How collaboration and co-design using real-world data can improve patient outcomes and clinician experience

Discover-NOW, led by Imperial College Health Partners, is pioneering the use of real-world evidence (RWE) in the treatment and prevention of disease. Emerging from Health Data Research UK’s £37.5m investment in digital innovation hubs, Discover-NOW brings together diverse organisations, along with patients and the public, to demonstrate the power of using real-world health data in research. It does this by offering access to one of the largest de-identified linked health datasets in Europe in a safe, secure and trusted research environment (TRE), across a population of more than 2.5 million in North West London.

In 2018, the Discover-NOW team, North West London Integrated Care System (ICS), AstraZeneca, Huma, and other academic, industry, technology, and research organisations, embarked on a new partnership that would combine our collective knowledge and expertise for the first time and foster a fresh approach to solving longstanding healthcare problems using real-world data.

A new kind of partnership

This new multi-partnership model was one that hadn’t been tested before. The real and far-reaching potential of this was clear from the start. What we hadn’t anticipated was how this very different relationship would challenge us all to think completely differently about the issues that we were independently looking to solve.

Leveraging a range of experiences

In large organisations and institutions, thinking can sometimes become narrowed over time. As everyone strives for the same goal, it can create a kind of tunnel vision, resulting in a lack of appetite for risk and experimentation. Similarly, it’s not always possible for an organisation to have depth and breadth of expertise across all fields, meaning innovation projects can become skewed towards particular areas.

Closely aligned thinking and a focus on the skills needed to deliver a shared goal can work well if an organisation’s aims stay the same and the environment in which it operates remains static. However, it can also stifle innovation, and through this partnership it’s been made clear that bringing different and sometimes opposing perspectives together can in fact be incredibly valuable and refreshing.

In this case, working with the global team from AstraZeneca brought experience and learnings from health economies from the US and elsewhere. Together, we’ve developed a design approach which is extremely agile. It involves testing new ideas, evaluating at pace, and then adapting to solve the real-world problems we’re tackling.

Preserving and improving health

In the continuing shadow of the COVID-19 pandemic, we have seen an increased understanding within the health service of the urgent need to accelerate pathway transformation, and preserve and improve health now rather than the traditional focus on treating disease.

This was a shift in direction that we were keen to make the most of and the initial work of the Discover-NOW team has been dedicated to using RWE to improve understanding of many long-term health conditions, including a specific programme to find new solutions to help people manage their type two diabetes (T2D) and, crucially, stay healthy and well.

A new way for primary care to support patients

Each bringing their own specialist expertise – be that clinical and local knowledge, technical solutions or an in-depth understanding of service and pathway design, alongside a baseline of evidence from Discover-NOW – our multifaceted alliance co-designed and piloted a remote intensification of care service for high-risk T2D patients in North West London.

By combining unique and complementary skills, we collaboratively devised this completely new way for primary care to support patients with T2D and have a positive impact on their health and wellbeing. Based on video group consultations, remote health monitoring, structured digital education and virtual multidisciplinary team working, the service is delivered over 12 weeks. By monitoring patients remotely and seeing multiple patients at once in group consultations, the clinicians involved in the pilot reported being able to offer more in-depth advice and support, and that their patients have become more motivated and able to make the recommended lifestyle changes.

Feedback from patients has been extremely positive. One person said: “It’s good to hear how other patients are doing, and what we can do to improve our health.”

Another said: “Seeing my sugar levels in front of me on the app made me realise how what I eat affects them.”

Most excitingly, this service has allowed for a new flexible model of remote care to be designed and tested in practice, enabling Primary Care Networks to deliver long-term condition enhanced services at scale, including frameworks for training, IT infrastructure configuration and staffing models.

Collaboration and co-production is vital

The T2D work is one of several healthcare pathway transformation programmes supported by Discover-NOW that are looking to improve care for Heart Failure and Chronic Kidney Disease. These all aim to establish collaboration with external partners, in the real-world ecosystem of North West London – our ‘living lab’ – to find opportunities to improve patient outcomes and clinician efficiency using real-world data.

Each of these programmes demonstrates that the NHS cannot solve all its problems alone. It’s clear that using real-world data and collaborating with industry, academia and involving the partners who are best placed to help, is going to be the most effective way to drive forward rapid pathway transformation, boost innovation and solve real-world health care problems.