When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic modelling study.
When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic modelling study.
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DOI：
10.1136/bmjopen-2017-018189
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发表时间：
2017-11-25
期刊：
影响因子：
2.9
通讯作者：
BBC CLAHRC investigators
中科院分区：
文献类型：
--
作者：
Barton P;Sheppard JP;Penaloza-Ramos CM;Jowett S;Ford GA;Lasserson D;Mant J;Mellor RM;Quinn T;Rothwell PM;Sandler D;Sims D;McManus RJ;BBC CLAHRC investigators
本研究的目的是检查短暂性脑缺血发作（TIA）服务修改在两家医院的成本和临床结果的影响。离散事件模拟模型，使用2011年的常规电子健康记录数据。对疑似TIA患者从症状发作到就诊、转诊至专科诊所、治疗和随后的卒中进行随访。包括现有的与以前的（当天诊所较少）和假设的服务重新配置（7天服务，每天诊所较少）。该模型的主要结果是TIA后严重卒中的患病率。次要结果包括服务成本（包括治疗后续卒中的成本）和治疗时间以及达到国家服务提供目标的时间（24小时内看到的高风险患者比例（根据ABCD 2评分））。每个研究中心每年为490例患者（年龄74±12岁，48.9%为女性，23.6%为高风险）提供既往服务的估计成本分别为340 000英镑和368 000英镑。这导致31%的高风险患者在转诊后24小时内就诊（47/150），从转诊到门诊就诊/治疗的中位时间为1.15天（IQR 0.93-2.88）。与现有和假设服务相关的成本在一个地点减少了5000英镑，在另一个地点增加了21000英镑。目标实现率提高到79%（118/150）。然而，至门诊就诊的中位时间仅减少至0.85天（IQR 0.17-0.99），因此未观察到对严重卒中模型发生率的明显影响（10.7/年，99% CI 10.5 - 10.9（既往服务）vs 10.6/年，99% CI 10.4 - 10.8（现有服务））。TIA服务的重新配置在提高目标实现方面是有效的，但是在已经有效工作的服务中（在1-2天内治疗患者），它对临床结果的影响估计很小，增加投资可能不值得。
The aim of this study was to examine the impact of transient ischaemic attack (TIA) service modification in two hospitals on costs and clinical outcomes. Discrete event simulation model using data from routine electronic health records from 2011. Patients with suspected TIA were followed from symptom onset to presentation, referral to specialist clinics, treatment and subsequent stroke. Included existing versus previous (less same day clinics) and hypothetical service reconfiguration (7-day service with less availability of clinics per day). The primary outcome of the model was the prevalence of major stroke after TIA. Secondary outcomes included service costs (including those of treating subsequent stroke) and time to treatment and attainment of national targets for service provision (proportion of high-risk patients (according to ABCD2 score) seen within 24 hours). The estimated costs of previous service provision for 490 patients (aged 74±12 years, 48.9% female and 23.6% high risk) per year at each site were £340 000 and £368 000, respectively. This resulted in 31% of high-risk patients seen within 24 hours of referral (47/150) with a median time from referral to clinic attendance/treatment of 1.15 days (IQR 0.93–2.88). The costs associated with the existing and hypothetical services decreased by £5000 at one site and increased £21 000 at the other site. Target attainment was improved to 79% (118/150). However, the median time to clinic attendance was only reduced to 0.85 days (IQR 0.17–0.99) and thus no appreciable impact on the modelled incidence of major stroke was observed (10.7 per year, 99% CI 10.5 to 10.9 (previous service) vs 10.6 per year, 99% CI 10.4 to 10.8 (existing service)). Reconfiguration of services for TIA is effective at increasing target attainment, but in services which are already working efficiently (treating patients within 1–2 days), it has little estimated impact on clinical outcomes and increased investment may not be worthwhile.
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影响因子：
8.3
作者：
Fonseca, Patricia G.;Weiss, Pedro A. K.;Cabral, Norberto L.
通讯作者：
Cabral, Norberto L.
影响因子：
9.9
作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Rothwell, Peter M.
影响因子：
13.3
作者：
Barton, M.;McClean, S.;Fullerton, K.
通讯作者：
Fullerton, K.
DOI：
10.1111/j.1365-2753.2006.00714.x
发表时间：
2007-06-01
影响因子：
2.4
作者：
Beech, Paula;Greenhalgh, Joanne;Tyrrell, Pippa
通讯作者：
Tyrrell, Pippa