A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England

Halvorsrud, Kristoffer; Flynn, Darren; Ford, Gary A.; McMeekin, Peter; Bhalla, Ajay; Balami, Joyce S.; Craig, Dawn; White, Phil

doi:10.1186/s12913-018-2922-3

Cited by 12 publications

(12 citation statements)

References 34 publications

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“…Informed by development work undertaken from our previous modelling [6, 12], we developed a discrete event simulation (DES) model to estimate the relative effects and cost-effectiveness that accrue from increasing the number of CSCs centres in England. Discrete Event Simulations are one of the most common modelling techniques and, its use is increasing in Health Technology Assessment (HTA) [13–16].…”

Section: Methodsmentioning

confidence: 99%

Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation

McMeekin

Flynn

Allen

et al. 2019

BMC Health Serv Res

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BackgroundWe have previously modelled that the optimal number of comprehensive stroke centres (CSC) providing endovascular thrombectomy (EVT) in England would be 30 (net 6 new centres). We now estimate the relative effectiveness and cost-effectiveness of increasing the number of centres from 24 to 30.MethodsWe constructed a discrete event simulation (DES) to estimate the effectiveness and lifetime cost-effectiveness (from a payer perspective) using 1 year’s incidence of stroke in England. 2000 iterations of the simulation were performed comparing baseline 24 centres to 30.ResultsOf 80,800 patients admitted to hospital with acute stroke/year, 21,740 would be affected by the service reconfiguration. The median time to treatment for eligible early presenters (< 270 min since onset) would reduce from 195 (IQR 155–249) to 165 (IQR 105–224) minutes. Our model predicts reconfiguration would mean an additional 33 independent patients (modified Rankin scale [mRS] 0–1) and 30 fewer dependent/dead patients (mRS 3–6) per year. The net addition of 6 centres generates 190 QALYs (95%CI − 6 to 399) and results in net savings to the healthcare system of £1,864,000/year (95% CI -1,204,000 to £5,017,000). The estimated budget impact was a saving of £980,000 in year 1 and £7.07 million in years 2 to 5.ConclusionChanges in acute stroke service configuration will produce clinical and cost benefits when the time taken for patients to receive treatment is reduced. Benefits are highly likely to be cost saving over 5 years before any capital investment above £8 million is required.

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Section: Methodsmentioning

confidence: 99%

Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation

McMeekin

Flynn

Allen

et al. 2019

BMC Health Serv Res

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“…In this study, three rounds were planned to ensure the process did not become too repetitive 20 since three rounds are sufficient to collect the needed information to reach a consensus 21 and provide the participants the opportunity to reflect on their responses to statements in the previous rounds. 22 Between the rounds, we provided controlled feedback to the participants and informed them of the opinions of their anonymous peers.…”

Section: Methodsmentioning

confidence: 99%

Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study

Ghaddar¹,

Matar²,

Noujaim³

et al. 2022

PPA

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Purpose In the absence of literature allowing for an evidence-based approach to therapeutic patient education (TPE) in Oropharyngeal Dysphagia (OD), this study aims to reach a consensus of experts on the content of a competency framework of an educational program for OD patients and their informal caregivers (ICGs). Methods We used the Delphi consensus-building method. Four categories of experts were recruited: 12 patients, 17 ICGs, 46 healthcare professionals (HCP) (experienced in OD, not necessarily certified in TPE), and 19 experts in TPE (trained individuals to set up and run TPE programs not necessarily HCPs). The content of the questionnaire of the first round (R) was established according to the result of a scoping review and the opinion of an expert committee. We carried out three rounds. In R1 and R2, we collected the opinions on the relevance (7-point Likert-type scale) and on comprehensiveness (YES/No question and asking participants to propose additional content). Participants were also invited to leave comments on each objective. In R3, we asked the participants to give their opinion about the relevance of the objectives again and asked them to rank the themes from highest to lowest priority. Results Objectives were considered relevant for all participants if they reached consensus when the interquartile (IQR) ≤ 1, and if the median indicated agreement (Mdn ≥ 6) (6= appropriate, 7 = totally appropriate). Following three rounds, the final content of the educational program is composed of 23 educational objectives organized in 13 themes with an agreement about relevance amongst all participants (Mdn ≥ 6; IQR ≤ 1). The comprehensiveness criterion received also a consensus (IQR ≤ 1). The participants ranked the theme “normal swallowing vs difficulty swallowing” as the highest priority. Conclusion This Delphi study resulted in a consensus, on the content of a competency framework of an educational program for OD patients and their ICGs. Further steps are needed to construct learning activities based on these objectives before testing their feasibility and efficacy.

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“…In line with other studies, consensus was defined as achieved if there was ≥75% agreement of all replies to a statement that fell within three categories (approve, quite or very strongly approve or disapprove) on the Likert scale [ 19 – 21 ]. The data was transferred and analysed using Excel and STATA 15/16.…”

Section: Methodsmentioning

confidence: 99%

Care priorities for stroke patients developing cognitive difficulties: a Delphi survey of UK professional views

Tang

Robinson

Exley

et al. 2020

BMC Health Serv Res

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Background: Post stroke cognitive difficulties are common but generally prioritised below other impairments. In the UK, clinical guidelines recommend a holistic review at six-months post-stroke including an assessment of cognitive function. In order to assist clinicians to provide better care for patients with post-stroke cognitive deficits and assist with service planning, our aim was to establish professional consensus on key actions at the six-month review. Methods: An electronic Delphi survey was developed with ten potential actions for clinicians to prioritise across five different clinical scenarios describing patients with cognitive difficulties. Scenarios varied in terms of age of the strokesurvivor, stroke severity and use of dementia risk assessment. A panel of professional volunteers was obtained through the British Association of Stroke Physicians and the UK National Stroke Nursing Forum. Results: Forty-five stroke clinicians completed round one, with 21 participants completing round two. Priorities consistently supported by professionals included access to psychological services, screening for a mood disorder and ensuring multi-professional input. Direct access to specialist memory services was not generally supported unless a dementia risk assessment tool indicated that the individual was at high risk of dementia. Conclusions: Assessment of post-stroke cognitive deficits needs to be routinely considered during the six-month review. A formal risk assessment tool could be a way to streamline direct access to memory clinic services to ensure that individuals at-risk of dementia receive ongoing care.

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A Delphi study and ranking exercise to support commissioning services: future delivery of Thrombectomy services in England

Cited by 12 publications

References 34 publications

Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation

Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation

Consensus on the Objectives of an Educational Intervention for Patients with Oropharyngeal Dysphagia and Their Informal Caregivers: A Delphi Study

Care priorities for stroke patients developing cognitive difficulties: a Delphi survey of UK professional views

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