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There is a need for information on what makes for a good model of health service delivery, in terms of clinical and cost-effectiveness, to ensure everyone gets the best care available.

Variations in access to healthcare have been described for a wide range of medical conditions and surgical procedures. Often there is limited evidence on clinical effectiveness, with several different treatment options.

Even for common surgical procedures such as joint replacement of the hip and knee, with good evidence of clinical and cost-effectiveness, variations in provision and outcomes of surgery exist.

Whilst variation in surgical outcomes may be accounted for by a hospital treating complex and sicker patients, this may also be explained by how hospital organise their services. Within a hospital, a model of care is chosen on how best to treat and manage patients.

These models of service delivery form complex interventions. They may be implemented differently and variably across different hospital settings. It is often unclear which model of care is best.

There is a need for information on what the core active ingredients are, in terms of clinical and cost-effectiveness, and how they are exerting their effect.

Our studies that explore variations in health service delivery make use of routinely collected large national datasets (Big Health Data) that capture actual NHS patient activity within primary and secondary care settings.

Examples of such data include: National Joint Registry (NJR) for England, Wales and Northern Ireland; Hospital Episode Statistics (HES) database; Patient-Reported Outcome Measures (PROM) data; Clinical Practice Research Datalink (CPRD).

We use innovative study designs for the evaluation of complex interventions that include Natural Experimental studies and Process Evaluations. We adopt a mixed methods approach using qualitative research methods, health economics and statistical analysis, in order to capture deep understanding and lessons for the service on implementation and change.

Related research themes