Evidence map›Paper›PMID 29175888›Full record

ArticleBMJ open2017

When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic modelling study.

Pelham Barton, James P Sheppard, Cristina M Penaloza-Ramos, Sue Jowett, Gary A Ford, Daniel Lasserson, Jonathan Mant, Ruth M Mellor, Tom Quinn, Peter M Rothwell and 4 more

Open access · goldAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact, top 81% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it, 1 citations in OpenAlex.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 7 institutions in 1 country.

Pelham BartonHealth Economics Unit, University of Birmingham, Birmingham, UK.
James P SheppardNuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK.ORCID http://orcid.org/0000-0002-4461-8756
Cristina M Penaloza-RamosHealth Economics Unit, University of Birmingham, Birmingham, UK.
Sue JowettHealth Economics Unit, University of Birmingham, Birmingham, UK.
Gary A FordOxford Academic Health Science Network, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Daniel LassersonNuffield Department of Medicine, University of Oxford, Oxford, UK.
Jonathan MantPrimary Care Unit, University of Cambridge, Cambridge, UK.
Ruth M MellorDepartment of Public Health, NHS Lanarkshire, Bothwell, UK.
Tom QuinnCentre for Health and Social Care Research, Faculty of Health, Social Care and Education, St George's University of London, Kingston University, London, UK.
Peter M RothwellNuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
David SandlerGeriatric Medicine, Heart of England NHS Foundation Trust, Birmingham, UK.
Don SimsStroke Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Richard J McManusNuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK.ORCID http://orcid.org/0000-0003-3638-028X
BBC CLAHRC investigators
University of Oxford · GBUniversity of Birmingham · GBHeart of England NHS Foundation Trust · GBNHS Lanarkshire · GBSt George's, University of London · GBUniversity Hospitals Birmingham NHS Foundation Trust · GBUniversity of Cambridge · GB

Funding

Department of Health NIHR-RP-02-12-015Medical Research Council MR/K022032/1
6 · The paper itself

Abstract

objectivesThe aim of this study was to examine the impact of transient ischaemic attack (TIA) service modification in two hospitals on costs and clinical outcomes.

designDiscrete event simulation model using data from routine electronic health records from 2011.

participantsPatients with suspected TIA were followed from symptom onset to presentation, referral to specialist clinics, treatment and subsequent stroke.

interventionsIncluded existing versus previous (less same day clinics) and hypothetical service reconfiguration (7-day service with less availability of clinics per day). OUTCOME MEASURES: The primary outcome of the model was the prevalence of major stroke after TIA. Secondary outcomes included service costs (including those of treating subsequent stroke) and time to treatment and attainment of national targets for service provision (proportion of high-risk patients (according to ABCD

resultsThe estimated costs of previous service provision for 490 patients (aged 74±12 years, 48.9% female and 23.6% high risk) per year at each site were £340 000 and £368 000, respectively. This resulted in 31% of high-risk patients seen within 24 hours of referral (47/150) with a median time from referral to clinic attendance/treatment of 1.15 days (IQR 0.93-2.88). The costs associated with the existing and hypothetical services decreased by £5000 at one site and increased £21 000 at the other site. Target attainment was improved to 79% (118/150). However, the median time to clinic attendance was only reduced to 0.85 days (IQR 0.17-0.99) and thus no appreciable impact on the modelled incidence of major stroke was observed (10.7 per year, 99% CI 10.5 to 10.9 (previous service) vs 10.6 per year, 99% CI 10.4 to 10.8 (existing service)).

conclusionsReconfiguration of services for TIA is effective at increasing target attainment, but in services which are already working efficiently (treating patients within 1-2 days), it has little estimated impact on clinical outcomes and increased investment may not be worthwhile.

Indexed as

AgedAmbulatory CareAmbulatory Care FacilitiesCosts and Cost AnalysisDelivery of Health CareEnglandFemaleFollow-Up StudiesHumansIschemic Attack, TransientMaleModels, EconomicPatient Acceptance of Health CareQuality ImprovementReferral and ConsultationSecondary Health Careeconomic modellinghealth servicessecondary caresecondary preventionstroke

Identifiers

PMID29175888
PMCPMC5719325
OpenAlexW2767522088

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.