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Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers

Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers
Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers
BACKGROUND: We developed a method to estimate the expected cost-effectiveness of a service intervention at the design stage and 'road-tested' the method on an intervention to improve patient handover of care between hospital and community.

METHOD: The development of a nine-step evaluation framework: 1. Identification of multiple endpoints and arranging them into manageable groups; 2. Estimation of baseline overall and preventable risk; 3. Bayesian elicitation of expected effectiveness of the planned intervention; 4. Assigning utilities to groups of endpoints; 5. Costing the intervention; 6. Estimating health service costs associated with preventable adverse events; 7. Calculating health benefits; 8. Cost-effectiveness calculation; 9. Sensitivity and headroom analysis.

RESULTS: Literature review suggested that adverse events follow 19% of patient discharges, and that one-third are preventable by improved handover (ie, 6.3% of all discharges). The intervention to improve handover would reduce the incidence of adverse events by 21% (ie, from 6.3% to 4.7%) according to the elicitation exercise. Potentially preventable adverse events were classified by severity and duration. Utilities were assigned to each category of adverse event. The costs associated with each category of event were obtained from the literature. The unit cost of the intervention was €16.6, which would yield a Quality Adjusted Life Year (QALY) gain per discharge of 0.010. The resulting cost saving was €14.3 per discharge. The intervention is cost-effective at approximately €214 per QALY under the base case, and remains cost-effective while the effectiveness is greater than 1.6%.

CONCLUSIONS: We offer a usable framework to assist in ex ante health economic evaluations of health service interventions.
2044-5415
i29-i38
Yao, Guiqing
d777f84c-cf3d-4fad-bbc1-ea01dec01695
Novielli, N.
29afa824-6ff0-410f-8e9e-c9852baa4f86
Manaseki-Holland, S.
e4e06824-2ca1-4d11-8016-c34659b4f918
Chen, Y.F.
97dfb00e-ae23-4a13-9814-586eb16e1748
van der Klink, M.
489d236c-097e-44c5-98a2-138a19c26dcb
Barach, P.
69ad6a57-8f9c-4a35-af61-f147784a09a1
Chilton, P.J.
5f096dec-c0a8-437d-a8ec-4e05d87c3a72
Lilford, R.J.
c23dbd37-c90e-43d9-9309-d6bf66dbaab4
Yao, Guiqing
d777f84c-cf3d-4fad-bbc1-ea01dec01695
Novielli, N.
29afa824-6ff0-410f-8e9e-c9852baa4f86
Manaseki-Holland, S.
e4e06824-2ca1-4d11-8016-c34659b4f918
Chen, Y.F.
97dfb00e-ae23-4a13-9814-586eb16e1748
van der Klink, M.
489d236c-097e-44c5-98a2-138a19c26dcb
Barach, P.
69ad6a57-8f9c-4a35-af61-f147784a09a1
Chilton, P.J.
5f096dec-c0a8-437d-a8ec-4e05d87c3a72
Lilford, R.J.
c23dbd37-c90e-43d9-9309-d6bf66dbaab4

Yao, Guiqing, Novielli, N., Manaseki-Holland, S., Chen, Y.F., van der Klink, M., Barach, P., Chilton, P.J. and Lilford, R.J. (2012) Evaluation of a predevelopment service delivery intervention: an application to improve clinical handovers. BMJ Quality and Safety, 21, supplement 1, i29-i38. (doi:10.1136/bmjqs-2012-001210). (PMID:22976505)

Record type: Article

Abstract

BACKGROUND: We developed a method to estimate the expected cost-effectiveness of a service intervention at the design stage and 'road-tested' the method on an intervention to improve patient handover of care between hospital and community.

METHOD: The development of a nine-step evaluation framework: 1. Identification of multiple endpoints and arranging them into manageable groups; 2. Estimation of baseline overall and preventable risk; 3. Bayesian elicitation of expected effectiveness of the planned intervention; 4. Assigning utilities to groups of endpoints; 5. Costing the intervention; 6. Estimating health service costs associated with preventable adverse events; 7. Calculating health benefits; 8. Cost-effectiveness calculation; 9. Sensitivity and headroom analysis.

RESULTS: Literature review suggested that adverse events follow 19% of patient discharges, and that one-third are preventable by improved handover (ie, 6.3% of all discharges). The intervention to improve handover would reduce the incidence of adverse events by 21% (ie, from 6.3% to 4.7%) according to the elicitation exercise. Potentially preventable adverse events were classified by severity and duration. Utilities were assigned to each category of adverse event. The costs associated with each category of event were obtained from the literature. The unit cost of the intervention was €16.6, which would yield a Quality Adjusted Life Year (QALY) gain per discharge of 0.010. The resulting cost saving was €14.3 per discharge. The intervention is cost-effective at approximately €214 per QALY under the base case, and remains cost-effective while the effectiveness is greater than 1.6%.

CONCLUSIONS: We offer a usable framework to assist in ex ante health economic evaluations of health service interventions.

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More information

Published date: 13 September 2012
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 352883
URI: http://eprints.soton.ac.uk/id/eprint/352883
ISSN: 2044-5415
PURE UUID: d0943852-ed87-40fe-9922-c1391372fe30

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Date deposited: 21 May 2013 14:41
Last modified: 25 Nov 2021 21:57

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Contributors

Author: Guiqing Yao
Author: N. Novielli
Author: S. Manaseki-Holland
Author: Y.F. Chen
Author: M. van der Klink
Author: P. Barach
Author: P.J. Chilton
Author: R.J. Lilford

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