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Dickerson, Emma, Lee-Ann Fenge, and Emily Rosenorn-Lanng. "The impact of leadership development on GP mental health commissioning." Leadership in Health Services 30, no. 3 (2017): 343–51. http://dx.doi.org/10.1108/lhs-09-2016-0046.
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Purpose This paper aims to explore the learning needs of general practitioners (GPs) involved in commissioning mental health provision in England, and offer an evaluation of a leadership and commissioning skills development programme for Mental Health Commissioners. Design/methodology/approach Retrospective mixed method, including online mixed method survey, rating participants’ knowledge, skills, abilities, semi-structured telephone interviews and third-party questionnaires were used. Results were analysed for significant differences using the Wilcoxon Signed Ranks test. Open-ended responses and interview transcripts were analysed thematically. Findings Indicative results showed that participants perceived significant impacts in ability across eight key question groups evaluated. Differences were found between the perceived and observed impact in relation to technical areas covered within the programme which were perceived as the highest scoring impacts by participants. Research limitations/implications The indicative results show a positive impact on practice has been both perceived and observed. Findings illustrate the value of this development programme on both the personal development of GP Mental Health Commissioners and commissioning practice. Although the findings of this evaluation increase understanding in relation to an important and topical area, larger scale, prospective evaluations are required. Impact evaluations could be embedded within future programmes to encourage higher participant and third-party engagement. Future evaluations would benefit from collection and analysis of attendance data. Further research could involve patient, service user and carer perspectives on mental health commissioning. Originality value Results of this evaluation could inform the development of future learning programmes for mental health commissioners as part of a national approach to improve mental health provision.
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Sandin, Sofie. "Making Use of Evaluations to Support a Transition towards a More Sustainable Energy System and Society—An Assessment of Current and Potential Use among Swedish State Agencies." Sustainability 12, no. 19 (2020): 8241. http://dx.doi.org/10.3390/su12198241.
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Evaluations hold the potential to support decision-making so that current global challenges related to climate and energy can be addressed; however, as the challenges are becoming increasingly large and complex, new and transformative evaluation approaches are called for. Such transformative evaluation in turn builds on an extended and more deliberate use of evaluations. This study focuses on the current evaluation use practices among Swedish state agencies who are commissioning and/or conducting evaluations within climate and energy-related areas. Building on focus group sessions with four agencies and a structured interview questionnaire answered by representatives at five state agencies, the results shed light on how informants perceive the current practices of using evaluations, following the models of use presented in the evaluation literature. These results show perceived use as mainly instrumental or conceptual, along with showing an overall emphasis on models of use that are deemed constructive for moving towards transformative evaluations. The results also outline key benefits and challenges related to the adoption of a transformative evaluation approach. Such benefits include a more structured planning and use of evaluations, while challenges relate to institutional barriers and mandates to coordinate evaluations on a transformative scale.
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Wye, Lesley, Helen Cramer, Kate Beckett, et al. "Collective knowledge brokering: the model and impact of an embedded team." Evidence & Policy: A Journal of Research, Debate and Practice 16, no. 3 (2020): 429–52. http://dx.doi.org/10.1332/174426419x15468577044957.
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Background:The Bristol Knowledge Mobilisation (KM) Team was an unusual collective brokering model, consisting of a multi-professional team of four managers and three academics embedded in both local healthcare policymaking (aka commissioning) and academic primary care. Aims and objectives:They aimed to encourage ‘research-informed commissioning’ and ‘commissioning-informed research’. This paper covers context, structure, processes, advantages, challenges and impact. Methods:Data sources from brokers included personal logs, reflective essays, exit interviews and a team workshop. These were analysed inductively using constant comparison. To obtain critical distance, three external evaluations were conducted, using interviews, observations and documentation. Findings:Stable, solvent organisations; senior involvement with good inter-professional relationships; secure funding; and networks of engaged allies in host organisations supported the brokers. Essential elements were two-way embedding, ‘buddying up’, team leadership, brokers’ interpersonal skills, and two-year, part-time contracts. By working collectively, the brokers fostered cross-community interactions and modelled collaborative behaviour, drawing on each other’s ‘insider’ knowledge, networks and experience. Challenges included too many taskmasters, unrealistic expectations and work overload. However, team-brokering provided a safe space to be vulnerable, share learning, and build confidence. As host organisations benefitted most from embedded brokers, both communities noted changes in attitude, knowledge, skills and confidence. The team were more successful in fostering ‘commissioning-informed research’ with co-produced research grants than ‘research-informed commissioning’. Discussion and conclusions:Although still difficult, the collective support and comradery of an embedded, two-way, multi-professional team made encouraging interactions, and therefore brokering, easier. A team approach modelled collaborative behaviour and created a critical mass to affect cultural change.
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Gates, Emily F. "Learning from seasoned evaluators: Implications of systems approaches for evaluation practice." Evaluation 23, no. 2 (2017): 152–71. http://dx.doi.org/10.1177/1356389017697613.
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In the last 20 years, approaches (i.e. concepts, theories, methods) from the systems fields have increased in popularity among evaluators and evaluation commissioners. Their popularity stems in part from a widespread view that systems approaches transform evaluation practice, despite a lack of evidence. There have been few empirical examinations of the implications of these approaches for evaluation practice. This study analyzed eight cases of seasoned evaluators using systems approaches in diverse areas of evaluation practice to identify implications for how these professionals practice evaluation. Case materials included semi-structured interviews with each evaluator and descriptions of evaluations they conducted. Findings support a variety of case-specific transformations rather than a wholesale transformation in evaluation practice. Future directions for evaluator training, evaluation commissioning and contracting, and research are identified.
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Isa Khan, Muhammad, Muhammad Bilal Tahir, Muhammad Rafique, et al. "Commissioning and evaluation of a radiochromic EBT3 film dosimetry system." Journal of Radiotherapy in Practice 18, no. 1 (2018): 55–62. http://dx.doi.org/10.1017/s1460396918000444.
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AbstractPurposeThis work reports our study to commission a radiochromic film dosimetry system using the timely EBT3 film. We carried out dosimetric evaluations on different characteristics of photon beams (e.g., flatness, symmetry and penumbra) in radiation dose delivery.Materials and MethodsA Varian linear accelerator producing 6 and 15 MV photon beams with 120 multi-leaf collimator was used in this study. PTW ionisation chamber was used to measure the beam characteristics such as symmetry, flatness and penumbra and these measurements were used to commission the radiochormic EBT3 film dosimetry system. The results of irradiated films were analysed using the radiochromic film QA Pro software 2016.ResultsThe measured film doses were analysed at two different colour channels (green and red) using two scanning geometries (i.e., upper or lower side of film facing the scanner light source) at two dose levels (10 and 40 Gy). The difference between the ionisation chamber and film results was found insignificant and within the acceptable range as per the World Health Organisation standard.ConclusionResults of the comparison between the ionisation chamber and film measurements show that our radiochormic EBT3 film dosimetry system is reliable and cost-effective in the output measurement of a linear accelerator. Our measurements confirm that our EBT3 film dosimetry agreed well with the ionisation chamber, and can be used as a re-validation tool for linear accelerator quality control.
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McCausland, Ruth. "‘I’m sorry but I can’t take a photo of someone’s capacity being built’: Reflections on evaluation of Indigenous policy and programmes." Evaluation Journal of Australasia 19, no. 2 (2019): 64–78. http://dx.doi.org/10.1177/1035719x19848529.
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The Australian Government has recently increased resourcing for evaluation of Indigenous programmes following critical reports by the Australian National Audit Office and Productivity Commission around their failure to significantly reduce Indigenous disadvantage. Evaluation in Indigenous affairs has a long history, although not a consistent or coordinated one. While there is significant knowledge held by those with experience in commissioning and conducting evaluations for Indigenous programmes over a number of decades that could usefully inform current efforts, there has been little research focused on this area. This article outlines the findings of qualitative research about evaluation in Indigenous policy conducted with policymakers, senior public servants, programme managers, researchers and independent evaluation consultants that sought to privilege the voices and perspectives of Aboriginal and Torres Strait Islander people. It outlines key themes derived from those interviews relating to the methods, parameters, politics and accountability around government-commissioned evaluation in Indigenous policy and programmes and concludes by canvassing ways that evaluation could better serve the interests of Aboriginal and Torres Strait Islander peoples.
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Bloch, Sonja C. M., Louise J. Jackson, Emma Frew, and Jonathan D. C. Ross. "Assessing the costs and outcomes of control programmes for sexually transmitted infections: a systematic review of economic evaluations." Sexually Transmitted Infections 97, no. 5 (2021): 334–44. http://dx.doi.org/10.1136/sextrans-2020-054873.
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ObjectiveTo identify economic evaluations of interventions to control STIs and HIV targeting young people, and to assess how costs and outcomes are measured in these studies.DesignSystematic review.Data sourcesSeven databases were searched (Medline (Ovid), EMBASE (Ovid), Web of Science, PsycINFO, NHS Economic Evaluation Database, NHS Health Technology Assessment and Database of Abstracts of Reviews of Effects) from January 1999 to April 2019. Key search terms were STIs (chlamydia, gonorrhoea, syphilis) and HIV, cost benefit, cost utility, economic evaluation, public health, screening, testing and control.Review methodsStudies were included that measured costs and outcomes to inform an economic evaluation of any programme to control STIs and HIV targeting individuals predominantly below 30 years of age at risk of, or affected by, one or multiple STIs and/or HIV in Organisation for Economic Co-operation and Development countries. Data were extracted and tabulated and included study results and characteristics of economic evaluations. Study quality was assessed using the Philips and BMJ checklists. Results were synthesised narratively.Results9530 records were screened and categorised. Of these, 31 were included for data extraction and critical appraisal. The majority of studies assessed the cost-effectiveness or cost-utility of screening interventions for chlamydia from a provider perspective. The main outcome measures were major outcomes averted and quality-adjusted life years. Studies evaluated direct medical costs, for example, programme costs and 11 included indirect costs, such as productivity losses. The study designs were predominantly model-based with significant heterogeneity between the models.Discussion/ConclusionNone of the economic evaluations encompassed aspects of equity or context, which are highly relevant to sexual health decision-makers. The review demonstrated heterogeneity in approaches to evaluate costs and outcomes for STI/HIV control programmes. The low quality of available studies along with the limited focus, that is, almost all studies relate to chlamydia, highlight the need for high-quality economic evaluations to inform the commissioning of sexual health services.
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Hinde, Sebastian, Laura Bojke, and Gerry Richardson. "Understanding and addressing the challenges of conducting quantitative evaluation at a local level: a worked example of the available approaches." BMJ Open 9, no. 11 (2019): e029830. http://dx.doi.org/10.1136/bmjopen-2019-029830.
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ObjectivesIn the context of tightening fiscal budgets and increased commissioning responsibility, local decision-makers across the UK healthcare sector have found themselves in charge of the implementation and evaluation of a greater range of healthcare interventions and services. However, there is often little experience, guidance or funding available at a local level to ensure robust evaluations are conducted. In this paper, we evaluate the possible scenarios that could occur when seeking to conduct a quantitative evaluation of a new intervention, specifically with regards to the availability of evidence.DesignWe outline the full set of possible data scenarios that could occur if the decision-maker seeks to explore the impact of the launch of a new intervention on some relevant quantifiable outcomes. In each case we consider the implicit assumptions associated with conducting an evaluation, exploring possible situations where such scenarios may occur. We go on to apply the scenarios to a simulated dataset to explore how each scenario can result in different conclusions as to the effectiveness of the new intervention.ResultsWe demonstrate that, across the full set of scenarios, differences in the scale of the estimated effectiveness of a new intervention and even the direction of effect are possible given different data availability and analytical approaches.ConclusionsWhen conducting quantitative evaluations of new interventions, the availability of data on the outcome of interest and the analytical approach can have profound effects on the conclusions of the evaluation. Although it will not always be possible to obtain a complete set of data and conduct extensive analysis, it is vital to understand the implications of the data used and consider the implicit assumptions made through its use.
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Johnstone, Paul, and Prabha Lacey. "Are decisions by purchasers in an English health district evidence-based?" Journal of Health Services Research & Policy 7, no. 3 (2002): 166–69. http://dx.doi.org/10.1258/135581902760082472.
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Objectives: First, to investigate how many decisions by one commissioning body (district health authority) were based on evidence of effectiveness from randomised controlled trials (RCTs) and systematic reviews of RCTs. Second, to investigate whether other types of quantitative studies and qualitative studies could be used as evidence to support commissioning decisions. Method: From three planning documents (for 1997-1998), all statements were identified. Effectiveness questions were constructed from each and used to search for evidence from trials and reviews in the Cochrane Library (Issue 4, 1998). Further searches for other studies (all methodologies) were performed on a subset of decisions and appraised by an independent expert panel. Results: A total of 124 decisions were identified of which two-thirds concerned organisation of care. Evidence existed for less than half (48.4%) the decisions, with 33.9% favouring the decision and 14.5% where evidence was either equivocal or unfavourable. From a random subset of ten decisions, relevant non-randomised quantitative studies and qualitative studies were identified for half the decisions. Evidence from economic evaluations was identified for only one decision. Conclusions: Large gaps in knowledge exist if health care purchasers are to base their decisions on evidence of effectiveness from RCTs. However, other types of evidence can be used to support such decisions. Summaries of research should be published in a format that is accessible to purchasers.
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Dharni, Nimarta, Josie Dickerson, Kathryn Willan, et al. "Implementation evaluation of multiple complex early years interventions: an evaluation framework and study protocol." BMJ Paediatrics Open 3, no. 1 (2019): e000479. http://dx.doi.org/10.1136/bmjpo-2019-000479.
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IntroductionImplementation evaluations are integral to understanding whether, how and why interventions work. However, unpicking the mechanisms of complex interventions is often challenging in usual service settings where multiple services are delivered concurrently. Furthermore, many locally developed and/or adapted interventions have not undergone any evaluation, thus limiting the evidence base available. Born in Bradford’s Better Start cohort is evaluating the impact of multiple early life interventions being delivered as part of the Big Lottery Fund’s ‘A Better Start’ programme to improve the health and well-being of children living in one of the most socially and ethnically diverse areas of the UK. In this paper, we outline our evaluation framework and protocol for embedding pragmatic implementation evaluation across multiple early years interventions and services.Methods and analysisThe evaluation framework is based on a modified version of The Conceptual Framework for Implementation Fidelity. Using qualitative and quantitative methods, our evaluation framework incorporates semistructured interviews, focus groups, routinely collected data and questionnaires. We will explore factors related to content, delivery and reach of interventions at both individual and wider community levels. Potential moderating factors impacting intervention success such as participants’ satisfaction, strategies to facilitate implementation, quality of delivery and context will also be examined. Interview and focus guides will be based on the Theoretical Domains Framework to further explore the barriers and facilitators of implementation. Descriptive statistics will be employed to analyse the routinely collected quantitative data and thematic analysis will be used to analyse qualitative data.Ethics and disseminationThe Health Research Authority (HRA) has confirmed our implementation evaluations do not require review by an NHS Research Ethics Committee (HRA decision 60/88/81). Findings will be shared widely to aid commissioning decisions and will also be disseminated through peer-reviewed journals, summary reports, conferences and community newsletters.
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Eon, Christine, Jessica K. Breadsell, Joshua Byrne, and Gregory M. Morrison. "The Discrepancy between As-Built and As-Designed in Energy Efficient Buildings: A Rapid Review." Sustainability 12, no. 16 (2020): 6372. http://dx.doi.org/10.3390/su12166372.
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Energy efficient buildings are viewed as one of the solutions to reduce carbon emissions from the built environment. However, studies worldwide indicate that there is a significant gap between building energy targets (as-designed) and the actual measured building energy consumption (as-built). Several underlying causes for the energy performance gap have been identified at all stages of the building life cycle. Focus is generally on the post-occupancy stage of the building life cycle. However, issues relating to the construction and commissioning stages of the building are a major concern, though not usually researched. There is uncertainty on how to address the as-designed versus as-built gap. The objective of this review article is to identify causes for the energy performance gap in buildings in relation to the post-design and pre-occupancy stages and review proposed solutions. The methodology applied in this research is the rapid review, which is a variant of the systematic literature review method. Findings suggest that causes for discrepancies between as-designed and as-built energy performance during the construction and commissioning stages relate to a lack of knowledge and skills, lack of communication between stakeholders and a lack of accountability for building performance post-occupancy. Recommendations to close this gap during this period include better training, improved communication standards, collaboration, energy evaluations based on post-occupancy performance, transparency of building performance, improved testing and verification and reviewed building standards.
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Finlay, Summer May, Margaret Cargo, James A. Smith, et al. "The dichotomy of commissioning Indigenous health and wellbeing program evaluations: What the Funder wants vs what the Community needs." Health Promotion Journal of Australia 32, no. 2 (2021): 149–51. http://dx.doi.org/10.1002/hpja.486.
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Woodall, James, and Karina Kinsella. "Striving for a “good” family visit: the facilitative role of a prison visitors’ centre." Journal of Criminal Psychology 8, no. 1 (2018): 33–43. http://dx.doi.org/10.1108/jcp-03-2017-0011.
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Purpose The purpose of this paper is to explore the conditions that create a “good” prison visit, focussing on the role that a dedicated third sector-run prison visitors’ centre plays in creating a supportive environment. Design/methodology/approach This paper draws on a synthesis of empirical data gathering conducted over a decade at a voluntary sector-managed prison visitors’ centre based at a male prison in Northern England. The paper draws specifically on qualitative data gathered through four independent evaluations of the centre over a ten-year period. Findings An important point to emerge from the research is the unwavering importance of the prison visit in the life, well-being and regime of a prisoner. Prison visitors’ centres are shown to be an important part of creating positive visits experiences offering a space for composure and for support for families. Originality/value Many voluntary sector organisations are unable to commission large research and evaluation studies, but are often able to fund smaller pieces of work. Pooling qualitative evidence from smaller studies is a viable way to potentially strengthen commissioning decisions in this sector.
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Weyland, Kurt. "Promotion Letters: Current Problems and a Reform Proposal." PS: Political Science & Politics 52, no. 2 (2019): 332–36. http://dx.doi.org/10.1017/s1049096518002147.
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ABSTRACTExternal referee letters can, in principle, provide essential inputs for tenure and promotion decisions. But scholars’ reluctance to prepare critical, not to speak of “negative” assessments has led to a skewed self-selection: Potential referees tend to accept the task only if they see a tenure or promotion case as worthy of support. The resulting overabundance of praise has devalued the content of referee reports; they are difficult to interpret and of limited use for distinguishing deserving from undeserving candidates. Maybe a simple reform can mitigate these problems: Departments should pay external referees a generous honorarium, perhaps up to $2,000 at well-endowed research universities. This substantial incentive will induce more scholars to provide these assessments, thus counterbalancing the current self-selection on candidate supportability. Moreover, a large honorarium clearly turns the commissioning department into the contractual “principal” of these assessments, leading referees to prepare more searching, balanced evaluations. The main criterion will be whether a promotion really improves the department’s academic quality and scholarly standing.
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Jester, Rebecca, Karen Titchener, Janet Doyle-Blunden, and Christine Caldwell. "The development of an evaluation framework for a Hospital at Home service." Journal of Integrated Care 23, no. 6 (2015): 336–51. http://dx.doi.org/10.1108/jica-09-2015-0038.
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Purpose – The purpose of this paper is to share good practice with interested professionals, commissioners and health service managers regarding the development of an evidence-based approach to evaluation of an integrated care service providing acute level care for patients in their own homes in South London called the Guys and St Thomas’ @home service. Design/methodology/approach – A literature review related to Hospital at Home (HH) schemes was carried out with an aim of scoping approaches used during previous evaluations of HH type interventions to inform the development of an evaluation strategy for @home. The results of the review were then applied to the Donabedian conceptual model: Structure; Process; and Outcome and contextualised to the population being served by the scheme to ensure a robust, practical and comprehensive approach to evaluation. Findings – Due to the heterogeneity of the studies it was not possible to conduct a systematic review or meta-analysis. In total, 28 studies were identified that met the inclusion criteria and included both HH to facilitate early discharge and admission prevention across a wide range of conditions. The key finding was there is a dearth of literature evaluating staff preparation to work on HH, models of delivery, specifically integrated care and trans-disciplinary working and few studies included the experiences of family carers. Originality/value – This paper will be of value to those involved in the commissioning and delivery of HH and other models of integrated care services type services and will help to inform evaluation strategies that are practical, evidence based and include all stakeholder perspectives.
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Orr, Jemma, and Alison McCamley. "Evaluating the effectiveness of a community-based dietary intervention in Nottingham." British Food Journal 119, no. 5 (2017): 1091–101. http://dx.doi.org/10.1108/bfj-09-2016-0444.
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Purpose The purpose of this paper is to evaluate the effectiveness of the Eatwell for Life (EWL) programme, with a particular focus on longer term effectiveness in terms of dietary behaviour and the wider impact. EWL is a six-week community-based dietary intervention which aims to increase nutritional knowledge, cooking confidence and provide the necessary skills to support behavioural change in relation to eating a balanced diet. There have been many evaluations of community-based dietary interventions, but most focus on brief measures and changes examined at the end of each course. Design/methodology/approach A mixed method evaluation was conducted using a self-reported questionnaire, focus groups and semi-structured telephone interviews. A follow-up evaluation was conducted at 3, 6 and 12 months with a purposive sample of EWL participants. Findings A total of 66 participants completed both pre- and post-intervention questionnaires. A total of 22 participants took part in the qualitative follow-up evaluation. The mixed method evaluation demonstrates improvements in participants’ fruit and vegetable consumption and a reduction in participants’ sugar consumption. Qualitative data highlight key themes such as “cooking from basic ingredients”, “knowledge of key healthy eating messages”, “changes in eating, cooking and shopping habits” and “wider influences on family and friends’ diets”. Originality/value This paper is useful to public health nutritionists and other practitioners delivering community-based dietary and cooking skills programmes and those commissioning such provision. It contributes to existing evidence of sustained change over time targeting those in areas of high deprivation.
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Williams, Iestyn, Daisy Phillips, Charles Nicholson, and Heather Shearer. "Evaluation of a deliberative approach to citizen involvement in health care priority setting." Leadership in Health Services 27, no. 1 (2014): 5–19. http://dx.doi.org/10.1108/lhs-01-2013-0002.
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Purpose – The purpose of this paper is to describe and evaluate a novel approach to citizen engagement in health priority setting carried out in the context of Primary Care Trust (PCT) commissioning in the English National Health Service. Design/methodology/approach – Four deliberative events were held with 139 citizens taking part in total. Events design incorporated elements of the Twenty-first Century Town Meeting and the World Café, and involved specially-designed dice games. Evaluation surveys reporting quantitative and qualitative participant responses were combined with follow-up interviews with both PCT staff and members of the public. An evaluation framework based on previous literature was employed. Findings – The evaluation demonstrates high levels of enjoyment, learning and deliberative engagement. However, concerns were expressed over the leading nature of the voting questions and, in a small minority of responses, the simplified scenarios used in dice games. The engagement exercises also appeared to have minimal impact on subsequent Primary Care Trust resource allocation, confirming a wider concern about the influence of public participation on policy decision making. The public engagement activities had considerable educative and political benefits and overall the evaluation indicates that the specific deliberative tools developed for the exercise facilitated a high level of discussion. Originality/value – This paper helps to fill the gap in empirical evaluations of deliberative approaches to citizen involvement in health care priority setting. It reports on a novel approach and considers a range of implications for future research and practice. The study raises important questions over the role of public engagement in driving priority setting decision making.
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Kent, Emma, and Thomas Paling. "VP16 A NICE Way To Manage Managed Access: Case Study In Muscular Dystrophy." International Journal of Technology Assessment in Health Care 35, S1 (2019): 79. http://dx.doi.org/10.1017/s0266462319002939.
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IntroductionManaged access arrangements (MAAs) represent a way of enabling patient access to promising treatments while collecting real world data to inform future health technology evaluations (HTE) and commissioning decisions. In July 2016, the National Institute for Health and Care Excellence (NICE) recommended Ataluren for treating Duchenne Muscular Dystrophy within a MAA. NICE is uniquely placed to oversee the implementation and monitoring of this MAA in collaboration with multiple stakeholders to ensure the final outputs meet the needs of a future HTE.MethodsNICE assembled an Ataluren Managed Access Oversight Committee (MAOC) consisting of representatives from the manufacturer, patient organisations, commissioning body and treatment centres. This group were to meet every six months under the chairmanship of NICE with the primary function of reviewing the progress of data collection and identifying operational challenges in implementing the terms of the arrangement.ResultsThe Ataluren MAOC has convened four times since the MAA commenced and these discussions identified a number of important actions. Data completeness was a concern and prompted stakeholders to collaborate on implementing measures to circumvent this, to ensure data quality for future HTE. Lack of awareness and understanding of the MAA in the patient community was highlighted and resulted in the production of lay information. A review of the statistical analysis plan resulted in the need for an agreement amendment. To ensure an audit trail and appropriate critique, NICE produced an amendment process to define and justify amendments made during the agreement term.ConclusionsMAOC meetings play an important role in monitoring the progress of MAAs and have ensured that implementation issues are identified promptly and resolved with input from key stakeholders. This process allows NICE to coordinate the work of stakeholders to facilitate the success of the MAA, and will be adopted in future NICE MAAs in ultra-rare diseases.
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Meads, David M., John L. O'Dwyer, Claire T. Hulme, Rocio Rodriguez Lopez, and Michael I. Bennett. "Cost-Effectiveness of Pain Management Strategies in Advanced Cancer." International Journal of Technology Assessment in Health Care 35, no. 2 (2019): 141–49. http://dx.doi.org/10.1017/s0266462319000114.
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AbstractObjectivesUncontrolled pain in advanced cancer is a common problem and has significant impact on individuals’ quality of life and use of healthcare resources. Interventions to help manage pain at the end of life are available, but there is limited economic evidence to support their wider implementation. We conducted a case study economic evaluation of two pain self-management interventions (PainCheck and Tackling Cancer Pain Toolkit [TCPT]) compared with usual care.MethodsWe generated a decision-analytic model to facilitate the evaluation. This modelled the survival of individuals at the end of life as they moved through pain severity categories. Intervention effectiveness was based on published meta-analyses results. The evaluation was conducted from the perspective of the U.K. health service provider and reported cost per quality-adjusted life-year (QALY).ResultsPainCheck and TCPT were cheaper (respective incremental costs -GBP148 [-EUR168.53] and -GBP474 [-EUR539.74]) and more effective (respective incremental QALYs of 0.010 and 0.013) than usual care. There was a 65 percent and 99.5 percent chance of cost-effectiveness for PainCheck and TCPT, respectively. Results were relatively robust to sensitivity analyses. The most important driver of cost-effectiveness was level of pain reduction (intervention effectiveness). Although cost savings were modest per patient, these were considerable when accounting for the number of potential intervention beneficiaries.ConclusionsEducational and monitoring/feedback interventions have the potential to be cost-effective. Economic evaluations based on estimates of effectiveness from published meta-analyses and using a decision modeling approach can support commissioning decisions and implementation of pain management strategies.
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Ware, Tim, David Hanlon, Glynn Hosking, Ray Perry, and Simon Richards. "Validation of JEFF-3.3 and ENDF/B-VIII.0 nuclear data libraries in ANSWERS codes." EPJ Web of Conferences 239 (2020): 19001. http://dx.doi.org/10.1051/epjconf/202023919001.
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The JEFF-3.3 and ENDF/B-VIII.0 evaluated nuclear data libraries were released in December 2017 and February 2018 respectively. Both evaluations represent a comprehensive update to their predecessor evaluations. The ANSWERS Software Service produces the MONK® and MCBEND Monte Carlo codes, and the WIMS deterministic code for nuclear criticality, shielding and reactor physics applications. MONK and MCBEND can utilise continuous energy nuclear data provided by the BINGO nuclear data library and MONK and WIMS can utilise broad energy group data (172 group XMAS scheme) via the WIMS nuclear data library. To produce the BINGO library, the BINGO Pre-Processor code is used to process ENDF-6 format evaluations. This utilises the RECONR-BROADR-PURR sequence of NJOY2016 to reconstruct and Doppler broaden the free gas neutron cross sections together with bespoke routines to generate cumulative distributions for the S(α,β) tabulations and equi-probable bins or probability functions for the secondary angle and energy data. To produce the WIMS library, NJOY2016 is again used to reconstruct and Doppler broaden the cross sections. The THERMR module is used to process the thermal scattering data. Preparation of data for system-dependent resonance shielding of some nuclides is performed. GROUPR is then used to produce the group averaged data before all the data are transformed into the specific WIMS library format. The MONK validation includes analyses based on around 800 configurations for a range of fuel and moderator types. The WIMS validation includes analyses of zero-energy critical and sub-critical, commissioning, operational and post-irradiation experiments for a range of fuel and moderator types. This paper presents and discusses the results of MONK and WIMS validation benchmark calculations using the JEFF-3.3 and ENDF/B-VIII.0 based BINGO and WIMS nuclear data libraries.
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Bertram, Mark. "Mental health, social inclusion and the development of vocational services in the NHS – what can be learnt?" Mental Health Review Journal 24, no. 2 (2019): 133–43. http://dx.doi.org/10.1108/mhrj-09-2018-0027.
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Purpose The purpose of this paper is to describe the learning from a historical NHS vocational service development that focused on: mental health, employment and social inclusion – in an inner city area – involving service users, staff and commissioners. Design/methodology/approach It is a descriptive case study. A range of historical documents was content analysed and described through a first-person narrative: service user consultations, service specifications, audit records, outcome frameworks, internal service evaluations and published literature. Findings When vocational NHS service developments are grounded in what service users say helps them (person-centred, networked and co-ordinated approaches) the evidence indicates people can achieve their vocational goals. Research limitations/implications The range of documents described is factual, although the learning insights from some of the service developments are based on personal judgements. The author was the responsible manager – personal bias is high. There is not enough robust evidence to warrant generalisation. Practical implications When employment and social inclusion are prioritised, as core business in NHS, outcomes and health impact can increase. Greater detail is needed from healthcare policy makers – focusing on who exactly should undertake this work and what the key commissioning social inclusion performance indicators are. Originality/value The bulk of literature on employment support focuses on promoting evidence from one model: individual placement and support. Evidence here indicates a broader range of activity (education, training and volunteering) can have value and health impact.
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Hare, Philly. "Dementia without Walls: reflections on the Joseph Rowntree Foundation programme." Working with Older People 20, no. 3 (2016): 134–43. http://dx.doi.org/10.1108/wwop-06-2016-0012.
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Purpose The purpose of this paper is to describe the key elements of a major work programme on dementia, and to reflect on the practical learning derived. Design/methodology/approach The paper describes the whole range of programme activity, including research projects, think-pieces, action research, demonstrations, evaluations and production of resources such as films, infographics, case studies, practice guides and positive image galleries. Findings The active, meaningful engagement of people with dementia and their families is fundamental. Communities must engage with, and achieve equity for, all people with dementia, whatever their circumstances. Practical barriers to inclusion must be addressed if normal lives are to be continued. The human rights of people with dementia and carers must be recognised and promoted. Local grassroots community activity is the bedrock of dementia friendly communities – but this activity must be supported by strong strategic planning, commissioning and leadership. There is no template – each community must develop its own approach. Practical implications The paper highlights many examples of good practice which can inform the work of commissioners and practitioners, as well as wider communities. These focus particularly on good practice in engagement and involvement; and the co-production of dementia friendly communities with people with dementia. Social implications The programme highlights the importance of social barriers to the inclusion of people with dementia in their communities, and gives examples of communities which have tried to overcome these through attitudinal and environmental change. Originality/value Joseph Rowntree Foundation’s programme is highly innovative and well-regarded.
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Snooks, Helen, Ashra Khanom, Robert Cole, et al. "PP27 What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the united kingdom." Emergency Medicine Journal 37, no. 10 (2020): e12.3-e13. http://dx.doi.org/10.1136/emermed-2020-999abs.27.
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BackgroundEmergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern.Aims and ObjectivesTo describe: service-wide and local policies or pathways for people classified as Frequent Caller; call volume; and results of any audit or evaluation.MethodsWe conducted a national survey of current practice in ambulance services in relation to the management of people who call the emergency ambulance service frequently using a structured questionnaire, for completion by email and telephone interview. We analysed responses using a descriptive and thematic approach.ResultsTwelve of 13 UK ambulance services responded. Most services used nationally agreed definitions for ‘Frequent Caller’, with 600 – 900 people meeting this classification each month. Service-wide policies were in place, with local variations. Models of care varied from within-service care where calls are flagged in the call centre, contact made with callers and their GP with an aim of discouraging further calls; to case management through cross-service, multi-disciplinary team meetings aiming to resolve callers’ needs. No formal audits or evaluations were reported.ConclusionsAmbulance services are under pressure to meet challenging response times for high acuity patients. Tensions are apparent in the provision of care to patients who have complex needs and call frequently. Within service care focused mainly on reducing calls whilst multi-disciplinary case management aimed to resolve clinical and emotional needs of patients. However, there is currently inadequate evidence to inform commissioning, policy or practice development.
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Briggs, David Stewart, Richard Nankervis, John Baillie, Catherine Turner, Kevin Rigby, and Lorin Livingstone. "Innovation to improve patient care in Australian Primary Health Network: an insider’s perspective." Public Administration and Policy 22, no. 2 (2019): 111–24. http://dx.doi.org/10.1108/pap-09-2019-0017.
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Purpose The purpose of this paper is to review the establishment of Primary Health Network (PHN) in Australia and its utility in commissioning Primary Health Care (PHC) services. Design/methodology/approach This study is an analysis of management practice about the establishment and development of a PHN as a case study over the three-year period. The PHN is the Hunter New England and Central Coast PHN (HNECCPHN). The study is based on “insiders perspectives” drawing from documentation, reports and evaluations undertaken. Findings HNECCPHN demonstrates a unique inclusive organisation across a substantial diverse geographic area. It has taken an innovative and evidence-based approach to its creation, governance and operation. HNECCPHN addresses the health challenges of a substantial Aboriginal and/or Torres Strait Islander population. It contains significant and diverse urban, coastal and distinct rural, regional and remote populations. It can be described as a “virtual” organisation, using a distributed network of practice approach to engage clinicians, communities and providers. The authors describe progress and learning in the context of theories of complex organisations, innovation, networks of practice, knowledge translation and social innovation. Research limitations/implications The study provides initial publication into the establishment phase of a PHN in Australia. Practical implications The study describes the implementation and progress in terms of relevant international practice and theoretical concepts. This paper demonstrates significant innovative practice in the short term. Social implications The study describes significant engagement and the importance of that with and between communities, service providers and health professionals. Originality/value This is the first study of the results of the implementation of an important change in the funding and delivery of PHC in Australia.
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Sheaff, Rod, Nigel Charles, Ann Mahon, et al. "NHS commissioning practice and health system governance: a mixed-methods realistic evaluation." Health Services and Delivery Research 3, no. 10 (2015): 1–184. http://dx.doi.org/10.3310/hsdr03100.
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BackgroundBy 2010 English health policy-makers had concluded that the main NHS commissioners [primary care trusts (PCTs)] did not sufficiently control provider costs and performance. After the 2010 general election, they decided to replace PCTs with general practitioner (GP)-controlled Clinical Commissioning Groups (CCGs). Health-care commissioners have six main media of power for exercising control over providers, which can be used in different combinations (‘modes of commissioning’).ObjectivesTo: elicit the programme theory of NHS commissioning policy and empirically test its assumptions; explain what shaped NHS commissioning structures; examine how far current commissioning practice allowed commissioners to exercise governance over providers; examine how commissioning practices differ in different types of commissioning organisation and for specific care groups; and explain what factors influenced commissioning practice and the relationships between commissioners and providers.DesignMixed-methods realistic evaluation, comprising: Leximancer and cognitive frame analyses of policy statements to elicit the programme theory of NHS commissioning policy; exploratory cross-sectional analysis of publicly available managerial data about PCTs; systematic comparison of case studies of commissioning in four English sites – including commissioning for older people at risk of unplanned hospital admission; mental health; public health; and planned orthopaedic surgery – and of English NHS commissioning practice with that of a German sick-fund and an Italian region (Lombardy); action learning sets, to validate the findings and draw out practical implications; and two framework analyses synthesising the findings and testing the programme theory empirically.ResultsIn the four English case study sites, CCGs were formed by recycling former commissioning structures, relying on and maintaining the existing GP commissioning leaderships. The stability of distributed commissioning depended on the convergence of commissioners’ interests. Joint NHS and local government commissioning was more co-ordinated at strategic than operational level. NHS providers’ responsiveness to commissioners reflected how far their interests converged, but also providers’ own internal ability to implement agreements. Commissioning for mental health services and to prevent recurrent unplanned hospital readmissions relied more on local ‘micro-commissioning’ (collaborative care pathway design) than on competition. Service commissioning was irrelevant to intersectoral health promotion, but not clinical prevention work. On balance, the possibility of competition did not affect service outcomes in the ways that English NHS commissioning policies assumed. ‘Commodified’ planned orthopaedic surgery most lent itself to provider competition. In all three countries, tariff payments increased provider activity and commissioners’ costs. To contain costs, commissioners bundled tariff payments into blocks, agreed prospective case loads with providers and paid below-tariff rates for additional cases. Managerial performance, negotiated order and discursive control were the predominant media of power used by English, German and Italian commissioners.ConclusionsCommissioning practice worked in certain respects differently from what NHS commissioning policy assumed. It was often laborious and uncertain. In the four English case study sites financial and ‘real-side’ contract negotiations were partly decoupled, clinician involvement being least on the financial side. Tariff systems weakened commissioners’ capacity to choose providers and control costs. Commissioners adapted the systems to solve this problem. Our findings suggest a need for further research into whether or not differently owned providers (corporate, third sector, public, professional partnership, etc.) respond differently to health-care commissioners and, if so, what specific implications for commissioning practice follow. They also suggest that further work is needed to assess how commissioning practices impact on health system integration when care pathways have to be constructed across multiple providers that must tender competitively for work, perhaps against each other.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Akin, Omer. "Embedded Commissioning©." PARC Pesquisa em Arquitetura e Construção 2, no. 7 (2011): 2. http://dx.doi.org/10.20396/parc.v2i7.8634579.
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Embedded Commissioning (ECx) a new digital technology promises to transform capital project delivery (CPD) and its evaluation in the years to come. The primary strategy in ECx is to create an entirely new approach to building evaluation by merging building commissioning methods and information technologies into a new framework. The vision of such broad innovations must include not just new digital tools and techniques but also advances in AEC practices that utilize these innovations. We envision design and engineering practices that are in the service of sound economy, environmental conservation, improved value, greater efficiency, and satisfied occupants. CPD is no longer about competence in delivering just conventional services. Engineers and Architects have to rise to the challenges of our time and insure the best economy in providing the greatest value to stakeholders. Performance needs have to be optimized against first and lifecycle cost of designs. Value must be assessed not just for the bottom line but for other tangible (health, productivity) and intangible (comfort, happiness, recognition) stakeholders benefits. Last but not least, their products must meet the three pillars of the CPD market place: quality, cost, and schedule.
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Booth, Andrew, Louise Preston, Susan Baxter, Ruth Wong, Duncan Chambers, and Janette Turner. "Interventions to manage use of the emergency and urgent care system by people from vulnerable groups: a mapping review." Health Services and Delivery Research 7, no. 33 (2019): 1–46. http://dx.doi.org/10.3310/hsdr07330.
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Background The NHS currently faces increasing demands on accident and emergency departments. Concern has been expressed regarding whether the needs of vulnerable groups are being handled appropriately or whether alternative methods of service delivery may provide more appropriate emergency and urgent care services for particular groups. Objective Our objective was to identify what interventions exist to manage use of the emergency and urgent care system by people from a prespecified list of vulnerable groups. We aimed to describe the characteristics of these interventions and examine service delivery outcomes (for patients and the health service) resulting from these interventions. Review methods We conducted an initial mapping review to assess the quantity and nature of the published research evidence relating to seven vulnerable groups (socioeconomically deprived people and families, migrants, ethnic minority groups, the long-term unemployed/inactive, people with unstable housing situations, people living in rural/isolated areas and people with substance abuse disorders). Databases, including MEDLINE and the Cumulative Index to Nursing and Allied Health Literature, and other sources were searched between 2008 and 2018. Quantitative and qualitative systematic reviews and primary studies of any design were eligible for inclusion. In addition, we searched for UK interventions and initiatives by examining press reports, commissioning plans and casebooks of ‘good practice’. We carried out a detailed intervention analysis, using an adapted version of the TIDieR (Template for Intervention Description and Replication) framework for describing interventions, and an analysis of current NHS practice initiatives. Results We identified nine different types of interventions: care navigators [three studies – moderate GRADE (Grading of Recommendations, Assessment, Development and Evaluations)], care planning (three studies – high), case finding (five studies – moderate), case management (four studies – high), front of accident and emergency general practice/front-door streaming model (one study – low), migrant support programme (one study – low), outreach services and teams (two studies – moderate), rapid access doctor/paramedic/urgent visiting services (one study – low) and urgent care clinics (one systematic review – moderate). Few interventions had been targeted at vulnerable populations; instead, they represented general population interventions or were targeted at frequent attenders (who may or may not be from vulnerable groups). Interventions supported by robust evidence (care navigators, care planning, case finding, case management, outreach services and teams, and urgent care clinics) demonstrated an effect on the general population, rather than specific population effects. Many programmes mixed intervention components (e.g. case finding, case management and care navigators), making it difficult to isolate the effect of any single component. Promising UK initiatives (front of accident and emergency general practice/front-door streaming model, migrant support programmes and rapid access doctor/paramedic/urgent visiting services) lacked rigorous evaluation. Evaluation should therefore focus on the clinical effectiveness and cost-effectiveness of these initiatives. Conclusions The review identified a limited number of intervention types that may be useful in addressing the needs of specific vulnerable populations, with little evidence specifically relating to these groups. The evidence highlights that vulnerable populations encompass different subgroups with potentially differing needs, and also that interventions seem particularly context sensitive. This indicates a need for a greater understanding of potential drivers for varying groups in specific localities. Limitations Resources did not allow exhaustive identification of all UK initiatives; the examples cited are indicative. Future work Research is required to examine how specific vulnerable populations differentially benefit from specific types of alternative service provision. Further exploration, using primary mixed-methods data and potentially realist evaluation, is required to explore what works for whom under what circumstances. Rigorous evaluation of UK initiatives is required, including a specific need for economic evaluations and for studies that incorporate effects on the wider emergency and urgent care system. Funding The National Institute for Health Research Health Services and Delivery Research programme.
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Olthof, Ian, and Thomas Rainville. "Evaluating Simulated RADARSAT Constellation Mission (RCM) Compact Polarimetry for Open-Water and Flooded-Vegetation Wetland Mapping." Remote Sensing 12, no. 9 (2020): 1476. http://dx.doi.org/10.3390/rs12091476.
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When severe flooding occurs in Canada, the Emergency Geomatics Service (EGS) is tasked with creating and disseminating maps that depict flood extents in near real time. EGS flood mapping methods were created with efficiency and robustness in mind, to allow maps to be published quickly, and therefore have the potential to generate high-repeat water products that can enhance frequent wetland monitoring. The predominant imagery currently used is synthetic aperture radar (SAR) from RADARSAT-2 (R2). With the commissioning phase of the RADARSAT Constellation Mission (RCM) complete, the EGS is adapting its methods for use with this new source of SAR data. The introduction of RCM’s circular-transmit linear-receive (CTLR) beam mode provides the option to exploit compact polarimetric (CP) information not previously available with R2. The aim of this study was to determine the most effective CP parameters for use in mapping open water and flooded vegetation, using current EGS methodologies, and compare these products to those created by using R2 data. Nineteen quad-polarization R2 scenes selected from three regions containing wetlands prone to springtime flooding were used to create reference flood maps, using existing EGS tools. These scenes were then used to simulate 22 RCM CP parameters at different noise floors and spatial resolutions representative of the three RCM beam modes. Using multiple criteria, CP parameters were ranked in order of importance and entered into a stepwise classification procedure, for evaluation against reference R2 products. The top four CP parameters —m-chi-volume or m-delta-volume, RR intensity, Shannon Entropy intensity (SEi), and RV intensity—achieved a maximum agreement with baseline R2 products of upward of 98% across all 19 scenes and three beam modes. Separability analyses between flooded vegetation and other land-cover classes identified four candidate CP parameters—RH intensity, RR intensity, SEi, and the first Stokes parameter (SV0)—suitable for flooded-vegetation-region growing. Flooded-vegetation-region-growing CP thresholds were found to be dependent on incidence angle for each of these four parameters. After region growing using each of the four candidate CP parameters, RH intensity was deemed best to map flooded vegetation, based on our evaluations. The results of the study suggest a set of suitable CP parameters to generate flood maps from RCM data, using current EGS methodologies that must be validated further as real RCM data become available.
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Duncan, Lorna J., and Kelly F. D. Cheng. "Modifications to the delivery of NHS face-to-face general practice consultations during the COVID-19 pandemic in England." F1000Research 10 (March 31, 2021): 261. http://dx.doi.org/10.12688/f1000research.52161.1.
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Background: To minimise transmission of SARS-CoV-2, the virus causing COVID-19, delivery of general practice consultations has been modified to enable the separation of diagnosed or suspected COVID-19 patients from others. Remote triage and consultations are currently the default model, with adapted face-to-face contact used when clinically necessary. This study aimed to identify the modified face-to-face delivery models used across England, and evidence for their effectiveness. Methods: In June 2020, a national survey was sent by email to the 135 Clinical Commissioning Groups (CCGs) in England to identify local organisation of face-to-face general practice consultations since March 2020. An email was sent to Public Health England (PHE) requesting information about COVID-19 outbreaks or clusters linked to general practice. Results: All CCGs responded. Separation of COVID-19 patients from others was achieved using combinations of the following models: zoned surgeries (used in 47% of CCGs), where COVID-19 and other patients are separated within their own practice;‘hot’ or ‘cold’ hubs (used in 90% of CCGs), separate sites where COVID-19 or other patients registered at one of several collaborating practices are seen;‘hot’ and ‘cold’ home visits (used in 70% of CCGs). One of seven model combinations was used across each CCG, with some flexibility according to changing need shown through hub availability. Concomitant PHE data showed less than 2% of COVID-19 outbreaks or clusters in England were linked to general practice. Conclusions: Varied, flexible ways of delivering face-to-face general practice consultations were identified. While COVID-19 outbreaks or clusters linked to general practice constituted a small proportion of totals, their investigation, together with evaluations of the modified delivery models in terms of management of COVID-19 and other conditions and impacts on staff and patients, may aid future management of the pandemic and identify aspects of adapted practice of benefit beyond this.
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Nelson, Kayleigh M., Aimee I. McKinnon, Angela Farr, Jaynie Y. Rance, and Ceri J. Phillips. "The development of a collaborative framework for commissioning health and social care." Journal of Integrated Care 26, no. 4 (2018): 286–95. http://dx.doi.org/10.1108/jica-01-2018-0001.
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Purpose The purpose of this paper is to present an evaluation of a collaborative commissioning approach to improve quality and experience and reduce cost within integrated health and social care. Design/methodology/approach A multi-method approach is used involving qualitative interviews, documentary analysis and non-participant observation. Findings The findings suggest that the approach provides a suitable framework for the collaborative commissioning of integrated health and social care services. Research limitations/implications Further research is now needed to provide a definitive evaluation of its value outside of Wales. Practical implications With the significant scrutiny on health systems, the approach demonstrates effectiveness in securing quality improvements, achievement of recognised care standards and patient outcomes, while providing scope for financial gains and a goal for stakeholders to engage in effective communication. Originality/value This research presents an innovative method for collaborative commissioning and reveals activities that appear to contribute to more effective commissioning processes.
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Carlisle, Karen, Rhonda Fleming, and Alison Berrigan. "Commissioning for healthcare: a case study of the general practitioners After Hours Program." Australian Journal of Primary Health 22, no. 1 (2016): 22. http://dx.doi.org/10.1071/py15036.
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A strong primary healthcare system that is effective and efficient is a priority for health reform in Australia. Commissioning to support primary healthcare delivery has received increasing attention as part of healthcare reform in Australia and beyond. The aim of this paper is to present a case study of transitioning to an activity-based model for the provision of GP after-hours services in Australia. The GP After-Hours Program utilised a commissioning model that comprised of needs assessment, service development, provider engagement and evaluation. Evaluation of the new model showed a 17% increase in after-hours services, with service providers indicating that they were satisfied with the new process. Examination of the experience of implementation suggests that the commissioning model provided a useful framework for guiding activity-based funding for after-hours services. However, relational factors, such as engagement with the community, knowledge of the wider context and legitimacy of the commissioning body, can affect the implementation process.
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Greener, Ian, and Russell Mannion. "A realistic evaluation of practice-based commissioning." Policy & Politics 37, no. 1 (2009): 57–73. http://dx.doi.org/10.1332/030557309x395614.
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McCafferty, Sara, Iestyn Williams, David Hunter, Suzanne Robinson, Cam Donaldson, and Angela Bate. "Implementing World Class Commissioning Competencies." Journal of Health Services Research & Policy 17, no. 1_suppl (2012): 40–48. http://dx.doi.org/10.1258/jhsrp.2011.011104.
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Background The world class commissioning (WCC) programme was introduced in the English NHS in 2007 to develop primary care trust (PCT) commissioning of health services. There has been limited evaluation of health commissioning initiatives over the years and in particular little is known about how commissioners interpret and implement initiatives and guidance intended to strengthen commissioning. This research explores the development and implementation of WCC and draws implications for future commissioning arrangements. Methods This research draws on interviews with key informants (n = 6) and a literature review to analyse the aims of, and stimulus for, WCC. In-depth interviews (n = 38) were conducted in three PCTs in the north of England in 2009 to analyse the interpretation and implementation of WCC. Results The aims and rationale of WCC, in particular, the specification of commissioning skills and the aspirations to improve health outcomes, were largely welcomed and supported by interviewees. However, the implementation of WCC posed a number of challenges, including: availability of resources and knowledge; lack of a supportive organizational culture and networks; and the dominance of central government control. Conclusions The findings have implications for emerging clinical commissioning groups (CCGs) in the English NHS. Specifically, the research highlights the need for a system-wide approach to improving commissioning, including appropriately aligned policy and objectives underpinned by a co-ordinated and supportive organizational culture.
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McDermott, Imelda, Kath Checkland, Anna Coleman, Dorota Osipovič, Christina Petsoulas, and Neil Perkins. "Engaging GPs in commissioning: realist evaluation of the early experiences of Clinical Commissioning Groups in the English NHS." Journal of Health Services Research & Policy 22, no. 1 (2016): 4–11. http://dx.doi.org/10.1177/1355819616648352.
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Objectives To explore the ‘added value’ that general practitioners (GPs) bring to commissioning in the English NHS. We describe the experience of Clinical Commissioning Groups (CCGs) in the context of previous clinically led commissioning policy initiatives. Methods Realist evaluation. We identified the programme theories underlying the claims made about GP ‘added value’ in commissioning from interviews with key informants. We tested these theories against observational data from four case study sites to explore whether and how these claims were borne out in practice. Results The complexity of CCG structures means CCGs are quite different from one another with different distributions of responsibilities between the various committees. This makes it difficult to compare CCGs with one another. Greater GP involvement was important but it was not clear where and how GPs could add most value. We identified some of the mechanisms and conditions which enable CCGs to maximize the ‘added value’ that GPs bring to commissioning. Conclusion To maximize the value of clinical input, CCGs need to invest time and effort in preparing those involved, ensuring that they systematically gather evidence about service gaps and problems from their members, and engaging members in debate about the future shape of services.
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Turkaslan-Bulbul, Muhsine Tanyel, and Omer Akin. "Computational support for building evaluation: Embedded Commissioning Model." Automation in Construction 15, no. 4 (2006): 438–47. http://dx.doi.org/10.1016/j.autcon.2005.06.010.
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Gardner, Karen, G. Powell Davies, Karen Edwards, et al. "A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy." Australian Journal of Primary Health 22, no. 1 (2016): 40. http://dx.doi.org/10.1071/py15148.
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The aim of this systematic review was to assess evidence of the impact of commissioning on health service use, quality, outcomes and value for money and to consider findings in the Australian context. Systematic searches of the literature identified 444 papers and, after exclusions, 36 were subject to full review. The commissioning cycle (planning, contracting, monitoring) formed a framework for analysis and impacts were assessed at individual, subpopulation and population levels. Little evidence of the effectiveness of commissioning at any level was available and observed impacts were highly context-dependent. There was insufficient evidence to identify a preferred model. Lack of skills and capacity were cited as major barriers to the implementation of commissioning. Successful commissioning requires a clear policy framework of national and regional priorities that define agreed targets for commissioning agencies. Engagement of consumers and providers, especially physicians, was considered to be critically important but is time consuming and has proven difficult to sustain. Adequate information on the cost, volume and quality of healthcare services is critically important for setting priorities, and for contracting and monitoring performance. Lack of information resulted in serious problems. High-quality nationally standardised performance measures and data requirements need to be built into contracts and ongoing monitoring and evaluation. In Australia, there is significant work to be done in areas of policy and governance, funding systems and incentives, patient enrolment or registration, information systems, individual and organisational capacity, community engagement and experience in commissioning.
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Early, Frances, Sarah-Jane Winders, Snigdha Reddy, Jonathan Ralphs, and Jonathan Fuld. "Co-production to inform clinical commissioning in COPD: an evaluation of Working Together for Change." European Journal for Person Centered Healthcare 5, no. 1 (2017): 111. http://dx.doi.org/10.5750/ejpch.v5i1.1229.
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Rationale, aims and objectives: Patient involvement in healthcare decision-making is often limited to consultation. Co-production is an approach that empowers patients to work collaboratively with providers as agents of change. The objective of this study was to explore participants’ experiences and satisfaction with a co-production process, Working Together for Change (WTfC), used to inform the commissioning of services for people living with Chronic Obstructive Pulmonary Disease (COPD). Method: Mixed methods developmental service evaluation drawing primarily on qualitative data from semi-structured interviews. Setting and participants: Community-based intervention with COPD patients, carers, commissioners and providers of COPD services. Intervention: One-to-one reviews with 45 patients identified what was working, not working and what was important for the future regarding COPD management. In 2 one-day workshops attended by 14 patients and carers and 17 professionals this information was analysed to inform commissioning priorities.Results: Participant satisfaction was high. Thematic analysis identified 3 themes: (1) an engaging experience, (2) a constructive process enabled by strong patient presence, real patient experiences, collaboration, sense of freedom, a range of contributions and commitment & (3) personal gains from the patient and carer voice being counted, mutual understanding, seeing the value of patient involvement and learning and sharing. Some concerns were raised about the process and suggestions made for improvement.Conclusions: WTfC was an acceptable process to inform COPD commissioning activity and resulted in an agreed and priorities action plan for COPD service commissioning. It supported collaborative working, egalitarian relationships and mutual learning between patients, carers and professionals. As a standalone activity it was not possible to evaluate the value of the outputs to commissioners or the objective impact but it provided a powerful introduction to co-production methods. WTfC can be an impactful starting point for embedding co-production into the commissioning process.
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Miller, Paul, and Luke Vale. "Programme Approach to Managing Informed Commissioning." Health Services Management Research 14, no. 3 (2001): 159–64. http://dx.doi.org/10.1177/095148480101400303.
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The objective of this paper is to examine possible organizational reasons for why UK NHS commissioners have not adopted programme budgeting and marginal analysis (PBMA). This is despite increasing evidence of discontent with current commissioning and priority-setting processes, increasing research evidence demonstrating the potential of PBMA and support for the principles of PBMA. Two separate semistructured surveys of the views of commissioning decision-makers on the use of PBMA were carried out at Grampian Health Board and Newcastle & North Tyneside Health Authority. Twenty-nine decision-makers were interviewed. Both surveys found common barriers to implementation of PBMA, described by respondents as ‘institutional inertia’. These were the reactive rather than proactive environment; the fear of ‘unnecessary’ explicitness; an aversion to unilateral innovation in the current NHS environment; and the demand for concrete evaluation evidence. It is concluded that these qualitative surveys have small samples and cannot claim to be representative. It may be significant that many issues were common to both surveys carried out separately in organizations. It is unlikely that NHS commissioning will independently adopt techniques such as PBMA, given the current commissioning environment and organizational structures. Implementation strategies and future research on such commissioning innovations may need to focus on institutions as well as the interventions.
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Miller, Paul, and Luke Vale. "Programme approach to managing informed commissioning." Health Services Management Research 14, no. 3 (2001): 159–64. http://dx.doi.org/10.1258/0951484011912663.
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The objective of this paper is to examine possible organizational reasons for why UK NHS commissioners have not adopted programme budgeting and marginal analysis (PBMA). This is despite increasing evidence of discontent with current commissioning and priority-setting processes, increasing research evidence demonstrating the potential of PBMA and support for the principles of PBMA. Two separate semistructured surveys of the views of commissioning decision-makers on the use of PBMA were carried out at Grampian Health Board and Newcastle & North Tyneside Health Authority. Twenty-nine decision-makers were interviewed. Both surveys found common barriers to implementation of PBMA, described by respondents as 'institutional inertia'. These were the reactive rather than proactive environment; the fear of 'unnecessary' explicitness; an aversion to unilateral innovation in the current NHS environment; and the demand for concrete evaluation evidence. It is concluded that these qualitative surveys have small samples and cannot claim to be representative. It may be significant that many issues were common to both surveys carried out separately in organizations. It is unlikely that NHS commissioning will independently adopt techniques such as PBMA, given the current commissioning environment and organizational structures. Implementation strategies and future research on such commissioning innovations may need to focus on institutions as well as the interventions.
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Skýpala, Richard, and Roman Ružarovský. "Virtual commissioning of automated manufacturing systems — Quality-handling station case study." MATEC Web of Conferences 343 (2021): 04002. http://dx.doi.org/10.1051/matecconf/202134304002.
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The aim of the contribution is to create an event-controlled simulation of an automated production system using selected simulation software according to analyses and creation PLC control program compatible with human-machine control interface (HMI) visualization. The programmer can test the control program without the need for additional hardware on a virtual model of the machine. This method is called as a Virtual Commissioning method. The question is whether these new digital technologies are beneficial in the development process of new machines. The theoretical part of the contribution deals with the evaluation of the current state of knowledge in the field of virtual commissioning systems from the perspective of the Industry 4.0 concept and the use of principles taken from the technology of digital twins for analysing the possibilities of productive support of simulation, programming and visualization of control. For the Virtual Commissioning of the Quality-handling station from a flexible production system. It was chosen Tecnomatix Process simulating software for the developing of the Digital Twin of the station that is suitable for the connection of the logical behaviour inputs and outputs of the Digital Twin to the PLCSIM emulator. The main goal is to create a functional PLC program, so that in the second phase the process of virtual commissioning can be tested by the Software-the-Loop method. The preparation of the simulation model consists in a sample of the control station model of the production system, the process of creating kinematic bonds, behaviour model, creating control signals in the Tecnomatix Process Simulate program. Programming procedure and acquaintance with control means in the Simatic Manager program, selection of communication interface and creation of control visualization. In the final work, validation is performed and evaluation supports the objectives and the results confirmed the benefits of the Virtual Commissioning tool.
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Turner, Catherine. "Outcomes based commissioning, evaluation and the challenge of decommissioning." International Journal of Integrated Care 20, no. 3 (2021): 29. http://dx.doi.org/10.5334/ijic.s4029.
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Martin, Antony, Brendan Mulhern, Anum Shaikh, et al. "Disease State Adaptation Experienced By Patients with Hemophilia: Literature Review and Expert Consensus." Blood 134, Supplement_1 (2019): 5801. http://dx.doi.org/10.1182/blood-2019-124396.
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Introduction Hemophilia is an inherited disorder that causes a deficiency of a blood clotting factor resulting in a lifelong bleeding diathesis. People with hemophilia (PWH) may experience significant morbidity including potentially life-threatening hemorrhages and accumulation of joint damage and require burdensome and costly chronic treatment with factor replacement therapies. Gene therapies aimed at providing endogenous production of the missing clotting factor have the potential to yield significant health benefits for PWH. Economic evaluation is an important component for the commissioning and funding of new treatments like gene therapies. In economic evaluation, quality-of-life (QoL) is measured using health state utility valuations (HSUV). However, people with inherited and long-term health conditions may adapt to their given health state and adjust their expectations, therefore biasing the estimates of QoL/HSUV (i.e., disease state adaptation (DSA) or "disability paradox"; Albrecht and Devlieger, 1999). Here, we describe the first stages of research to evaluate DSA experienced by PWH. Methods To facilitate the selection of research methodology, a systematic litearure review (SLR) was performed to examine existing studies on QoL/HSUVs for PWH. A SLR was conducted to identify full-text studies by searching electronic databases (e.g. MEDLINE, Web of Science, Cochrane Library). Studies were included in the review using predefined inclusion/exclusion criteria for population, study type, language (English). Additionally, a manual search (last three years) for conferences abstracts was performed to capture the most up-to-date research. Findings from the SLR informed the conceptualisation of a study framework. The proposed research approach was then discussed with an expert panel consisting of clinicians, patient advocacy representatives, and Health Technology Assessment (HTA) specialists. Results The SLR identified 32 studies reporting HSUVs in hemophilia. The studies identified applied a mix of direct and indirect HSUV elicitation techniques. Two studies applied direct time trade-off methodology and the remaining 30 studies adopted indirect valuation methodologies. Utility values were found to vary by disease severity, musculoskeletal damage, bleed frequency, inhibitors, hemophilia subtype, treatment regimen, and adherence. Interestingly, HSUVs derived from valuations from the general public were found to be valued lower than those derived from PWH for the same health states. For example, in Carlsson et al. (2017), general public participants consistently rated significantly lower HSUVs for hemophilia disease states compared to PWH (range: 0.54-0.60 vs. 0.67-0.73), suggesting DSA might exist for PWH. Based on SLR findings, an expert panel discussed the feasibility and acceptability of an approach for conducting a preference elicitation study to directly evaluate DSA in PWH. Preference elicitation is an established research framework that is widely used in health economics. A comparative preference elicitation study was proposed to describe and quantify DSA by comparing responses from PWH, caregivers of PWH, and the general public. Conclusion Based on the SLR and expert panel inputs from clinicians, patients and HTA experts, an agreement was achieved about the research methodology for a new study directly assessing DSA experienced by PWH. Experts agreed that a comparative preference elicitation approach among PWH, caregivers of PWH, and the general public was fit-for-purpose for this research. The impact of DSA on QoL/HSUV should be characterized within economic evaluations of novel treatments with transformative impact on patients' lives, such as gene therapies. Disclosures Martin: HCD Economics: Employment. Mulhern:HCD Economics: Consultancy. Shaikh:HCD Economics: Employment. Asghar:HCD Economics: Employment. O'Hara:HCD Economics: Employment, Equity Ownership. Pedra:HCD Economics: Employment. Sawyer:uniQure Inc.: Employment. Li:uniQure Inc.: Employment.
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Wang, Shengwei, and Jin-Bo Wang. "Automatic sensor evaluation in BMS commissioning of building refrigeration systems." Automation in Construction 11, no. 1 (2002): 59–73. http://dx.doi.org/10.1016/s0926-5805(01)00050-4.
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Gibbons, David E. "An evaluation of primary dental care practitioners in commissioning groups." British Dental Journal 189, no. 12 (2000): 662. http://dx.doi.org/10.1038/sj.bdj.4800858.
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Gibbons, David. "An evaluation of primary dental care practitioners in commissioning groups." British Dental Journal 189, no. 12 (2000): 662. http://dx.doi.org/10.1038/sj.bdj.4800858a.
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Hine, C. E., and M. O. Bachmann. "What does locality commissioning in Avon offer? Retrospective descriptive evaluation." BMJ 314, no. 7089 (1997): 1246. http://dx.doi.org/10.1136/bmj.314.7089.1246.
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Kadoya, Noriyuki, Satoshi Kito, Masahiko Kurooka, et al. "Factual survey of the clinical use of deformable image registration software for radiotherapy in Japan." Journal of Radiation Research 60, no. 4 (2019): 546–53. http://dx.doi.org/10.1093/jrr/rrz034.
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Abstract Deformable image registration (DIR) has recently become commercially available in the field of radiotherapy. However, there was no detailed information regarding the use of DIR software at each medical institution. Thus, in this study, we surveyed the status of the clinical use of DIR software for radiotherapy in Japan. The Japan Society of Medical Physics and the Japanese Society for Radiation Oncology mailing lists were used to announce this survey. The questionnaire was created by investigators working under the research grant of the Japanese Society for Radiation Oncology (2017–2018) and intended for the collection of information regarding the use of DIR in radiotherapy. The survey was completed by 161 institutions in Japan. The survey results showed that dose accumulation was the most frequent purpose for which DIR was used in clinical practice (73%). Various commissioning methods were performed, although they were not standardized. Qualitative evaluation with actual patient images was the most commonly used method (28%), although 30% of the total number of responses (42% of institutions) reported that they do not perform commissioning. We surveyed the current status of clinical use of DIR software for radiotherapy in Japan for the first time. Our results indicated that a certain number of institutions used DIR software for clinical practice, and various commissioning methods were performed, although they were not standardized. Taken together, these findings highlight the need for a technically unified approach for commissioning and quality assurance for the use of DIR software in Japan.
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Abou-elenein, HassanS, H. Ammar, Mohamed Farouk, EhabM Attalla, Ismail Eldesoky, and MohamedS Zaghloul. "Megavoltage cone beam computed tomography: Commissioning and evaluation of patient dose." Journal of Medical Physics 36, no. 4 (2011): 205. http://dx.doi.org/10.4103/0971-6203.89969.
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Yonekawa, H., Y. O. Kim, Hyun Jung Lee, et al. "KSTAR Magnetic Field Measurement During the Commissioning and Remanent Field Evaluation." IEEE Transactions on Applied Superconductivity 19, no. 3 (2009): 1573–76. http://dx.doi.org/10.1109/tasc.2009.2018486.
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Mandelzweig, Y., and V. Feygelman. "Evaluation of electron-beam uniformity during commissioning of a linear accelerator." Medical Physics 20, no. 4 (1993): 1233–36. http://dx.doi.org/10.1118/1.596974.
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