Inequalities in outcomes are commonly observed in healthcare settings. These may arise due to social, economic, environmental and structural disparities. Local demographics are major determinants of inequality, in LLR ethnicity is one such factor. 

With funding from Leicester Hospitals Charity we aim to understand structural drivers of ethnicity-related inequality in provider NHS Trusts.

We will do this by:

• Using service user focus groups to analyse care pathways for evidence of bias
• Working closely with the Centre for Ethnic Health Research
• Defining datasets that accurately describe and measure inequalities in health outcomes in ethnic minority populations receiving care at NHS trusts
• Evaluating the impact of deprivation and ethnicity in health outcomes in Leicester’s Hospitals
• Developing an indicator toolkit for Trusts to identify and address structural drivers of inequality

Funded by the Leicestershire Academic Health Partnership (LAHP), the aim of this project is to develop a prospective, internally linked, minimum dataset derived from UHL Clinical Data Systems that includes service user data, broken down by ethnicity and deprivation to allow in-depth service evaluation and research, to understand and address Health Inequalities in Leicester, Leicestershire and Rutland (LLR). 

We will do this by:

• Building and developing a dataset that can be accessed by Clinicians and Researchers to allow service level research and improvement, driven by real-time data.
• Using the learning from this Project to develop a tool-kit that can be used across LLR Integrated Care System and beyond, to inform and facilitate inequality data collection and analysis.
• Major decision points will occur at the end of the initial data extraction and subsequent data analysis periods, aiming to utilise the dataset to inform service improvement / evaluation work on inpatient services.
• The project will be presented to the UHL Health Inequalities Taskforce and through the UHL Research & Innovation Board.

Funded by the Leicestershire Academic Health Partnership (LAHP), the aim of this project is to implement an Asthma MDT with a Respiratory Physician in the community to upskill and train Primary Care Staff to improve the management of Asthma.  

We will do this by:

• Reducing Asthma exacerbation and therefore avoidable ED Admissions
• Improving Asthma management in the community by training staff on care plans
• Improving Patient reported outcomes, such as reduced wheezing / coughing, improved sense of control, less exacerbations
• Reducing variations in Asthma related Healthcare outcomes between the most and least deprived Patients.
• Ensuring a “Making Every Contact Count” (MECC) approach is embedded and that the MDT are confident and competent in discussions around lifestyle choices and wider determinants of health.
• Working with Leicestershire County Councils Healthy Workplaces programme, to raise the awareness of management of Asthma amongst the working age population.

Funded by the Leicestershire Academic Health Partnership (LAHP), the aim of this project is to improve communication practices in acute Paediatric Care.  

We will do this by:

• Reviewing current communication practices around safety netting, developing a baseline understanding of them, and how inequalities may interact in these consultations.
• Proving the feasibility of videoing consultations between families and Health Care Professionals in Primary and Secondary Care as a qualitative research method.
• Developing proposals to further improve the quality and safety of communication and safety netting practices i.e., training, guidelines or other tools.

Funded by the Leicestershire Academic Health Partnership (LAHP), the aim of this project is to utilise a community-based participatory approach, to reduce Head and Neck Cancer Inequalities among minority ethnic groups, through co-production of effective awareness-raising methods, that translate to behavioural change.  

We will do this in three phases:

• Phase One: Setting up PPIE Groups with lay diverse ethnic communities using established relationships with voluntary organisations in Leicester to:
  • Secure the agreement of voluntary organisations to recruit users for Public Advisory Groups of up to 8 Public Contributors.
  • Setup two engagement meetings of two hours each, with seven ethnic groups to provide information about Head and Neck Cancer, including risks and prevention. Also, to discuss messages to include in social media / radio campaigns that are culturally and linguistically appropriate for their communities.
• Phase Two: To have PPIE Consultation meetings with Patients who have had Head and Neck Cancer in Leicester. These meetings aim to gain an understanding of lived experience, barriers to diagnosis and key messages to wider communities on earlier diagnosis.
• Phase Three: To gain national perspective from PPIE Consultations with patients who have had Head and Neck Cancer. Consultations bring together a diverse geographic and demographic perspectives to understand lived experience, barriers to diagnosis and key messages on earlier diagnosis.

Funded by the Leicestershire Academic Health Partnership (LAHP), the aim of this project is to investigate inequalities in access to and outcomes of Cardio-Respiratory Rehabilitation, by Multi-Morbidity, Socioeconomic status, Ethnicity and the influence of the COVID-19 Pandemic on any disparities in care.  

We will do this by:

• Describing the multi-mobidity, socio-demographic and ethnic distribution of Patients accessing cardio-respiratory rehabilitation in Leicesershire, pre, peri and post COVID-19 Pandemic.
• To compare attendance and outcomes (adherence, physiological markers and quality of life) among groups (multi-morbidity, socio-economic status and ethnicity)
• Engage with all stakeholders to identify areas for improving access to cardio-respiratory rehabilitation and patients experiences.

Funded by the Leicestershire Academic Health Partnership (LAHP), the aim of this project is to create an updated Leicestershire Database for Chronic Kidney Disease to assess the performance of the KFRE in a contemporary dataset.

We will do this by:

• To update the KFRE to ensure accurate and up to date risk predictions are produced for new patients.
• Evaluate the performance of the newly proposed KFRE that accounts for ethnicity and competing risks
• Evaluate the need for ongoing model assessment and further updates of the model to prevent the accuracy of the predictions worsening over time (calibration drift).
• The availability of data up until December 2022 will allow the performance of the current KFRE and the ethnicity specific KFRE to be assessed and temporally validated.

Funded by the Leicestershire Academic Health Partnership (LAHP), the aim of this project is to conduct underpinning empirical research by mapping community awareness and understanding of Dementia and digital literacy and access. The underpinning empirical work will inform the co-design, and evaluation of a culturally appropriate communication intervention, to raise Dementia Awareness and facilitate help-seeking among Black and South Asian communities in LLR and surrounding areas.

We will do this by:

• Examining the current level of awareness and understanding of Dementia within Black and South Asian communities, and the socio-economic, cultural and demographic factors contributing to the level of awareness and understanding.
• Examine the current level of digital access and digital literacy within the two communities
• Examining the barriers and facilitators of Dementia help-seeking
• Identifying culturally appropriate knowledge and resources needed for dementia support.
• The methodology will draw on community-based participatory research (CBPR), with in-depth qualitative methods to foreground lived experiences of Ethnic Minority individuals and communities, and identify locally rooted best practices.

Chronic Kidney Disease (CKD) is common and places a high burden of disease on Patients, and high costs on Healthcare Systems Worldwide. Contemporary differences between South Asian and White ethnicities in the incidence of End Stage Kidney Disease (ESKD) and mortality are poorly described. We conducted one of the largest analyses of patterns of Chronic Kidney Disease risk in South Asians compared with White individuals.

We did this by: 

• Extracting data from the Clinical Practice Research Datalink (CPRD) for all South Asian Patients who had an ‘estimated Glomerular Filtration Rate’ (eGFR) measure after 1 Jan 2006 and an additional 1 million randomly selected participants of other ethnicities.
• Participants were followed up from the index date until End-Stage Kidney Disease (ESKD) and all-cause mortality, end of the study, or death.
• All-cause mortality rate and ESKD incidence rate by age were described in Whites and South Asians, and adjusted hazard ratios of the two outcomes by baseline eGFR, estimated using ‘Cox Proportional-Hazards Model’.

Our Results:

• 40,888 South Asians and 236,634 Whites were followed for a median of 5.3 and 9.4 years for ESKD incidence and mortality outcomes, respectively.
• All-cause mortality rates were higher in Whites than South Asians; South Asian women aged between 70 and 85 years had a slightly higher End Stage Kidney Disease (ESKD) incidence rate, compared to White counterparts.

Discussion:

South Asians experience lower mortality than White ethnicities, but not substantially higher rates of End Stage Kidney Disease. Further research to better understand the reasons for these ethnic differences and possible impact on Chronic Kidney Disease service delivery, and Patient outcomes is warranted.

University of Leicester researchers and NHS clinicians are custodians of large datasets of patients from primary and secondary care as part of cohort studies, clinical trials and audit projects. These data sets form a rich resource for continuing research, however many are not visible or easily available to other researchers.

We aim to establish a single data asset platform to host health data assets for research held in Leicester.

We will do this by: 

• Creating an online platform for the submission and discovery of study metadata
• Developing a dynamic query interface to enhance the ability to search data availability.
• Working with NIHR Leicester Biomedical Research Centre who will host the platform via their website
• Ensuring that datasets submitted to the Leicester discovery platform will be available for submission to the HDRUK Innovation Gateway
• Ensuring compatible with the current HDRUK metadata model