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Michaels J, Wilson E, Maheswaran R, Radley S, Jones G, Tong TS, Kaltenthaler E, Aber A, Booth A, Buckley Woods H, Chilcott J, Duncan R, Essat M, Goka E, Howard A, Keetharuth A, Lumley E, Nawaz S, Paisley S, Palfreyman S, Poku E, Phillips P, Rooney G, Thokala P, Thomas S, Tod A, Wickramasekera N, Shackley P. Configuration of vascular services: a multiple methods research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Vascular services is changing rapidly, having emerged as a new specialty with its own training and specialised techniques. This has resulted in the need for reconfiguration of services to provide adequate specialist provision and accessible and equitable services.
Objectives
To identify the effects of service configuration on practice, resource use and outcomes. To model potential changes in configuration. To identify and/or develop electronic data collection tools for collecting patient-reported outcome measures and other clinical information. To evaluate patient preferences for aspects of services other than health-related quality of life.
Design
This was a multiple methods study comprising multiple systematic literature reviews; the development of a new outcome measure for users of vascular services (the electronic Personal Assessment Questionnaire – Vascular) based on the reviews, qualitative studies and psychometric evaluation; a trade-off exercise to measure process utilities; Hospital Episode Statistics analysis; and the development of individual disease models and a metamodel of service configuration.
Setting
Specialist vascular inpatient services in England.
Data sources
Modelling and Hospital Episode Statistics analysis for all vascular inpatients in England from 2006 to 2018. Qualitative studies and electronic Personal Assessment Questionnaire – Vascular evaluation with vascular patients from the Sheffield area. The trade-off studies were based on a societal sample from across England.
Interventions
The data analysis, preference studies and modelling explored the effect of different potential arrangements for service provision on the resource use, workload and outcomes for all interventions in the three main areas of inpatient vascular treatment: peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. The electronic Personal Assessment Questionnaire – Vascular was evaluated as a potential tool for clinical data collection and outcome monitoring.
Main outcome measures
Systematic reviews assessed quality and psychometric properties of published outcome measures for vascular disease and the relationship between volume and outcome in vascular services. The electronic Personal Assessment Questionnaire – Vascular development considered face and construct validity, test–retest reliability and responsiveness. Models were validated using case studies from previous reconfigurations and comparisons with Hospital Episode Statistics data. Preference studies resulted in estimates of process utilities for aneurysm treatment and for travelling distances to access services.
Results
Systematic reviews provided evidence of an association between increasing volume of activity and improved outcomes for peripheral arterial disease, abdominal aortic aneurysm and carotid artery disease. Reviews of existing patient-reported outcome measures did not identify suitable condition-specific tools for incorporation in the electronic Personal Assessment Questionnaire – Vascular. Reviews of qualitative evidence, primary qualitative studies and a Delphi exercise identified the issues to be incorporated into the electronic Personal Assessment Questionnaire – Vascular, resulting in a questionnaire with one generic and three disease-specific domains. After initial item reduction, the final version has 55 items in eight scales and has acceptable psychometric properties. The preference studies showed strong preference for endovascular abdominal aortic aneurysm treatment (willingness to trade up to 0.135 quality-adjusted life-years) and for local services (up to 0.631 quality-adjusted life-years). A simulation model with a web-based interface was developed, incorporating disease-specific models for abdominal aortic aneurysm, peripheral arterial disease and carotid artery disease. This predicts the effects of specified reconfigurations on workload, resource use, outcomes and cost-effectiveness. Initial exploration suggested that further reconfiguration of services in England to accomplish high-volume centres would result in improved outcomes, within the bounds of cost-effectiveness usually considered acceptable in the NHS.
Limitations
The major source of evidence to populate the models was Hospital Episode Statistics data, which have limitations owing to the complexity of the data, deficiencies in the coding systems and variations in coding practice. The studies were not able to address all of the potential barriers to change where vascular services are not compliant with current NHS recommendations.
Conclusions
There is evidence of potential for improvement in the clinical effectiveness and cost-effectiveness of vascular services through further centralisation of sites where major vascular procedures are undertaken. Preferences for local services are strong, and this may be addressed through more integrated services, with a range of services being provided more locally. The use of a web-based tool for the collection of clinical data and patient-reported outcome measures is feasible and can provide outcome data for clinical use and service evaluation.
Future work
Further evaluation of the economic models in real-world situations where local vascular service reconfiguration is under consideration and of the barriers to change where vascular services do not meet NHS recommendations for service configuration is needed. Further work on the electronic Personal Assessment Questionnaire – Vascular is required to assess its acceptability and usefulness in clinical practice and to develop appropriate report formats for clinical use and service evaluation. Further studies to assess the implications of including non-health-related preferences for care processes, and location of services, in calculations of cost-effectiveness are required.
Study registration
This study is registered as PROSPERO CRD42016042570, CRD42016042573, CRD42016042574, CRD42016042576, CRD42016042575, CRD42014014850, CRD42015023877 and CRD42015024820.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jonathan Michaels
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Emma Wilson
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ravi Maheswaran
- Department of Public Health, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Stephen Radley
- Department of Obstetrics and Gynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Georgina Jones
- Leeds School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Thai-Son Tong
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Eva Kaltenthaler
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Ahmed Aber
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Booth
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Buckley Woods
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - James Chilcott
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rosie Duncan
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Munira Essat
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Edward Goka
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Aoife Howard
- Department of Economics, National University of Ireland Galway, Galway, Ireland
| | - Anju Keetharuth
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Elizabeth Lumley
- Medical Care Research Unit, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Shah Nawaz
- Department of Vascular Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Suzy Paisley
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Edith Poku
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Patrick Phillips
- Cancer Clinical Trials Centre, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Gill Rooney
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Praveen Thokala
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steven Thomas
- Department of Vascular Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angela Tod
- Division of Nursing and Midwifery, Health Sciences School, University of Sheffield, Sheffield, UK
| | - Nyantara Wickramasekera
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Phil Shackley
- Health Economics & Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Patriquin G, Hatchette JE, Hatchette TF. Canadian physicians' knowledge, attitudes, and beliefs about the risk of HTLV infection in solid organ transplantation. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2020; 5:124-126. [PMID: 36341315 PMCID: PMC9608730 DOI: 10.3138/jammi-2019-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/15/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jill E Hatchette
- Research Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Patriquin G, Hatchette JE, Hatchette TF. Risk acceptance of human T-lymphotropic virus infection in solid organ transplantation-A survey of Atlantic Canadian ambulatory patients. Transpl Infect Dis 2018; 20:e12958. [PMID: 29959880 DOI: 10.1111/tid.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/28/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human T-lymphotropic virus (HTLV) has an estimated prevalence of 12 per 100 000 in the general Canadian population (with higher rates in distinct groups) and is most commonly transmitted by breast feeding, sexual intercourse, sharing injection tools, and blood transfusions. A minority of those infected will develop severe disease. Health Canada mandates that people who are positive for HTLV are not suitable to be solid organ donors. Given the apparent low-disease burden of HTLV in Canada, we explored HTLV risk tolerance among patients, in the context of organ transplantations. METHODS Using telephone, and in-person questionnaires, we assessed willingness of patients to accept the risk of HTLV infection in hypothetical scenarios in which they required an organ transplant for survival. RESULTS Seventy-four outpatients attending various medical clinics participated in the survey. In a standard gamble scenario, 37.5% of respondents would have accepted a solid organ transplant regardless of HTLV risk, as compared to 27.3% and 24.6% accepting organ transplantation if there was a risk of human immunodeficiency virus (HIV) or of human virus Y (HVY; a fictitious virus describing HTLV in terms of neurological outcomes), respectively. Similarly, the median longevity traded to ensure a virus-free organ was 4-5 years regarding all viruses, except for HVY, for which the median time exchanged to ensure a virus-free organ was 10 (out of a possible 20) years. CONCLUSIONS These data suggest that patients, though willing to accept some risk of viral infection, would not be willing to forgo HTLV screening of solid organs.
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Affiliation(s)
- Glenn Patriquin
- Division of Medical Microbiology, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill E Hatchette
- Research Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Medical Microbiology, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Duncan R, Essat M, Jones G, Booth A, Buckley Woods H, Poku E, Kaltenthaler E, Keetharuth AD, Palfreyman S, Michaels J. Systematic review and qualitative evidence synthesis of patient-reported outcome measures for abdominal aortic aneurysm. Br J Surg 2016; 104:317-327. [PMID: 27935014 DOI: 10.1002/bjs.10407] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/29/2016] [Accepted: 09/20/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim was to identify and evaluate existing patient-reported outcome measures (PROMs) for use in patients with an abdominal aortic aneurysm (AAA) to inform the selection for use in surgical practice. METHODS Two reviews were conducted: a systematic review to identify valid, reliable and acceptable PROMs for patients with an AAA, and a qualitative evidence synthesis to assess the relevance to patients of the identified PROM items. PROM studies were evaluated for their psychometric properties using established assessment criteria, and for their methodological quality using the COSMIN checklist. Qualitative studies were synthesized using framework analysis, and concepts identified were then triangulated using a protocol with the item concepts of the identified PROMs. RESULTS Four PROMs from three studies were identified in the first review: Short Form 36, Australian Vascular Quality of Life Index, Aneurysm Dependent Quality of Life (AneurysmDQoL) and Aneurysm Symptoms Rating Questionnaire (AneurysmSRQ). None of the identified PROMs had undergone a rigorous psychometric evaluation within the AAA population. Four studies were included in the qualitative synthesis, from which 28 concepts important to patients with an AAA were identified. The AneurysmDQoL and AneurysmSRQ together provided the most comprehensive assessment of these concepts. Fear of rupture, control, ability to forget about the condition and size of aneurysm were all concepts identified in the qualitative studies but not covered by items in the identified PROMs. CONCLUSION Further research is needed to develop PROMs for AAA that are reliable, valid and acceptable to patients.
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Affiliation(s)
- R Duncan
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - M Essat
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - G Jones
- School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - A Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - H Buckley Woods
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Poku
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - E Kaltenthaler
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - S Palfreyman
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - J Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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