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Health economic skills for advancing health policy: capturing effects of prevention and intervention beyond traditional health services

推进卫生政策的卫生经济技能：捕捉传统卫生服务之外的预防和干预效果

基本信息

批准号：
MR/T027517/1
负责人：
Jonathan Stokes
金额：
$ 38.01万
依托单位：
University of Manchester
依托单位国家：
英国
项目类别：
Fellowship
财政年份：
2019
资助国家：
英国
起止时间：
2019 至无数据
项目状态：
已结题

来源：
https://gtr.ukri.org/projects?ref=MR%2FT027517%2F1
关键词：
Health economic skills advancing health

项目摘要

Health systems around the world are lagging behind the needs of their patients. Larger, older populations with increasing numbers of long-term conditions are increasing demand on health services. Until recently, services have tried to target resources on those at highest risk of emergency care. However, this approach has not worked well. More recently, services have focused on prevention as a potential means of reducing demand. The NHS Long Term Plan advocates prevention, working beyond traditional health services (e.g. social work and social prescribing) and using policy levers such as new ways of financing and organising services. We need research to provide evidence for these new approaches, particularly for patients with multimorbidity who currently experience the worst outcomes.I will:1) Examine the relative effects of NHS/Local Authority public spending on prevention and priority outcomes; It has been proposed that only around 10% of health outcomes depend on access to traditional medical services. During austerity, the NHS budget has been relatively protected, but there have been substantial cuts in some Local Authorities. Building on work by colleagues and others, I will use publically available data on public spending and work out the relative benefits of spending in the health care system, and spending on other services that can affect health. This will help decisions about where to spend public money.2) Map Vanguard new care models using my published framework and examine what combination of interventions works to affect specific outcomes; From 2015, 50 Vanguard new care models were funded by NHS England. All had roughly the same aims, but with some variation in approach. I will use my previous multimorbidity framework to map interventions in Vanguards. I will then see if different types of interventions in a Vanguard lead to particular outcomes. This will build on work at UoM through the Vanguard National Programme Evaluation. Furthermore, while the whole of England has developed Sustainability and Transformation Plans (STPs) (2016), only 14/44 STPs have taken the additional step (in 2018) of forming an integrated care system (a.k.a accountable care organisation, ACO). These organisations will have greater financial and operational freedoms. I will examine the effects on health, experience and cost outcomes of this extra organisational integration over and above STP formation. I will use individual-level outcomes from hospital episode statistics (HES) to measure activity and costs, but also the GP Patient Survey (GPPS) which records patient quality of life and patient experience. The results will help commissioners decide what mix of interventions to provide to get defined outcomes. 3) Build a model to examine and simulate within-system effects of new policy changes Salford has been one of the first health systems in England to trial the ACO approach, and is a relative leader in integrated care policy in England. I will work with local linked data (held at UoM), the Salford integrated care record, to begin to build a microsimulation model to examine within-geographical system effects on the impact of future policy decisions, and develop the model as a tool to inform policymakers. A recent vignette commissioned by the MRC Methodology Research Programme Advisory Group highlighted the underuse of this type of modelling applied to health service delivery, primarily due to lack of stakeholder engagement. It also focused on "modelling flows and interactions between organisations and sectors within health and social care" as an area where development of methods has potential. I will aim to address these gaps. Results will inform local policy direction and roll-out. Research visits throughout the project and yearly stakeholder engagement meetings will keep the project policy and clinically relevant increasing dissemination and impact.

世界各地的卫生系统都落后于患者的需求。老年人口增多，长期患病人数增加，对保健服务的需求也在增加。直到最近，服务部门一直试图将资源集中在那些紧急护理风险最高的人身上。然而，这一做法并不奏效。最近，服务的重点是预防，以此作为减少需求的潜在手段。国民保健服务长期计划倡导预防，超越传统的保健服务（如社会工作和社会处方），并利用政策杠杆，如新的融资和组织服务的方式。我们需要研究来为这些新方法提供证据，特别是对于目前经历最糟糕结果的多发性硬化症患者，我将：1）检查NHS/地方当局公共支出对预防和优先结果的相对影响;有人提出，只有大约10%的健康结果取决于获得传统医疗服务。在紧缩期间，国民保健服务的预算得到了相对的保护，但一些地方当局的预算却大幅削减。在同事和其他人的工作基础上，我将使用有关公共支出的可用数据，计算出医疗保健系统支出的相对效益，以及其他可能影响健康的服务支出。这将有助于决定在哪里花公共资金。2）使用我发布的框架绘制先锋新的护理模式，并研究干预措施的组合如何影响特定的结果;从2015年起，50个先锋新的护理模式由NHS英格兰资助。他们的目标大致相同，但在方法上有所不同。我将使用我以前的多形态框架来绘制先锋队的干预措施。然后，我将看看先锋中不同类型的干预是否会导致特定的结果。这将通过“先锋国家方案评价”，在乌姆兰加大学的工作基础上进一步开展。此外，虽然整个英格兰都制定了可持续发展和转型计划（STPs）（2016年），但只有14/44的STPs采取了额外的步骤（2018年），形成了一个综合护理系统（又称责任护理组织，ACO）。这些组织将拥有更大的财务和运营自由。我将研究的影响，健康，经验和成本的结果，这种额外的组织整合以上STP的形成。我将使用来自医院事件统计（HES）的个人水平结果来衡量活动和成本，但也使用记录患者生活质量和患者体验的GP患者调查（GPPS）。调查结果将有助于委员们决定提供何种干预组合，以获得明确的结果。 3)建立一个模型来检查和模拟新政策变化的系统内影响索尔福德一直是英格兰第一个试行ACO方法的卫生系统之一，也是英格兰综合护理政策的相对领导者。我将与当地的关联数据（在密歇根大学举行），索尔福德综合护理记录，开始建立一个微观模拟模型，以研究地理系统内的影响，对未来的政策决定的影响，并开发该模型作为一种工具，告知决策者。MRC方法研究方案咨询小组最近委托的一个小插曲强调了这类适用于卫生服务提供的建模未得到充分利用，主要是由于缺乏利益攸关方的参与。它还侧重于“卫生和社会保健内组织和部门之间的流动和相互作用建模”，作为方法开发具有潜力的领域。我将致力于弥补这些差距。结果将为地方政策方向和推出提供信息。整个项目期间的研究访问和每年的利益相关者参与会议将保持项目政策和临床相关性，增加传播和影响。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

A typology of integrated care policies in the care home sector: A policy document analysis.

DOI：
10.3389/fpubh.2023.943351
发表时间：
2023
期刊：
FRONTIERS IN PUBLIC HEALTH
影响因子：
5.2
作者：
Simpson, Glenn;Entwistle, Charlotte;Short, Andrea D.;Morciano, Marcello;Stokes, Jonathan
通讯作者：
Stokes, Jonathan

Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study.