HMS: Identifying and Measuring Spillover Effects of Changes to Healthcare Organisation and Delivery

HMS：识别和衡量医疗保健组织和交付变革的溢出效应

• 批准号: MR/R013314/1
• 负责人: Matt Sutton
• 金额: $ 55.29万
• 依托单位: University of Manchester
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2018
• 资助国家: 英国
• 起止时间: 2018 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FR013314%2F1
• 关键词: HMS; Identifying; Measuring; Spillover; Effects

Changes to the way in which healthcare services are organised and delivered have wider consequences beyond the patients or the services targeted. These types of wider changes are called spillovers. They may have positive effects, because more patients benefit than was originally intended, and/or they may have negative effects, because more attention is paid to some patients and activities at the expense of others. A limited amount of research has shown that these spillover effects can be substantial. They may be substantial enough to affect whether a proposed change in service organisation is good value-for-money. There is therefore a need for a systematic method of identifying and measuring spillover effects.Our aim is to develop structured guidance for incorporating spillovers in the evaluation of changes to health care organisation and delivery. Our proposal contains three work packages. The first work package will review the published literature to identify and summarise how spillovers have been considered and measured in previous studies. The second work package will use the example of three case studies to develop the methods. The first case study will focus on a new system introduced for General Practitioners (GPs) under which they received financial bonuses for improving a wide range of quality measures. The second case study will focus on a change to the way hospitals were paid to encourage them to discharge patients on the same day rather than keep them in hospital overnight. We have previously shown that both of these initiatives changed activity as intended and improved the outcomes for the patients that were targeted. However, the wider consequences for other activities and other patients have not been considered. The third case study will focus on the initiative to provide the population with access to GPs seven-days a week. This is expected to increase the use of general practice services and improve convenience for patients. It is also hoped that it will improve the health of the population and lead to a reduction in visits to Accident and Emergency departments for relatively minor complaints that would be better dealt with by GPs. However, the overall impact of these changes will depend on whether availability at the weekend leads to reduced access to GPs during the week, the size of the reduction in demand on A&E, the benefits to the patients with more severe conditions who continue to visit A&E and the costs of compensating GPs for opening out-of-hours. We will estimate these wider consequences using our spillovers framework and provide an overall assessment of extending access to GP services. We will re-visit each of these policy changes and examine whether they had spillover effects. We will consider how these spillover effects influence the overall costs and benefits of these policy changes.In the third and final work package, we will generate structured methodological guidance to evaluate diverse changes to health services. We will work with a project advisory group including decision-makers, health care professionals and academic experts to identify the potential for spillovers, develop the methods and ensure the guidance is comprehensive, authoritative and user-friendly. The work will provide a consistent way of assessing the wider effects on all patients of changing the way that health and social care services are organised for some patients. We will demonstrate these methods on three important policy changes and examine how considerations of spillovers affect the design of service changes and the way these are evaluated. We will work with decision-makers, professionals and evaluators throughout the project to create guidance that will ensure that the potential for spillover effects is widely recognised and that they are included in the evaluation of changes to the way care services are organised and delivered.

改变医疗保健服务的组织和提供方式会产生更广泛的影响，超出患者或目标服务的范围。这种更广泛的变化被称为溢出效应。它们可能有积极的影响，因为比最初预期的更多的患者受益，和/或它们可能有负面影响，因为更多的关注一些患者和活动，而不是其他人。有限数量的研究表明，这些溢出效应可能是巨大的。它们可能足以影响拟议中的服务组织变革是否物有所值。因此，我们需要一个有系统的方法来识别和衡量溢出效应。我们的目标是制定有系统的指导，以便在评估医疗保健组织和提供的变化时纳入溢出效应。我们的提案包含三个工作方案。第一个工作包将回顾已发表的文献，以确定和总结在以前的研究中如何考虑和衡量溢出效应。第二个工作包将使用三个案例研究的例子来开发方法。第一个案例研究将侧重于为全科医生引入的新制度，在该制度下，全科医生因改进一系列质量措施而获得财政奖金。第二个案例研究将侧重于改变医院的支付方式，以鼓励他们在当天出院，而不是让他们在医院过夜。我们之前已经证明，这两项举措都按预期改变了活动，并改善了目标患者的结果。然而，没有考虑到对其他活动和其他患者的更广泛的后果。第三个案例研究将侧重于向民众提供一周七天的全科医生服务的倡议。预计这将增加对全科医生服务的使用，并改善患者的便利性。还希望这将改善人们的健康，并减少因相对较小的投诉而前往急诊室就诊的情况，而这些投诉将由全科医生更好地处理。然而，这些改变的整体影响将视乎周末是否会导致一周内普通科医生的使用量减少、急症室需求减少的幅度、病情较严重而继续前往急症室求诊的病人的利益，以及补偿普通科医生在非工作时间开放的费用。我们将使用我们的溢出框架来估计这些更广泛的后果，并对扩大获得GP服务的机会进行总体评估。我们将重新审视这些政策变化中的每一个，并检查它们是否产生了溢出效应。我们将考虑这些溢出效应如何影响这些政策变化的整体成本和收益。在第三个也是最后一个工作方案中，我们将制定结构化的方法指导，以评估医疗服务的各种变化。我们将与一个包括决策者、医疗保健专业人员和学术专家在内的项目咨询小组合作，以确定溢出的可能性，开发方法，并确保指导全面、权威和用户友好。这项工作将提供一种一致的方法来评估改变为某些患者组织卫生和社会护理服务的方式对所有患者的更广泛影响。我们将在三个重要的政策变更上演示这些方法，并研究考虑溢出如何影响服务变更的设计以及评估这些变更的方式。我们将在整个项目中与决策者、专业人员和评估人员合作，制定指导意见，确保广泛认识到溢出效应的可能性，并将其纳入对护理服务组织和提供方式的变化的评估中。

项目成果

Additional file 2 of Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS)

政策实施中溢出效应识别和衡量框架的附加文件 2：有意的、非有意的、有针对性的、有针对性的、非有针对性的溢出效应（INTENTS）

• DOI: 10.6084/m9.figshare.19359621
• 发表时间: 2022
• 作者: Francetic I

Understanding Concordance in Health Behaviours among Couples: Evidence from the Bowel Cancer Screening Programme in England

了解夫妻健康行为的一致性：来自英国肠癌筛查计划的证据

• DOI: 10.1016/j.jebo.2022.08.001
• 发表时间: 2022
• 期刊: Journal of Economic Behavior & Organization
• 影响因子: 2.2
• 作者: Francetic I

Household bargaining over screening for bowel cancer: Evidence from the English Longitudinal Study of Ageing

家庭关于肠癌筛查的讨价还价：来自英国老龄化纵向研究的证据

• 发表时间: 2021
• 作者: Francetic I

Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS).

• DOI: 10.1186/s43058-022-00280-8
• 发表时间: 2022-03-14
• 期刊: Implementation science communications
• 作者: Francetic I;Meacock R;Elliott J;Kristensen SR;Britteon P;Lugo-Palacios DG;Wilson P;Sutton M
• 通讯作者: Sutton M

Additional file 3 of Framework for identification and measurement of spillover effects in policy implementation: intended non-intended targeted non-targeted spillovers (INTENTS)

政策实施中溢出效应识别和衡量框架的附加文件 3：有意的、非有意的、有针对性的、非有针对性的溢出效应（INTENTS）

• DOI: 10.6084/m9.figshare.19359624
• 发表时间: 2022
• 作者: Francetic I