A Hutchinson

The University of Sheffield, Sheffield, England, United Kingdom

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Publications (82)208.77 Total impact

  • Observatory Studies Series 40 edited by Dionne S. Kringos, Wienke G.W. Boerma, Allen Hutchinson, Richard B. Saltman, 05/2015; World Health Organization., ISBN: 978 92 890 50 333
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    ABSTRACT: http://www.euro.who.int/en/about-us/partners/observatory/publications/studies/building-primary-care-in-a-changing-europe
    01/2015; World Health Organization., ISBN: 978 92 890 5031 9
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    ABSTRACT: A suitable definition of primary care to capture the variety of prevailing international organisation and service-delivery models is lacking. Evaluation of strength of primary care in Europe. International comparative cross-sectional study performed in 2009-2010, involving 27 EU member states, plus Iceland, Norway, Switzerland, and Turkey. Outcome measures covered three dimensions of primary care structure: primary care governance, economic conditions of primary care, and primary care workforce development; and four dimensions of primary care service-delivery process: accessibility, comprehensiveness, continuity, and coordination of primary care. The primary care dimensions were operationalised by a total of 77 indicators for which data were collected in 31 countries. Data sources included national and international literature, governmental publications, statistical databases, and experts' consultations. Countries with relatively strong primary care are Belgium, Denmark, Estonia, Finland, Lithuania, the Netherlands, Portugal, Slovenia, Spain, and the UK. Countries either have many primary care policies and regulations in place, combined with good financial coverage and resources, and adequate primary care workforce conditions, or have consistently only few of these primary care structures in place. There is no correlation between the access, continuity, coordination, and comprehensiveness of primary care of countries. Variation is shown in the strength of primary care across Europe, indicating a discrepancy in the responsibility given to primary care in national and international policy initiatives and the needed investments in primary care to solve, for example, future shortages of workforce. Countries are consistent in their primary care focus on all important structure dimensions. Countries need to improve their primary care information infrastructure to facilitate primary care performance management.
    British Journal of General Practice 11/2013; 63(616):742-750. DOI:10.3399/bjgp13X674422 · 2.36 Impact Factor
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    ABSTRACT: Case note review remains a prime means of retrospectively assessing quality of care. This study examines a new implicit judgement method, combining structured reviewer comments with quality of care scores, to assess care of people who die in hospital. Using 1566 case notes from 20 English hospitals, 40 physicians each reviewed 30-40 case notes, writing structured judgement-based comments on care provided within three phases of care, and on care overall, and scoring quality of care from 1 (unsatisfactory) to 6 (very best care). Quality of care comments on 119 people who died (7.6% of the cohort) were analysed independently by two researchers to investigate how well reviewers provided structured short judgement notes on quality of care, together with appropriate care scores. Consistency between explanatory textual data and related scores was explored, using overall care score to group cases. Physician reviewers made informative, clinical judgement-based comments across all phases of care and usually provided a coherent quality of care score relating to each phase. The majority of comments (83%) were explicit judgements. About a fifth of patients were considered to have received less than satisfactory care, often experiencing a series of adverse events. A combination of implicit judgement, explicit explanatory comment and related quality of care scores can be used effectively to review the spectrum of care provided for people who die in hospital. The method can be used to quickly evaluate deaths so that lessons can be learned about both poor and high quality care.
    BMJ quality & safety 07/2013; 22(12). DOI:10.1136/bmjqs-2013-001839 · 3.28 Impact Factor
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    ABSTRACT: For every person over the age of 65 in today's European Union there are four people of working age but, by 2050, there will only be two. Demand for long-term care, of which home care forms a significant part, will inevitably increase in the decades to come. Despite the importance of the issue there is, however, a lack of up-to-date and comparative information on home care in Europe. This volume attempts to fill some of that gap by examining current European policy on home-care services and strategies. Home Care across Europe probes a wide range of topics including the linkage between social services and health-care systems, the prevailing funding mechanisms, how service providers are paid, the impact of governmental regulation, and the complex roles played by informal caregivers. Drawing on a set of Europe-wide case studies (available in a second, online volume), the study provides comparable descriptive information on many aspects of the organization, financing and provision of home care across the continent. It is a text that will help frame the coming debate about how best to serve elderly citizens as European populations age.
    01/2013; European Observatory on Health Systems and Policies., ISBN: 978 92890 02882
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    ABSTRACT: The emergency care practitioner (ECP) role in the UK health service involves paramedic and nurse practitioners with advanced training to assess and treat minor illness and injury. Available evidence suggests that the introduction of this role has been advantageous in terms of managing an increased demand for emergency care, but there is little evidence regarding the quality and safety implications of ECP schemes. The objectives were to compare the quality and safety of care provided by ECPs with non-ECP (eg, paramedic, nurse practitioner) care across three different types of emergency care settings: static services (emergency department, walk-in-centre, minor injury unit); ambulance/care home services (mobile); primary care out of hours services. A retrospective patient case note review was conducted to compare the quality and safety of care provided by ECPs and non-ECPs across matched sites in three types of emergency care settings. Retrospective assessment of care provided was conducted by experienced clinicians. The study was part of a larger trial evaluating ECP schemes (http://www.controlled-trials.com/ISRCTN22085282). Care provided by ECPs was rated significantly higher than that of non-ECPs across some aspects of care. The differences detected, although statistically significant, are small and may not reflect clinical significance. On other aspects of care, ECPs were rated as equal to their non-ECP counterparts. As a minimum, care provided should meet the standards of existing service models and the findings from the study suggest that this is true of ECPs regardless of the service they are operational in.
    Emergency Medicine Journal 04/2011; 29(4):327-32. DOI:10.1136/emj.2010.104190 · 1.78 Impact Factor
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    ABSTRACT: Doctors have traditionally been viewed as the dominant healthcare profession, with the authority to prescribe medicines, but recent non-medical prescribing initiatives have been viewed as possible challenges to such dominance. Using the example of the introduction of supplementary prescribing in the UK, this study sought to explore whether such initiatives represent a challenge to medical authority. Ten case study sites in England involving primary and secondary care and a range of clinical areas were used to undertake a total of 77 observations of supplementary prescribing consultations and interviews with 28 patients, 11 doctors and nurse and pharmacist prescribers at each site. Supplementary prescribing was viewed positively by all participants but several doctors and patients appeared to lack awareness and understanding of supplementary prescribing. Continued medical authority was supported empirically in five areas: patients' and supplementary prescribers' perception of doctors as being hierarchically superior; doctors legitimation of nurses' and pharmacists' prescribing initially; doctors' belief that they could control (particularly nurses') access to prescribing training; supplementary prescribers' frequent recourse to use doctors' advice, coupled with doctors' encouragement of such 'knock on door' prescribing advice policies; doctors' denigration of most routine prescribing but claims that diagnosis was more skilled and key to medicine. Supplementary prescribing appeared to be successfully accomplished in practice in a range of clinical settings and was acceptable to all involved but did not ultimately challenge medical dominance. However, more recent nurse and pharmacist independent prescribing (involving diagnosis) may represent a more significant threat.
    Health 03/2011; 16(2):115-33. DOI:10.1177/1363459310364159 · 2.10 Impact Factor
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    ABSTRACT: To determine which of the two methods of case note review provide the most useful and reliable information for reviewing quality of care. Retrospective, multiple reviews of 692 case notes were undertaken using both holistic (implicit) and criterion-based (explicit) review methods. Quality measures were evidence-based review criteria and a quality of care rating scale. Nine randomly selected acute hospitals in England. Sixteen doctors, 11 specialist nurses and three clinically trained audit staff, and eight non-clinical audit staff. ANALYSIS METHODS: Intrarater consistency, inter-rater reliability between pairs of staff using intraclass correlation coefficients (ICCs), completeness of criterion data capture and between-staff group comparison. A total of 1473 holistic reviews and 1389 criterion-based reviews were undertaken. When the three same staff types reviewed the same record, holistic scale score inter-rater reliability was moderate within each group (ICC 0.46 to 0.52). Inter-rater reliability for criterion-based scores was moderate to good (ICC 0.61 to 0.88). Comparison of holistic review score and criterion-based score of case notes reviewed by doctors and by non-clinical audit staff showed a reasonable level of agreement between the two methods. Using a holistic approach to review case notes, same staff groups can achieve reasonable repeatability within their professional groups. When the same clinical record was reviewed twice by the doctors, and by the non-clinical audit staff, using both holistic and criterion-based methods, there are close similarities between the quality of care scores generated by the two methods. When using retrospective review of case notes to examine quality of care, a clear view is required of the purpose and the expected outputs of the project.
    Quality and Safety in Health Care 12/2010; 19(6):e2. DOI:10.1136/qshc.2007.023911 · 2.16 Impact Factor
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    ABSTRACT: Scientific research has provided evidence on benefits of well developed primary care systems. The relevance of some of this research for the European situation is limited.There is currently a lack of up to date comprehensive and comparable information on variation in development of primary care, and a lack of knowledge of structures and strategies conducive to strengthening primary care in Europe. The EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU) aims to fill this gap by developing a Primary Care Monitoring System (PC Monitor) for application in 31 European countries. This article describes the development of the indicators of the PC Monitor, which will make it possible to create an alternative model for holistic analyses of primary care. A systematic review of the primary care literature published between 2003 and July 2008 was carried out. This resulted in an overview of: (1) the dimensions of primary care and their relevance to outcomes at (primary) health system level; (2) essential features per dimension; (3) applied indicators to measure the features of primary care dimensions. The indicators were evaluated by the project team against criteria of relevance, precision, flexibility, and discriminating power. The resulting indicator set was evaluated on its suitability for Europe-wide comparison of primary care systems by a panel of primary care experts from various European countries (representing a variety of primary care systems). The developed PC Monitor approaches primary care in Europe as a multidimensional concept. It describes the key dimensions of primary care systems at three levels: structure, process, and outcome level. On structure level, it includes indicators for governance, economic conditions, and workforce development. On process level, indicators describe access, comprehensiveness, continuity, and coordination of primary care services. On outcome level, indicators reflect the quality, and efficiency of primary care. A standardized instrument for describing and comparing primary care systems has been developed based on scientific evidence and consensus among an international panel of experts, which will be tested to all configurations of primary care in Europe, intended for producing comparable information. Widespread use of the instrument has the potential to improve the understanding of primary care delivery in different national contexts and thus to create opportunities for better decision making.
    BMC Family Practice 10/2010; 11:81. DOI:10.1186/1471-2296-11-81 · 1.74 Impact Factor
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    ABSTRACT: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health.
    BMC Health Services Research 03/2010; 10(1):65. DOI:10.1186/1472-6963-10-65 · 1.66 Impact Factor
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    ABSTRACT: To determine which of two methods of case note review--holistic (implicit) and criterion-based (explicit)--provides the most useful and reliable information for quality and safety of care, and the level of agreement within and between groups of health-care professionals when they use the two methods to review the same record. To explore the process-outcome relationship between holistic and criterion-based quality-of-care measures and hospital-level outcome indicators. Case notes of patients at randomly selected hospitals in England. In the first part of the study, retrospective multiple reviews of 684 case notes were undertaken at nine acute hospitals using both holistic and criterion-based review methods. Quality-of-care measures included evidence-based review criteria and a quality-of-care rating scale. Textual commentary on the quality of care was provided as a component of holistic review. Review teams comprised combinations of: doctors (n = 16), specialist nurses (n = 10) and clinically trained audit staff (n = 3) and non-clinical audit staff (n = 9). In the second part of the study, process (quality and safety) of care data were collected from the case notes of 1565 people with either chronic obstructive pulmonary disease (COPD) or heart failure in 20 hospitals. Doctors collected criterion-based data from case notes and used implicit review methods to derive textual comments on the quality of care provided and score the care overall. Data were analysed for intrarater consistency, inter-rater reliability between pairs of staff using intraclass correlation coefficients (ICCs) and completeness of criterion data capture, and comparisons were made within and between staff groups and between review methods. To explore the process-outcome relationship, a range of publicly available health-care indicator data were used as proxy outcomes in a multilevel analysis. Overall, 1473 holistic and 1389 criterion-based reviews were undertaken in the first part of the study. When same staff-type reviewer pairs/groups reviewed the same record, holistic scale score inter-rater reliability was moderate within each of the three staff groups [intraclass correlation coefficient (ICC) 0.46-0.52], and inter-rater reliability for criterion-based scores was moderate to good (ICC 0.61-0.88). When different staff-type pairs/groups reviewed the same record, agreement between the reviewer pairs/groups was weak to moderate for overall care (ICC 0.24-0.43). Comparison of holistic review score and criterion-based score of case notes reviewed by doctors and by non-clinical audit staff showed a reasonable level of agreement (p-values for difference 0.406 and 0.223, respectively), although results from all three staff types showed no overall level of agreement (p-value for difference 0.057). Detailed qualitative analysis of the textual data indicated that the three staff types tended to provide different forms of commentary on quality of care, although there was some overlap between some groups. In the process-outcome study there generally were high criterion-based scores for all hospitals, whereas there was more interhospital variation between the holistic review overall scale scores. Textual commentary on the quality of care verified the holistic scale scores. Differences among hospitals with regard to the relationship between mortality and quality of care were not statistically significant. Using the holistic approach, the three groups of staff appeared to interpret the recorded care differently when they each reviewed the same record. When the same clinical record was reviewed by doctors and non-clinical audit staff, there was no significant difference between the assessments of quality of care generated by the two groups. All three staff groups performed reasonably well when using criterion-based review, although the quality and type of information provided by doctors was of greater value. Therefore, when measuring quality of care from case notes, consideration needs to be given to the method of review, the type of staff undertaking the review, and the methods of analysis available to the review team. Review can be enhanced using a combination of both criterion-based and structured holistic methods with textual commentary, and variation in quality of care can best be identified from a combination of holistic scale scores and textual data review.
    02/2010; 14(10):iii-iv, ix-x, 1-144. DOI:10.3310/hta14100
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    ABSTRACT: Introduction: A key feature of home care is its divided nature. Conditions for coordination are poor. A variety of professionals provides a coherent mix of services. The social care system is in general local, less professionalised and usually more poorly financed than the health care system. These differences are related to or result in different interests, culture and style and are a ground for communication problems. The existence of this divide will be explored it will be considered what remedies are available and are applied. Methods and Materials: This presentation is drawn upon the results of the EC-financed EURHOMAP project and a discussion between country experts invited to the conference. The study has collected a wealth of data on various types of home care (including nursing care, personal care, domestic aid and respite care). In 31 countries information was gathered on a large set of indicators in the areas of policy & regulation, financing, organisation & delivery and clients & informal carers. Results: Home care services may stem from different sectors, systems and organisations. Several countries have identified and addressed problems related to this situation. However, the degree of splitting varies among countries. It can exist at one or more of the following levels: governance and regulation; entry to the home care system; delivery of services. Furthermore the extent to which the division occurs may differ as well. Integration at governance level creates more favourable conditions for integration at access and delivery level. From a clients’ perspective poor integration may manifest itself both at the point of entry (absence of a clear-cut easy access point), and in the delivery of services (which are not tailored to what is needed or lack flexibility). Conclusion: There are many possible remedies against problems of poor integration; depending on the level and the situation where the problem occurs.(aut. ref.)
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    ABSTRACT: Introduction: Financial incentives are widely used to get better value for money. Incentives can be applied to authorities responsible for home care, or to agencies that provide services or to clients who receive care. Details of the financing system of home care services very much determine the possibilities for financial incentives. At present, there is a need for comparative information on financing mechanisms for home care. Methods and Materials: This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been developed in this project to map the home care systems in Europe, including details of financing. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results: Prevailing models of financing for home care will be presented as well as information of the extent to which home care across Europe is pressured by financial restraints. Especially in Eastern European countries, where home care is not well developed yet, funding is a major problem. Co-payments are applicable in most countries to reduce expenditures and to prevent over-utilisation of services. Usually, financing mechanisms for social community based services differ from the mechanisms in place for home health care services. Consequently, modes of reimbursement for providers of different sorts of home care services and the financial implications for clients differ. Co-payments are more prevalent with social services than with health care. Another financial allocation mechanism is means testing, which is frequently used with publicly financed home care services. Conclusion: There is a large diversity in the type of financing mechanism, both between and within countries in Europe. Budgetary restraints are one of the main problems with regard to home care in almost all countries. Usually, access to home care services is restricted in some way by financial restrictions. (aut. ref.)
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    ABSTRACT: Introduction: The increasing old-age dependency ratio implies future reduction of human resources available to provide services. Little information is available about the level of qualification, contractual aspects, payment and working conditions of home care workers and the existence of staff shortages and recruitment problems in different countries. Methods and Materials: This presentation is based on the results of the EC-financed EURHOMAP project. Indicators have been developed in this project to map the home care systems in Europe, including details of human resources. In 2009 and early 2010, EURHOMAP partners have collected data on these indicators in 31 countries in collaboration with experts in these countries. Results were described in uniformly structured country reports and fed back to national experts for validation. Results: In many countries numbers of those working in private organisations are not available. Furthermore financial incentives and working conditions will be compared, as well as the task division between home care workers and to what extent educational requirements are explicitly formalised. Mechanisms of quality control of human resources differ strongly (e.g. recertification of nurses; rules for the education of home care nurses). An interesting phenomenon, related to pressures to increase efficiency, is the transfer of tasks or substitution which is taking place between home care workers of different qualification levels. In contrast to the provision of technical nursing, the provision of personal care and domestic aid is less strictly related to specific qualifications. Conclusion: Shortages in human resources are a common problem in many countries, but expectedly most in countries just having developed home care. There is a strong variation in mechanisms of quality control of home care professionals; in the level of education required; and in the strength of the position of home care workers. (aut. ref.)
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    ABSTRACT: Introduction: Demand for health and social care services in the community will grow as a result of the ageing of populations across Europe. At present, however, very little is known about the preparedness of national home care systems for changing demand, which is not just quantitative but also qualitative in kind. There is a need for insight into the state of home care, including policy and regulation and aspects of financing, organisation and provision of services. Methods and Materials: EURHOMAP study has developed an extensive set of indicators to map home care systems that focus on: policy and regulation; financing; organisation & service delivery; and clients & informal carers. Data were collected in 31 European countries. We also used the answers of key informants on questions related to four ‘vignettes’ (hypothetical case descriptions of home living people in need of care). Results: Home care systems widely vary in their degree of development and that the structures of governance, regulation and models of provision are very heterogeneous. An aspect of home care that creates challenges at all levels is the mix of social, nursing and health services, which are supposed to be delivered in an integrated way to clients and patients. Cost control in community care is a common issue of most countries, but budgetary and efficiency measures taken and mechanisms developed are very different. Maintaining and improving home care services is a priority in many countries which does not always match with needs to increase efficiency. Conclusion: Although home care is a major point of policy in many countries, it is not heavily regulated. In many countries home care governance is split between different types of care and, consequently, not well integrated. Despite the dominance of public provision, tendencies towards more privatisation, contracting and competition can be identified. (aut. ref.)
  • Reza Rabiei, Peter A Bath, Allen Hutchinson, Derek Burke
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    ABSTRACT: In England, the Choose and Book service, a main component of the England National Programme for IT (NPfIT), aims at empowering patients. Little research has been performed to evaluate clinicians' perceptions of, and satisfaction with, the Choose and Book service. The aim of the research was to examine clinicians' perceptions of, and satisfaction with, the Choose and Book service. A qualitative approach, using in-depth, semi-structured interviews, was used to collect data. Framework analysis was used to analyse the data. Twenty clinicians were interviewed, including 14 general practitioners (GPs) and six hospital consultants. Although clinicians were positive about the benefits of the Choose and Book service, they were concerned about the adverse impact of the electronic referral process on their job. Paying attention to the impact of the service on clinicians' jobs, at both ends of the process, could help to improve the referral process and the use of the system.
    Health Informatics Journal 10/2009; 15(3):167-78. DOI:10.1177/1460458209337423 · 0.79 Impact Factor
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    ABSTRACT: Evidence-based guidelines have the potential to improve healthcare. However, their de-novo-development requires substantial resources -- especially for complex conditions, and adaptation may be biased by contextually influenced recommendations in source guidelines. In this paper we describe a new approach to guideline development -- the systematic guideline review method (SGR), and its application in the development of an evidence-based guideline for family physicians on chronic heart failure (CHF). A systematic search for guidelines was carried out. Evidence-based guidelines on CHF management in adults in ambulatory care published in English or German between the years 2000 and 2004 were included. Guidelines on acute or right heart failure were excluded. Eligibility was assessed by two reviewers, methodological quality of selected guidelines was appraised using the AGREE instrument, and a framework of relevant clinical questions for diagnostics and treatment was derived. Data were extracted into evidence tables, systematically compared by means of a consistency analysis and synthesized in a preliminary draft. Most relevant primary sources were re-assessed to verify the cited evidence. Evidence and recommendations were summarized in a draft guideline. Of 16 included guidelines five were of good quality. A total of 35 recommendations were systematically compared: 25/35 were consistent, 9/35 inconsistent, and 1/35 un-rateable (derived from a single guideline). Of the 25 consistencies, 14 were based on consensus, seven on evidence and four differed in grading. Major inconsistencies were found in 3/9 of the inconsistent recommendations. We re-evaluated the evidence for 17 recommendations (evidence-based, differing evidence levels and minor inconsistencies) - the majority was congruent. Incongruity was found where the stated evidence could not be verified in the cited primary sources, or where the evaluation in the source guidelines focused on treatment benefits and underestimated the risks. The draft guideline was completed in 8.5 man-months. The main limitation to this study was the lack of a second reviewer. The systematic guideline review including framework development, consistency analysis and validation is an effective, valid, and resource saving-approach to the development of evidence-based guidelines.
    BMC Health Services Research 06/2009; 9:74. DOI:10.1186/1472-6963-9-74 · 1.66 Impact Factor

Publication Stats

2k Citations
208.77 Total Impact Points


  • 1997–2013
    • The University of Sheffield
      • School of Health and Related Research (ScHARR)
      Sheffield, England, United Kingdom
  • 2008–2009
    • University of Nottingham
      • • School of Community Health Sciences
      • • Division of Social Research in Medicines and Health
      Nottigham, England, United Kingdom
  • 2003
    • University of Chicago
      • Department of Anesthesia & Critical Care
      Chicago, Illinois, United States
  • 1994–1999
    • University of Hull
      Kingston upon Hull, England, United Kingdom
  • 1991–1998
    • Newcastle University
      • Centre for Oral Health Research
      Newcastle upon Tyne, ENG, United Kingdom
  • 1995
    • University of Aberdeen
      • Health Services Research Unit
      Aberdeen, SCT, United Kingdom