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Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service
OBJECTIVE: This research aims to evaluate the wider health system effects of the introduction of an intermediate-tier service for eye care. SETTING: This research employs the Minor Eye Conditions Scheme (MECS), an intermediate-tier eye care service introduced in two London boroughs, Lewisham and Lam...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Open
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541458/ https://www.ncbi.nlm.nih.gov/pubmed/28698317 http://dx.doi.org/10.1136/bmjopen-2016-014089 |
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author | Mason, Thomas Jones, Cheryl Sutton, Matt Konstantakopoulou, Evgenia Edgar, David F Harper, Robert A Birch, Stephen Lawrenson, John G |
author_facet | Mason, Thomas Jones, Cheryl Sutton, Matt Konstantakopoulou, Evgenia Edgar, David F Harper, Robert A Birch, Stephen Lawrenson, John G |
author_sort | Mason, Thomas |
collection | PubMed |
description | OBJECTIVE: This research aims to evaluate the wider health system effects of the introduction of an intermediate-tier service for eye care. SETTING: This research employs the Minor Eye Conditions Scheme (MECS), an intermediate-tier eye care service introduced in two London boroughs, Lewisham and Lambeth, in April 2013. DESIGN: Retrospective difference-in-differences analysis comparing changes over time in service use and costs between April 2011 and October 2014 in two commissioning areas that introduced an intermediate-tier service programme with changes in a neighbouring area that did not introduce the programme. DATA SOURCES: MECS audit data; unit costs for MECS visits; volumes of first and follow-up outpatient attendances to hospital ophthalmology; the national schedule of reference costs. MAIN OUTCOME MEASURES: Volumes and costs of patients treated. RESULTS: In one intervention area (Lewisham), general practitioner (GP) referrals to hospital ophthalmology decreased differentially by 75.2% (95% CI −0.918% to −0.587%) for first attendances, and by 40.3% for follow-ups (95% CI −0.489% to −0.316%). GP referrals to hospital ophthalmology decreased differentially by 30.2% (95% CI −0.468% to −0.137%) for first attendances in the other intervention area (Lambeth). Costs increased by 3.1% in the comparison area between 2011/2012 and 2013/2014. Over the same period, costs increased by less (2.5%) in one intervention area and fell by 13.8% in the other intervention area. CONCLUSIONS: Intermediate-tier services based in the community could potentially reduce volumes of patients referred to hospitals by GPs and provide replacement services at lower unit costs. |
format | Online Article Text |
id | pubmed-5541458 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BMJ Open |
record_format | MEDLINE/PubMed |
spelling | pubmed-55414582017-08-18 Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service Mason, Thomas Jones, Cheryl Sutton, Matt Konstantakopoulou, Evgenia Edgar, David F Harper, Robert A Birch, Stephen Lawrenson, John G BMJ Open Ophthalmology OBJECTIVE: This research aims to evaluate the wider health system effects of the introduction of an intermediate-tier service for eye care. SETTING: This research employs the Minor Eye Conditions Scheme (MECS), an intermediate-tier eye care service introduced in two London boroughs, Lewisham and Lambeth, in April 2013. DESIGN: Retrospective difference-in-differences analysis comparing changes over time in service use and costs between April 2011 and October 2014 in two commissioning areas that introduced an intermediate-tier service programme with changes in a neighbouring area that did not introduce the programme. DATA SOURCES: MECS audit data; unit costs for MECS visits; volumes of first and follow-up outpatient attendances to hospital ophthalmology; the national schedule of reference costs. MAIN OUTCOME MEASURES: Volumes and costs of patients treated. RESULTS: In one intervention area (Lewisham), general practitioner (GP) referrals to hospital ophthalmology decreased differentially by 75.2% (95% CI −0.918% to −0.587%) for first attendances, and by 40.3% for follow-ups (95% CI −0.489% to −0.316%). GP referrals to hospital ophthalmology decreased differentially by 30.2% (95% CI −0.468% to −0.137%) for first attendances in the other intervention area (Lambeth). Costs increased by 3.1% in the comparison area between 2011/2012 and 2013/2014. Over the same period, costs increased by less (2.5%) in one intervention area and fell by 13.8% in the other intervention area. CONCLUSIONS: Intermediate-tier services based in the community could potentially reduce volumes of patients referred to hospitals by GPs and provide replacement services at lower unit costs. BMJ Open 2017-07-10 /pmc/articles/PMC5541458/ /pubmed/28698317 http://dx.doi.org/10.1136/bmjopen-2016-014089 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Ophthalmology Mason, Thomas Jones, Cheryl Sutton, Matt Konstantakopoulou, Evgenia Edgar, David F Harper, Robert A Birch, Stephen Lawrenson, John G Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service |
title | Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service |
title_full | Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service |
title_fullStr | Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service |
title_full_unstemmed | Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service |
title_short | Retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service |
title_sort | retrospective economic analysis of the transfer of services from hospitals to the community: an application to an enhanced eye care service |
topic | Ophthalmology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541458/ https://www.ncbi.nlm.nih.gov/pubmed/28698317 http://dx.doi.org/10.1136/bmjopen-2016-014089 |
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