Andrew Taylor, MD, MHS, associate professor of biomedical informatics and data science and of emergency medicine, will work with partners in Scotland on a £1 million study to improve unscheduled end-of-life care.
The University of St Andrews has been awarded up to £1 million each by Scotland's Chief Scientist Office to conduct major research programs into population health issues. The grant, announced by Health and Social Care Secretary Neil Gray on June 4, will support an Applied Health Research Program focused on improving unscheduled care for people across Scotland in their last year of life. Collaborators include NHS Fife, NHS Highland / Highland Hospice, the Fife Community Advisory Council, the University of Edinburgh, and Yale University.
The project arose in the context of unprecedented strain on the country’s unscheduled care services due to workforce shortages, demographic change, and widespread multimorbidity (when a person has two or more long-term health conditions). In 2022, Accident & Emergency waiting times hit record levels and over a quarter-million calls to NHS24 went unanswered. Alongside these services, unscheduled care also includes General Practice Out-of-Hours (GPOOH) and the Scottish Ambulance Service (SAS).
Previous research has identified that one group of people who use such services frequently is those in their last year of life. Although it plays an essential role in the healthcare system, unscheduled care is often not the most appropriate option for this population, being necessarily reliant on a reactive approach to care without the benefit of more nuanced, anticipatory, and coordinated planning. The result can often be more fragmented, expensive and less effective care, causing unintended additional distress to patients in their last year of life and their families.
“We are very aware that use of unscheduled care services increases for a person with a palliative diagnosis in the last year of their lives,” said team member and Clinical Partnership Director for NHS Highland/Highland Hospice, Michael Loynd. “We need to understand if better identification of this population and different supports such as dedicated helplines can enable an alternative route of support.” As part of this process, a key objective of the research program will be to develop a single point of contact and care coordination for this vulnerable group.
This program will use machine learning to analyze existing healthcare data and predict future patterns of unscheduled care use by patients in their last year of life. This will in turn allow for the identification of such patients who may be in need of social care reviews, prescribing interventions, or other anticipatory care measures that would reduce their need for unscheduled care.
“The significant CSO funding awarded to the University of St. Andrews, along with NHS Fife, Yale University, and other key partners, signifies a transformative moment in end-of-life care research. At Yale, we are eager to lend our expertise in emergency medicine and artificial intelligence to this critical initiative," said Taylor. "This collaboration will not only aim to improve the quality of life for patients in their final year but also reduce the burden on unscheduled care services through pioneering anticipatory care models. This project offers a remarkable opportunity for cross-institutional collaboration, set to drive substantial enhancements in healthcare delivery and outcomes worldwide.”
The team’s research will not only benefit patients, first and foremost, but aims to improve NHS sustainability by reducing the unscheduled care workload. “Better identification of this group of people will facilitate improved NHS care, but it will also increase the capacity of emergency care services”, said Colin McCowan, Head of the School of Medicine’s Population and Behavioral Science research division.
With this significant grant from the Scottish Government, the University of St Andrews and its partners are poised to make a profound impact on the healthcare landscape in Scotland. By leveraging advanced machine learning techniques and a deep understanding of the challenges facing the unscheduled care system, this research aims to not only enhance the quality of life for patients in their last year of life but also ensure a more sustainable future for NHS services.
Members of the research team include Colin McCowan, Alex Baldacchino, Peter D. Donnelly, Sarah E. E. Mills, Veronica O'Carroll, Frank Sullivan and Joseph Tay Wee Teck from University of St Andrews; Peter Hall and Elizabeth Lemmon from University of Edinburgh; Michael Loynd from NHS Highland/Highland Hospice; Joanna Bowden, Rishma Maini, Christopher McKenna, Frances Quirk and Rajendra Raman from NHS Fife; and Andrew Taylor from Yale School of Medicine.
Taylor was named a University of St Andrews Global Fellow in 2023.