Using the EQ-5D as a performance measurement tool in the NHS

In a landmark move, the UK Department of Health (DH) is introducing the routine use of Patient Reported Outcome Measures (PROMs) as a means of measuring the performance of health care providers in improving patient health. From April 2009 all patients will be asked to complete both generic (EQ-5D) and condition specific PROMs before and after surgery for four elective procedures; the intention is to extend this to a wide range of other NHS services. The aim of this paper is to report analysis of the EQ-5D data generated from a pilot study commissioned by the DH, and to consider the implications of the results for their use as performance indicators and measures of patient benefit. The EQ-5D has the potential advantage in the context of PROMs of enabling comparisons of performance across services as well as between providers; and in facilitating assessments of the cost effectiveness of NHS services. We present two new methods we have developed for analysing and displaying EQ-5D profile data: a Paretian Classification of Health Change, and a Health Profile Grid. Using these methods, we show that EQ-5D data can readily be used to generate useful insights into differences between providers in improving overall changes in health; results are also suggestive of striking differences in changes in health between surgical procedures. We conclude by noting a number of issues that remain to be addressed in the use of PROMs data as a basis for performance indicators

Opportunity costs and local health service spending decisions:a qualitative study from Wales

Background: All health care systems face the need to find the resources to meet new demands such as a new, cost-increasing health technology. In England and Wales, when a health technology is recommended by the National Institute for Health and Care Excellence (NICE), the National Health Service (NHS) is mandated to provide the funding to accommodate it within three months of publication of the recommendation. Identifying what, in practice, is foregone when new cost-increasing technologies are introduced is important for understanding the effects of health technology assessment (HTA) decisions on the NHS or any other health care system. Our objective was to investigate how in practice local NHS commissioners in Wales accommodated financial �shocks� arising from technology appraisals (TAs) issued by NICE and from other cost pressures

Breaking the Redshift Deadlock - I: Constraining the star formation history of galaxies with sub-millimetre photometric redshifts

Future extragalactic sub-millimetre and millimetre surveys have the potential to provide a sensitive census of the level of obscured star formation in galaxies at all redshifts. While in general there is good agreement between the source counts from existing SCUBA (850um) and MAMBO (1.25mm) surveys of different depths and areas, it remains difficult to determine the redshift distribution and bolometric luminosities of the sub-millimetre and millimetre galaxy population. This is principally due to the ambiguity in identifying an individual sub-millimetre source with its optical, IR or radio counterpart which, in turn, prevents a confident measurement of the spectroscopic redshift. Additionally, the lack of data measuring the rest-frame FIR spectral peak of the sub-millimetre galaxies gives rise to poor constraints on their rest-frame FIR luminosities and star formation rates. In this paper we describe Monte-Carlo simulations of ground-based, balloon-borne and satellite sub-millimetre surveys that demonstrate how the rest-frame FIR-sub-millimetre spectral energy distributions (250-850um) can be used to derive photometric redshifts with an r.m.s accuracy of +/- 0.4 over the range 0 < z < 6. This opportunity to break the redshift deadlock will provide an estimate of the global star formation history for luminous optically-obscured galaxies [L(FIR) > 3 x 10^12 Lsun] with an accuracy of 20 per cent.Comment: 14 pages, 22 figures, submitted to MNRAS, replaced with accepted versio

The causal role of left and right superior temporal gyri in speech perception in noise, a TMS study

Successful perception of speech in everyday listening conditions requires effective listening strategies to overcome common acoustic distortions, such as background noise. Convergent evidence from neuroimaging and clinical studies identify activation within the temporal lobes as key to successful speech perception. However, current neurobiological models disagree on whether the left temporal lobe is sufficient for successful speech perception or whether bilateral processing is required. We addressed this issue using TMS to selectively disrupt processing in either the left or right superior temporal gyrus (STG) of healthy participants to test whether the left temporal lobe is sufficient or whether both left and right STG are essential. Participants repeated keywords from sentences presented in background noise in a speech reception threshold task while receiving online repetitive TMS separately to the left STG, right STG, or vertex or while receiving no TMS. Results show an equal drop in performance following application of TMS to either left or right STG during the task. A separate group of participants performed a visual discrimination threshold task to control for the confounding side effects of TMS. Results show no effect of TMS on the control task, supporting the notion that the results of Experiment 1 can be attributed to modulation of cortical functioning in STG rather than to side effects associated with online TMS. These results indicate that successful speech perception in everyday listening conditions requires both left and right STG and thus have ramifications for our understanding of the neural organization of spoken language processing