ORCID Profile
0000-0002-2115-2447
Current Organisation
University of British Columbia
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Publisher: SAGE Publications
Date: 16-06-2016
Abstract: Background. Policy evaluations taking a lifetime horizon have converted estimated changes in short-term mortality to expected life year gains using general population life expectancy. However, the life expectancy of the affected patients may differ from the general population. In trials, survival models are commonly used to extrapolate life year gains. The objective was to demonstrate the feasibility and materiality of using parametric survival models to extrapolate future survival in health care policy evaluations. Methods. We used our previous cost-effectiveness analysis of a pay-for-performance program as a motivating ex le. We first used the cohort of patients admitted prior to the program to compare 3 methods for estimating remaining life expectancy. We then used a difference-in-differences framework to estimate the life year gains associated with the program using general population life expectancy and survival models. Patient-level data from Hospital Episode Statistics was utilized for patients admitted to hospitals in England for pneumonia between 1 April 2007 and 31 March 2008 and between 1 April 2009 and 31 March 2010, and linked to death records for the period from 1 April 2007 to 31 March 2011. Results. In our cohort of patients, using parametric survival models rather than general population life expectancy figures reduced the estimated mean life years remaining by 30% (9.19 v. 13.15 years, respectively). However, the estimated mean life year gains associated with the program are larger using survival models (0.380 years) compared to using general population life expectancy (0.154 years). Conclusions. Using general population life expectancy to estimate the impact of health care policies can overestimate life expectancy but underestimate the impact of policies on life year gains. Using a longer follow-up period improved the accuracy of estimated survival and program impact considerably.
Publisher: Springer Science and Business Media LLC
Date: 03-11-2020
Publisher: Wiley
Date: 27-02-2020
DOI: 10.1002/ACR.23838
Abstract: Patients experience discomfort and compromised quality of life while waiting for hip replacement. Symptom duration may affect quality of life attained following surgery. We undertook this study to investigate the impact of symptom duration on patient-reported postsurgical outcomes from hip replacement surgery. National observational data collected before and after hip replacement surgery in England between 2009 and 2016 were used to investigate determinants of symptom duration prior to surgery and the relationship between symptom duration and presurgical and postsurgical patient-reported outcomes. Multivariable linear regression models were used to estimate associations between patient-reported outcomes and symptom duration, controlling for a range of covariates. The s le included 209,192 patients most (69%) experienced symptoms for 1-5 years. A few patients (14%) experienced symptoms for 10 years (5%). Symptom duration decreased overall over the studied time period and was shorter among patients who were male, older, and from areas of lesser deprivation. Patients with a symptom duration 5 years had increasingly poorer postsurgical outcomes (OHS -0.730 [95% CI -0.847, -0.613] for those with disease duration 6-10 years and OHS -1.112 [95% CI -1.278, -0.946] for those with disease duration >10 years). Symptom duration prior to hip replacement has become more standardized in England over time. However, increasing duration remains a significant predictor of poorer outcomes after surgery.
Publisher: Springer Science and Business Media LLC
Date: 26-10-2023
Publisher: BMJ
Date: 11-11-2014
DOI: 10.1136/BMJ.G6423
Abstract: To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs). Controlled longitudinal study. English National Health Service between 1998/99 and 2010/11. Populations registered with each of 6975 family practices in England. Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs. Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. The introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities.
Publisher: Springer Science and Business Media LLC
Date: 26-07-2019
Publisher: Springer Science and Business Media LLC
Date: 09-01-2015
Publisher: Springer Science and Business Media LLC
Date: 17-07-2020
DOI: 10.1007/S40271-020-00431-W
Abstract: Patient-oriented research is a process whereby patients or caregivers are included as research partners so that research focusses on topics that are priorities and lead to findings that translate into practice. Using a case study of preferences for stem cell transplant in scleroderma, we report on a patient-oriented research approach to developing a discrete choice experiment. Our patient-oriented research application followed the four guiding principles in Canada's Strategy for Patient-Oriented Research: inclusiveness, support, mutual respect and co-build. In this case study, patient partners were involved at different levels of engagement to match in idual availability, skillset and roles in the team. They advised, to different degrees, on all aspects of the study from design to analyses. Using a patient-oriented research approach led to the inclusion of attributes that would likely have been excluded (e.g. support from a multidisciplinary team), and realistic framing of patient-relevant and sometimes sensitive attributes (e.g. mortality and cost). Meeting locations and times were adjusted to accommodate all-team circumstances. Institutional constraints on the reimbursement for patient partners influenced the timing and extent of involvement. We found that adopting a patient-oriented research approach to discrete choice experiment design injected unique knowledge and expertise into the team, improved the representativeness of the s le recruited, minimised researcher biases, and ensured appropriate attribute selection and descriptions. The patient-oriented research approach highlighted some constraints of discrete choice experiment designs and, while not a solution, might ensure the methodological trade-offs remain patient relevant. Institutional challenges must be addressed to progress patient-oriented health economics research.
Publisher: Springer Science and Business Media LLC
Date: 25-02-2014
DOI: 10.1007/S40271-014-0048-1
Abstract: Discrete choice experiments (DCEs) are used to elicit preferences of current and future patients and healthcare professionals about how they value different aspects of healthcare. Risk is an integral part of most healthcare decisions. Despite the use of risk attributes in DCEs consistently being highlighted as an area for further research, current methods of incorporating risk attributes in DCEs have not been reviewed explicitly. This study aimed to systematically identify published healthcare DCEs that incorporated a risk attribute, summarise and appraise methods used to present and analyse risk attributes, and recommend best practice regarding including, analysing and transparently reporting the methodology supporting risk attributes in future DCEs. The Web of Science, MEDLINE, EMBASE, PsycINFO and Econlit databases were searched on 18 April 2013 for DCEs that included a risk attribute published since 1995, and on 23 April 2013 to identify studies assessing risk communication in the general (non-DCE) health literature. Healthcare-related DCEs with a risk attribute mentioned or suggested in the title/abstract were obtained and retained in the final review if a risk attribute meeting our definition was included. Extracted data were tabulated and critically appraised to summarise the quality of reporting, and the format, presentation and interpretation of the risk attribute were summarised. This review identified 117 healthcare DCEs that incorporated at least one risk attribute. Whilst there was some evidence of good practice incorporated into the presentation of risk attributes, little evidence was found that developing methods and recommendations from other disciplines about effective methods and validation of risk communication were systematically applied to DCEs. In general, the reviewed DCE studies did not thoroughly report the methodology supporting the explanation of risk in training materials, the impact of framing risk, or exploring the validity of risk communication. The primary limitation of this review was that the methods underlying presentation, format and analysis of risk attributes could only be appraised to the extent that they were reported. Improvements in reporting and transparency of risk presentation from conception to the analysis of DCEs are needed. To define best practice, further research is needed to test how the process of communicating risk affects the way in which people value risk attributes in DCEs.
Publisher: Elsevier BV
Date: 05-2018
Publisher: Springer Science and Business Media LLC
Date: 09-09-2021
DOI: 10.1186/S13063-021-05575-0
Abstract: Increasingly, it is argued that clinical trials struggle to recruit participants because they do not respond to key questions or study treatments that patients will be willing or able to use. This study explores how elicitation of patient-preferences can help designers of randomized controlled trials (RCTs) understand the impact of changing modifiable aspects of treatments or trial design on recruitment. Focus groups and a discrete choice experiment (DCE) survey were used to elicit preferences of people with scleroderma for autologous hematopoietic stem cell transplant (AHSCT) treatment interventions. Preferences for seven attributes of treatment (effectiveness, immediate and long-term risk, care team composition and experience, cost, travel distance) were estimated using a mixed-logit model and used to predict participation in RCTs. Two hundred seventy-eight people with scleroderma answered the survey. All AHSCT treatment attributes significantly influenced preferences. Treatment effectiveness and risk of late complications contributed the most to participants’ choices, but modifiable factors of distance to treatment center and cost also affected preferences. Predicted recruitment rates calibrated with participation in a recent trial (33%) and suggest offering a treatment closer to home, at lower patient cost, and with holistic, multidisciplinary care could increase participation to 51%. Through a patient engaged approach to preference elicitation for different features of AHSCT treatment options, we were able to predict what drives the decisions of people with scleroderma to participate in RCTs. Knowledge regarding concerns and the trade-offs people are willing to make can inform clinical study design, improving recruitment rates and potential uptake of the treatment of interest.
Publisher: Wiley
Date: 26-05-2015
DOI: 10.1002/HEC.3195
Abstract: Reducing waiting times has been a major focus of the English National Health Service for many years, but little is known about the impact on health outcomes. The collection of data on patient-reported outcome measures for all patients undergoing four large-volume procedures facilitates analysis of the impact of waiting times on patient outcomes. The availability of patient-reported outcome measures before and after surgery allows us to estimate the impact of waiting times on the effectiveness of treatment, controlling for pre-surgery health and the endogeneity of waiting times caused by prioritisation with respect to pre-intervention health. We find that waiting time has a negative and statistically significant impact on the health gain from hip and knee replacement surgery and no impact on the effectiveness of varicose vein and hernia surgery. The magnitude of this effect at patient level is small, 0.1% of the outcome measure range for each additional week of waiting. However, the value of this effect is substantially larger than existing estimates of the disutility experienced during the waiting period. The health losses associated with an additional week of waiting for annual populations of hip and knee replacement patients are worth £11.1m and £11.5m, respectively. Copyright © 2015 John Wiley & Sons, Ltd.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Mark Harrison.