Christina Pagel Ph.D., M.Sc.

2016/2017 Recent Returners

Christina Pagel

I was a 2016-17 U.K. Harkness Fellow in Health Care Policy and Practice. I am now Director of the Clinical Operational Research Unit at University College London and a Reader (Associate Professor). My previous work includes the development of the PRAiS risk model for 30-day mortality following pediatric cardiac surgery, which has been used across the U.K, including national audit, since 2013. I subsequently led a project to improve the model and develop a web-tool to help families & others interpret published survival outcomes.

Since my return, I am leading a new project (LAUNCHES) to link across 5 national data sets to build the UK’s first description of the lifelong interaction with the NHS of those born with congenital heart disease and working with national paediatric intensive care units to model optimal delivery of paediatric emergency retrieval services (DEPICT).

I have a Ph.D. in Space Physics from Imperial College London, a B.A in Mathematics from Oxford University and 4 Masters degrees in physics, statistics and history.

What attracted me most about the Harkness Fellowship was the opportunity to take a year away from the academic traditional career path and learn about other health systems and from experts not just from the US, but across all the countries represented by the fantastic other Fellows. As well as learning about the US health system, I definitely gained a deeper insight into the NHS and how I could best contribute to health care improvement once back in the UK. I also left with an addiction to US politics podcasts!

Harkness Project Title: Identifying State Legislator Priory Goals for U.S. Health Policy (Project A); How Can Information Systems be Implemented and Used More Effectively within Acute Care Hospitals? (Project B)

Project A: I wanted to understand legislator’s most important goals of national health policy. I administered a brief survey to U.S. state legislators to rank their priorities from a set of possible health policy goals. I used a combination of mathematical and statistical techniques to combine individual priorities into group priorities.

The survey results revealed a clear prioritization of health policy goals for each party’s state legislators. The thirteen health policy goals grouped into four distinct clusters corresponding to distinct domains of health policy: reducing costs; improving health; smaller government; health services delivery. The clusters were almost identical between parties but were assigned differing importance. Both parties ranked reducing costs, improving health and improving access highly. However, Democrats prioritized improving health and access over reducing costs while Republicans instead prioritized reducing costs over improving health and access. Additionally, reducing government involvement was the second highest priority for Republicans but the lowest priority for Democrats.

Project B: There is strong and increasing pressure to introduce new health information technology systems into hospitals. However, implementing new systems within hospitals is challenging and often fails. Using a single intensive care information technology system as a case study, I wanted to use the experience of previous implementations to develop tips and guidelines that can be shared widely. Abstracting insights from semi-structured interviews with 17 hospital staff at 4 hospitals and 3 key representatives of the IT company, I developed a set of cartoons highlighting the key barriers and challenges in implementing such systems. The main challenge is that HIT implementation is often seen by hospital teams as a purely technical challenge whereas the sociotechnical challenges of implementation are often greater than the technical.