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Jane Hirst and team at the Nuffield Department of Women’s and Reproductive Health: NCRM Impact Prize entry

The title of this application was Enhancing Maternity Care through Interdisciplinary Collaboration and Data Science: Addressing Challenges in Gestational Diabetes Mellitus (GDM) Research.

It was submitted by Profesor Jane Hirst, Dr Lucy Mackillop, Dr Sara White, Professor Saravanan Ponnusamy, Dr Huiqi (Yvonne) Lu and Yasmina Al Ghadban, of the Nuffield Department of Women’s and Reproductive Health at the University of Oxford.


Summary of NCRM participation

The NCRM Innovation Forum was an in-person meeting held on December 8-9th, 2022, at Jesus College, University of Oxford. The forum brought together clinicians, researchers, data scientists, engineers, and industry colleagues, representing different expertise and levels of seniority. The forum was themed around four topics:

  1. Routinely collected data in pregnancy research: Challenges and successes
  2. Challenges accessing NHS and other data sources for research on women in pregnancy
  3. Challenges combining different data platforms for research and clinical purposes
  4. Methodologic and analytic challenges: machine learning & classic statistical modelling

Participants were asked to share methodologic challenges they had experienced in their own research, with discussions around the research priorities and opportunities to move forwards. The workshop concluded with a final session where all participants discussed key priorities and gaps for data science to improve outcomes and clinical experiences for women with GDM.


Impact achieved

Summary

In December 2022, a National Centre for Research Methods (NCRM) Innovation forum focused on the opportunities and challenges of using complex clinical data to improve women’s health. Whilst data challenges affect nearly all illnesses and health service delivery areas, this innovation forum considered these issues in the context of one specific clinical condition, gestational diabetes mellitus (GDM), defined as glucose intolerance with first onset or recognition during pregnancy.

Context and Background

The delivery of healthcare is being transformed by the increasing use of complex clinical data. Increasing volumes of digital health data are accumulated in primary and secondary care, along with data from personal devices, sensors, third-party programs and ‘Apps’. Whilst these data have enormous potential to improve health outcomes, and service delivery, only an estimated 2% of the 40 zettabytes of existing clinical data are used for research.

The care of pregnant people with GDM is undergoing rapid changes driven by increasing prevalence of the condition and evolving technologies to monitor glucose with a consequent surge in data generated, placing pressure on over-stretched maternity services. While the use of medical data can support healthcare providers in delivering quality care, several practical and methodologic barriers exist to accessing and using complex clinical data for research, making the process time-consuming, expensive, and challenging.

Methods

The forum was held to discuss the specific challenges in accessing and using data to improve care for women with GDM, the digital data currently available for research in maternity care in the UK, data integration, standards and security and learning from case studies of other complex clinical data challenges. The forum brought together 28 participants from across the UK: obstetricians, endocrinologists, and other clinicians; researchers in maternal health, public health, medical statistics, and machine learning; data scientists, engineers, NHS Digital (Maternity Services Data Set); a representative from a funding body, and industry colleagues, with representing different expertise and levels of seniority.

Impact

Impact on GDM Research Direction

The forum has been instrumental in shaping the direction of GDM research. By emphasizing the significance of addressing type 2 diabetes (T2D) prevention strategies for women with GDM, the forum directed attention to an area of research that holds the potential to make a substantial impact on public health outcomes. For example, Prof. Jane Hirst’s group expanded the scope of an on-going systematic review to include predictive models of long-term outcomes such as T2D, rather than just birth outcomes. Additionally, following the forum, Prof. Saravanan Ponnusamy’s group started working on the co-development of a multi-component intervention to improving testing for T2D in women with a previous history GDM.

Interdisciplinary Collaboration & Knowledge Sharing

The forum acted as a catalyst for collaboration among researchers, clinicians, and data scientists. Case studies were presented to learn from each other's challenges and successes. Engineers and data scientists also presented their work leading to discussions on the optimal utilization of data science methods to address clinically relevant questions in pregnancy care. Additionally, attendees identified many data sources relevant to pregnancy research and recognised the need for a common platform for data linkage. Ultimately, this approach not only optimizes the research process but also ensures a more efficient and impactful utilization of resources, with the potential to drive positive changes in patient care and outcomes.

Bridging the Gap between Academia and Industry

The collaboration between industry partners and researchers was exemplified through the partnership with Huma, which owns GDm-Health, a smartphone-app-based blood glucose monitoring system. The forum initiated discussions on the best way for data collected by the company to be used by researchers. This collaboration has the potential to accelerate research progress and generate actionable insights that benefit patients and healthcare systems alike. Additionally, attendees brainstormed how the National GDM Audit for England could benefit from industrial collaboration, for example with EMIS Health (used in 56% of GP practices in the UK).

Legacy

The forum’s impact extended beyond its immediate scope.

First, a working group was established to meet monthly to capitalise on the momentum initiated by the innovation forum. The working group continues to work on the initiatives raised at the forum such as the industrial collaboration with Huma and EMIS; the funding of a common platform for data linkage; the identification of a respected institution, such as a Royal college, to neutrally host the common infrastructure; and the development of new interventions for GDM and T2D prevention.

Second, a dedicated UK national session was integrated into the Diabetes in Pregnancy 2023 International Conference. This session served as a platform to disseminate the forum’s outcomes and discussions to a broader audience, encouraging other researchers to adopt similar collaborative and data-driven approaches.

Third, recommendations from the forum were synthesized and will be submitted for publication in an obstetrics and gynaecology international journal. These recommendations will resonate with the larger clinical community, as they are not UK specific and can be extended beyond GDM.

Finally, the Royal College of Obstetricians and Gynaecologists Diabetes in Pregnancy research group have also had discussions with college office bearers around establishing a national data hub for diabetes in pregnancy research. This directly addresses one of the key recommendations of the workshop, and would be a step change in research in this area to benefit women.

Reach and Significance

The reach of the NCRM forum extends beyond its 28 attendees as it triggered collaborations between organisations. For example, while only two Huma employees attended the forum, the collaboration between the company and researchers now involves a significantly larger number of people. Additionally, the forum legacy has reached a broader audience of healthcare professionals, researchers, and policymakers by their participation and engagement at the Diabetes in Pregnancy 2023 International Conference. The publication of recommendations from the forum will reach a wider research and clinical community.

In summary, the forum has had significant impact on research progress and knowledge exchange. It has reshaped research priorities, encouraged data sharing and collaboration, and introduced cutting-edge methodologies. By facilitating interactions between academia, industry, and the broader healthcare community, the forum’s influence extends far beyond its duration, shaping the future of diabetes research and patient care.