Associations between Research Activity and Patient Health Outcomes (ARAPAHO)

Problem

There is increasing evidence that participation in research drives better performance in health care settings. However, the evidence mostly comes from secondary care, while the bulk of patient contacts are through general practice. If research participation improves outcomes, achieving those benefits through general practice could improve health for a wider population of patients. England is in a unique position to explore this issue, as it has excellent data on both general practice and research activity (through the NIHR Clinical Research Network infrastructure). This provides the potential for a comprehensive analysis of the relationship between research activity and outcomes at a national scale.

Approach

The ARAPAHO project (funded by the Policy Research Programme) is a mixed methods study to answer the following research questions:1. Are there associations between research activity in general practice and outcomes? 2. What mechanisms may explain associations between research activity and outcomes?3. What are the characteristics of effective ‘research active’ practices from the perspective of staff, practitioners and patients?4. What are the impacts on patients and staff of research activity in general practice? We have created a preliminary logic model based on existing literature and patient and expert stakeholder input, which will inform our methods. We will use a variety of statistical methods (including causal modelling) with routine data to answer research questions 1 and 2. We will use qualitative methods with professionals and patients to explore research questions 3 and 4. For this, we will use outputs from our quantitative analyses and work closely with patients and other stakeholders to sample different types of general practices for in-depth study across England.The results from ARAPAHO will be synthesised with input from PPI and other stakeholders to consider the broader implications for future research activity in this setting.

Findings

ARAPAHO is ongoing, and at the conference we will present our initial logic model, and the results of initial quantitative analyses exploring the association between research activity and outcomes. We will use a variety of measures of research activity (volume, type, and duration) and multiple outcomes, including Quality and Outcomes Framework scores, and patient experience from the General Practice Patient Survey. These analyses will allow us to demonstrate whether the relationships demonstrated in secondary care settings generalise to general practice. We will also consider their implications for sampling in the subsequent qualitative work.

Consequences

General practice remains fundamental to the delivery of high quality care in England. However, there are significant pressures in this setting due to changing population demographics, rising patient expectations and issues of recruitment and retention in the workforce. Understanding the role that research activity can play in improving practice performance and patient outcomes could make an important contribution to maintaining the vitality of general practice in the future.