title: Research activity and the association with mortality.
abstract: BACKGROUND
  The aims of this study were to describe the key features of acute NHS Trusts with different levels of research activity and to investigate associations between research activity and clinical outcomes.
  
  
  METHODS
  National Institute for Health Research (NIHR) Comprehensive Clinical Research Network (CCRN) funding and number of patients recruited to NIHR Clinical Research Network (CRN) portfolio studies for each NHS Trusts were used as markers of research activity. Patient-level data for adult non-elective admissions were extracted from the English Hospital Episode Statistics (2005-10). Risk-adjusted mortality associations between Trust structures, research activity and, clinical outcomes were investigated.
  
  
  RESULTS
  Low mortality Trusts received greater levels of funding and recruited more patients adjusted for size of Trust (n = 35, 2,349 £/bed [95% CI 1,855-2,843], 5.9 patients/bed [2.7-9.0]) than Trusts with expected (n = 63, 1,110 £/bed, [864-1,357] p<0.0001, 2.6 patients/bed [1.7-3.5] p<0.0169) or, high (n = 42, 930 £/bed [683-1,177] p = 0.0001, 1.8 patients/bed [1.4-2.1] p<0.0005) mortality rates. The most research active Trusts were those with more doctors, nurses, critical care beds, operating theatres and, made greater use of radiology. Multifactorial analysis demonstrated better survival in the top funding and patient recruitment tertiles (lowest vs. highest (odds ratio & 95% CI: funding 1.050 [1.033-1.068] p<0.0001, recruitment 1.069 [1.052-1.086] p<0.0001), middle vs. highest (funding 1.040 [1.024-1.055] p<0.0001, recruitment 1.085 [1.070-1.100] p<0.0001).
  
  
  CONCLUSIONS
  Research active Trusts appear to have key differences in composition than less research active Trusts. Research active Trusts had lower risk-adjusted mortality for acute admissions, which persisted after adjustment for staffing and other structural factors.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Baris A
authors.initials: BA
authors.lastname: Ozdemir
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Sidhartha
authors.initials: S
authors.lastname: Sinha
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Jan D
authors.initials: JD
authors.lastname: Poloniecki
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Matt M
authors.initials: MM
authors.lastname: Thompson
authors.affiliation: NIHR Comprehensive Clinical Research Network Coordinating Centre, Leeds, United Kingdom.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Gower
authors.affiliation: Centre for Health and Social Care Research, St George's University of London, Cranmer Terrace, London, United Kingdom.
authors.forename: Annette
authors.initials: A
authors.lastname: Boaz
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
authors.forename: Peter J E
authors.initials: PJ
authors.lastname: Holt
mesh_terms: D000328:Adult; D035843:Biomedical Research / Q000191:economics / Q000706:statistics & numerical data*; D004469:Economics, Hospital / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D013222:State Medicine / Q000191:economics / Q000706:statistics & numerical data; D006113:United Kingdom