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  • 1
    In: Health Services and Delivery Research, National Institute for Health and Care Research, Vol. 8, No. 1 ( 2020-1), p. 1-100
    Abstract: Community hospitals are small hospitals providing local inpatient and outpatient services. National surveys report that inpatient rehabilitation for older people is a core function but there are large differences in key performance measures. We have investigated these variations in community hospital ward performance. Objectives (1) To measure the relative performance of community hospital wards (studies 1 and 2); (2) to identify characteristics of community hospital wards that optimise performance (studies 1 and 3); (3) to develop a web-based interactive toolkit that supports operational changes to optimise ward performance (study 4); (4) to investigate the impact of community hospital wards on secondary care use (study 5); and (5) to investigate associations between short-term community (intermediate care) services and secondary care utilisation (study 5). Methods Study 1 – we used national data to conduct econometric estimations using stochastic frontier analysis in which a cost function was modelled using significant predictors of community hospital ward costs. Study 2 – a national postal survey was developed to collect data from a larger sample of community hospitals. Study 3 – three ethnographic case studies were performed to provide insight into less tangible aspects of community hospital ward care. Study 4 – a web-based interactive toolkit was developed by integrating the econometrics (study 1) and case study (study 3) findings. Study 5 – regression analyses were conducted using data from the Atlas of Variation Map 61 (rate of emergency admissions to hospital for people aged ≥ 75 years with a length of stay of 〈  24 hours) and the National Audit of Intermediate Care. Results Community hospital ward efficiency is comparable with the NHS acute hospital sector (mean cost efficiency 0.83, range 0.72–0.92). The rank order of community hospital ward efficiencies was distinguished to facilitate learning across the sector. On average, if all community hospital wards were operating in line with the highest cost efficiency, savings of 17% (or £47M per year) could be achieved (price year 2013/14) for our sample of 101 wards. Significant economies of scale were found: a 1% rise in output was associated with an average 0.85% increase in costs. We were unable to obtain a larger community hospital sample because of the low response rate to our national survey. The case studies identified how rehabilitation was delivered through collaborative, interdisciplinary working; interprofessional communication; and meaningful patient and family engagement. We also developed insight into patients’ recovery trajectories and care transitions. The web-based interactive toolkit was established [ http://mocha.nhsbenchmarking.nhs.uk/ (accessed 9 September 2019)]. The crisis response team type of intermediate care, but not community hospitals, had a statistically significant negative association with emergency admissions. Limitations The econometric analyses were based on cross-sectional data and were also limited by missing data. The low response rate to our national survey means that we cannot extrapolate reliably from our community hospital sample. Conclusions The results suggest that significant community hospital ward savings may be realised by improving modifiable performance factors that might be augmented further by economies of scale. Future work How less efficient hospitals might reduce costs and sustain quality requires further research. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research ; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.
    Type of Medium: Online Resource
    ISSN: 2050-4349 , 2050-4357
    Language: English
    Publisher: National Institute for Health and Care Research
    Publication Date: 2020
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  • 2
    In: BMJ Open, BMJ, Vol. 7, No. 2 ( 2017-02), p. e010483-
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 2599832-8
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  • 3
    In: Genome Biology, Springer Science and Business Media LLC, Vol. 8, No. 11 ( 2007), p. R254-
    Type of Medium: Online Resource
    ISSN: 1465-6906
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2007
    detail.hit.zdb_id: 2040529-7
    SSG: 12
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  • 4
    Online Resource
    Online Resource
    Academy of Management ; 2023
    In:  Academy of Management Proceedings Vol. 2023, No. 1 ( 2023-08)
    In: Academy of Management Proceedings, Academy of Management, Vol. 2023, No. 1 ( 2023-08)
    Type of Medium: Online Resource
    ISSN: 0065-0668 , 2151-6561
    Language: English
    Publisher: Academy of Management
    Publication Date: 2023
    detail.hit.zdb_id: 2069299-7
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  • 5
    In: Addiction, Wiley, Vol. 114, No. 8 ( 2019-08), p. 1427-1435
    Abstract: To estimate young adults’ preferences for cigarettes and e‐cigarettes, and how preferences vary by policy‐relevant factors. A related aim was to provide information on potential substitution/complementarity across cigarettes and e‐cigarettes ahead of policy selection. Design An online discrete choice experiment (DCE) in which respondents chose their preferred option among cigarettes, two types of e‐cigarettes (disposable/reusable) and ‘none’. Each cigarette‐type was characterized by policy‐relevant attributes: flavors, short‐term health risks to self, secondhand smoke risks and price. A latent class model identified smoking types that respond differently to these. Setting US tobacco market. Participants A total of 2003 young adults (aged 18–22 years) who ever tried either cigarettes or e‐cigarettes, recruited via the survey platform Qualtrics, matched to the 2015 National Health Interview Survey by age, gender, education and census region. Measurements Respondents’ DCE choices . Findings Young adults fell into two broad categories. One latent group, termed ‘prefer smoking group’, preferred cigarettes and another, ‘prefer vaping group’, preferred e‐cigarettes. The ‘prefer smoking group’ preferred lower prices and lower health harms more than other attributes. The ‘prefer vaping group’ valued these, although price less intensely, and valued health and fruit/candy flavors more. Conclusion Banning all flavors in cigarettes and e‐cigarettes might improve the health of young adults who ever tried either cigarettes or e‐cigarettes. Young adult ever‐triers might be deterred from smoking by increasing cigarette prices and encouraged to switch to e‐cigarettes by reducing the health harms of e‐cigarettes. Reducing health harms of e‐cigarettes could also make the ‘prefer vaping group’ less likely to quit, resulting in increased health harm.
    Type of Medium: Online Resource
    ISSN: 0965-2140 , 1360-0443
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2002997-4
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  • 6
    Online Resource
    Online Resource
    Wiley ; 2019
    In:  Addiction Vol. 114, No. 10 ( 2019-10), p. 1816-1823
    In: Addiction, Wiley, Vol. 114, No. 10 ( 2019-10), p. 1816-1823
    Abstract: To estimate the impact of tobacco‐21 laws on smoking among young adults who are likely to smoke, and consider potential social multiplier effects. Design Quasi‐experimental, observational study using new 2016–17 survey data. Setting United States. Participants/cases A total of 1869 18–22‐year‐olds who have tried a combustible or electronic cigarette. Intervention and comparators Tobacco‐21 laws raise the minimum legal sales age of cigarettes to 21 years. Logistic regressions compared the association between tobacco‐21 laws and smoking among 18–20‐year‐olds with that for 21–22‐year‐olds. The older age group served as a comparison group that was not bound by these restrictions, but could have been affected by correlated factors. Age 16 peer and parental tobacco use were considered as potential moderators. Measurements Self‐reported recent smoking (past 30‐day smoking) and current established smoking (recent smoking and life‐time consumption of at least 100 cigarettes). Findings Exposure to tobacco‐21 laws yielded a 39% reduction in the odds of both recent smoking [odds ratio (OR) = 0.61; 95% confidence interval (CI) = 0.42, 0.89] and current established smoking (OR = 0.61; 95% CI = 0.39, 0.97) among 18–20‐year‐olds who had ever tried cigarettes. This association exceeded the policy's relationship with smoking among 21–22‐year‐olds. For current established smoking, the tobacco‐21 reduction was amplified among those whose closest friends at age 16 used cigarettes (OR = 0.50; 95% CI = 0.29, 0.87), consistent with peer effects moderating the policy's impact on young adult smoking. Conclusions Tobacco‐21 laws appear to reduce smoking among 18–20‐year‐olds who have ever tried cigarettes.
    Type of Medium: Online Resource
    ISSN: 0965-2140 , 1360-0443
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2019
    detail.hit.zdb_id: 2002997-4
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  • 7
    In: SSRN Electronic Journal, Elsevier BV
    Type of Medium: Online Resource
    ISSN: 1556-5068
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
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  • 8
    In: SSRN Electronic Journal, Elsevier BV
    Type of Medium: Online Resource
    ISSN: 1556-5068
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2017
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  • 9
    In: BMJ Open, BMJ, Vol. 12, No. 6 ( 2022-06), p. e062833-
    Abstract: Wide variation in the management of key paediatric surgical conditions in the UK has likely resulted in outcomes for some children being worse than they could be. Consequently, it is important to reduce unwarranted variation. However, major barriers to this are the inability to detect differences between observed and expected hospital outcomes based on the casemix of the children they have treated, and the inability to detect variation in significant outcomes between hospitals. A stated-preference study has been designed to estimate the value key stakeholders place on different elements of the outcomes for a child with a surgical condition. This study proposes to develop a summary metric to determine what represents successful treatment of children with surgical conditions. Methods and analysis Preferences from parents, individuals treated for surgical conditions as infants/children, healthcare professionals and members of the public will be elicited using paired comparisons and kaizen tasks. A descriptive framework consisting of seven attributes representing types of operations, infections treated in hospital, quality of life and survival was identified. An experimental design has been completed using a D-efficient design with overlap in three attributes and excluding implausible combinations. All participants will be presented with an additional choice task including a palliative scenario that will be used as an anchor. The survey will be administered online. Primary analysis will estimate a mixed multinomial logit model. A traffic light system to determine what combination of attributes and levels represent successful treatment will be created. Ethics and dissemination Ethics approval to conduct this study has been obtained from the Medical Sciences Inter-Divisional Research Ethics Committee (IDREC) at the University of Oxford (R59631/RE001-05). We will disseminate all of our results in peer-review publications and scientific presentations. Findings will be additionally disseminated through relevant charities and support groups and professional organisations.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 10
    In: Health Economics, Wiley, Vol. 32, No. 8 ( 2023-08), p. 1710-1732
    Abstract: Discrete choice models are almost exclusively estimated assuming random utility maximization (RUM) is the decision rule applied by individuals. Recent studies indicate alternative behavioral assumptions may be more appropriate in health. Decision field theory (DFT) is a psychological theory of decision‐making, which has shown promise in transport research. This study introduces DFT to health economics, empirically comparing it to RUM and random regret minimization (RRM) in risky health settings, namely tobacco and vaccine choices. Model fit, parameter ratios, choice shares, and elasticities are compared between RUM, RRM and DFT. Test statistics for model differences are derived using bootstrap methods. Decision rule heterogeneity is investigated using latent class models, including novel latent class DFT models. Tobacco and vaccine choice data are better explained with DFT than with RUM or RRM. Parameter ratios, choice shares and elasticities differ significantly between models. Mixed results are found for the presence of decision rule heterogeneity. We conclude that DFT shows promise as a behavioral assumption that underpins the estimation of discrete choice models in health economics. The significant differences demonstrate that care should be taken when choosing a decision rule, but further evidence is needed for generalizability beyond risky health choices.
    Type of Medium: Online Resource
    ISSN: 1057-9230 , 1099-1050
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 1483261-6
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