Hotly Debated Weekend Effect May Have Been A Statistical Mirage? (Journal of Health Services Research and Policy / BBC News / Lancet / BMJ)

Summary

Research does not take place in a socio-political vacuum. The ongoing junior doctors’ dispute has supplied fertile ground for allegations of “spin” and politically-motivated distortion in the interpretation of the so-called “weekend effect”, and raises questions concerning the planned benefits for patients from the Government’s policy on seven-day NHS services.

A new “Manchester Study” suggests that the weekend effect identified in previous studies may have been a statistical epiphenomenon arising from “selection bias”, introduced unwittingly by earlier studies concentrating on the sub-set of patients attending accident and emergency at the weekend who were actually admitted to hospital. There appears to have been a “higher bar” for admissions at weekends.

“Patients who attend A&E on weekends are at no higher mortality risk than patients who attend A&E on weekdays”. (p.7)

This re-interpretation of Hospital Episode Statistics (HES) weekend-related mortality data is also used by the authors to question the value of standardised mortality rates as an indicator of quality of care in hospitals.

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Reference

Meacock, R. Anselmi, L. [and] Kristensen, SR. [et al] (2016). Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission. Journal of Health Services Research and Policy. May 6th 2016. [Epub ahead of print].

Fortuitous Synchronicity or Political Axe-Grinding?

The question of “timing” regarding the appearance of this article cannot be dismissed entirely. Comments and further analysis of the background context, from BBC News:

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Reference

Pym, H. (2016). Hospital death data – the row heats up. London: BBC Health News, May 7th 2016.

Re-Interpretation of the Oxford Vascular Study: the “Bandwagon Effect” ?

Oxford University researchers, re-analysing earlier Oxford Vascular Study findings, have arrived a similar conclusions; this time concerning mortality arising from hospital admissions for stroke between 2002 and 2014. Conclusions previously construed as “supporting” the Department of Health’s drive for seven-day NHS services in England are now judged to have been based on flawed data.

“There’s a wealth of poor-quality evidence based on hospital administrative data”. Professor Peter Rothwell.

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Reference

Brimelow, A. (2016). Junior doctors’ contracts: fresh talks to begin later. London: BBC Health News, May 9th 2016.

This relates to:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Bray, BD. et al. Cloud, GC. [and] James, MA. [et al]; on behalf of the SSNAP Collaboration (2016). Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. The Lancet. May 10th 2016. [Epub ahead of print].

Taking acute stroke as an example, it seems likely that potential biases and limitations in the coding of acute medical admissions could create an apparent weekend effect across a range of acute conditions:

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Reference

Li, L. [and] Rothwell, PM.; Oxford Vascular Study (2016). Biases in detection of apparent “weekend effect” on outcome with administrative coding data: population based study of stroke. BMJ. May 16th 2016; 353: i2648.

Freemantle briefly defends the “weekend effect” and hints that it would be recklessly mistaken to deny the relevance it has for NHS patient safety:

Full Text Link

Reference

Pym, H. (2016). Weekend death data for NHS England ‘highly misleading’. London: BBC Health News, May 9th 2016.

Adding to the Relentless Cascade: an Emerging Consensus (Of Dissent)

There would appear to be an emerging meta-consensus (if only one of disdainful dissent) regarding allegedly erroneous or simplistic interpretations of the “Weekend Effect”.

Further research from the University of Birmingham supports cautioning policy makers to exercise due diligence before attributing the weekend effect to differences in specialist staffing.

Full Text Link

Reference

Aldridge, C. Bion, J. [and] Boyal, A. [et al]; the HiSLAC Collaborative (2016). Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study. The Lancet. May 10th 2016. [Epub ahead of print].

House of Commons Health Select Committee Review Expected?

An independent review to assess the “weekend effect” may be required? (Then again, the literature on the weekend effect appears to be enormous, lively and controversy-prone enough already).

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Torjesen, I. (2016). Academic calls for MPs to investigate “weekend effect” in view of conflicting evidence. BMJ. May 11th 2016; 353: i2667.

Lest anyone forget the real context: last-ditch talks about the junior doctors contract dispute in England have been extended.

Full Text Link

Reference

Triggle, N. (2016). Junior doctors’ contracts: crunch talks extended. London: BBC Health News, May 13th 2016.

Editorials Coming To Light After the Dust Settled

Further comment and analysis:

Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).

Reference

Wise, J. (2016). The weekend effect-how strong is the evidence? BMJ. May 19th 2016; 353: i2781.

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Reference

McKee, M. (2016).The weekend effect: now you see it, now you don’t. BMJ. May 16th 2016; 353: i2750.

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Reference

Black, N. (2016). Is hospital mortality higher at weekends? If so, why? Lancet. May 10th 2016. [Epub ahead of print].

Pernicious Falsehood?

The cherry-picking of evidence debate re-emerged into the political mainstream; probably not for the last time?

Full Text Link

Reference

Triggle, N. (2017). Stephen Hawking: I’m worried about the future of the NHS. London: BBC Health News, August 20th 2017.

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About Dementia and Elderly Care News

Dementia and Elderly Care News. Wolverhampton Medical Institute: WMI. (jh)
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