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C H Pain

Publications and source records attributed to C H Pain.

5 recordsLinked to original sources
PubMed1996

Setting targets for CABG surgery in the north western region.

BACKGROUND: A national target for coronary artery bypass graft (CABG) operations of 300 per million population was established by the Department of Health in 1987. Regional Health Authorities were required in 1993-1994 to achieve this target. The 1990-1991 Regional all-ages CABG rate was 239 per million population. The North Western Region planned to devolve the purchasing of certain services, including cardiac surgery, to districts in April 1993. Three districts had provider units within their boundaries. No means existed for estimating the appropriate operation rate, according to need, for district populations. A method was therefore devised for calculating guideline targets. METHODS: Based on the assumption that the ischaemic heart disease standardized mortality ratio (IHD SMR) is a valid proxy of the need for CABG operations and using a linear regression model, the existing district IHD SMRs and IHD hospitalization rates were used to derive guideline targets for districts, taking account of the need to raise the average operation rate for the Region to 300 per million population. Further targets using alternative Poisson regression model and weighting formulae were also derived. RESULTS: The derived operation targets based on the linear regression model were lower than the existing operation rate in the three provider districts and in the biggest provider's two neighbours. In all other districts, except one, targets were higher than the existing number of operations. The two further analyses produced essentially similar results. CONCLUSIONS: In the North Western Region wide variations in CABG operation rates existed. Access to CABG surgery in the North Western Region appears to depend on proximity to the provider districts. Operation rates should reflect need. This paper presents a method for deriving targets which take account of need.

Adult↗
PubMed1996

Death certification: production and evaluation of a training video.

The purpose of this study was to produce an effective training video on death certification suitable for use by medical students and postgraduates. A 15-minute video was commissioned from a video production unit and two authors (PA and CP) provided advice and support in the process of script writing and production. An evaluation by means of a randomized controlled trial took place among 185 first year medical students at the University of Leicester. The video was shown as an addition to the usual lecture on death certification. Performance in a test of knowledge, skill and motivation was recorded in each of the two groups. Students assigned to see the video scored slightly better overall in a test of knowledge and skill (difference in medians = 3, in a test marked out of 68, P = 0.046). The intervention group also gave a significantly higher priority to avoiding distress caused to relatives as a reason for certifying death accurately (60% vs. 35%, difference in proportions = 24%, P = 0.002). There was no evidence that enjoyment or views about the nature or content of the video had an impact on performance in the test. It is concluded that adding the video to the usual lecture had a limited effect on the overall knowledge and skills of undergraduate students but was highly effective in conveying the message that inaccurate death certification can cause distress to relatives. The randomized controlled trial is a practical and simple means of evaluating teaching methods for medical undergraduates.

Death Certificates↗
PubMed1991

Length of stay in general medical beds; implications for the NHS White Paper of variance within one performance indicator.

Data over several years have shown that the average length of stay in general medical beds in the Royal Preston Hospital is approximately 20 per cent above regional average. To investigate this we carried out a prospective study of 259 successive medical admissions to the hospital. We also carried out a retrospective study of routine data from the Korner episode system (KES) for the specialties of general medicine and geriatrics, using standardization techniques. After correcting for age and diagnostic group, the average length of stay in the hospital was close to the regional average. It is concluded that difference between districts in respect of age and diagnostic group can cause substantial difference in average length of stay. Future contracts between purchasing and providing health service authorities will need to take such difference into account if valid comparisons are to be made between two or more apparently similar alternatives.

Adult↗