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Workshop C
Health Economics Evidence
Review & MCDA Process:
Newcastle University
Professor Luke Vale
Jo Dinning
Jenni Hisl...
Summary of evidence
• Systematic reviews/meta analysis
• UK based single studies ( recently published)
• 4 families of PSC...
Engaging people in keeping
healthy/supported self management
Intervention Area ( number of studies)
Community led interven...
Engaging people in keeping healthy
Intervention Area ( no of studies)
Behavioural interventions/behaviour
change (includin...
Shared Decision Making and
Involving Families and Carers
Intervention Area ( no of studies)
Care Management Smoking Cessat...
Supporting Self-Management #1
Intervention Area ( no of studies)
Rehabilitation/Early Discharge support
interventions
CHD ...
Supporting Self-Management #2
Intervention Area ( no of studies)
Information Arthritis (1), Asthma (3), Cancer (4), Genera...
Supporting Self-Management #3
Intervention Area ( no of studies)
Self-
management/monitoring/efficacy
Anticoagulation (6),...
Typically used outcome measures
Types of outcomes
· Disease specific scales
· Self reported generic physical health, menta...
UK Based Single Studies
Heart Failure Expressive writing
1
Heart Failure Self management 1
Heart Failure Education and reh...
Supported Self Management
Study Type of
person
centred care
Area Outcome Outcome Outcome
Dale JR, Williams SM,
Bowyer V. W...
Engaging People in Keeping Healthy
Study Type of
person
centred care
Area Outcome Outcome Outcome
Bravata DM, Smith-
Spang...
Shared Decision Making
Study Type of
person
centred care
Area Outcome Outcome Outcome
Forster A, Brown L, Smith
J, House A...
Involving Families and Carers
Study Type of
person
centred care
Area Outcome Outcome Outcome
Cooper C, Mukadam N,
Katona C...
MCDA process to help inform
intervention types
• Assessing options against multiple criteria
• Can be conflicting objectiv...
Potential criteria for intervention
selection
• Quality of evidence ( SRs/Meta analysis)
• Quantity of evidence
• Setting?...
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Realising the Value Stakeholder Event - Workshop:Prioritising our ‘long list’ of person and community centred approaches

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Workshop C - Prioritising our ‘long list’ of person and community centred approaches
Hear an update from Newcastle’s Health Economics team on interim findings from their evidence review of person and community centred care before participating in discussions to help develop criteria for prioritising which approaches the rest of the programme will ‘deep dive’ into. Criteria will be be evidence driven but also take into account ensuring a good mix of approaches and practice / grey evidence submitted to the consortium.

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Realising the Value Stakeholder Event - Workshop:Prioritising our ‘long list’ of person and community centred approaches

  1. 1. Workshop C Health Economics Evidence Review & MCDA Process: Newcastle University Professor Luke Vale Jo Dinning Jenni Hislop
  2. 2. Summary of evidence • Systematic reviews/meta analysis • UK based single studies ( recently published) • 4 families of PSC interventions: Engaging people in keeping healthy Share Decision Making (SDM) Supported self management Involving families and carers
  3. 3. Engaging people in keeping healthy/supported self management Intervention Area ( number of studies) Community led interventions CVD (1), Housing (1), Maternal/Neonatal care (1), Physical Activity (1), Public Health (1), Smoking Cessation (2) Community health workers TB (1) Education Arthritis (8), Cancer (1), CHD (1), Chronic Conditions (1), Diabetes (12), Kidney Disease (2), Low Back Pain (4), Mental Health (2), Orthopaedics (2), Screening (2), Smoking Cessation (2), NHS staff (1), Stroke (1) Education and IT based peer support Chronic conditions (1) Education, self management, behavioural interventions Public Health (2), Sexual Health (2), Smoking Cessation (3) School/workbased interventions Alcohol Misuse (1), chronic conditions (1), CVD (1), Mental Health (1), obesity/weight management (9), Physical Activity (2), Public Health (9), Smoking Cessation (1)
  4. 4. Engaging people in keeping healthy Intervention Area ( no of studies) Behavioural interventions/behaviour change (including IT-based interventions) CVD (3), General (1), Housing (1), Pain/Disability (1), Physical Activity (9), Public Health (6), Sexual Health (3) Community engagement in schools Obesity/Weight Management (2) Educational & Behavioural Interventions Asthma (4), Diabetes (5), Epilepsy/Neurological Disorders (1), Environmental interventions/policies Public Health (2), Smoking Cessation (2) Mass media interventions Cancer (1), General (2), Housing (1), Physical Activity (1), Screening (1), Smoking Cessation (1) Self-management behavioural interventions Housing (6), Hypertension (1), Kidney Disease (1), Learning Disabilities (2), Low Back Pain (3), Maternal/Neonatal Care (1), Mental Health (1), obesity/weight management (9), Physical Activity (8), Public Health (3), Smoking Cessation (1) Smoking Cessation Interventions Mental Health (1), Smoking Cessation (4) Suicide Prevention Programmes Mental Health (1) Volunteering Diabetes (1), General (1)
  5. 5. Shared Decision Making and Involving Families and Carers Intervention Area ( no of studies) Care Management Smoking Cessation (3) Communication Advanced/Serious Illness (1), Cancer (5), Childhood Vaccinations (1), General (4), Geriatrics/Paediatrics (1), Screening (1), Stroke (7) Decision aids/support tools Cancer (1), General (3), Genetics (2), Maternal/Neonatal Care (1), Musculoskeletal Health (1), Surgery (1), Screening (3) Shared Decision Making (General) Advanced/Serious Illness (1), Breastfeeding (1), Emergency Medicine (1), Gynaecology (1), HIV (1), NHS Staff (1) Involving Families and Carers Advanced/Serious Illness (1), Alcohol Misuse (1), Dementia (1), Diabetes (1), Geriatrics/Paediatrics (2), Obesity/Weight Management (3), Physical Activity (1),
  6. 6. Supporting Self-Management #1 Intervention Area ( no of studies) Rehabilitation/Early Discharge support interventions CHD (1), Low back pain (1), Pain/Disability (1), Stroke (1) Care management Advanced/Serious Illness (1), Breastfeeding (2), Cardiac Rehabilitation (1), CVD (1), Dementia (1), Diabetes (3), Epilepsy/Neuro (1), General (4), Geriatrics/Paediatrics (1), Hypertension (1), Mental Health (1), Palliative Care (1), Physical Activity (1), Public Health (2), Screening (2), Sexual Health (4) Community-based interventions COPD (1), General (2), Geriatrics/Paediatrics (2) Education/Coaching interventions Asthma (8), CHD (1), COPD (4), Epilepsy/Neuro (4), General (2), MSK (2), Obesity/Weight Management (4), Fall Prevention Programmes Geriatrics/Paediatrics (3) Group Therapy Dementia (1) Health Literacy COPD (4), General (4), Geriatrics/Paediatrics (3), MSK (1)
  7. 7. Supporting Self-Management #2 Intervention Area ( no of studies) Information Arthritis (1), Asthma (3), Cancer (4), General (2), Maternal/Neonatal Care (1), Mental Health (1), Rehabilitation (1), Physical Activity (2), Smoking Cessation (1), NHS Staff (1), Stroke (1) IT-based interventions Asthma (1), Anxiety/Depression (2), Cancer (1), Chronic Conditions (5), COPD (1), Diabetes (7), General (13), Geriatrics/Paediatrics (2), Mental Health (1), Obesity/Weight Management (4), Public Health (3), Sexual Health (1), Smoking Cessation (1), NHS Staff (1) Lay workers Maternal/Neonatal Care (2) Mobile phone interventions General (1), Chronic Conditions (2), Diabetes (1) Occupational Therapy Dementia (1), Occupational Therapy (1), Stroke (2) Patient adherence/prompts Blood Donation (1), Childhood vaccinations (1), Chronic Conditions (2), COPD (1), CVD (1), Diabetes (2), Kidney Disease (1), Mental Health (5), Public Health (1)Screening (7), Sexual Health (1) Patient-centred approaches Chronic Conditions (1)
  8. 8. Supporting Self-Management #3 Intervention Area ( no of studies) Self- management/monitoring/efficacy Anticoagulation (6), Anxiety/Depression (5), ENT (1), Cancer (3), Cardiac Rehab (1), Chronic Conditions (4), COPD (1), CVD (4), Diabetes (15), General (3), Heart Failure (2), Hypertension (2), IBS (1), Mental Health (6), obesity/weight management (3), Pain/Disability (1), Physical disability (1), Smoking Cessation (3), Stroke (2) Peer support Breastfeeding (2), Cancer (2), Cardiac Rehab (1), CHD (1), COPD (2), Maternal/Neonatal Care (1), Mental Health (8), Pain/Disability (1), Public Health (2) Psychological interventions Asthma (3), Cancer (3), Diabetes (2), Epilepsy/Neuro (2), Gynaecology (1), IBS (1), Low Back Pain (1), MSK (3), Obesity/Weight Management (2), Oral Health (1), Smoking Cessation (3) Telemedicine Asthma (2), CHD (1), Chronic Conditions (3), COPD (1), CVD (1), Diabetes (2), General (3), Geriatrics/Paediatrics (1), Heart Failure (2), Telephone based interventions Maternal/Neonatal Care (1), Obesity/Weight Management (1), Public Health (1), Smoking Cessation (2)
  9. 9. Typically used outcome measures Types of outcomes · Disease specific scales · Self reported generic physical health, mental health, well being, quality of life, activation scales scales · Health indicators /health events · Behaviour change measures- e.g. time in physical activity, smoking rates, attendance, adherence · Use of formal care resources · Patient satisfaction · Self efficacy scales · Cost effectiveness
  10. 10. UK Based Single Studies Heart Failure Expressive writing 1 Heart Failure Self management 1 Heart Failure Education and rehabilitation 1 HIV Singing 1 Housing/Built Environment/Neighbour hood regeneration Behaviour change 1 Low back pain Education, self management- behavioural interventions 2 Low back pain Self management 1 Mental health Family interventions 1 Mental health Work based social support 3 Mental health Social capital defined by generalised trust 1 Mental health Arts based projects 1 Mental health CBT 1 MS Self management 1 Oral Health Social Capital: Social participation and Volunteering 1 Orthopaedics lifestyle interventions 1 Pain/Disability Telephone CBT 1 Pain/Disability Self management 1 Public Health Community development activities 2 Public Health Social capital 3 Public Health Community engagement 1 Public Health Community centre activities 1 Public Health Social prescribing 1 Smoking cessation social capital measured by trust and community participation 1 Smoking cessation Education and self management 1 Urology Self management 2 Anxiety/Depression Third sector self help clinic 1 Anxiety/Depression Self management 1 Arthritis Self management 2 Arthritis Self management and education 1 Asthma Self management 2 Asthma Targeted care/ telephone triage 1 Cancer Community lay health champions 1 CHD Community led pharmacists 2 CHD Education and Self management 2 CHD Lay health mentors 1 Chronic conditions Social networks 1 Chronic conditions Group self management 1 Chronic conditions Lay led self management 1 COPD Rehabilitation 2 CVD Lay trainers 1 Diabetes Education and self management 3 Diabetes Trained GP practices in self management support 1 Diabetes Community champions 1 Diabetes Adherence and behaviour change 1 Diabetes (adolescents) Self management 2 Diabetes (adolescents) Education and self management 1 General Lay and clinician led self management training for clinicians to improve self management in patients 1 General Telehealth 1 Heart Failure Lay led mentoring groups 1
  11. 11. Supported Self Management Study Type of person centred care Area Outcome Outcome Outcome Dale JR, Williams SM, Bowyer V. What is the effect of peer support on diabetes outcomes in adults? A systematic review. Diabet Med 2012;29(11):1361- 1377. peer support Diabetes Depression Perceived social support Self efficacy Dennis CL,.Kingston D. A systematic review of telephone support for women during pregnancy and the early postpartum period. J Obstet Gynecol Neonatal Nurs 2008;37(3):301-314. Telephone based support from professional Maternal and neonatal morbidity and mortality Smoking rates Birth weight Duration of breast feeding
  12. 12. Engaging People in Keeping Healthy Study Type of person centred care Area Outcome Outcome Outcome Bravata DM, Smith- Spangler C, Sundaram V, Gienger AL, Lin N, Lewis R, Stave CD, Olkin I, Sirard JR. Using pedometers to increase physical activity and improve health: a systematic review. JAMA 2007;298(19):2296- 2304. Pedometer Use Physical Activity BMI Steps per day Systolic blood pressure Cahill K, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Sys Rev 2014(26;2): CD003440 Group Therapy Smoking cessation in the workplace Smoking cessation rates
  13. 13. Shared Decision Making Study Type of person centred care Area Outcome Outcome Outcome Forster A, Brown L, Smith J, House A, Knapp P, Wright JJ, Young J et al (2012). ‘Information provision for stroke patients and their caregivers (Cochrane review).’ The Cochrane Library Information provision strategies Stroke Patient & carer knowledge depression satisfaction Evans R, Edwards A, Brett J et al. Reduction in uptake of PSA tests following decision aids: systematic review of current aids and their evaluations. Patient Educ Couns 2005;58(1):13-26. Decison Aids Screening Probability of PSA testing Knowledge
  14. 14. Involving Families and Carers Study Type of person centred care Area Outcome Outcome Outcome Cooper C, Mukadam N, Katona C, Lyketsos CG, Ames D, Rabins P, et al. Systematic review of the effectiveness of non- pharmacological interventions to improve quality of life of people with dementia. Int Psychogeriatr 2012;24:856–70 Family based interventions: e.g. patient and carer coping strategies Dementia Patient HRQoL Boyd M, Lasserson TJ, McKean MC, Gibson PG, Ducharme FM, Haby M. Interventions for educating children who are at risk of asthma- related emergency department attendance. Cochrane Database Syst Rev 2009;2:CD001290 Education for children and their carers Asthma A&E visits GP visits Hospital admissions Medication use FEV1 PEF Patient quality of life
  15. 15. MCDA process to help inform intervention types • Assessing options against multiple criteria • Can be conflicting objectives • Weighting and scoring criteria • Uses different data sources • Combines hard data & value judgements • East to use – scorecard/tabular format • Today….
  16. 16. Potential criteria for intervention selection • Quality of evidence ( SRs/Meta analysis) • Quantity of evidence • Setting? Non NHS? • Extent of community/lay interventions • Practice coverage • Breadth of interventions ( spread)

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