evaluate cost-effectiveness studies of PR programmes worldwide. Methods A systematic review was conducted in accordance with PRISMA guidelines. A thorough literature search strategy was employed across PubMed, the Cost-Effectiveness Analysis Registry (CEA Registry), National Health Service Economic Evaluation Database (NHS EED), Physiotherapy Evidence Database (PEDro) and Google Scholar from inception to October 2019 for studies comparing the cost-effectiveness of PR programmes with that of usual care. Included studies had to meet the Cochrane definition of PR; at minimum, exercise training for at least 4 weeks. Cost-effectiveness measures included cost per quality-adjusted life year (QALY), cost per clinically significant outcome, incremental cost-effectiveness ratio (ICER) and/or cost savings to the healthcare system involved. These findings were then narratively synthesised. Results 8 studies consisting of 1437 patients were included. Settings for the PR programmes were UK, Ireland, France, Netherlands, Canada and Australia. 7 studies included COPD patients only. 1 study assessing the uncertainties around the cost and outcome found that the cost per QALY was below £17000, below the willingness to pay threshold suggested by the NICE. Evidence from the studies suggests that PR is cost-effective with savings for the healthcare provider involved. Conclusion PR is a cost-effective intervention with potential savings for the service providers. Future studies should examine whether cost-effectiveness varies with the age of patients undergoing PR.
Introduction Medical certificate cause of death form (MCCD) completion is seen as a daunting process, especially for junior medical staff. Death certification is an expectation of all doctors, as set by the general medical council. Quick completion of medical examiner referral forms (MERFs) and MCCDs positively impacts on patients' families. This requires confidence and knowledge in certifying death, which this quality improvement project aims to assess and improve. Method We brainstormed our stakeholders, created a driver diagram and SMART aims: 1) For 100% and 75% of MCCD's to be completed within five and three days from death, respectively and 2) To improve junior doctor confidence in the death certification process at Manchester Foundation Trust (MFT). We collected qualitative data through an anonymized survey and quantitative data including time from death to MERF and MCCD completion from December 2020 -March 2021. Our interventions included teaching incoming junior doctors and creating visual aids to display in key clinical areas. The above data was re-audited from September -October 2021. Results Almost all of MCCDs were completed within five days, 95% (129/136), versus pre-intervention findings of 98% (128/133). The number of MCCDs completed within three days improved from 51% (68/133) pre-intervention to 66% (90/136) post-intervention. Confidence in completing MCCDs improved from 0% to 33%. MCCD completion times varied widely and there were a significant number of patients in whom it was not within the legal requirement of five days. Despite education and visual aids, junior doctors at MFT feel that there should be more senior support when completing MCCDs. There needs to be ongoing education around death certification including annual face-to-face teaching sessions for incoming junior doctors. Conclusion Junior doctors lack confidence and insight into the responsibility surrounding MCCD completion at MFT. This needs to be addressed through ongoing focus and education.
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