,
27(3), E21-E27.
Abstract:
Self-reported traumatic brain injury and postconcussion symptoms in incarcerated youth.
To determine the prevalence rate of traumatic brain injury (TBI) in incarcerated youth and whether frequency and severity of TBI are associated with postconcussion symptoms (PCS), violent offending behaviors, age of first conviction, and substance abuse.
Abstract.
Author URL.
Tonks J, Williams WH, Mounce L, Harris D, Frampton I, Yates P, Slater A (2011). 'Trails B or not Trails B?' is attention-switching a useful outcome measure?.
Brain Inj,
25(10), 958-964.
Abstract:
'Trails B or not Trails B?' is attention-switching a useful outcome measure?
Difficulties with attention contribute to behavioural and cognitive problems during childhood and may reflect subtle deficits in executive functioning (EF). Attention problems in early childhood have also been found to predict higher levels of anxiety and depression symptoms at 10 years old. It has also been reported that attention problems during childhood may be differentially related to later-emerging distinct EF difficulties. Many of these findings, however, rely on teacher-ratings of attention difficulties.
Abstract.
Author URL.
Conferences
Salema N, Gangannagaripalli J, Mounce L, Valderas JM, Ricci-Cabello I, Avery A (2020). Patients' perceptions of safety in general practice captured using an online patient safety questionnaire for primary care (PREOS-PC).
Author URL.
Calitri R, Mounce L, Abel G, Campbell J, Spencer A, Medina-Lara A, Pitt M, Shepard E, Warren F, Dean S, et al (2019). Protocol for a pragmatic cluster randomised controlled trial assessing the clinical effectiveness and cost effectiveness of electronic risk-assessment tools for cancer for patients in general practice (ERICA).
Author URL.
Mounce L, Gangannagaripalli J, Ricci-Cabello I, Avery AJ, Valderas JM (2017). Development of two short versions of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire: PREOS-PC Compact and PREOS-PC-6.
Author URL.
Mounce LTA (2014). Do Patient’s Characteristics Predict Failure to Receive Care for Type 2 Diabetes?. Society for Academic Primary Care (regional). 6th - 7th Mar 2014.
Mounce LTA (2014). Do Patient’s Characteristics Predict Failure to Receive Care for Type 2 Diabetes?. Society for Academic Primary Care. 9th - 11th Jul 2014.
Abstract:
Do Patient’s Characteristics Predict Failure to Receive Care for Type 2 Diabetes?
Abstract.
Hardcastle AC, Mounce LTA, Steel N (2014). What predicts quality of care: results from the English Longitudinal Study of Ageing. Gerontological Society of America 66th annual scientific meeting. 14th - 18th Nov 2014.
Hardcastle AC, Mounce LTA, Steel N (2014). What predicts quality of care: results from the English Longitudinal Study of Ageing. Gerontological Society of America 66th annual scientific meeting. 14th - 18th Nov 2014.
Mounce LTA (2012). Outcome following mild traumatic brain injury: the interplay of concussion and post-traumatic stress. 9th World Congress on Brain Injury. 22nd - 25th Mar 2012.
Mounce LTA, Williams WH (2011). The Neurological and Psychological Roots of Post-Concussion Syndrome After MTBI: the Role of Traumatic Re-Experiencing. 4th Pacific Rim Meeting. 6th - 9th Jul 2011.
Mounce LTA, Williams WH (2010). Does acute stress predict mTBI symptoms?. Annual Meeting of Emergency Medicine. 22nd - 25th Mar 2010.
Mounce LTA (2007). Risk of psychiatric disorder in children with congenital versus acquired brain-dysfunction. 4th Satellite Symposium on Neuropsychological Rehabilitation. 9th - 11th Jul 2007.
Reports
Melzer D, Tavakoly B, Winder R, Richards S, Mounce LTA, Gericke C, Lang I (2012). Health Care Quality for an Active Later Life: Improving quality of prevention and treatment through information - England 2005 to 2012. A report from the Peninsula College of Medicine and Dentistry Ageing Research Group for Age UK.
Publications by year
In Press
Mounce LTA, Williams WH, Harris A, Yates PJ, Llewellyn D (In Press). Deprivation increases risk of head versus orthopaedic injury in children and young people.
Price S, Mounce L, Shephard E, Hamilton W (In Press). Effect of pre-existing conditions on stage of bladder cancer at diagnosis: a cohort study using electronic primary care records. British Journal of General Practice, 1-22.
2023
Price S, Wiering B, Mounce LTA, Hamilton W, Abel G (2023). Examining methodology to identify patterns of consulting in primary care for different groups of patients before a diagnosis of cancer: an exemplar applied to oesophagogastric cancer. Cancer Epidemiology, 82, 102310-102310.
Parsons J, Abel G, Mounce LT, Atherton H (2023). The changing face of missed appointments. The British journal of general practice : the journal of the Royal College of General Practitioners, 73(728), 134-135.
2022
Lamont RA, Calitri R, Mounce LTA, Hollands L, Dean SG, Code C, Sanders A, Tarrant M (2022). Shared social identity and perceived social support among stroke groups during the COVID‐19 pandemic: Relationship with psychosocial health. Applied Psychology: Health and Well-Being, 15(1), 172-192.
2021
Funston G, Mounce LTA, Price S, Rous B, Crosbie EJ, Hamilton W, Walter FM (2021). CA125 test result, test-to-diagnosis interval, and stage in ovarian cancer at diagnosis: a retrospective cohort study using electronic health records.
British Journal of General Practice,
71(707), e465-e472.
Abstract:
CA125 test result, test-to-diagnosis interval, and stage in ovarian cancer at diagnosis: a retrospective cohort study using electronic health records
BackgroundIn the UK, the cancer antigen 125 (CA125) test is recommended as a first-line investigation in women with symptoms of possible ovarian cancer.AimTo compare time between initial primary care CA125 test and diagnosis, tumour morphology, and stage in women with normal (<35 U/ml) and abnormal (≥35 U/ml) CA125 levels prior to ovarian cancer diagnosis.Design and settingRetrospective cohort study using English primary care and cancer registry data.MethodAssociations between CA125 test results and test-to-diagnosis interval, stage, and ovarian cancer morphology were examined.ResultsIn total, 456 women were diagnosed with ovarian cancer in the 12 months after having a CA125 test. of these, 351 (77%) had an abnormal, and 105 (23%) had a normal, CA125 test result. The median test-to-diagnosis interval was 35 days (interquartile range [IQR] 21–53) for those with abnormal CA125 levels, and 64 days (IQR 42–127) for normal CA125 levels. Tumour morphology differed by CA125 result: indolent borderline tumours were less common in those with abnormal CA125 levels (n = 47, 13%) than those with normal CA125 levels (n = 51, 49%) (P<0.001). Staging data were available for 304 women with abnormal, and 77 with normal, CA125 levels. of those with abnormal CA125 levels, 35% (n = 106) were diagnosed at an early stage, compared to 86% (n = 66) of women with normal levels. The odds of being diagnosed with early-stage disease were higher in women with normal as opposed to abnormal CA125 levels (odds ratio 12.2, 95% confidence interval = 5.8 to 25.1, P<0.001).ConclusionDespite longer intervals between testing and diagnosis, women with normal, compared with abnormal, CA125 levels more frequently had indolent tumours and were more commonly diagnosed at an early stage in the course of the disease. Although testing approaches that have greater sensitivity might expedite diagnosis for some women, it is not known if this would translate to earlier-stage diagnosis.
Abstract.
Bradley SH, Bhartia BS, Callister ME, Hamilton WT, Hatton NLF, Kennedy MP, Mounce LT, Shinkins B, Wheatstone P, Neal RD, et al (2021). Chest X-ray sensitivity and lung cancer outcomes: a retrospective observational study.
Br J Gen Pract,
71(712), e862-e868.
Abstract:
Chest X-ray sensitivity and lung cancer outcomes: a retrospective observational study.
BACKGROUND: Chest X-ray (CXR) is the first-line investigation for lung cancer in many healthcare systems. An understanding of the consequences of false-negative CXRs on time to diagnosis, stage, and survival is limited. AIM: to determine the sensitivity of CXR for lung cancer and to compare stage at diagnosis, time to diagnosis, and survival between those with CXR that detected, or did not detect, lung cancer. DESIGN AND SETTING: Retrospective observational study using routinely collected healthcare data. METHOD: all patients diagnosed with lung cancer in Leeds Teaching Hospitals NHS Trust during 2008-2015 who had a GP-requested CXR in the year before diagnosis were categorised based on the result of the earliest CXR performed in that period. The sensitivity of CXR was calculated and analyses were performed with respect to time to diagnosis, survival, and stage at diagnosis. RESULTS: CXR was negative for 17.7% of patients (n = 376/2129). Median time from initial CXR to diagnosis was 43 days for those with a positive CXR and 204 days for those with a negative CXR. of those with a positive CXR, 29.8% (95% confidence interval [CI] = 27.9% to 31.8%) were diagnosed at stage I or II, compared with 33.5% (95% CI = 28.8% to 38.6%) with a negative CXR. CONCLUSION: GPs should consider lung cancer in patients with persistent symptoms even when CXR is negative. Despite longer duration to diagnosis for those with false-negative CXRs, there was no evidence of an adverse impact on stage at diagnosis or survival; however, this comparison is likely to be affected by confounding variables.
Abstract.
Author URL.
Strain WD, Elyas S, Wedge N, Mounce L, Henley W, James M, Shore AC (2021). Evaluation of microalbuminuria as a prognostic indicator after a TIA or minor stroke in an outpatient setting: the prognostic role of microalbuminuria in TIA evolution (ProMOTE) study.
BMJ Open,
11(9), e043253-e043253.
Abstract:
Evaluation of microalbuminuria as a prognostic indicator after a TIA or minor stroke in an outpatient setting: the prognostic role of microalbuminuria in TIA evolution (ProMOTE) study
ObjectiveTransient ischaemic attacks (TIA) and minor strokes are important risk factors for further vascular events. We explored the role of albumin creatinine ratio (ACR) in improving risk prediction after a first event.SettingRapid access stroke clinics in the UK.Participants2202 patients attending with TIA or minor stroke diagnosed by the attending stroke physician, able to provide a urine sample to evaluate ACR using a near-patient testing device.Primary and secondary outcomesPrimary outcome was major adverse cardiac events (MACE: recurrent stroke, myocardial infarction or cardiovascular death) at 90 days. The key secondary outcome was to determine whether urinary ACR could contribute to a risk prediction tool for use in a clinic setting.Results151 MACE occurred in 144 participants within 90 days. Participants with MACE had higher ACR than those without. A composite score awarding a point each for age >80 years, previous stroke/TIA and presence of microalbuminuria identified those at low risk and high risk. 90% of patients were at low risk (scoring 0 or 1). Their 90-day risk of MACE was 5.7%. of the remaining ‘high-risk’ population (scoring 2 or 3) 12.4% experienced MACE over 90 days (p<0.001 compared with the low-risk population). The need for acute admission in the first 7 days was twofold elevated in the high-risk group compared with the low-risk group (3.23% vs 1.43%; p=0.05). These findings were validated in an independent historic sample.ConclusionA risk score comprising age, previous stroke/TIA and microalbuminuria predicts future MACE while identifying those at low risk of a recurrent event. This tool shows promise in the risk stratification of patients to avoid the admission of low-risk patients.
Abstract.
Ricci-Cabello I, Gangannagaripalli J, Mounce LTA, Valderas JM (2021). Identifying Factors Leading to Harm in English General Practices: a Mixed-Methods Study Based on Patient Experiences Integrating Structural Equation Modeling and Qualitative Content Analysis. Journal of Patient Safety, 17(1), e20-e27.
2020
Salema N, Gangannagaripalli J, Mounce L, Valderas JM, Ricci-Cabello I, Avery A (2020). Patients' perceptions of safety in general practice captured using an online patient safety questionnaire for primary care (PREOS-PC).
Author URL.
Rodgers LR, Dennis JM, Shields BM, Mounce L, Fisher I, Hattersley AT, Henley WE (2020). Prior event rate ratio adjustment produced estimates consistent with randomized trial: a diabetes case study. Journal of Clinical Epidemiology, 122, 78-86.
2019
Watson J, Mounce L, Bailey SER, Cooper SL, Hamilton W (2019). Blood markers for cancer. BMJ, l5774-l5774.
Watson J, Bailey S, Hamilton F, Mounce LTA, Hamilton W (2019). Clinical implications of increased testing in primary care. BMJ, 364, l175-l175.
Calitri R, Mounce L, Abel G, Campbell J, Spencer A, Medina-Lara A, Pitt M, Shepard E, Warren F, Dean S, et al (2019). Protocol for a pragmatic cluster randomised controlled trial assessing the clinical effectiveness and cost effectiveness of electronic risk-assessment tools for cancer for patients in general practice (ERICA).
Author URL.
2018
Mounce LTA, Campbell JL, Henley WE, Tejerina Arreal MC, Porter I, Valderas JM (2018). Predicting Incident Multimorbidity.
Ann Fam Med,
16(4), 322-329.
Abstract:
Predicting Incident Multimorbidity.
PURPOSE: Multimorbidity is associated with adverse outcomes, yet research on the determinants of its incidence is lacking. We investigated which sociodemographic, health, and individual lifestyle (eg, physical activity, smoking behavior, body mass index) characteristics predict new cases of multimorbidity. METHODS: We used data from 4,564 participants aged 50 years and older in the English Longitudinal Study of Aging that included a 10-year follow-up period. Discrete time-to-event (complementary log-log) models were constructed for exploring the associations of baseline characteristics with outcomes between 2002-2003 and 2012-2013 separately for participants with no initial conditions (n = 1,377) developing multimorbidity, any increase in conditions within 10 years regardless of initial conditions, and the impact of individual conditions on incident multimorbidity. RESULTS: the risks of developing multimorbidity were positively associated with age, and they were greater for the least wealthy, for participants who were obese, and for those who reported the lowest levels of physical activity or an external locus of control (believing that life events are outside of one's control) for all groups regardless of baseline conditions (all linear trends
Abstract.
Author URL.
2017
Mounce LTA, Price S, Valderas JM, Hamilton W (2017). Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
Br J Cancer,
116(12), 1536-1543.
Abstract:
Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records.
BACKGROUND: Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis. METHOD: Incident cases (aged ⩾40 years, 2007-2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as 'competing demands' (unrelated to colorectal cancer) or 'alternative explanations' (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means. RESULTS: Out of the 4512 patients included, 72.9% had ⩾1 competing demand and 31.3% had ⩾1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14-39). CONCLUSIONS: the burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged ⩾80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity.
Abstract.
Author URL.
Mounce L, Gangannagaripalli J, Ricci-Cabello I, Avery AJ, Valderas JM (2017). Development of two short versions of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire: PREOS-PC Compact and PREOS-PC-6.
Author URL.
Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, et al (2017). Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience.
Programme Grants for Applied Research,
5(9), 1-452.
Abstract:
Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Abstract.
Wright C, Davey A, Elmore N, Carter M, Mounce L, Wilson E, Burt J, Roland M, Campbell J (2017). Patients' use and views of real-time feedback technology in general practice.
Health Expect,
20(3), 419-433.
Abstract:
Patients' use and views of real-time feedback technology in general practice.
BACKGROUND: There is growing interest in real-time feedback (RTF), which involves collecting and summarizing information about patient experience at the point of care with the aim of informing service improvement. OBJECTIVE: to investigate the feasibility and acceptability of RTF in UK general practice. DESIGN: Exploratory randomized trial. SETTING/PARTICIPANTS: Ten general practices in south-west England and Cambridgeshire. All patients attending surgeries were eligible to provide RTF. INTERVENTION: Touch screens were installed in waiting areas for 12 weeks with practice staff responsible for encouraging patients to provide RTF. All practices received fortnightly feedback summaries. Four teams attended a facilitated reflection session. OUTCOMES: RTF 'response rates' among consulting patients were estimated, and the representativeness of touch screen users were assessed. The frequency of staff-patient interactions about RTF (direct observation) and patient views of RTF (exit survey) were summarized. Associated costs were collated. RESULTS: About 2.5% consulting patients provided RTF (range 0.7-8.0% across practices), representing a mean of 194 responses per practice. Patients aged above 65 were under-represented among touch screen users. Receptionists rarely encouraged RTF but, when this did occur, 60% patients participated. Patients were largely positive about RTF but identified some barriers. Costs per practice for the twelve-week period ranged from £1125 (unfacilitated team-level feedback) to £1887 (facilitated team ± practitioner-level feedback). The main cost was the provision of touch screens. CONCLUSIONS: Response rates for RTF were lower than those of other survey modes, although the numbers of patients providing feedback to each practice were comparable to those achieved in the English national GP patient survey. More patients might engage with RTF if the opportunity were consistently highlighted to them.
Abstract.
Author URL.
2016
Mounce LTA, Barry HE, Calitri R, Henley WE, Campbell J, Roland M, Richards S (2016). Establishing the validity of English GP Patient Survey items evaluating out-of-hours care.
BMJ Qual Saf,
25(11), 842-850.
Abstract:
Establishing the validity of English GP Patient Survey items evaluating out-of-hours care.
BACKGROUND: a 2014 national audit used the English General Practice Patient Survey (GPPS) to compare service users' experience of out-of-hours general practitioner (GP) services, yet there is no published evidence on the validity of these GPPS items. OBJECTIVES: Establish the construct and concurrent validity of GPPS items evaluating service users' experience of GP out-of-hours care. METHODS: Cross-sectional postal survey of service users (n=1396) of six English out-of-hours providers. Participants reported on four GPPS items evaluating out-of-hours care (three items modified following cognitive interviews with service users), and 14 evaluative items from the Out-of-hours Patient Questionnaire (OPQ). Construct validity was assessed through correlations between any reliable (Cochran's α>0.7) scales, as suggested by a principal component analysis of the modified GPPS items, with the 'entry access' (four items) and 'consultation satisfaction' (10 items) OPQ subscales. Concurrent validity was determined by investigating whether each modified GPPS item was associated with thematically related items from the OPQ using linear regressions. RESULTS: the modified GPPS item-set formed a single scale (α=0.77), which summarised the two-component structure of the OPQ moderately well; explaining 39.7% of variation in the 'entry access' scores (r=0.63) and 44.0% of variation in the 'consultation satisfaction' scores (r=0.66), demonstrating acceptable construct validity. Concurrent validity was verified as each modified GPPS item was highly associated with a distinct set of related items from the OPQ. CONCLUSIONS: Minor modifications are required for the English GPPS items evaluating out-of-hours care to improve comprehension by service users. A modified question set was demonstrated to comprise a valid measure of service users' overall satisfaction with out-of-hours care received. This demonstrates the potential for the use of as few as four items in benchmarking providers and assisting services in identifying, implementing and assessing quality improvement initiatives.
Abstract.
Author URL.
Davey AF, Roberts MJ, Mounce L, Maramba I, Campbell JL (2016). Test–retest stability of patient experience items derived from the national GP patient survey.
SpringerPlus,
5(1).
Abstract:
Test–retest stability of patient experience items derived from the national GP patient survey
Purpose: the validity and reliability of various items on the GP Patient Survey (GPPS) survey have been reported, however stability of patient responses over time has not been tested. The purpose of this study was to determine the test–retest reliability of the core items from the GPPS. Methods: Patients who had recently consulted participating GPs in five general practices across the South West England were sent a postal questionnaire comprising of 54 items concerning their experience of their consultation and the care they received from the GP practice. Patients returning the questionnaire within 3 weeks of mail-out were sent a second identical (retest) questionnaire. Stability of responses was assessed by raw agreement rates and Cohen’s kappa (for categorical response items) and intraclass correlation coefficients and means (for ordinal response items). Results: 348 of 597 Patients returned a retest questionnaire (58.3 % response rate). In comparison to the test phase, patients responding to the retest phase were older and more likely to have white British ethnicity. Raw agreement rates for the 33 categorical items ranged from 66 to 100 % (mean 88 %) while the kappa coefficients ranged from 0.00 to 1.00 (mean 0.53). Intraclass correlation coefficients for the 21 ordinal items averaged 0.67 (range 0.44–0.77). Conclusions: Formal testing of items from the national GP patient survey examining patient experience in primary care highlighted their acceptable temporal stability several weeks following a GP consultation.
Abstract.
2015
Steel N, Hardcastle AC, Bachmann MO, Richards SH, Mounce LTA, Clark A, Lang I, Melzer D, Campbell JL (2015). Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.
BMJ Open,
4(10).
Abstract:
Economic inequalities in burden of illness, diagnosis and treatment of five long-term conditions in England: panel study.
Objective We compared the distribution by wealth of self-reported illness burden (estimated from validated scales, biomarker and reported symptoms) for angina, cataract, depression, diabetes and osteoarthritis, with the distribution of self-reported medical diagnosis and treatment. We aimed to determine if the greater illness burden borne by poorer participants was matched by appropriately higher levels of diagnosis and treatment.Design the English Longitudinal Study of Ageing, a panel study of 12
765 participants aged 50
years and older in four waves from 2004 to 2011, selected using a stratified random sample of households in England. Distribution of illness burden, diagnosis and treatment by wealth was estimated using regression analysis.Outcome measures the main outcome measures were ORs for the illness burden, diagnosis and treatment, respectively, adjusted for age, sex and wealth. We estimated the illness burden for angina with the Rose Angina scale, diabetes with fasting glycosylated haemoglobin, depression with the Centre for Epidemiologic Studies Depression Scale, osteoarthritis with self-reported pain and disability and cataract with self-reported poor vision. Medical diagnoses were self-reported for all conditions. Treatment was defined as β-blocker prescription for angina, surgery for osteoarthritis and cataract, and receipt of predefined effective interventions for diabetes and depression.Results Compared with the wealthiest, the least wealthy participant had substantially higher odds for illness burden from any of the five conditions at all four time points, with ORs ranging from 4.2 (95% CI 2.6 to 6.8) for diabetes to 15.1 (11.4 to 20.0) for osteoarthritis. The ORs for diagnosis and treatment were smaller in all five conditions, and ranged from 0.9 (0.5 to 1.4) for diabetes treatment to 4.5 (3.3 to 6.0) for angina diagnosis.Conclusions the substantially higher illness burden in less wealthy participants was not matched by appropriately higher levels of diagnosis and treatment.
Abstract.
Ricci-Cabello I, Violán C, Foguet-Boreu Q, Mounce LTA, Valderas JM (2015). Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review.
Eur J Gen Pract,
21(3), 192-202.
Abstract:
Impact of multi-morbidity on quality of healthcare and its implications for health policy, research and clinical practice. A scoping review.
The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing healthcare systems globally. It potentially threatens the coordination, continuity and safety of care. In this paper, we report the results of a scoping review examining the impact of multi-morbidity on the quality of healthcare. We used its results as a basis for a discussion of the challenges that research in this area is currently facing. In addition, we discuss its implications for health policy and clinical practice. The review identified 37 studies focussing on multi-morbidity but using conceptually different approaches. Studies focusing on 'comorbidity' (i.e. the 'index disease' approach) suggested that quality may be enhanced in the presence of synergistic conditions, and impaired by antagonistic or neutral conditions. Studies on 'multi-morbidity' (i.e. multiplicity of problems) and 'morbidity burden' (i.e. the total severity of conditions) suggested that increasing number of conditions and severity may be associated with better quality of healthcare when measured by process or intermediate outcome indicators, but with worse quality when patient-centred measures are used. However, issues related to the conceptualization and measurement of multi-morbidity (inconsistent across studies) and of healthcare quality (restricted to evaluations for each separate condition without incorporating considerations about multi-morbidity itself and its implications for management) compromised the generalizability of these observations. Until these issues are addressed and robust evidence becomes available, clinicians should apply minimally invasive and patient-centred medicine when delivering care for clinically complex patients. Health systems should focus on enhancing primary care centred coordination and continuity of care.
Abstract.
Author URL.
Mounce LTA, Steel N, Hardcastle AC, Henley WE, Bachmann MO, Campbell JL, Melzer D, Richards SH (2015). Patient characteristics predicting failure to receive indicated care for type 2 diabetes.
Diabetes Research and Clinical Practice,
107(2), 247-258.
Abstract:
Patient characteristics predicting failure to receive indicated care for type 2 diabetes
Aims
Diabetes complications are potentially avoidable, yet incomplete care is common. Little is known about patient characteristics that predict incomplete care.
Methods
English Longitudinal Study of Ageing participants aged 50 years or older with diabetes reported on four diabetes quality indicators (QIs) in 2008-9 and 2010-11. Annual checks for glycated haemoglobin (HbA1c), proteinuria and foot examination were assessed as a care bundle (n=907). A further QI
assessed whether participants with cardiac risk factors were offered ACE inhibitors/receptor blockers
(n=759). Individual's baseline (2008-9) socio-demographic, lifestyle and health characteristics,
diabetes self-management knowledge and health literacy, and previous QI achievement were assessed
with logistic regressions on outcomes in 2010-11.
Results
A third of participants (2008-9=32.8%; 2010-11=32.2%) did not receive all annual checks in the care
bundle. Nearly half of those eligible were not offered ACE inhibitors/receptor blockers (2008-
9=44.6%; 2010-11=44.5%). Odds of not receiving a complete care bundle were increased for
participants lacking diabetes self-management knowledge (OR=2.05), having poorer cognitive
performance (OR=1.78) or having previously received incomplete care (OR=3.32). Participants who
were single (OR=2.16), had with low health literacy (OR=1.50) and who had received incomplete care
previously (OR=6.94) were less likely to subsequently be offered ACE inhibitors/receptor blockers,
whereas trend test showed that being older (OR=0.76) and increased BMI categorisation (OR=0.70)
improved odds of receiving this aspect of care.
Conclusions
Quality improvement initiatives for diabetes might usefully target patients with characteristics shown
here to predict non-receipt of indicated care, such as poor knowledge of annual diabetes care
processes or previous receipt of incomplete care.
Abstract.
Hardcastle AC, Mounce LTA, Richards SH, Bachmann MO, Clark A, Henley WE, Campbell JL, Melzer D, Steel N (2015). The dynamics of quality: a national panel study of evidence-based standards.
Health Services and Delivery Research,
3(11), 1-128.
Abstract:
The dynamics of quality: a national panel study of evidence-based standards
BackgroundShortfalls in the receipt of recommended health care have been previously reported in England, leading to preventable poor health.ObjectivesTo assess changes over 6 years in the receipt of effective health-care interventions for people aged 50 years or over in England with cardiovascular disease, depression, diabetes or osteoarthritis; to identify how quality varied with participant characteristics; and to compare the distribution of illness burden in the population with the distributions of diagnosis and treatment.Setting and participantsInformation on health-care quality indicators and participant characteristics was collected using face-to-face structured interviews and nurse visits in participants’ homes by the English Longitudinal Study of Ageing in 2004–5, 2006–7, 2008–9 and 2010–11. A total of 16,773 participants aged 50 years or older were interviewed at least once and 5114 were interviewed in all four waves; 5404 reported diagnosis of one or more of four conditions in 2010–11.Main outcome measuresPercentage of indicated health care received by eligible participants for 19 quality indicators: seven for cardiovascular disease, three for depression, five for diabetes and four for osteoarthritis, and condition-level quality indicator achievement, including achievement of a bundle of three diabetes indicators.AnalysisChanges in quality indicator achievement over time and variations in quality with participant characteristics were tested with Pearson’s chi-squared test and logistic regression models. The size of inequality between the hypothetically wealthiest and poorest participants, for illness burden, diagnosis and treatment, was estimated using slope indices of wealth inequality.ResultsAchievement of indicators for cardiovascular disease was 82.7% [95% confidence interval (CI) 79.9% to 85.5%] in 2004–5 and 84.2% (95% CI 82.1% to 86.2%) in 2010–11, for depression 63.3% (95% CI 57.6% to 69.0%) and 59.8% (95% CI 52.4% to 64.3%), for diabetes 76.0% (95% CI 74.1% to 77.8%) and 76.5% (95% CI 74.8% to 78.1%), and for osteoarthritis 31.2% (95% CI 28.5% to 33.8%) and 35.6% (95% CI 34.2% to 37.1%). Achievement of the diabetes care bundle was 67.8% (95% CI 64.5% to 70.9%) in 2010–11. Variations in quality by participant characteristics were generally small. Diabetes indicator achievement was worse in participants with cognitive impairment [odds ratio (OR) 0.5, 95% CI 0.4 to 0.7] and better in those living alone (OR 1.7, 95% CI 1.3 to 2.0). Hypertension care was better for those aged over 74 years (vs. 50–64 years) (OR 3.2, 95% CI 2.0 to 5.3). Osteoarthritis care was better for those with severe (vs. mild) pain (OR 1.8, 95% CI 1.4 to 2.2), limiting illness (OR 1.8, 95% CI 1.5 to 2.1), and obesity (OR 1.6, 95% CI 1.2 to 2.0). Previous non-achievement of the diabetes care bundle was the biggest predictor of non-achievement 2 years later (OR 3.3, 95% CI 2.2 to 4.7). Poorer participants were always more likely than wealthier participants to have illness burden (statistically significant OR 3.9 to 16.0), but not always more likely to be diagnosed or receive treatment (0.2 to 5.3).ConclusionsShortfalls in quality of care for these four conditions have persisted over 6 years, with only half of the level of indicated health care achieved for osteoarthritis, compared with the other three conditions. Quality for osteoarthritis improved slightly over time but remains poor. The relatively high prevalence of specific illness burden in poorer participants was not matched by an equally high prevalence of diagnosis or treatment, suggesting that barriers to equity may exist at the stage at diagnosis. Further research is needed into the association between quality and health system characteristics at the level of clinicians, general practices or hospitals, and regions. Linkage to routinely collected data could provide information on health service characteristics at the individual patient level.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Abstract.
Hughes N, Williams WH, Chitsabesan P, Walesby RC, Mounce LTA, Clasby B (2015). The prevalence of traumatic brain injury among young offenders in custody: a systematic review.
J Head Trauma Rehabil,
30(2), 94-105.
Abstract:
The prevalence of traumatic brain injury among young offenders in custody: a systematic review.
OBJECTIVES: to examine the prevalence of traumatic brain injury (TBI) among young people in custody and to compare this with estimates within the general youth population. DESIGN: Systematic review of research from various national contexts. Included studies were assessed for the relevance of the definition of TBI and the research population, and the quality of the study design. RESULTS: Ten studies were identified for inclusion in the review. Four of these studies included control groups. No studies examining comorbidity of TBI and other neurodevelopmental disorders among incarcerated young people were identified. CONCLUSION: Reported prevalence rates of brain injury among incarcerated youth range from 16.5% to 72.1%, with a rate of 100% reported among a sample of young people sentenced to death. This suggests considerable levels of need among incarcerated young people. Where control groups or directly comparable studies within the general population exist, there is strong and consistent evidence of a prevalence of TBI among incarcerated youth that is substantially greater than that in the general population. This disparity is seemingly more pronounced as the severity of the injury increases.
Abstract.
Author URL.
2014
Mounce LTA (2014). Do Patient’s Characteristics Predict Failure to Receive Care for Type 2 Diabetes?. Society for Academic Primary Care (regional). 6th - 7th Mar 2014.
Mounce LTA (2014). Do Patient’s Characteristics Predict Failure to Receive Care for Type 2 Diabetes?. Society for Academic Primary Care. 9th - 11th Jul 2014.
Abstract:
Do Patient’s Characteristics Predict Failure to Receive Care for Type 2 Diabetes?
Abstract.
Steel N, Hardcastle AC, Clark A, Mounce LTA, Bachmann MO, Richards SH, Henley WE, Campbell JL, Melzer D (2014). Self-reported quality of care for older adults from 2004 to 2011: a cohort study.
Age Ageing,
43(5), 716-720.
Abstract:
Self-reported quality of care for older adults from 2004 to 2011: a cohort study.
BACKGROUND: little is known about changes in the quality of medical care for older adults over time. OBJECTIVE: to assess changes in technical quality of care over 6 years, and associations with participants' characteristics. DESIGN: a national cohort survey covering RAND Corporation-derived quality indicators (QIs) in face-to-face structured interviews in participants' households. PARTICIPANTS: a total of 5,114 people aged 50 or more in four waves of the English Longitudinal Study of Ageing. METHODS: the percentage achievement of 24 QIs in 10 general medical and geriatric clinical conditions was calculated for each time point, and associations with participants' characteristics were estimated using logistic regression. RESULTS: participants were eligible for 21,220 QIs. QI achievement for geriatric conditions (cataract, falls, osteoarthritis and osteoporosis) was 41% [95% confidence interval (CI): 38-44] in 2004-05 and 38% (36-39) in 2010-11. Achievement for general medical conditions (depression, diabetes mellitus, hypertension, ischaemic heart disease, pain and cerebrovascular disease) improved from 75% (73-77) in 2004-05 to 80% (79-82) in 2010-11. Achievement ranged from 89% for cerebrovascular disease to 34% for osteoarthritis. Overall achievement was lower for participants who were men, wealthier, infrequent alcohol drinkers, not obese and living alone. CONCLUSION: substantial system-level shortfalls in quality of care for geriatric conditions persisted over 6 years, with relatively small and inconsistent variations in quality by participants' characteristics. The relative lack of variation by participants' characteristics suggests that quality improvement interventions may be more effective when directed at healthcare delivery systems rather than individuals.
Abstract.
Author URL.
Hardcastle AC, Mounce LTA, Steel N (2014). What predicts quality of care: results from the English Longitudinal Study of Ageing. Gerontological Society of America 66th annual scientific meeting. 14th - 18th Nov 2014.
Hardcastle AC, Mounce LTA, Steel N (2014). What predicts quality of care: results from the English Longitudinal Study of Ageing. Gerontological Society of America 66th annual scientific meeting. 14th - 18th Nov 2014.
2013
Hardcastle A, Mounce LT, Steel N (2013). HAS THE QUALITY OF CARE WORSENED FOR GERIATRIC CONDITIONS?.
GERONTOLOGIST,
53, 204-204.
Author URL.
Mounce LTA, Williams WH, Jones JM, Harris A, Haslam SA, Jetten J (2013). Neurogenic and psychogenic acute postconcussion symptoms can be identified after mild traumatic brain injury.
J Head Trauma Rehabil,
28(5), 397-405.
Abstract:
Neurogenic and psychogenic acute postconcussion symptoms can be identified after mild traumatic brain injury.
OBJECTIVES: As provenance of postconcussion symptoms after mild traumatic brain injury (mTBI) is controversial, with similar rates found in other populations, we aimed to identify postconcussion symptoms specific to mTBI compared with controls. We also compared differences between complicated and uncomplicated mTBIs. SETTING: Hospital emergency department. PARTICIPANTS: Adult individuals (34 individuals with complicated mTBI, 76 individuals with uncomplicated mTBI, and 47 orthopedic controls) who sought care in the emergency department and were consecutively recruited by post at 2 weeks postinjury. MAIN MEASURES: Rivermead Postconcussion Symptom Questionnaire. Preinjury factors were used as covariates. RESULTS: Compared with orthopedic controls, complicated mTBI group reported greater severity of headaches, dizziness, and nausea, as well as concentration difficulties, suggesting that these are neurogenic. Severity of other symptoms measured on the Rivermead Postconcussion Symptom Questionnaire was not significantly different between these groups, suggesting that these are psychogenic. Differences were evident between the 2 mTBI samples on the items of dizziness, nausea, fatigue, sleep disturbance, and concentration difficulties. CONCLUSIONS: Neurogenic and psychogenic postconcussion symptoms were identified at the acute-phase postinjury. Findings suggest that treating persons with mTBI as a homogenous sample is not prudent. This should inform prognostic models and follow-up support offered after leaving the emergency department.
Abstract.
Author URL.
Hardcastle A, Mounce LT, Steel N (2013). WHAT PREDICTS QUALITY OF CARE: RESULTS FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING.
GERONTOLOGIST,
53, 205-205.
Author URL.
2012
Melzer D, Tavakoly B, Winder R, Richards S, Mounce LTA, Gericke C, Lang I (2012). Health Care Quality for an Active Later Life: Improving quality of prevention and treatment through information - England 2005 to 2012. A report from the Peninsula College of Medicine and Dentistry Ageing Research Group for Age UK.
Mounce L, Williams H (2012). Outcome following Mild Traumatic Brain Injury: the interplay of concussion and post-traumatic stress.
BRAIN INJURY,
26(4-5), 638-639.
Author URL.
Mounce LTA (2012). Outcome following mild traumatic brain injury: the interplay of concussion and post-traumatic stress. 9th World Congress on Brain Injury. 22nd - 25th Mar 2012.
Davies RC, Williams WH, Hinder D, Burgess CN, Mounce LT (2012). Self-reported traumatic brain injury and postconcussion symptoms in incarcerated youth.
J Head Trauma Rehabil,
27(3), E21-E27.
Abstract:
Self-reported traumatic brain injury and postconcussion symptoms in incarcerated youth.
To determine the prevalence rate of traumatic brain injury (TBI) in incarcerated youth and whether frequency and severity of TBI are associated with postconcussion symptoms (PCS), violent offending behaviors, age of first conviction, and substance abuse.
Abstract.
Author URL.
2011
Tonks J, Williams WH, Mounce L, Harris D, Frampton I, Yates P, Slater A (2011). 'Trails B or not Trails B?' is attention-switching a useful outcome measure?.
Brain Inj,
25(10), 958-964.
Abstract:
'Trails B or not Trails B?' is attention-switching a useful outcome measure?
Difficulties with attention contribute to behavioural and cognitive problems during childhood and may reflect subtle deficits in executive functioning (EF). Attention problems in early childhood have also been found to predict higher levels of anxiety and depression symptoms at 10 years old. It has also been reported that attention problems during childhood may be differentially related to later-emerging distinct EF difficulties. Many of these findings, however, rely on teacher-ratings of attention difficulties.
Abstract.
Author URL.
Mounce LTA, Williams WH (2011). The Neurological and Psychological Roots of Post-Concussion Syndrome After MTBI: the Role of Traumatic Re-Experiencing. 4th Pacific Rim Meeting. 6th - 9th Jul 2011.
2010
Mounce LTA, Williams WH (2010). Does acute stress predict mTBI symptoms?. Annual Meeting of Emergency Medicine. 22nd - 25th Mar 2010.
2007
Mounce LTA (2007). Risk of psychiatric disorder in children with congenital versus acquired brain-dysfunction. 4th Satellite Symposium on Neuropsychological Rehabilitation. 9th - 11th Jul 2007.
