The UK government is pursuing policies to improve primary care access, as many patients visit acc... more The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Mu...
Transit observations at UV wavelengths probe the hot, extended and highly ionized upper atmospher... more Transit observations at UV wavelengths probe the hot, extended and highly ionized upper atmospheres of close-in extrasolar planets. HD209458b and HD189733b both orbit their host stars within 0.05 AU and are loosing mass due to intense heating by stellar XUV radiation. However, their surface gravities differ by a factor of ∼2 and while HD209458 is a solar-type star, HD189733 is a K type star. Consequently, the X-ray and EUV flux received by HD189733b is expected to be significantly higher than that received by HD209458b. Therefore, the upper atmospheres of the planets should have different characteristics. Here we discuss the interpretation of the UV transit observations and show how they can be used to obtain information about the thermal structure, composition and escape rates in the upper atmosphere. Based on the results, we highlight the differences and similarities between HD189733b and HD209458b.
We present results of the study of gravity wave (GW) effects on the circulation in the thermosphe... more We present results of the study of gravity wave (GW) effects on the circulation in the thermosphere-ionosphere (TI). A spectral GW drag scheme suitable for the thermosphere has been developed and implemented into the Coupled Middle Atmosphere-Thermosphere Model (CMAT2) extending from the lower atmosphere into the F- region. Results of the simulations demonstrate that GWs of the tropospheric origin can effectively penetrate into the upper thermosphere. Momentum deposited by these waves is not only negligible above the turbopause, but is comparable to that of ion drag, at least up to 180-200 km. Effects of the thermospheric GW drag are particularly noticeable in the winter hemisphere, where the inclusion of GW parameterization allowed to reproduce weaker westerlies and stronger high-latitude easterlies, well in agreement with the empirical Horizontal Wind Model. We shall discuss some inferences concerning the dynamic response in the F-region to the variations of the source spectrum.
As atmospheric gravity waves propagate through the Earth s middle atmosphere they deposit momentu... more As atmospheric gravity waves propagate through the Earth s middle atmosphere they deposit momentum into the background flow In the upper atmosphere this process can be modified by the varying levels of heating induced by solar radiation -- both electromagnetic and particulate Changing levels of gravity wave drag subsequently affects the large-scale circulation of air Similarly different levels of planetary wave activity from season to season affects the background atmosphere through which these gravity waves must propagate so bringing about a different response to any given set of solar conditions Using two distinct models of the coupled middle and upper atmosphere system we examine the extent of the coupling between the different layers under a range of forcing scenarios based on observed solar indices and lower boundary forcing data from the 40-year NCEP reanalysis database We discuss the results in the context of the climatological impact of solar-terrestrial forcing
Cooling of the middle and upper atmosphere by CO2 is dependent on the temperature of the ambient ... more Cooling of the middle and upper atmosphere by CO2 is dependent on the temperature of the ambient atmosphere. Since the temperature structure is partly controlled by the residual circulation, driven mostly by the dissipation of gravity waves, CO2 cooling is expected to be dependent on the strength of the residual circulation, and thereby on the gravity wave activity. Also, the dissipation process of gravity waves is dependent on the temperature of the atmosphere they are propagating through, and this dependence is reflected differently in different gravity wave parameterization schemes. This may have important consequences for temperature trends due to changes in the CO2 concentration as calculated by middle and upper atmospheric GCMs. Therefore we will show, using the Coupled Middle Atmosphere and Thermosphere model 2 (CMAT2), how such trends depend on the gravity wave parameterization that is used and the gravity wave activity that is assumed by the model.
Reform of the National Health Service in England will increase power and responsibility for famil... more Reform of the National Health Service in England will increase power and responsibility for family doctors. They will have a larger role in planning and buying health care including control of substantial budgets. This article examines the likely implications of the proposed reforms for primary care, and in particularly for family doctors. This article considers the effect of the new clinical role in commissioning health care, changes to the accountability structures, and the effect on competition and integration within health services. It also considers the effect of new financial incentives and the possibility of creating conflicts of interest.
The North West London Integrated Care Pilot (ICP) was launched in June 2011 and brings together m... more The North West London Integrated Care Pilot (ICP) was launched in June 2011 and brings together more than 100 general practices, 2 acute care trusts, 5 primary care trusts, 2 mental health care trusts, 3 community health trusts, 5 local authorities, and 2 voluntary sector organizations (Age UK and Diabetes UK) to improve the coordination of care for a pilot population of 550 000 people. Specifically, the ICP serves people older than 75 years and those with diabetes. Although still in the early stages of implementation, the ICP has already received national awards for its innovations in design and delivery. This article critically describes the ICP objectives, facilitating processes, and planned impact as well as the organizational and financial challenges that policy makers are facing in the implementation of the pilot program.
To examine the effect of systolic and diastolic blood pressure achieved in the first year of trea... more To examine the effect of systolic and diastolic blood pressure achieved in the first year of treatment on all cause mortality in patients newly diagnosed with type 2 diabetes, with and without established cardiovascular disease. Retrospective cohort study. United Kingdom General Practice Research Database, between 1990 and 2005. 126,092 adult patients (age ≥ 18 years) with a new diagnosis of type 2 diabetes who had been registered with participating practices for at least 12 months. All cause mortality. Before diagnosis, 12,379 (9.8%) patients had established cardiovascular disease (myocardial infarction or stroke). During a median follow-up of 3.5 years, we recorded 25,495 (20.2%) deaths. In people with cardiovascular disease, tight control of systolic (<130 mm Hg) and diastolic (<80 mm Hg) blood pressure was not associated with improved survival, after adjustment for baseline characteristics (age at diagnosis, sex, practice level clustering, deprivation score, body mass inde...
Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from ... more Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures-the Valence, the Focus, and the Level. Standardized wei...
Several local attempts to introduce integrated care in the English National Health Service have b... more Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understa...
This paper provides the results of a year-long evaluation of a large-scale integrated care pilot ... more This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study). The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes. Al...
In the context of integrated care, Multidisciplinary Group meetings involve participants from div... more In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working. We purposively selected four Multidisciplinary Group meetings and conducted a content analysis of audio-recorded and transcribed Case Discussions. Two coders independently coded utterances according to their 'integrative intensity' which was defined against three a-priori independent domains - the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution); the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discussion. Standar...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2014
The annual number of unplanned attendances at accident and emergency (A&E) departments in England... more The annual number of unplanned attendances at accident and emergency (A&E) departments in England increased by 11% (2.2 million attendances) between 2008-2009 and 2012-2013. A national review of urgent and emergency care has emphasised the role of access to primary care services in preventing A&E attendances. To estimate the number of A&E attendances in England in 2012-2013 that were preceded by the attending patient being unable to obtain an appointment or a convenient appointment at their general practice. Cross-sectional analysis of a national survey of adults registered with a GP in England. The number of general practice consultations in England in 2012-2013 was estimated by extrapolating the linear trend of published data for 2000-2001 to 2008-2009. This parameter was multiplied by the ratio of attempts to obtain a general practice appointment that resulted in an A&E attendance to attempts that resulted in a general practice consultation estimated using the GP Patient Survey 2...
The UK government is pursuing policies to improve primary care access, as many patients visit acc... more The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Mu...
Transit observations at UV wavelengths probe the hot, extended and highly ionized upper atmospher... more Transit observations at UV wavelengths probe the hot, extended and highly ionized upper atmospheres of close-in extrasolar planets. HD209458b and HD189733b both orbit their host stars within 0.05 AU and are loosing mass due to intense heating by stellar XUV radiation. However, their surface gravities differ by a factor of ∼2 and while HD209458 is a solar-type star, HD189733 is a K type star. Consequently, the X-ray and EUV flux received by HD189733b is expected to be significantly higher than that received by HD209458b. Therefore, the upper atmospheres of the planets should have different characteristics. Here we discuss the interpretation of the UV transit observations and show how they can be used to obtain information about the thermal structure, composition and escape rates in the upper atmosphere. Based on the results, we highlight the differences and similarities between HD189733b and HD209458b.
We present results of the study of gravity wave (GW) effects on the circulation in the thermosphe... more We present results of the study of gravity wave (GW) effects on the circulation in the thermosphere-ionosphere (TI). A spectral GW drag scheme suitable for the thermosphere has been developed and implemented into the Coupled Middle Atmosphere-Thermosphere Model (CMAT2) extending from the lower atmosphere into the F- region. Results of the simulations demonstrate that GWs of the tropospheric origin can effectively penetrate into the upper thermosphere. Momentum deposited by these waves is not only negligible above the turbopause, but is comparable to that of ion drag, at least up to 180-200 km. Effects of the thermospheric GW drag are particularly noticeable in the winter hemisphere, where the inclusion of GW parameterization allowed to reproduce weaker westerlies and stronger high-latitude easterlies, well in agreement with the empirical Horizontal Wind Model. We shall discuss some inferences concerning the dynamic response in the F-region to the variations of the source spectrum.
As atmospheric gravity waves propagate through the Earth s middle atmosphere they deposit momentu... more As atmospheric gravity waves propagate through the Earth s middle atmosphere they deposit momentum into the background flow In the upper atmosphere this process can be modified by the varying levels of heating induced by solar radiation -- both electromagnetic and particulate Changing levels of gravity wave drag subsequently affects the large-scale circulation of air Similarly different levels of planetary wave activity from season to season affects the background atmosphere through which these gravity waves must propagate so bringing about a different response to any given set of solar conditions Using two distinct models of the coupled middle and upper atmosphere system we examine the extent of the coupling between the different layers under a range of forcing scenarios based on observed solar indices and lower boundary forcing data from the 40-year NCEP reanalysis database We discuss the results in the context of the climatological impact of solar-terrestrial forcing
Cooling of the middle and upper atmosphere by CO2 is dependent on the temperature of the ambient ... more Cooling of the middle and upper atmosphere by CO2 is dependent on the temperature of the ambient atmosphere. Since the temperature structure is partly controlled by the residual circulation, driven mostly by the dissipation of gravity waves, CO2 cooling is expected to be dependent on the strength of the residual circulation, and thereby on the gravity wave activity. Also, the dissipation process of gravity waves is dependent on the temperature of the atmosphere they are propagating through, and this dependence is reflected differently in different gravity wave parameterization schemes. This may have important consequences for temperature trends due to changes in the CO2 concentration as calculated by middle and upper atmospheric GCMs. Therefore we will show, using the Coupled Middle Atmosphere and Thermosphere model 2 (CMAT2), how such trends depend on the gravity wave parameterization that is used and the gravity wave activity that is assumed by the model.
Reform of the National Health Service in England will increase power and responsibility for famil... more Reform of the National Health Service in England will increase power and responsibility for family doctors. They will have a larger role in planning and buying health care including control of substantial budgets. This article examines the likely implications of the proposed reforms for primary care, and in particularly for family doctors. This article considers the effect of the new clinical role in commissioning health care, changes to the accountability structures, and the effect on competition and integration within health services. It also considers the effect of new financial incentives and the possibility of creating conflicts of interest.
The North West London Integrated Care Pilot (ICP) was launched in June 2011 and brings together m... more The North West London Integrated Care Pilot (ICP) was launched in June 2011 and brings together more than 100 general practices, 2 acute care trusts, 5 primary care trusts, 2 mental health care trusts, 3 community health trusts, 5 local authorities, and 2 voluntary sector organizations (Age UK and Diabetes UK) to improve the coordination of care for a pilot population of 550 000 people. Specifically, the ICP serves people older than 75 years and those with diabetes. Although still in the early stages of implementation, the ICP has already received national awards for its innovations in design and delivery. This article critically describes the ICP objectives, facilitating processes, and planned impact as well as the organizational and financial challenges that policy makers are facing in the implementation of the pilot program.
To examine the effect of systolic and diastolic blood pressure achieved in the first year of trea... more To examine the effect of systolic and diastolic blood pressure achieved in the first year of treatment on all cause mortality in patients newly diagnosed with type 2 diabetes, with and without established cardiovascular disease. Retrospective cohort study. United Kingdom General Practice Research Database, between 1990 and 2005. 126,092 adult patients (age ≥ 18 years) with a new diagnosis of type 2 diabetes who had been registered with participating practices for at least 12 months. All cause mortality. Before diagnosis, 12,379 (9.8%) patients had established cardiovascular disease (myocardial infarction or stroke). During a median follow-up of 3.5 years, we recorded 25,495 (20.2%) deaths. In people with cardiovascular disease, tight control of systolic (<130 mm Hg) and diastolic (<80 mm Hg) blood pressure was not associated with improved survival, after adjustment for baseline characteristics (age at diagnosis, sex, practice level clustering, deprivation score, body mass inde...
Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from ... more Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures-the Valence, the Focus, and the Level. Standardized wei...
Several local attempts to introduce integrated care in the English National Health Service have b... more Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understa...
This paper provides the results of a year-long evaluation of a large-scale integrated care pilot ... more This paper provides the results of a year-long evaluation of a large-scale integrated care pilot in north-west London. The pilot aimed to integrate care across primary, acute, community, mental health and social care for people with diabetes and/or those aged 75+ through care planning, multidisciplinary case reviews, information sharing and project management support. The evaluation team conducted qualitative studies of change at organisational, clinician and patient levels (using interviews, focus groups and a survey); and quantitative analysis of change in service use and patient-level clinical outcomes (using patient-level datasets and a matched control study). The pilot had successfully engaged provider organisations, created a shared strategic vision and established governance structures. However, the engagement of clinicians was variable and there was no evidence to date of significant reductions in emergency admissions. There was some evidence of changes in care processes. Al...
In the context of integrated care, Multidisciplinary Group meetings involve participants from div... more In the context of integrated care, Multidisciplinary Group meetings involve participants from diverse professional groups and organisations and are potential vehicles to advance efficiency improvements within the local health economy. We advance a novel method to characterise the communication within Multidisciplinary Group meetings measuring the extent to which participants integrate and whether this integration leads to improved working. We purposively selected four Multidisciplinary Group meetings and conducted a content analysis of audio-recorded and transcribed Case Discussions. Two coders independently coded utterances according to their 'integrative intensity' which was defined against three a-priori independent domains - the Level (i.e. Individual, Collective and Systems); the Valence (Problem, Information and Solution); the Focus (Concrete and Abstract). Inter- and intra-rater reliability was tested with Kappa scores on one randomly selected Case Discussion. Standar...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2014
The annual number of unplanned attendances at accident and emergency (A&E) departments in England... more The annual number of unplanned attendances at accident and emergency (A&E) departments in England increased by 11% (2.2 million attendances) between 2008-2009 and 2012-2013. A national review of urgent and emergency care has emphasised the role of access to primary care services in preventing A&E attendances. To estimate the number of A&E attendances in England in 2012-2013 that were preceded by the attending patient being unable to obtain an appointment or a convenient appointment at their general practice. Cross-sectional analysis of a national survey of adults registered with a GP in England. The number of general practice consultations in England in 2012-2013 was estimated by extrapolating the linear trend of published data for 2000-2001 to 2008-2009. This parameter was multiplied by the ratio of attempts to obtain a general practice appointment that resulted in an A&E attendance to attempts that resulted in a general practice consultation estimated using the GP Patient Survey 2...
Uploads
Papers by Matthew Harris