Vascular services across the NHS are being redesigned without knowing which changes actually improve patient outcomes or deliver value for money. This programme builds the measurement tools needed to fix that. The problem is stark. Vascular surgery has fragmented into new sub-specialties while treatments for conditions like aneurysms, blocked leg arteries, and stroke-causing carotid disease have changed rapidly. Commissioners must reconfigure services—centralising some, keeping others local—but lack the data to judge what works. Existing outcome measures are patchy, and no one has systematically asked patients what they value in a service beyond clinical results. This research will produce a full toolkit: preference-based outcome measures for each major vascular disease, an electronic system to collect them (ePAQ-VAS), and cost-utility models that map entire care pathways. These models can predict the effects of different service configurations and test whether new technologies are worth adopting before they are rolled out. If successful, the tools will let NHS commissioners and providers optimise vascular services for both clinical effectiveness and patient priorities—not just guess. The methodology is designed to transfer to other areas of healthcare facing similar reconfiguration pressures.
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Aims and Objectives The programme will draw together the necessary tools to establish high quality sub-specialist vascular services. Key objectives are; 1) the characterisation of service arrangements, activity and outcomes, 2) the development of outcome measures covering the major disease areas within vascular services, suitable for; i) clinical use, ii) monitoring service quality and iii) cost utility modelling, 3) the identification and valuation of key service attributes of importance to users and 4) the development of a set cost utility models for the major disease areas in vascular services. Background and Rationale Clinical services are becoming increasingly complex and sub-specialised, leading to tensions between maximising efficiency, cost effectiveness and other desirable features such as local responsiveness and equity. These pressures are particularly marked in vascular services, where there have been rapid changes due to the development of a new sub-specialty and the introduction of new procedures for diagnosis, treatment and screening. There is a need for service reconfiguration and their design, implementation and evaluation will require comprehensive outcome indicators and an understanding of the aspects of service provision that are important to service users and clinicians. The methodology and outputs of this study will be relevant across many areas of health service provision. Research Environment The School of Health and Related Research (ScHARR) at the University of Sheffield and NHS Sheffield, have extensive experience and an international reputation in all methodological areas required for this programme. All necessary skills can be provided within the grouping, which has an excellent history of delivering such research to inform NHS practice, including extensive work with the HTA programme and NICE. Research Plan The research programme includes sub-studies which include analysis of hospital episode statistics and surveys of current working arrangements to relate workload, service provision and outcomes and to develop measures that can monitor service quality. Case studies in reconfigured services will allow detailed evaluation of the relationship between service change and outcome measures. The programme will identify and/or develop preference-based outcome measures in each of the main disease areas, along with a mechanism for collecting and analysing the data in electronic format (the ePAQ-VAS). These will be validated for clinical use and to generate QALY estimates. The programme will develop decision analytic economic (cost utility) models to characterise the pathways of care for the main disease areas within vascular services. These will allow the evaluation and optimisation of care pathways, the prediction of the effects of different service models and the evaluation of the potential cost effectiveness of new technologies or changes in practice. Projected Outputs and Dissemination The programme will develop:- Measures of workload, activity, case mix and outcomes from existing datasets. Generic and condition-specific preference-based measures for assessing vascular outcomes that can be used to generate utilities for QALY estimation. An electronic format for collection of outcome measures. A library of utility valuations for health outcomes related to vascular conditions. Economic models covering the main disease areas within vascular services. A methodology for considering the effect of incorporating preferences for other attributes of services into cost utility modelling using a "net health benefit" approach. These instruments and models will be made widely available to organisations responsible for the commissioning and provision of vascular services. Relevant Expertise Of The Research Team The research team is based upon a group of academics, methodological and clinical experts who have worked together using similar methodologies and have succ
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