Qualitative research to inform economic modelling: a case study in older people’s views on implementing the NICE falls prevention guideline

Abstract

Background High prevalence of falls among older persons makes falls prevention a public health priority. Yet community-based falls prevention face complexity in implementation and any commissioning strategy should be subject to economic evaluation to ensure cost-effective use of healthcare resources. The study aims to capture the views of older people on implementing the National Institute for Health and Care Excellence (NICE) guideline on community-based falls prevention and explore how the qualitative data can be used to inform commissioning strategies and conceptual modelling of falls prevention economic evaluation in the local area of Sheffield. Methods Focus group and interview participants (n = 27) were recruited from Sheffield, England, and comprised falls prevention service users and eligible non-users of varying falls risks. Topics concerned key components of the NICE-recommended falls prevention pathway, including falls risk screening, multifactorial risk assessment and treatment uptake and adherence. Views on other topics concerning falls prevention were also invited. Framework analysis was applied for data analysis, involving data familiarisation, identifying themes, indexing, charting and mapping and interpretation. The qualitative data were mapped to three frameworks: (1) facilitators and barriers to implementing the NICE-recommended pathway and contextual factors; (2) intervention-related causal mechanisms for formulating commissioning strategies spanning context, priority setting, need, supply and demand; and (3) methodological and evaluative challenges for public health economic modelling. Results Two cross-component factors were identified: health motives of older persons; and professional competence. Participants highlighted the need for intersectoral approaches and prioritising the vulnerable groups. The local commissioning strategy should consider the socioeconomic, linguistic, geographical, legal and cultural contexts, priority setting challenges, supply-side mechanisms spanning provider, organisation, funding and policy (including intersectoral) and health and non-health demand motives. Methodological and evaluative challenges identified included: incorporating non-health outcomes and societal intervention costs; considering dynamic complexity; considering social determinants of health; and conducting equity analyses. Conclusions Holistic qualitative research can inform how commissioned falls prevention pathways can be feasible and effective. Qualitative data can inform commissioning strategies and conceptual modelling for economic evaluations of falls prevention and other geriatric interventions. This would improve the structural validity of quantitative models used to inform geriatric public health policies.

Economic model of community-based falls prevention: seeking methodological solutions in evaluating the efficiency and equity of UK guideline recommendations

“…[ 64 ]. The conceptual model accounted for variables of key equity relevance [ 42 ], and not those of no relevance. In this scenario, the use of unadjusted INHBs is likely justified.…”

“…Conceptualisation was conducted in Sheffield, seen here as representative of urban UK local health economies. It involved consultations of local commissioners and clinical professionals, qualitative research with local older persons [ 42 ], literature reviews, consultation of modelling experts, and primary data analyses. Phase (D) is reported below.…”

“…The target population was community-dwelling adults aged 60 + . This covers a broader age range than NICE CG161 targeting those aged 65 + and was motivated by local commissioners’ emphasis on early/primary prevention and local older persons’ awareness of falls risk before the age of 65 [ 42 ]. Commissioners oversee a geographical jurisdiction rather than a specific cohort; hence, the target population included cohorts who newly turn age 60 during simulation.…”

Economic models of community-based falls prevention: a systematic review with subsequent commissioning and methodological recommendations

“…This should involve active collaboration with local stakeholders in interpreting the model evidence and even adapting an existing model to maximise its local relevance [31]. Frameworks such as the Context and Implementation of Complex Interventions (CICI) can systematically examine the influence of local context (e.g., regulation/policy on age-based targeting [99]) and supply conditions (e.g., capacity constraints) on HTA outcomes and thereby assist the assessment of transferability [100,101]. The subgroup delineator of equity relevance would also be locally specific, thus affecting the generalisability of the health equity impacts of previously modelled interventions.…”

Systematic review and critical methodological appraisal of community-based falls prevention economic models

“…Hence, the falls prevention strategy should consider social inequities of health across population subgroups. Third, falls prevention access is highly dependent upon older persons’ motives and professional behaviour [ 45 – 47 ] and therefore face significant implementation issues [ 48 ]. These features of falls prevention suggest that the aforementioned challenges to public health economic evaluation apply equally to falls prevention economic evaluations, particularly falls prevention economic models.…”