Jonathan Clarke

Jonathan Clarke
Harvard University | Harvard · Department of Biostatistics

MA (Cantab) MB BChir MRCS(Eng) MPH PhD FRSA

About

168
Publications
21,189
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2,542
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Publications

Publications (168)
Article
Background The Adelaide Score is an artificial intelligence system that integrates objective vital signs and laboratory tests to predict likelihood of hospital discharge. Methods A prospective implementation trial was conducted at the Lyell McEwin Hospital in South Australia. The Adelaide Score was added to existing human, artificial intelligence,...
Article
Full-text available
Background: Better continuity in primary and secondary care is linked to improved health outcomes, but it is unclear whether the sociodemographic determinants of continuity are the same in both settings and whether continuity measures in each setting are associated. Aim: To examine the determinants of relational continuity in general practice (G...
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Background The proliferation of electronic health records (EHR) in health systems of many high-income countries has ushered in profound changes to how clinical information is used, stored, and disseminated. For patients, being able to easily access and share their health information electronically through interoperable EHRs can often impact safety...
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Full-text available
Background Medication errors are the leading cause of preventable harm in healthcare. Despite proliferation of medication-related clinical decision support systems (CDSS), current systems have limitations. We therefore developed an indication-based prescribing tool. This performs dose calculations using an underlying formulary and provides patient-...
Article
The environmental impact of large language models (LLMs) in medicine spans carbon emission, water consumption and rare mineral usage. Prior‐generation LLMs, such as GPT‐3, already have concerning environmental impacts. Next‐generation LLMs, such as GPT‐4, are more energy intensive and used frequently, posing potentially significant environmental ha...
Article
Background Relational continuity in primary and secondary care is linked to better health outcomes for patients, but it is unclear whether metrics of continuity in each setting are associated. Our study examined the association between relational continuity in general practice (GP) and continuity of hospital outpatient specialties in people with cl...
Article
Background People with multimorbidity are often seen in many different specialist health services, resulting in fragmented care. Conventional services are designed around specialties based on anatomical systems, rather than diseases that occur together. We examined whether organising services around clusters of co-occurring diseases would lead to f...
Article
Purpose This study aims to assess the extent to which acute hospital trust mergers in England are associated with quality improvements. Design/methodology/approach We apply an event study design using difference-in-difference (DID) and coarsened exact matching to compare the before-and-after performance of eight mergers from 2011 to 2015. Finding...
Article
Background Hypertension affects over one billion people worldwide, posing a significant global health burden. Clinical practice guidelines could play a key role in guiding healthcare providers in improving hypertension management. However, how the quality of hypertension CPGs differs across country income settings is not well understood. This study...
Preprint
Full-text available
Background Long COVID is a multisystem condition first identified in the COVID-19 pandemic characterised by a wide range of symptoms including fatigue, breathlessness and cognitive impairment. Considerable disagreement exists in who is most at risk of developing Long COVID, driven in part by incomplete coding of a Long COVID diagnosis in medical re...
Preprint
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Background: The lack of interoperability has been a well-recognised limitation associated with the use of electronic health records (EHR). However, less is known about how it manifests for frontline NHS staff when delivering care, how it impacts patient care, and what are its implications on care efficiency. Objectives: (1) To capture the perceptio...
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Blood pressure (BP) measurement is the mainstay for diagnosing and treating hypertension. Blood pressure screening in the May Measurement Month (MMM) project is helpful for the early detection of hypertension, which is usually asymptomatic. This study aimed to investigate the epidemiology of hypertension from data in the MMM21 project in Thailand....
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The aim of this study was to highlight the importance of measuring blood pressure (BP) to identify new, known, and treated individuals with hypertension and to raise awareness in the general population about the importance of good BP control. In Paraguay, 3663 individuals aged ≥18 years of both sexes were recruited from May to November 2021 as part...
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Despite the well-recognized importance of prevention and early treatment of hypertension, the majority of adults in Nepal are not aware of their high blood pressure (BP) and are left untreated. In this paper, we report the result of the May Measure Month 2021 campaign in Nepal: a nationwide community-based hypertension screening campaign. An opport...
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The Philippine Society of Hypertension (PSH) took part again in the annual May Measurement Month 2021 (MMM21) blood pressure (BP) campaign to raise awareness of hypertension. The MMM standard protocol designed by the MMM coordinating centre was used during screening. These included the collection of basic data on demography, lifestyle, and environm...
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Raised blood pressure (BP) is the leading preventable risk factor for cardiovascular diseases that makes a major impact on early mortality and morbidity. Recognizing hypertension in the community, educating people about routine BP monitoring, and improving medication compliance are all important steps in detecting, controlling, and managing hyperte...
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May Measurement Month (MMM) is a global and national blood pressure (BP) screening campaign initiated by the International Society of Hypertension to improve awareness of BP worldwide. This study reports on the findings of the MMM21 campaign in Australia. Adult participants (≥18 years) were screened through opportunistic sampling across Australia b...
Preprint
Full-text available
Background Medication errors are the leading cause of preventable harm in healthcare. Despite proliferation of medication-related clinical decision support systems (CDSS), current systems have limitations. We therefore developed an indication-based prescribing tool. This performs dose calculations using an underlying formulary and provides patient-...
Preprint
Full-text available
A job usually involves the application of several complementary or synergistic skills to perform its required tasks. Such relationships are implicitly recognised by employers in the skills they demand when recruiting new employees. Here we construct a skills network based on their co-occurrence in a national level data set of 65 million job posting...
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Background Identifying clusters of diseases may aid understanding of shared aetiology, management of co-morbidities, and the discovery of new disease associations. Our study aims to identify disease clusters using a large set of long-term conditions and comparing methods that use the co-occurrence of diseases versus methods that use the sequence of...
Article
Objective Natural language processing (NLP) algorithms are increasingly being applied to obtain unsupervised representations of electronic health record (EHR) data, but their comparative performance at predicting clinical endpoints remains unclear. Our objective was to compare the performance of unsupervised representations of sequences of disease...
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Full-text available
Background Identifying clusters of co-occurring diseases may help characterise distinct phenotypes of Multiple Long-Term Conditions (MLTC). Understanding the associations of disease clusters with health-related outcomes requires a strategy to assign clusters to people, but it is unclear how the performance of strategies compare. Aims First, to com...
Preprint
Full-text available
Background The proliferation of electronic health records (EHR) in health systems of many high-income countries has ushered in profound changes to how clinical information is used, stored, and disseminated. For patients, being able to easily access and share their health information electronically through interoperable EHRs can often impact safety...
Article
Full-text available
Background Surgical video contains data with significant potential to improve surgical outcome assessment, quality assurance, education, and research. Current utilisation of surgical video recording is unknown and related policies/governance structures are unclear. Methods A nationwide Freedom of Information (FOI) request concerning surgical video...
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Objective To determine the extent to which the choice of timeframe used to define a long term condition affects the prevalence of multimorbidity and whether this varies with sociodemographic factors. Design Retrospective study of disease code frequency in primary care electronic health records. Data sources Routinely collected, general practice,...
Preprint
Full-text available
Background The proliferation of electronic health records (EHR) in health systems of many high-income countries has ushered in profound changes to how clinical information is used, stored, and disseminated. For patients, being able to easily access and share their health information electronically through interoperable EHRs can often impact safety...
Preprint
Full-text available
The personal well-being of workers may be influenced by the risk of job automation brought about by technological innovation. Here we use data from the Understanding Society survey in the UK and a fixed-effects model to examine associations between working in a highly automatable job and life and job satisfaction. We find that employees in highly a...
Preprint
BACKGROUND The proliferation of electronic health records (EHR) in health systems of many high-income countries has ushered in profound changes to how clinical information is used, stored, and disseminated. For patients, being able to easily access and share their health information electronically through interoperable EHRs can often impact safety...
Preprint
Full-text available
Natural language processing (NLP) is increasingly being applied to obtain unsupervised representations of electronic healthcare record (EHR) data, but their performance for the prediction of clinical endpoints remains unclear. Here we use primary care EHRs from 6,286,233 people with Multiple Long-Term Conditions in England to generate vector repres...
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From the perspective of human mobility, the COVID-19 pandemic constituted a natural experiment of enormous reach in space and time. Here, we analyse the inherent multiple scales of human mobility using Facebook Movement maps collected before and during the first UK lockdown. Firstly, we obtain the pre-lockdown UK mobility graph and employ multiscal...
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Objectives To determine whether the frequency of diagnostic codes for long-term conditions (LTCs) in primary care electronic healthcare records (EHRs) is associated with (1) disease coding incentives, (2) General Practice (GP), (3) patient sociodemographic characteristics and (4) calendar year of diagnosis. Design Retrospective cohort study. Sett...
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Background In the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, ma...
Preprint
Full-text available
Identifying clusters of co-occurring diseases can aid understanding of shared aetiology, management of co-morbidities, and the discovery of new disease associations. Here, we use data from a population of over ten million people with multimorbidity registered to primary care in England to identify disease clusters through a two-stage process. First...
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Full-text available
Health systems around the world are aiming to improve the integration of health and social care services to deliver better care for patients. Existing evaluations have focused exclusively on the impact of care integration on health outcomes and found little effect. That suggests the need to take a step back and ask whether integrated care programme...
Article
Introduction Increasingly, hospitals rely on local clinical practice guidelines (CPGs) alongside national guidance to standardise clinical care. This study examines variation between national and local CPGs, using the example of acute paediatric asthma (APA) CPGs from the United Kingdom and the Netherlands. Methods Fifteen British and Dutch local...
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Full-text available
Background: Hypoxaemia is an important predictor of severity in individuals with COVID-19 and can present without symptoms. The COVID Oximetry @home (CO@h) programme was implemented across England in November, 2020, providing pulse oximeters to higher-risk people with COVID-19 to enable early detection of deterioration and the need for escalation o...
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Background: To identify the impact of enrolment onto a national pulse oximetry remote monitoring programme for COVID-19 (COVID-19 Oximetry @home; CO@h) on health service use and mortality in patients attending Emergency Departments (EDs). Methods: We conducted a retrospective matched cohort study of patients enrolled onto the CO@h pathway from E...
Technical Report
View Interactive Report on UK's Local Authorities working conditions 2009-2021: https://www.ifow.org/resources/the-good-work-time-series-2023 Institute for the Future of Work
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Purpose of review: Home oxygen monitoring and therapy have been increasingly used in the management of patients with chronic diseases. The COVID-19 pandemic has prompted the rapid uptake of remote monitoring programmes to support people with COVID-19 at home. This review discusses the recent evidence and learning in home oxygen monitoring and ther...
Preprint
Full-text available
Background In the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, ma...
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Full-text available
Context A surge of COVID cases globally is often portrayed as “very likely”, which overwhelms health systems and challenges their capacities. A mitigation strategy is seen by remotely monitoring COVID patients in out-of-hospital settings to determine the risk of deterioration. Description of the problem We need an indicator to enable remote monito...
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Background Electronic health records (EHRs) and poor system interoperability are well-known issues in the use of health information technologies in most high-income countries worldwide. Despite the abundance of literature exploring their relationship, their practical implications on patient safety and quality of care remain unclear. Objective This...
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Background Primary Care Networks (PCNs) were established in England in 2019 and will play a key role in providing care at a neighbourhood level within Integrated Care Systems (ICSs). Aim To identify PCN ‘catchment’ areas and compare the overlap between registered and resident populations of PCNs. Design & setting Observational study using publicl...
Article
Objective To develop prediction models to predict long-term survival and time-to-recurrence following surgery for esophageal cancer. Background Long-term survival after esophagectomy remains poor, with recurrence common. Prediction tools can identify high-risk patients and optimize treatment decisions based on their prognostic factors. Methods Pa...
Article
Background: Excess mortality has been used to assess the overall health impact of COVID-19 across countries. Democracies aim to build trust in government and enable checks and balances on decision making, which may be useful in a pandemic. But during the pandemic, they have been criticised as being hesitant to enforce restrictive public health mea...
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Full-text available
Background Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands. Methods Fifteen B...
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Full-text available
The Covid-19 mortality rate varies between countries and over time but the extent to which this is explained by the underlying risk in those infected is unclear. Using data on all adults in England with a positive Covid-19 test between 1st October 2020 and 30th April 2021 linked to clinical records, we examined trends and risk factors for hospital...
Article
Background and aim Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can help clinicians identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed and evaluated a prediction model to predict long-term survival and time-to-recurre...
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Full-text available
Background To identify the population-level impact of a national pulse oximetry remote monitoring programme for COVID-19 (COVID Oximetry @home (CO@h)) in England on mortality and health service use. Methods We conducted a retrospective cohort study using a stepped wedge pre-implementation and post-implementation design, including all 106 Clinical...
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Full-text available
The COVID-19 pandemic has led health systems to increase the use of tools for monitoring and triaging patients remotely. In this systematic review, we aim to assess the effectiveness and safety of pulse oximetry in remote patient monitoring (RPM) of patients at home with COVID-19. We searched five databases (MEDLINE, Embase, Global Health, medRxiv,...
Article
Aim Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed a prediction model to predict long-term survival and time-to-recurrence following surgery for oesophageal cancer....
Article
Aim Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed a prediction model to predict long-term survival and time-to-recurrence following surgery for oesophageal cancer....
Technical Report
Good Work builds resilience against social, economic and health shocks. More than any other single factor, access to good jobs will determine future prospects for people and places across the country.
Preprint
Full-text available
Strict lockdown measures have been put in place in many countries around the world to constrain human mobility in response to the unparalleled challenges posed by the COVID-19 pandemic. Here we apply network-theoretic tools to analyse a geolocalised dataset of human mobility of 16 million UK Facebook users from March to July 2020. A special emphasi...
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Background NHS hospitals do not have clearly defined geographic populations to whom they provide care, with patients able to attend any hospital. Identifying a core population for a hospital trust, particularly those in urban areas where there are multiple providers and high population churn, is essential to understanding local key health needs esp...
Article
Full-text available
Background Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can help clinicians identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed and evaluated a prediction model to predict long-term survival and time-to-recurrence foll...
Article
Objectives: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. Background: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic on thi...
Preprint
Full-text available
Background The Covid-19 case fatality ratio varies between countries and over time but it is unclear whether variation is explained by the underlying risk in those infected. This study aims to describe the trends and risk factors for admission and mortality rates over time in England. Methods In this retrospective cohort study, we included all adul...
Article
Full-text available
Objectives With a growing role for health services in managing population health, there is a need for early identification of populations with high need. Segmentation approaches partition the population based on demographics, long-term conditions (LTCs) or healthcare utilisation but have mostly been applied to adults. Our study uses segmentation me...
Preprint
Full-text available
Objectives To identify the population level impact of a national pulse oximetry remote monitoring programme for covid-19 (COVID Oximetry @home; CO@h) in England on mortality and health service use. Design Retrospective cohort study using a stepped wedge pre- and post- implementation design. Setting All Clinical Commissioning Groups (CCGs) in Englan...
Preprint
Full-text available
Objectives To identify the impact of a national pulse oximetry remote monitoring programme for covid-19 (COVID Oximetry @home; CO@h) on health service use and mortality in patients attending Accident and Emergency (A&E) departments. Design Retrospective matched cohort study of patients enrolled onto the CO@h pathway from A&E. Setting National Healt...
Preprint
Full-text available
Background: Clinical practice guidelines (CPGs) aim to standardize clinical care. Increasingly, hospitals rely on locally produced guidelines alongside national guidance. This study examines variation between national and local CPGs, using the example of acute paediatric asthma guidance from the United Kingdom and the Netherlands. Methods: Fifteen...
Article
Full-text available
Objectives To determine the safety and effectiveness of home oximetry monitoring pathways for patients with COVID-19 in the English National Health Service. Design Retrospective, multisite, observational study of home oximetry monitoring for patients with suspected or proven COVID-19. Setting This study analysed patient data from four COVID-19 ho...
Preprint
Full-text available
Background Excess mortality has been used to assess the health impact of COVID-19 across countries. Democracies aim to build trust in government and enable checks and balances on decision-making, which may be useful in a pandemic. On the other hand, democratic governments have been criticised as slow to enforce restrictive policies and being overly...
Article
Full-text available
Objectives: The PREDICT study aimed to determine how the COVID-19 pandemic affected surgical services and surgical patients and to identify predictors of outcomes in this cohort. Background: High mortality rates were reported for surgical patients with COVID-19 in the early stages of the pandemic. However, the indirect impact of the pandemic o...
Article
Full-text available
Background Hypertension accounts for the greatest burden of disease worldwide, yet hypertension awareness and control rates are suboptimal, especially within low- and middle-income countries. Guidelines can enable consistency of care and improve health outcomes. A small body of studies investigating clinicians’ perceptions and implementation of hyp...