Determining optimal locations for urgent care centres in Cornwall using computer modelling

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record.Background/Aims Urgent care centres provide a broad range of services in comparison to minor injury units. In order to establish new urgent care centres, the Sustainability and Transformation Partnership in Cornwall aimed to identify the optimal number and location for these centres, which could then help to reduce the volume of patients attending emergency departments. Methods A computer model that calculated average and maximum travel times, along with number of attendances, for over 4000 potential urgent care centre geographic configurations, was developed. The model predicted that establishing five urgent care centres would significantly minimise travel times for patients across the county. The model also predicted the locations for these centres that would minimise average travel times. Results The results from the model were used to directly inform a decision made by the Sustainability and Transformation Partnership. Conclusion The first urgent care centres in Cornwall, at Treliske, Bodmin Community Hospital and West Cornwall Hospital, were established in 2018. The urgent care centre in West Cornwall is now accepting patients; the two other sites are still under construction.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula (NIHR CLAHRC South West Peninsul

Role of Methionine in Fetal Development of Beef Cattle

The objective of this study was to evaluate whether total amino acids (AA) or methionine have an effect on fetal programming of calves using 108 Angus Brangus cows. Treatments were 1) Control, limpograss hay with molasses plus urea (16% CP as fed basis) at 2.72 kg./hd/d, 2) Fishmeal, Control plus 0.33 kg./hd/d of fishmeal ( methionine 2.85 % of RUP), and 3) Methionine, Control plus 10 g/hd/d of MetaSmart liquid (Addisseo Alpharetta, GA) . Fishmeal and Methionine treatments supplied similar amounts of metabolizable methionine. Weight of cows and calves along with body condition score of cows were measured at the start and end of the 120 day supplementation period, and milk yield was measured at 3 time points by weigh-suckle-weigh technique. In Year 2, 24 steer calves conceived during the treatment period in Year 1 were fed individually during a metabolism experiment following weaning at approximately 7 months of age. Body weight, feed intake, plasma metabolites, and nutrient digestibility were measured in steers during the metabolism experiment. Body weight and body condition score change of cows were not different among treatments during the treatment period in Year 1. Treatment did not affect calf weight gain even though there was a trend for Methionine dams to have greater energy-corrected milk yield and for Fishmeal and Methionine dams to have greater milk protein content than Control dams. In Year 2, treatment did not affect weaning weight of calves conceived during the treatment period in Year 1. During the post weaning metabolism experiment, Average daily gain, final body weight (FBW), and gain: feed ratio were greater in steers whose dams supplemented with Fishmeal or Methionine during early gestation. Steers born to Control and Methionine dams had greater plasma urea nitrogen concentrations before and after feeding, and tended to have greater change in plasma urea nitrogen concentration than steers born to Fishmeal dams. Steers born to Methionine dams had lower plasma glucose concentration before and after feeding, but greater change in plasma glucose concentration than steers born to Fishmeal dams. There was a trend for treatment to effect Neutral detergent fiber (NDF) and Acid detergent fiber (ADF) digestibility with steers born to Methionine dams having greater digestibility than steers born to Control or Fishmeal dams. In conclusion, methionine is a key nutrient in fetal programming and can be used in conjunction with poor quality forage to improve performance of offspring

The hospital discharge game : A game theory-inspired workshop to encourage cooperation between health and social care organisations

Traditionally, health and social care organisations have operated independently, with minimal interaction and poor integration of the various services with which a patient comes into contact. In some cases, 'perverse' systemic incentives have discouraged cooperation and led to a 'silo mentality'. In this paper, we present an interactive workshop game that can be played with those working in and around health and social care. The game places teams in the roles of community and acute hospitals, and asks them to make discharge decisions about patients. However, a 'perverse' incentive is present in the system, and opposing teams are not allowed to communicate, which leads to increasingly 'selfish' decision making. We outline the details of this game, and show how it can be used as a tool to facilitate understanding of the benefits of cross-organisational communication and cooperation. We also present data from an initial pilot of this workshop.National Institute for Health Research (NIHR

The impact of minor injury unit closures on travel time and attendances

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record Data availability: An anonymised version of the full data used to parameterise the model, along with the full outputs of the model, may be provided on request.Geographic modelling techniques provide a means of optimising the location of services, or understanding the potential impact of geographic service reconfigurations. In response to commissioner queries, we assessed the potential impact on patient travel time and attendances of the closure of four minor injury units (MIUs) in a locality of South West England. We used the MPMileCharter add-in for Microsoft MapPoint and the attendance records of 90252 minor injury unit patients to calculate car travel time data to the units in the locality. We then built a geographic model of the existing configuration of MIUs in Microsoft Excel, and used 'what if' analysis to determine the potential impact of the proposed closures. The model predicted that if the four MIUs were closed, there would be only a trivial increase in average travel time across all patients, but a significant increase of around 20 minutes per patient for those whose nearest unit was closed. The model also predicted that the closure of one of the MIUs could lead to significant increased demand at the walk-in centre located at the acute hospital. Using these results, the local commissioners decided to close only three of the four units.National Institute for Health Research (NIHR

Guidelines on glaucoma and the demand for services

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record The authors produced a seasonalised forecast using a linear regression trendline to predict the level of demand for ophthalmology services at Royal Devon and Exeter hospital between 2013 and 2017. The model predicts an average annual increase in demand of 9.92%, but a significant proportion of this predicted increased demand is for glaucoma services. Given the historical patterns of demand observed in the data, it is possible that the increases in demand for glaucoma services have arisen because of dramatically increased referral rates from community optometrists, following the publication by the National Institute for Clinical Excellence (NICE) of clinical guidelines on the diagnosis and management of glaucoma and ocular hypertension (NICE, 2009). As this patient cohort may be best served by assessment outside of secondary care, we would encourage other hospital managers and analysts to produce similar forecasts and consider alternative pathways of care for this patient group

Fractured neck of femur patients: Rehabilitation and the acute hospital

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record Typically, fractured neck of femur patients admitted to an acute hospital are discharged to a community hospital for a period of rehabilitation after their treatment. However, there is concern that this might unnecessarily extend the total period of hospitalisation for these patients. Using data from a local acute hospital, we used discrete event simulation to predict the practicability of fractured neck of femur patients remaining in an acute hospital for their entire superspell (the overall length of stay across hospitals). We tested scenarios in which patient superspell duration was shortened, as well as a scenario in which no reduction in superspell length was observed. The model predicts that - even assuming that the superspell of fractured neck of femur patients could be significantly reduced - bed occupancy levels at the acute hospital would increase to operationally infeasible levels. Therefore, it is unlikely that fractured neck of femur patients could remain in a typical acute hospital unless there were sufficient increases in available resources.National Institute for Health Research (NIHR

Cost-effectiveness of bevacizumab for diabetic macular oedema

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record A Markov model was developed to predict the outcomes and cost-effectiveness of bevacizumab compared to macular laser therapy for diabetes patients with clinically significant macular oedema (CSMO). This study used outcome data from a randomised controlled trial, utility data and health states from a ranibizumab health technology assessment, and costs from the UK national tariff. A total of 37.73% of patients treated with bevacizumab in the model had a visual acuity of at least 76 Early Treatment Diabetic Retinopathy Study Research Group (ETDRS) letters after four years, compared with 4.09% of laser therapy patients. Only 0.11% of bevacizumab patients were blind after four years compared with 6.45% of laser therapy patients. However, with an incremental cost-effectiveness ratio of £51,182, we predict that bevacizumab would not be cost-effective compared to laser therapy because of the influence of the NHS national tariff costs for monitoring patients and administering bevacizumab, and the inability of the EQ-5D measure to capture the impact of sensory deprivation on quality of life sufficiently. This study recommends significant caution when interpreting the results of cost-effectiveness analyses of interventions that involve vision-related interventions.National Institute for Health Research (NIHR

Which factors most influence demand for ambulances in South West England?

This is the author accepted manuscript. The final version is available from Mark Allen Healthcare via the DOI in this record Ambulance demand in South West England is increasing year-on-year, but the driving forces behind such increases are poorly understood. We developed a system dynamics model to simulate the factors that influence a call being made for an ambulance. We used data from the South West Ambulance Service NHS Foundation Trust (SWAST), the Office of National Statistics (ONS) and quantitative relationship data in both national and international literature to parameterise the model. We compared predicted ambulance demand over 12 months in the base case model with scenarios in which each influencing factor was removed in turn. The model predicts that the prevalence of regular falls among older people most influences the level of demand for ambulances. The model also predicts that the number of users of adult mental health services could be a significant contributor to ambulance demand. Additional focus on, and investment in, falls prevention strategies could help to significantly alleviate increasing levels of demand for ambulance services in South West England. Additionally, efforts to understand why those with mental health needs tend to use ambulances more than those without such needs could also be beneficial.National Institute for Health Research (NIHR

Using computer simulation to model the expansion needs of the Ambulatory Emergency Care unit at Derriford Hospital

This is the final version. Available from Royal College of Physicians via the DOI in this recordAmbulatory Emergency Care (AEC) can treat a wide variety of patients referred from the Emergency Department and acute GPs, helping to ease ED pressures and reduce unnecessary hospital admissions. We developed a simulation model to assess the potential benefits of expanding the size and opening times of the AEC unit at Derriford Hospital in Plymouth, both separately and in combination. The model predicted that an expanded size of AEC unit could help to improve the effectiveness of the unit, but not as much as extending the opening hours of the unit, which was predicted to result in a significant impact on the number of patients that can be seen and treated in the AEC unit. The hospital used the evidence generated by the model to support a business to case to extend opening hours of the AEC unit, and open the AEC unit at the weekend.National Institute for Health Research (NIHR

Can the retinal screening interval be safely increased to 2 years for type 2 diabetic patients without retinopathy?

This is the final version. Available from American Diabetes Association via the DOI in this recordOBJECTIVE: In the U.K., people with diabetes are typically screened for retinopathy annually. However, diabetic retinopathy sometimes has a slow progression rate. We developed a simulation model to predict the likely impact of screening patients with type 2 diabetes, who have not been diagnosed with diabetic retinopathy, every 2 years rather than annually. We aimed to assess whether or not such a policy would increase the proportion of patients who developed retinopathy-mediated vision loss compared with the current policy, along with the potential cost savings that could be achieved. RESEARCH DESIGN AND METHODS: We developed a model that simulates the progression of retinopathy in type 2 diabetic patients, and the screening of these patients, to predict rates of retinopathy-mediated vision loss. We populated the model with data obtained from a National Health Service Foundation Trust. We generated comparative 15-year forecasts to assess the differences between the current and proposed screening policies. RESULTS The simulation model predicts that implementing a 2-year screening interval for type 2 diabetic patients without evidence of diabetic retinopathy does not increase their risk of vision loss. Furthermore, we predict that this policy could reduce screening costs by ~25%. CONCLUSIONS: Screening people with type 2 diabetes, who have not yet developed retinopathy, every 2 years, rather than annually, is a safe and cost-effective strategy. Our findings support those of other studies, and we therefore recommend a review of the current National Institute for Health and Clinical Excellence (NICE) guidelines for diabetic retinopathy screening implemented in the U.K.National Institute for Health Research (NIHR