NHS is told to save £2.2bn by being more efficient
Ontology highlight
ABSTRACT:
SUBMITTER: Dobson R
PROVIDER: S-EPMC1626348 | biostudies-literature | 2006 Oct
REPOSITORIES: biostudies-literature
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Project description: Not available
| S-EPMC1246106 | biostudies-literature
Project description:Recent substantive reforms to the English National Health Service expanded patient choice and encouraged hospitals to compete within a market with fixed prices. This study investigates whether these reforms led to improvements in hospital quality. We use a difference-in-difference-style estimator to test whether hospital quality (measured using mortality from acute myocardial infarction) improved more quickly in more competitive markets after these reforms came into force in 2006. We find that after the reforms were implemented, mortality fell (i.e. quality improved) for patients living in more competitive markets. Our results suggest that hospital competition can lead to improvements in hospital quality.
| S-EPMC4373154 | biostudies-other
Project description:ObjectiveDespite the appeal of early intervention in psychosis, there is concern that identifying youth as having high psychosis risk (PR) may trigger stigma. This study employed a pre-post design to measure change in PR participants' emotions about PR upon being told of their PR status and according to whether this was the first time receiving this information.MethodsParticipants (n = 54) identified as at PR via structured interview rated their emotions about PR before and after being told they were at PR. Qualitative analyses explored the valence of participant reflections on being given this information.ResultsParticipants reported significantly less negative emotion after being told of their PR status (p < .001), regardless of whether they were hearing this for the first time (p = .72). There was no change in positive emotions or the predominant belief that they should keep their PR status private. Most participants commented positively about the process of feedback but negatively about its impact on their self-perceptions and/or expectations of others' perceptions of them.ConclusionThis is the first study to collect pre-post data related to being told one is at PR and to examine quantitative and qualitative responses across and within individuals. For a majority of participants, clinical feedback stimulated negative stereotypes even as it relieved some distress. To actively address internalized stigma, clinicians providing feedback to PR youth must attend to the positive and negative impacts on how youth think about themselves as well as how they feel.
| S-EPMC8633064 | biostudies-literature
Project description: Not available
| S-EPMC1489218 | biostudies-literature
Project description:Little is known about the placebo effects when comparing training interventions. Consequently, we investigated whether subjects being told they are in the intervention group get better training results compared to subjects being told they are in a control group. Forty athletes (male: n = 31, female: n = 9) completed a 10-week training intervention (age: 22 ± 4 years, height: 183 ± 10 cm, and body mass: 84 ± 15 kg). After randomization, the participants were either told that the training program they got was individualized based on their force-velocity profile (Placebo), or that they were in the control group (Control). However, both groups were doing the same workouts. Measurements included countermovement jump (CMJ), 20-m sprint, one-repetition maximum (1RM) back-squat, a leg-press test, ultrasonography of muscle-thickness (m. rectus femoris), and a questionnaire (Stanford Expectations of Treatment Scale) (Younger et al. in Clin Trials 9(6):767-776, 2012). Placebo increased 1RM squat more than Control (5.7 ± 6.4% vs 0.9 ± 6.9%, [0.26 vs 0.02 Effect Size], Bayes Factor: 5.1 [BF10], p = 0.025). Placebo had slightly higher adherence compared to control (82 ± 18% vs 72 ± 13%, BF10: 2.0, p = 0.08). Importantly, the difference in the 1RM squat was significant after controlling for adherence (p = 0.013). No significant differences were observed in the other measurements. The results suggest that the placebo effect may be meaningful in sports and exercise training interventions. It is possible that ineffective training interventions will go unquestioned in the absence of placebo-controlled trials.
| S-EPMC9895971 | biostudies-literature
Project description:Junior doctors, nursing staff, and phlebotomists spend a large proportion of their time taking blood samples and siting (venous) cannulae. Approximately 350 blood samples are taken daily across 25 wards at the Royal United Hospital Bath NHS Trust. There is no standard storage solution for venepuncture or cannulation equipment. On-call junior doctors cover most of the hospital's wards. Time is wasted locating essential equipment on unfamiliar wards and nurses are frequently interrupted to assist. These delays can compromise patient safety in emergencies as well as contributing to a source of daily inefficiency. Junior doctors were timed collecting equipment needed for venepuncture and cannulation on unfamiliar wards. Initial results suggested large variation between timings on different wards. The medical admissions unit (MAU), which organises items for venepuncture and cannulation on a single trolley, was 4 times quicker than the mean of all other wards. MAU mean time 21.0s vs. Non-standardised wards mean time 103.0s (p<0.0001). Estimates suggest approximately 47 hours per week (the equivalent of a fulltime doctor) could be saved by implementing a standard trust-wide storage solution. We set out to introduce the MAU trolley format to all adult inpatient wards. All ward managers agreed to implement the trolley. 18 wards (72% of adult inpatient wards) already possessed the 'MAU style' trolley, which we standardised using an easy-to-follow inventory and laminated draw inlays. Feedback was very positive from doctors and ward staff alike. We repeated timings to validate the change and successfully presented a business case to senior management for a further 10 trolleys (£3623.78) for full adult inpatient ward coverage. As junior doctors, we identified a common problem, tested solutions, and made early simple affordable changes. Initial work helped us present a compelling case for patient safety and efficiency improvements, releasing money to implement modest trust-wide quality improvement changes.
| S-EPMC4663819 | biostudies-literature
Project description: Not available
| S-EPMC7471591 | biostudies-literature
Project description:Policy makers seeking to reduce childhood obesity must prioritize investment in treatment and primary prevention. We estimated the cost-effectiveness of seven interventions high on the obesity policy agenda: a sugar-sweetened beverage excise tax; elimination of the tax subsidy for advertising unhealthy food to children; restaurant menu calorie labeling; nutrition standards for school meals; nutrition standards for all other food and beverages sold in schools; improved early care and education; and increased access to adolescent bariatric surgery. We used systematic reviews and a microsimulation model of national implementation of the interventions over the period 2015-25 to estimate their impact on obesity prevalence and their cost-effectiveness for reducing the body mass index of individuals. In our model, three of the seven interventions--excise tax, elimination of the tax deduction, and nutrition standards for food and beverages sold in schools outside of meals--saved more in health care costs than they cost to implement. Each of the three interventions prevented 129,000-576,000 cases of childhood obesity in 2025. Adolescent bariatric surgery had a negligible impact on obesity prevalence. Our results highlight the importance of primary prevention for policy makers aiming to reduce childhood obesity.
| S-EPMC9627551 | biostudies-literature
Project description:BackgroundUpdated World Health Organization guidelines have amplified debate about how resource constraints should impact monitoring strategies for HIV-infected persons on combination antiretroviral therapy (cART). We estimated the incremental benefit and cost effectiveness of alternative monitoring strategies for east Africans with known HIV infection.MethodsUsing a validated HIV computer simulation based on resource-limited data (USAID and AMPATH) and circumstances (east Africa), we compared alternative monitoring strategies for HIV-infected persons newly started on cART. We evaluated clinical, immunologic and virologic monitoring strategies, including combinations and conditional logic (e.g., only perform virologic testing if immunologic testing is positive). We calculated incremental cost-effectiveness ratios (ICER) in units of cost per quality-adjusted life year (QALY), using a societal perspective and a lifetime horizon. Costs were measured in 2008 US dollars, and costs and benefits were discounted at 3%. We compared the ICER of monitoring strategies with those of other resource-constrained decisions, in particular earlier cART initiation (at CD4 counts of 350 cells/mm3 rather than 200 cells/mm3).ResultsMonitoring strategies employing routine CD4 testing without virologic testing never maximized health benefits, regardless of budget or societal willingness to pay for additional health benefits. Monitoring strategies employing virologic testing conditional upon particular CD4 results delivered the most benefit at willingness-to-pay levels similar to the cost of earlier cART initiation (approximately $2600/QALY). Monitoring strategies employing routine virologic testing alone only maximized health benefits at willingness-to-pay levels (> $4400/QALY) that greatly exceeded the ICER of earlier cART initiation.ConclusionsCD4 testing alone never maximized health benefits regardless of resource limitations. Programmes routinely performing virologic testing but deferring cART initiation may increase health benefits by reallocating monitoring resources towards earlier cART initiation.
| S-EPMC3163507 | biostudies-literature
Project description:BackgroundIncreasing the scope of an evidence based approach to areas outside healthcare has renewed the importance of a long-standing discussion on randomised versus observational study designs in evaluating the effectiveness of interventions. We investigate statistically if an increasing recognition of the role of certain nonrandomised studies to support or generalize the results of randomised controlled trials has had an impact on the actual inclusion criteria applied in Cochrane reviews.MethodsWe conduct an on-line search of the Cochrane Database of Systematic Reviews (CDSR) and divide all Cochrane reviews according to their design inclusion criterion: (A) RCTs only or (B) RCTs and (some subset of) observational studies. We test statistically whether a shift in the proportion of category B reviews has occurred by comparing reviews published before 2008 with reviews published during 2008/09.ResultsWe find that the proportion of Cochrane reviews choosing a broader inclusion criterion has increased, although by less than two percentage points. The shift is not statistically significant (P = 0.08).ConclusionsThere is currently not sufficient data to support a hypothesis of a significant shift in favour of including observational studies, neither at the aggregate level nor at the level of individual Review Groups within the Cochrane Collaboration.
| S-EPMC3503546 | biostudies-literature