Enhanced integration of primary and secondary health systems and patient empowerment through improved continuity of patient care and clinical handover

Lead Research Organisation: University of Birmingham
Department Name: Health and Population Sciences

Abstract

Effective integration of care between community (primary) and hospital care (secondary) health services is essential for a patient whose needs extend beyond the initial episode, and more care is required by the next level of health provider. This may include referral to a hospital if a primary care doctor cannot manage the condition or the continuation of medication and check-ups in the primary care after a hospital admission. The crucial stage is communication of patient-specific information from one caregiver to another or to the patient and family, for the purpose of ensuing patient care continuity and safety, termed clinical handover. A review of evidence in the high-income countries showed that the consequences of ineffective handover led to incorrect treatment, delays in medical diagnosis, life-threatening adverse events, patient complaints, increased health care expenditure, increased length of stay, increased re-admissions, and other impacts on health systems. Although we have not been able to find similar data for LMIC, experience and discussions with partners and experts indicate that the rate of adverse events and other unwanted outcomes due to poor handover are even greater in LMICs due to huge gaps in integration of health providers. It is likely therefore, that considerable scope exists to improve practice in a way that is cost-effective and potentially even cost releasing. These may be adapted from methods that have been successfully implemented in high-income countries (e.g. check-lists, patient held records). There is a global focus from the WHO on health systems development, critical for a better response to challenges of emergencies, infectious and other diseases. The rise in elderly populations and deteriorating lifestyle behaviours (e.g. smoking rates) in LMICs have increased the burden of heart related, diabetes and other long term diseases. Due to their need for on-going care, these are particularly adversely affected by poor integration between primary and secondary care.
Thus the main drivers for our proposal are evidence for the following:
-clinical handover processes are at the core of patient safety and consequences of inadequate clinical handover result in poor patient outcome and high cost to the health system
- Clinical handover is a global priority identified by the WHO Patient Safety Programme. There is need and interest in many LMICs to improve integration between-levels of health care, but little evidence to guide local decision makers in how to identify and overcome barriers to improved practice
-initial interventions can be culturally and politically acceptable, affordable and sustainable, but that such interventions have not been systematically explored, tested or implemented
The objectives of this one year project (part of a extensive five-year programme) are: 1) describe existing situation in terms of policies, training, activities, and culture for clinical handover between primary and secondary care during referrals and discharge 2)identify barriers and facilitators (health care system and patient related) for improving clinical handover 3)develop options for intervention 4)build health systems research capacity. These will be achieved through a range of complex research methods that would involve all stakeholders from policy makers to patients.
The immediate benefits of this phase will be for the hospital and community health care practitioners and policy makers who will be able to use the findings to start addressing some of the affordable solutions identified, researchers who will learn health system assessment techniques novel to them, and ultimately the patients who will receive a better seamless health care through the development and implementation of interventions. The follow-on intervention study is hoped to roll out into long-term programmes that could dramatically improve integration of primary and hospital care services.

Technical Summary

Design: Observational prospective study using mixed-methodology; Setting: One rural, urban and periurban hospitals in 2 states of India
Objectives
1.situation analysis of policies, training, activities, and culture for clinical handover between primary and secondary care during referrals and discharge
2.identification of barriers and facilitators (health care system and patient related) for improving clinical handover
3.exploration of options for complex health systems and patient related interventions to improve clinical handover
4.pilot data collection tools for handover intervention evaluation
5. build health systems research capacity in order to enable further research and progress in integration of health systems for the development and implementation of a future cluster-RCT testing out potential interventions
Methods: These will be achieved through mixed-methodology research to include:
a)semi-structured interviews, focus groups, patient journey observation, and expert groups with health care academics, policy makers, managers, providers in primary and secondary care and patients: Views will be elicited on barriers, facilitators, potential interventions and identifying training needs
b)document content review
c)health care provider surveys
d)patient and case note surveys on admission, discharge, 3 weeks and 3 months post-discharge for high-burden tracer health conditions requiring follow-up: stroke, diabetes, hypertension, and elderly (>65 years) with multiple co-morbidities.
A range of analytical frameworks will triangulate the findings together with evidence of best practice, to identifying opportunities for improvement and options for intervention definition. The findings will be used by local policy makers, managers and practitioners to start addressing the identified low-cost barriers and solutions, while a systematic application of the findings will develop a complex-health systems intervention programme for a cluster trial to follow.

Planned Impact

The impact of the development phase will be realised by many different groups, in the short and long term, directly and indirectly: Internationally academic impact will be felt as new methods of research and knowledge are shared publications and presentations, setting new agenda for research. Local researchers will learn from the experience of the mixed-methodology employed in this project, and local service providers begin to meaningfully consider service integration and optimal clinical handover. Our findings of barriers, facilitators and intervention options for optimal clinical handover will empower the policy makers and managers with evidence in order to begin to act to improve the system. A local process of better cohesion will develop amongst practitioners through multi-disciplinary research and expert groups consulted on the research questions. Patients will also benefit through helping to design services for their community which is a positive, empowering and even enjoyable experience.

However, the full impact will be achieved through the implementation of the follow-on trial, there will have wider impact at the local, national and international levels: This will test out a package of complex, but affordable and cost-effective health service design interventions. Patients will benefit from the impact of the study in the short term through the provision of safer, improved and integrated health care, and in the longer term from generic knowledge about the science and art of service improvement. Front line staff will gain in knowledge and experience through acquiring generic skills in service innovation to improve the quality and safety of care and will benefit from the inclusive ideology of the proposed methods. Any lacunae in technical knowledge will be remedied and they will have a practical introduction to systems thinking and the principles of safety and implementation of effective care. They will also have experience of working on cognitively demanding tasks in teams involving doctors, nurses and mangers, as well as service users. Managers and policy makers will benefit through the experience of state-of-the-art techniques of service redesign and quality improvement and involvement in a program that has aspects of action research embedded in it. The national and international experts and policy makers will benefit through their involvement at the start of the program and at regular intervals thereafter as findings emerge and theories develop and can explore emerging themes that can be applied more generically to other LMIC settings. Local academics will benefit as they learn through application of new methods of health systems situation analysis, development of complex service design improvement interventions, evaluation of interventions through a large cluster randomised controlled trial, and the development of pre-service and in-service training courses to sustain and embed knowledge and attitudes within the system. Economic impact will be felt by individual patients as their out-of-pocket expenditures are reduced through improved and safer services, and society as the whole will benefit as the members thereof become healthier, productive and better-of economically. The health services spend less on unnecessary adverse events and litigation (emerging in middle-income countries), and retain their staff through motivation, training and integration.

These impacts are maximised through involvement of all stakeholders in the health system and community from the start, the use of evidence based practice, training and capacity building, a comprehensive and managed communication and dissemination plan and robust governance and project management plans. The latter will include weekly virtual meetings with field staff and monthly all Co-I and managers project steering group meetings.
 
Description Introduction of Clinical Handover Lecture into the Public Health in Low and Middle-Income countries module; Part of the Masters in Public Health course
Geographic Reach National 
Policy Influence Type Influenced training of practitioners or researchers
 
Description College of Medical and Dental Sciences Doctoral Scholarship for a Master's student
Amount £47,000 (GBP)
Organisation Medical Research Council (MRC) 
Sector Public
Country United Kingdom
Start 10/2015 
End 10/2018
 
Description Indian Collaboration Fund
Amount £1,500 (GBP)
Organisation University of Birmingham 
Sector Academic/University
Country United Kingdom
Start 02/2018 
End 04/2018
 
Description The Global Challenges Award for PhD Scholarship
Amount £100,000 (GBP)
Organisation University of Birmingham 
Sector Academic/University
Country United Kingdom
Start 09/2018 
End 09/2022
 
Title Clinical handover data collection questionnaires 
Description Two questionnaires were developed by the collaborating research partners to capture information regarding current clinical handover practices for inpatients and outpatients. These two questionnaires were then translated, cross-culturally validated and piloted for use in India. Another questionnaire was also developed by researchers to capture data from healthcare workers regarding clinical handover training and practices/policies in place for current clinical handover practices in hospitals and primary care. This was also translated, cross-culturally validated and piloted for use in India. 
Type Of Material Improvements to research infrastructure 
Provided To Others? No  
Impact Questionnaires are being adapted for utilisation in further clinical handover research in other countries. 
 
Description Collaboration for PhD funding and research 
Organisation Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST)
Country India 
Sector Academic/University 
PI Contribution The university of Birmingham will be recruiting and leading the supervision for a PhD student to complete further research, based on the original grant work, in India.
Collaborator Contribution The partner will be helping to supervise the PhD student and their research whilst they are completing the field work in India.
Impact PhD is yet to commence.
Start Year 2018
 
Description Handover in Europe and Central Asia 
Organisation Aga Khan Foundation
Department Aga Khan Health Service
Country Switzerland 
Sector Charity/Non Profit 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Amrita Institute of Medical Sciences
Country India 
Sector Charity/Non Profit 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Centre for Chronic Disease Control (CCDC)
Country India 
Sector Hospitals 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Ernakulam General Hospital, India
Country India 
Sector Hospitals 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Fundacion Avedis Donabedian
Country Spain 
Sector Public 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Netherlands Institute for Health Services Research
Country Netherlands 
Sector Public 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Polish Society for Quality Promotion in Healthcare
Country Poland 
Sector Charity/Non Profit 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Public Health Foundation of India
Country India 
Sector Public 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Regional Hospital Solan
Country India 
Sector Hospitals 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Riga Stradins University
Country Latvia 
Sector Academic/University 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation University of Michigan
Department School of Public Health
Country United States 
Sector Academic/University 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Handover in Europe and Central Asia 
Organisation Wellspring NGO
Country Mongolia 
Sector Charity/Non Profit 
PI Contribution -Design of the study -Development of study tools and piloting (with input from colleagues in India) -Training of field staff (with input from colleagues in India) -Expert group meeting leadership and design -Data cleaning and analysis -Dissemination of results via preparations for publication and newsletters
Collaborator Contribution -Developing a European grant and a programme of research in clinical handover for eastern and central Europe and central Asia. -Partners in Mongolia have contributed to facilitation and supervision of two research projects on clinical handover without additional funds. -Partners in India have contributed office space, equipment and staff time to the project.
Impact A number of outputs have resulted from this collaboration. These include: -BmedSci student dissertation projects -A horizon 2020 health systems proposal -Drafts for publications from student projects This collaboration is multi-disciplinary. The following disciplines are involved: -Clinical medicine & dentistry: doctors, dentists & nurses -Social scientists: anthropologists & sociologists -Non-Governmental Organisation (NGO) service providers (managers) -Clinical and other academic researchers
Start Year 2015
 
Description Internship with the Kerala Ministry of Health and ACCESS HEALTH International. 
Organisation ACCESS Health International
Country India 
Sector Private 
PI Contribution The PI and affiliated PhD student applied for this funding and the PhD student will be travelling to Kerala for 2 months to complete an internship project regarding health systems development and chronic disease management.
Collaborator Contribution Some of the partners assisted with the funding application.
Impact TBC
Start Year 2018
 
Description Internship with the Kerala Ministry of Health and ACCESS HEALTH International. 
Organisation Indian Ministry of Health
Country India 
Sector Public 
PI Contribution The PI and affiliated PhD student applied for this funding and the PhD student will be travelling to Kerala for 2 months to complete an internship project regarding health systems development and chronic disease management.
Collaborator Contribution Some of the partners assisted with the funding application.
Impact TBC
Start Year 2018
 
Title Multi-dimensional clinical handover intervention 
Description The components of the intervention are as follows: a.) A chronic disease patient-held booklet - including blank pages where doctors can make records, for attachment of test results, discharge summaries etc. A section will be included for educational material, a medication table to record changes in medication, and a blood pressure and a blood sugar chart. b.) A discharge-planning checklist: for better discharge organisation and patient-centred communication. c.) Training for clinicians and managers: a 1.5 day training event to improve knowledge, attitude, skills and motivation for handover and improved information written in the booklet and discharge checklist. d.) Establish hospital leadership and state Department of Health endorsement: introduction of programme champions, reminder systems, non-monitory incentives, patient-safety/handover groups, and monitoring to ensure uptake of behaviour change by healthcare workers. e.) Education for patients/carers: utilising a range of means (e.g. during clinician consultation, in clinic waiting rooms and through posters/range of community-based activities). At present this intervention is in its initial stages of development and an application for trial funding has been submitted to the MRC health systems research initiative call 3. 
Type Management of Diseases and Conditions
Current Stage Of Development Initial development
Year Development Stage Completed 2015
Development Status Actively seeking support
Impact N/A 
 
Description Expert Group, Delhi 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Policymakers/politicians
Results and Impact Experts and policy-makers in public health systems, chronic diseases, and patient safety, based in both the UK and India, met in October 2015 to discuss the initial findings of our project and their views on potential interventions to improve clinical handover in India for future study. Expert Meeting attending Organisations:
-Ministry of Health & Family Welfare, India
-Directorate of Health Services, Kerala
-Fortis Healthcare
-World Health Organisation, India
-World Bank, India
-All India Institute of Medical Sciences
-AIMS, Kerala
-Aga Khan Heath Services, India
-ACCESS Health International
-CCDC
-National Centre for Disease Control, India
-National Health Mission, Kerala
-National Health System Resources Centre, India
-Public Health Foundation of India
-University of Birmingham, UK
-University of Warwick, UK
Year(s) Of Engagement Activity 2015
 
Description Handover Research Web Page 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact A comprehensive web page was created via the University of Birmingham's official website in order to inform people of the aims, objectives, and methods of the handover study. A section containing participant information was also created for those who were taking part in the research. In addition, study results have been disseminated using this web page via the publication of two newsletters.
Year(s) Of Engagement Activity 2014
URL http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PCCS/handover-india/index.aspx
 
Description Lecturing on the UoB MPH programme 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact The affiliated PhD student currently working on the data collected from the original project has delivered two annual lectures as part of the International Masters in Public Health Programme at the University of Birmingham.
Year(s) Of Engagement Activity 2016,2017
 
Description Newsletters 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact During our 13 month project we produced 2 newsletters that summarised our work and were widely distributed electronically and on print to all relevant contacts of the 3 partner academic units in the UK and India, as well as farther a field such as to WHO Headquarters in Geneva.
Year(s) Of Engagement Activity 2015
 
Description Poster Presentation at the World Non-Communicable Disease Congress (2017) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact One of the members of the research team (SJ), in collaboration with our affiliated PhD student, created and presented a poster focussing on the inpatient data collected as part of the India handover project to attendees at the World NCD Congress in Chandigarh, India.
Year(s) Of Engagement Activity 2017
 
Description Poster presentation at the Health Systems Global Conference (2016) 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Our affiliated PhD student presented a poster focussing on the outpatient data collected as part of the original India project to conference attendees.
Year(s) Of Engagement Activity 2016
 
Description Poster presentations at the Health Systems Global Conference 2018 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact PhD student, Claire Humphries, presented the following poster at the Health Systems Global conference in Liverpool, UK (2018): "Investigating the relationship between quality of discharge and health outcomes for chronic disease patients in 3 hospitals in India".

An e-poster was also presented online, which was created by Claire Humphries and Suganthi Jaganathan, titled: "A qualitative study of barriers to continuity of care for chronic disease patients accessing government healthcare in India"
Year(s) Of Engagement Activity 2018