||A Systematic Review of Clinical Outcome and Cost Effectiveness Comparing a Policy of Triage and Direct Transfer to Specialist Care Centres with Delivery to the Nearest Local Hospital.
||National Institute for Health Research Service Delivery and Organisation (NIHR SDO)
- Dr Alastair Pickering, School of Health & Related Research (ScHARR), University of Sheffield (Chief Investigator)
- Professor Jon Nicholl, School of Health & Related Research (ScHARR), University of Sheffield
- Professor Suzanne Mason, School of Health & Related Research (ScHARR), University of Sheffield
- Fiona Campbell, School of Health & Related Research (ScHARR), University of Sheffield
- Rosemary Harper, School of Health & Related Research (ScHARR), University of Sheffield
- Mike Holmes, School of Health & Related Research (ScHARR), University of Sheffield
- Professor Niroshan Siriwardena, School of Health & Social Care, University of Lincoln
- Professor Matt Stevenson, School of Health & Related Research (ScHARR), University of Sheffield.
||To enable evidence-based policy decisions about the reconfiguration of hospital and pre-hospital services; specifically on the clinical and cost effectiveness of bypassing local hospitals to transfer emergency patients directly to specialist care centres.
- Perform a systematic review of the evidence for a policy of triage and direct transfer to specialist care centres in three clinical conditions. These are: Multi-system trauma (classed as major/severe), Stroke and Head injury
- Identify previous relevant reviews that compare directly the clinical effectiveness of different transfer strategies
- Identify current recommendations for best practice for acute management of the three clinical presentations specified
- Develop evidence-based models for each decision-making strategy with assessment of both clinical and cost-effectiveness, including potential secondary effects of service reconfiguration
- Provide recommendations for areas of primary research.
- Systematic Review including randomised and non-randomised controlled studies, published and unpublished grey literature to identify relevant studies
- Decision Analysis Modelling to identify strategies that are both clinically and cost effective for each of the conditions under review..
|Outcomes explored in the systematic review
- Mortality measured at pre-hospital; seven days; and 30 days post-event
- Morbidity measured using validated outcome measures including: Barthel Index; Glasgow Outcome Scale; Medical Outcomes Study Short Form (SF36); and Nottingham Health Profile
- Length of stay
- Time on intensive care
- Patient satisfaction, using tools such as the Picker Patient Experience Questionnaire or Patient Satisfaction Questionnaire
- Impact on existing service provision, using previous health impact assessments and identification of any quantifiable data, secondary effects on local catchment area patients
- Costs and utilities data specific to identify incremental costs per Quality Adjusted Life Year (QALY).
- Publication of the systematic review in peer-reviewed journals
- Oral and poster presentations at national and international conferences. A priority would be for a published report being demonstrated to local policy makers within the Strategic Health Authority for feedback and comments.
||Significant findings would be highlighted to the Department of Health as potential suggestions for changes in policy and practice.