NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

National Clinical Guideline Centre (UK). Patient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult NHS Services: Patient Experience in Generic Terms. London: Royal College of Physicians (UK); 2012 Feb. (NICE Clinical Guidelines, No. 138.)

Cover of Patient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult NHS Services

Patient Experience in Adult NHS Services: Improving the Experience of Care for People Using Adult NHS Services: Patient Experience in Generic Terms.

Show details

Appendix DLiterature review questions and protocols

Review questionsWhat is the effectiveness and cost-effectiveness of decision aids versus no intervention, usual care, alternative interventions, or a combination?
ObjectivesTo compare the clinical and cost effectiveness of decision aids with no intervention, usual care, alternative interventions in of adults making decisions about screening or treatment for themselves, for a child, or for an incapacitated significant other.
CriteriaPopulation: Adults (≥ 18 years old) making decisions about screening or treatment for themselves, for a child, or for an incapacitated significant other.
Excluded: studies in which people were making hypothetical choices.
Intervention: Decision aids
Comparison: No intervention, Usual care, Alternative interventions, Combination
Primary outcomes:
  • Evaluation criteria which map onto the IPDAS criteria
  • Attributes of the decision
  • Attributes of the decision process
  • Decisional conflict
  • Patient-practitioner communication
  • Participation in decision making
  • Satisfaction
Secondary Outcomes:
  • Decisions (proportion undecided, option selected)
  • Adherence to chosen option
  • Health status and quality of life (generic and condition specific)
  • Anxiety, depression, emotional distress, regret, confidence
  • Patients' and physicians' satisfaction
  • Costs, cost effectiveness
  • Consultation length
  • Litigation rates
Study Design: RCT
Population size and directness:
  • No limits of sample size
  • Studies with indirect populations will not be considered
Search strategyNo search to be undertaken – Cochrane review to be accepted as is (search cut-off Dec 2009) (confirmed with NICE)
Review strategyThe methodology and results of the 2011 Cochrane review “decision aids for people facing health treatment or screening decisions” will be presented to the guidance development group for consideration.
Economic review strategyThe Cochrane review included cost and cost-effectiveness as outcomes but was restricted to RCTs. Additional search to be run on NHS EED, HTA and HEED only with aim of checking for cost-effectiveness models based on RCT data. Note deviation from Guidelines Manual – we will not run search in Medline/Embase for past year – this is considered a reasonable pragmatic approach given the Cochrane cut-off is Dec 2009.
Study design: cost-utility analysis, cost-benefit analysis, cost-effectiveness analysis, cost-consequence analysis, comparative cost analysis
Each study is assessed using the NICE economic evaluation checklist – NICE (2009)
Guidelines Manual, Appendix H. See also table below ‘Economic review – inclusion/exclusion criteria’
Review questionWhat is the effectiveness and cost effectiveness of interventions to improve the continuity of care of patients in the National Health Service?
ObjectivesTo evaluate the effectiveness of interventions used to improve continuity of patient care.
CriteriaPopulation: Adults
Exclusions: People under the age of 18 years, people using health services specifically for the treatment of mental health problems.
Interventions: For example: centralised records, electronic patient records, established routines for handovers and exchange of information, proactive follow-up of patients after significant life events or health events, key workers, nurse-led care
Comparison: Usual care
Outcomes: These will be determined once relevant interventions have been identified.
Study Design: Systematic reviews of RCTs or cohort studies
Setting: All settings where NHS care is delivered
Search strategySearches were conducted in Medline, Embase, PsychInfo, CINAHL and the Cochrane Library, with a cut-off date of 9th May 2011. For full search strategies see Appendix E.
Review strategyAppraisal of methodological quality: the methodological quality of the systematic reviews will be appraised using NICE checklists.
Protocol amendment: Midwife-led care was selected for review from the identified interventions as there was a clear mechanism for operationalising continuity of care in that clinical area that was well defined in the literature. The applicability and transferability of these findings for generic guidance would then be considered by the Guidance Development Group. It was not possible to conduct a review across all clinical areas to identify all potentially relevant studies and so mid-wife led care was viewed as a good proxy area which was likely to include many generic components. The aim of this review was to identify components of care that specifically improve continuity that could be generalised across disease areas.
Economic review strategyTargeted searches to be undertaken following clinical review looking for specific interventions identified from clinical review. Protocol amendment: in line with clinical review this was restricted to midwife-led care.
Study design: cost-utility analysis, cost-benefit analysis, cost-effectiveness analysis, cost- consequence analysis, comparative cost analysis.
Each study assessed using the NICE economic evaluation checklist – NICE (2009)
Guidelines Manual, Appendix H. See also table below ‘Economic review – inclusion/exclusion criteria’.
Review questionsRisk Communication
ObjectivesWhat methods of presenting information improve a patient’s understanding of the risks and benefits associated with their treatment options?
CriteriaPopulation: Adults
Excluded: People under the age of 18 years, people using health services specifically for the treatment of mental health problems.
Intervention: data will be extracted for risk language, design of visual presentations, tailored risk language and format of communication
Outcomes: will be determined once relevant papers have been identified.
Study Design: systematic reviews of RCTs and/or cohort studies
Setting: all settings
Search strategySearches were conducted in Medline, Embase, PsychInfo, CINAHL and the Cochrane Library, with a cut-off date of 9th May 2011. For full search strategies see Appendix E.
Review strategyAppraisal of methodological quality: the methodological quality of each systematic review/meta-analysis will be assessed using NICE checklists.
Economic review strategyAn economic search will not be undertaken for this review question. It is considered that in most cases there will not be cost differences between strategies (e.g. using different language to communicate risk).
Review questionsWhat generic components of patient education programmes improve patient experience?
ObjectivesTo determine what generic components of patient education programmes improve patient-related outcomes and are transferable across disease populations.
CriteriaPopulation: Adults (≥ 18 years old).
Excluded: People under the age of 18 years, people using health services specifically for the treatment of mental health problems. Comparisons of implementation of a disease specific patient education programme versus usual care will not be sought.
Intervention: Any comparison of generic components of patient education programmes (for example, one-on-one counselling, group work, audiovisual presentations)
Study Design: Systematic reviews of RCTs and cohort studies
Population size and directness:
  • No limits of sample size
  • Studies with indirect populations will not be considered
Search strategySearches were conducted in Medline, Embase, PsychInfo, CINAHL and the Cochrane Library, with a cut-off date of 9th May 2011. For full search strategies see Appendix E.
Review strategyAppraisal of methodological quality: the methodological quality of the systematic reviews will be appraised using NICE checklists.
Economic review strategyAn economic search will not be undertaken for this review question as useful cost effectiveness analysis would not be able to be performed for generic components and disease specific analyses would not be generalisable.
Economic review – inclusion/exclusion criteria
Each study is assessed using the NICE economic evaluation checklist – NICE (2009) Guidelines Manual, Appendix H.
Inclusion/exclusion criteria
  • If a study is rated as both ‘Directly applicable’ and ‘Minor limitations’ (using the NICE economic evaluation checklist) then it should be included in the guideline. An evidence table should be completed and it should be included in the economic profile.
  • If a study is rated as either ‘Not applicable’ or ‘Very serious limitations’ then it should be excluded from the guideline. It should not be included in the economic profile and there is no need to include an evidence table.
  • If a study is rated as ‘Partially applicable’ and/or ‘Potentially serious limitations’ then there is discretion over whether it should be included. The health economist should make a decision based on the relative applicability and quality of the available evidence for that question, in discussion with the GDG if required. The ultimate aim being to include studies that are helpful for decision making in the context of the guideline. Where exclusions occur on this basis, this should be noted in the relevant section of the guideline with references.
Also exclude:
  • unpublished reports unless submitted as part of the call for evidence
  • abstract-only studies
  • letters
  • editorials
  • reviews of economic evaluations 0
  • foreign language articles
Where there is discretion
The health economist should be guided by the following hierarchies.
Setting:
  • UK NHS
  • OECD countries with predominantly public health insurance systems (e.g. France, Germany, Sweden)
  • OECD countries with predominantly private health insurance systems (e.g. USA, Switzerland)
  • Non-OECD settings (always ‘Not applicable’)
Economic study type: Year of analysis:
  • Studies that are based on resource use and unit costs from more than 10 years ago will be downgraded in terms of applicability
  • Studies that are based on resource use and unit costs from more than 20 years ago will be judged not applicable
Quality and relevance of effectiveness data used in the economic analysis:
  • The more closely the effectiveness data used in the economic analysis matches with the studies included for the clinical review the more useful the analysis will be to decision making for the guideline.
a

Recent reviews will be ordered although not reviewed. The bibliographies will be checked for relevant studies, which will then be ordered.

Copyright © 2012, National Clinical Guideline Centre.

Apart from any fair dealing for the purposes of research or private study, criticism or review, as permitted under the Copyright, Designs and Patents Act, 1988, no part of this publication may be reproduced, stored or transmitted in any form or by any means, without the prior written permission of the publisher or, in the case of reprographic reproduction, in accordance with the terms of licences issued by the Copyright Licensing Agency in the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publisher at the UK address printed on this page.

The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore for general use.

The rights of National Clinical Guideline Centre to be identified as Author of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act, 1988.

Bookshelf ID: NBK115222

Views

  • PubReader
  • Print View
  • Cite this Page
  • PDF version of this title (3.6M)
  • Disable Glossary Links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...