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University of Exeter Medical School

Dr Luke Mounce

Dr Luke Mounce

Research Fellow


 +44 (0) 1392 722900

 College House 1.20


College House, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK


I am a Health Services Researcher working within Primary Care, and particularly Cancer Epidemiology, at the University of Exeter Medical School.  I have expertise in methodology, especially applied statistics, and in the management and analysis of large databases of routine records to answer health research questions.

I am the lead Statistician on the Electronic Risk Assessment for Cancer (ERICA) cluster-randomised controlled trial, exploring whether electronic risk assessment tools (eRATs) embedded into GP clinical software improve cancer diangosis outcomes.  Specifically, through use of the English national cancer registration data, we are investigating whether eRATs improve the proportion of cancers diagnosed at an early stage.

As a methodologist, I have work across various groups within the University of Exeter Medical School.  I am jointly shared between Professor Willie Hamilton in Cancer Diagnostics, and Dr Gary Abel in Primary Care.  I am also affiliated with the Health Statistics Group, and Health Services and Policy Research Group.  Previously I worked in the Epidemiology and Public Health group. 

Before joining the medical school in 2012, I earned a BSc, MSc and PhD in Psychology at the University of Exeter, with my PhD focussing on the longitudinal modelling of health outcomes following traumatic brain injury.


BSc (hons) in Psychology (Exeter, UK)

MSc in Psychological Research Methods (Exeter, UK)

PhD in Psychology (focus: clinical neuropsychology) (Exeter, UK)

Graduate Certificate in Statistics (Sheffield, UK)

Research group links

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Research interests

I am a methodologist, and seek to translate clinically important research questions into a scientifically rigorous research protocol, and then to carry that out.  As such, I work across a range of fields within health research.  My work has focussed particulary on cancer epidemiology, the causes and consequences of having multiple heatlh conditions (multimorbidity), and patient experience of Primary Care.

I have considerable expertise in the use of routine records, including:

  • The Clinical Practice Research Datalink (CPRD), the largest database of electronic primary care records in the world.
  • The National Cancer Registration and Analysis Service (NCRAS) cancer registration data, covering over 99% of all cancers diagnosed within England.
  • Hospital Episode Statistics
  • The GP Patient Survey (GPPS), the largest survey of patient experience of Primary Care in the world, with 2.7 million annual responses.
  • The English Longitudinal Study of Ageing (ELSA) database, a national panel survey of adults aged 50 and over, with waves every two years since 2002.

Research projects

The ERICA trial

I am the lead Statistician on the Electronic Risk Assessment for Cancer (ERICA) trial.  ERICA is a pragmatic, cluster-randomised controlled trial (cRCT) that is currently recruiting GP practices to be involved in an investigation of the possible benefits of electronic risk assessment tools (eRATs) for cancer.  The eRATs are embedded into GP clinical software and flag when a patient's recorded symtpoms / test results correspond to a cancer risk of >2% to aid clinical decision making.  The primary outcome measure for the trial, assessed using routine data from the English national cancer registry, is the poroportion of cancers diagnosed at an early stage at the practice-level.

Reliability of a process indicator for quality of cancer care

This project is exploring the possibility of using the percentage of eligible patients with alarm symptoms of cancer who are given an urgent referral for investigation of cancer (a "two week wait" referral) as a process indicator for the quality of cancer care provided at the practice-level.  It will:

  1. Explore varaibility in this indicators at the practice-level and clinician level.
  2. Investigate whether the indicator can reliably distinguish between high-performing and low-performing practices.
  3. Explore who performance on the indicator is affected by a practice's case-mix (e.g. the proportions of different cancers diagnosed).

This project is funded by the Moore Foundation, and is being conducted in collaboration with the University of Houston, Texas, and University College London.

The Community Groups for Post-Stroke Support (CoGS) study

This project, funded by the Stroke Association, is exploring the possible benefits of belonging to a community group for post-stroke support.  In particular, it is exploring the impact of group memebership on loneliness and well-being.

Cancer incidence following a high-normal platelet count

I recently completed the role of lead analyst on a project in cancer diagnostics titled "Are patients with high normal platelet counts at increased risk of cancer? The NORMA study."  Previous work has shown that patients with high platelet counts (thrombocytosis) are at much higher risk of cancer than the 3% criterion indicated in NICE guidelines for referral for investigation for suspected cancer.  The aim of NORMA, therefore, was to investigate the risk of cancer in patients at the high-end of the normal range of a platelet count.  This project involved analysing the anonymised electronic health records of ~300,000 patients, contained in the Clinical Practice Research Datalink with linkage to national cancer registration data, to explore how cancer risk varies by age, gender, and platelet count. We found that men aged 60 and over with a platelet count at the high end of the normal range had cancer incidences exceeding the 3% risk threshold in national guidance, though no female subgroup met the threshold.  Regardless of gender, a high-normal count was associated with up to 5 times the risk for lung cancer, and 4 times the risk of colorectal cancer.  Patients with a high-normal count diagnosed with cancer were 50% more likely to be diagnosed at an advanced stage. NORMA is funded by the Policy Research Unit.

I am involved in projects covering a number of other work-streams:

Use of chest x-ray for detecting lung cancer

I am working in collaboration with Stephen Bradley and colleages at the University of Leeds, providing methodological support to several projects exploring the test-characteristics of chest x-ray in the detection of lung cancer.

Use of Cancer antigen 125 for detecting ovarian cancer

I am collaborating with Garth Funstun and colleagues at the University of Cambridge on projects exploring methods for determining CA125 levels, and the use of CA125 in the early detection of ovarian cancer.

Patient Safety

Developing short-form versions of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) questionnaire.  PREOS-PC is a recently developed patient reported outcome measure (PROM) of experiences safety in Primary Care, consisting of 54 items and 11 scales.  This project is developing a compact version of the instrument, retaining the scales, but using a reduced number of items, as well as a short 6 item screening tool.  This process is being informed by use of both Classical Test Theory and Item Response Theory, and uses data collected for the development of the original measure.

Research networks

I am an associate member of the CanTest Collaborative, an international team of primary care cancer researchers working on early detection and diagnosis of cancer in Primary Care.

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Journal articles

Down E, Barlow M, Bailey S, Mounce L, Martins T (In Press). Association between patient ethnicity and prostate cancer diagnosis following a Prostate Specific Antigen test: a cohort study of 730,000 men in primary care in the UK. BMC Medicine
Bailey S, Mounce L, Hamilton W (In Press). Cancer incidence following a high-normal platelet count: cohort study using electronic healthcare records from English primary care. British Journal of General Practice
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.
Kapadia P, Zimolzak AJ, Upadhyay DK, Korukonda S, Murugaesh Rekha R, Mushtaq U, Mir U, Murphy DR, Offner A, Abel GA, et al (2024). Development and Implementation of a Digital Quality Measure of Emergency Cancer Diagnosis. J Clin Oncol Abstract.  Author URL.
Chen G, Barlow M, Down L, Mounce LTA, Merriel SWD, Watson J, Martins T, Bailey SER (2024). Exploring ethnic differences in the distribution of blood test results in healthy adult populations to inform earlier cancer detection: a systematic review. Family Practice Abstract.
Koo MM, Mounce LTA, Rafiq M, Callister MEJ, Singh H, Abel GA, Lyratzopoulos G (2024). Guideline concordance for timely chest imaging after new presentations of dyspnoea or haemoptysis in primary care: a retrospective cohort study. Thorax, 79(3), 236-244. Abstract.  Author URL.
Parsons J, Abel G, Mounce LTA, Atherton H (2023). Analysis the changing face of missed appointments. British Journal of General Practice, 73(728), 134-135.
Barlow M, Down L, Mounce LTA, Merriel SWD, Watson J, Martins T, Bailey SER (2023). Ethnic differences in prostate-specific antigen levels in men without prostate cancer: a systematic review. Prostate Cancer Prostatic Dis, 26(2), 249-256. Abstract.  Author URL.
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.
Funston G, Moullet M, Mounce L, Lyratzopoulos G, Walter FM, Zhou Y (2023). Pre-diagnostic prescription patterns in bladder and renal cancer: a longitudinal linked data study. BRITISH JOURNAL OF GENERAL PRACTICE  Author URL.
Mounce LTA, Salema N-E, Gangannagaripalli J, Ricci-Cabello I, Avery AJ, Kadam UT, Valderas JM (2022). Development of 2 Short Patient-Report Questionnaires of Patient Safety in Primary Care. J Patient Saf, 18(3), 161-170. Abstract.  Author URL.
Martins T, Abel G, Ukoumunne OC, Mounce LTA, Price S, Lyratzopoulos G, Chinegwundoh F, Hamilton W (2022). Ethnic inequalities in routes to diagnosis of cancer: a population-based UK cohort study. Br J Cancer, 127(5), 863-871. Abstract.  Author URL.
Moullet M, Funston G, Mounce LT, Abel GA, de Wit N, Walter FM, Zhou Y (2022). Pre-diagnostic clinical features and blood tests in patients with colorectal cancer: a retrospective linked data study. British Journal of General Practice, 72(721).
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. Abstract.
Barr CE, Funston G, Jeevan D, Sundar S, Mounce LTA, Crosbie EJ (2022). The Performance of HE4 Alone and in Combination with CA125 for the Detection of Ovarian Cancer in an Enriched Primary Care Population. Cancers (Basel), 14(9). Abstract.  Author URL.
Bhartia BSK, Hatton NLF, Aslam R, Bradley SH, Darby M, Hamilton WT, Hurst E, Kennedy MPT, Mounce LTA, Neal RD, et al (2021). A prospective cohort evaluation of the sensitivity and specificity of the chest X-ray for the detection of lung cancer in symptomatic adults. European Journal of Radiology, 144 Abstract.
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.
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.  Author URL.
Barr CE, Funston G, Mounce LTA, Pemberton PW, Howe JD, Crosbie EJ (2021). Comparison of two immunoassays for the measurement of serum HE4 for ovarian cancer. Pract Lab Med, 26 Abstract.  Author URL.
Bradley SH, Hatton NLF, Aslam R, Bhartia B, Callister ME, Kennedy MP, Mounce LT, Shinkins B, Hamilton WT, Neal RD, et al (2021). Estimating lung cancer risk from chest X-ray and symptoms: a prospective cohort study. Br J Gen Pract, 71(705), e280-e286. 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.
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. Abstract.
Zhou Y, Walter FM, Mounce L, Abel GA, Singh H, Hamilton W, Stewart GD, Lyratzopoulos G (2021). Identifying opportunities for timely diagnosis through patterns of primary care tests in patients with bladder and renal cancer: a longitudinal linked data study. British Journal of General Practice, 72(714).
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.
Quiroga M, Shephard EA, Mounce LTA, Carney M, Hamilton WT, Price SJ (2020). Quantifying the impact of pre-existing conditions on the stage of oesophagogastric cancer at diagnosis: a primary care cohort study using electronic medical records. Family Practice, 38(4), 425-431. Abstract.
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.  Author URL.
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.  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.
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.  Author URL.
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.  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.
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.
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.  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.
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.
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.  Author URL.
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.  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.  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.  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.  Author URL.


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. 9th - 11th Jul 2014. Abstract.
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.
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.


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.

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I was an Associate Teaching Fellow for four years during my PhD in Psychology.  Since joining the Medical School, I am a tutor on the Making Sense of Evidence module for BMBS students, and demonstrate statastics as part of the Fundamental Skills for Medical Scientists module on the Medical Science bachelors degree.

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