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Protocol for the health economic evaluation of increasing the weekend specialist to patient ratio in hospitals in England
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Watson, Samuel I., Chen, Y-F., Bion, Julian F, Aldridge, Cassie P., Girling, Alan and Lilford, Richard (2018) Protocol for the health economic evaluation of increasing the weekend specialist to patient ratio in hospitals in England. BMJ Open, 8 (2). e015561. doi:10.1136/bmjopen-2016-015561
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WRAP-protocol-health-economic-evaluation-increasing-weekend-specialist-Lilford-2018.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons: Attribution-Noncommercial 4.0. Download (1066Kb) | Preview |
Official URL: http://dx.doi.org/10.1136/bmjopen-2016-015561
Abstract
Introduction: This protocol concerns the evaluation of increased specialist staffing at weekends in hospitals in England. Seven-day health services are a key policy for the UK government and other health systems trying to improve use of infrastructure and resources. A particular motivation for the 7-day policy has been the observed increase in the risk of death associated with weekend admission, which has been attributed to fewer hospital specialists being available at weekends. However, the causes of the weekend effect have not been adequately characterised; many of the excess deaths associated with the ‘weekend effect’ may not be preventable, and the presumed benefits of improved specialist cover might be offset by the cost of implementation.
Methods/design: The Bayesian-founded method we propose will consist of four major steps. First, the development of a qualitative causal model. Specialist presence can affect multiple, interacting causal processes. One or more models will be developed from the results of an expert elicitation workshop and probabilities elicited for each model and relevant model parameters. Second, systematic review of the literature. The model from the first step will provide search limits for a review to identify relevant studies. Third, a statistical model for the effects of specialist presence on care quality and patient outcomes. Fourth, valuation of outcomes. The expected net benefits of different levels of specialist intensity will then be evaluated with respect to the posterior distributions of the parameters.
| Item Type: | Journal Article | |||||||||
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| Subjects: | R Medicine > R Medicine (General) | |||||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Hospital care -- Great Britain, Medical personnel -- Supply and demand -- Great Britain, Medicine -- Specialties and specialists -- Great Britain, Bayesian statistical decision theory | |||||||||
| Journal or Publication Title: | BMJ Open | |||||||||
| Publisher: | BMJ | |||||||||
| ISSN: | 2044-6055 | |||||||||
| Official Date: | 23 February 2018 | |||||||||
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| Volume: | 8 | |||||||||
| Number: | 2 | |||||||||
| Article Number: | e015561 | |||||||||
| DOI: | 10.1136/bmjopen-2016-015561 | |||||||||
| Status: | Peer Reviewed | |||||||||
| Publication Status: | Published | |||||||||
| Access rights to Published version: | Open Access | |||||||||
| RIOXX Funder/Project Grant: |
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