Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK.
BMC Oral Health. 2014 Jan 21;14:6. doi: 10.1186/1472-6831-14-6.
Pain affecting the face or mouth and lasting longer than three months ("chronic orofacial pain", COFP) is relatively common in the UK. This study aims to describe and model current care pathways for COFP patients, identify areas where current pathways could be modified, and model whether these changes would improve outcomes for patients and use resources more efficiently.
METHODS/DESIGN: The study takes a prospective operations research approach. A cohort of primary and secondary care COFP patients (n = 240) will be recruited at differing stages of their care in order to follow and analyse their journey through care. The cohort will be followed for two years with data collected at baseline 6, 12, 18, and 24 months on: 1) experiences of the care pathway and its impacts; 2) quality of life; 3) pain; 4) use of health services and costs incurred; 5) illness perceptions. Qualitative in-depth interviews will be used to collect data on patient experiences from a purposive sub-sample of the total cohort (n = 30) at baseline, 12 and 24 months. Four separate appraisal groups (public, patient, clincian, service manager/commissioning) will then be given data from the pathway analysis and asked to determine their priority areas for change. The proposals from appraisal groups will inform an economic modelling exercise. Findings from the economic modelling will be presented as incremental costs, Quality Adjusted Life Years (QALYs), and the incremental cost per QALY gained. At the end of the modelling a series of recommendations for service change will be available for implementation or further trial if necessary.
The recent white paper on health and the report from the NHS Forum identified chronic conditions as priority areas and whilst technology can improve outcomes, so can simple, appropriate and well-defined clinical care pathways. Understanding the opportunity cost related to care pathways benefits the wider NHS. This research develops a method to help design efficient systems built around one condition (COFP), but the principles should be applicable to a wide range of other chronic and long-term conditions.
在英国，面部或口腔疼痛且持续时间超过三个月（“慢性口面痛”，COFP）较为常见。本研究旨在描述和建立 COFP 患者当前的治疗途径，确定当前途径可以改进的领域，并建立这些改变是否会改善患者的预后和更有效地利用资源。
方法/设计：本研究采用前瞻性运筹学研究方法。将招募初级和二级医疗 COFP 患者（n=240）进入不同的治疗阶段，以跟踪和分析他们的治疗过程。该队列将在两年内进行随访，在基线、6、12、18 和 24 个月时收集以下数据：1）治疗途径的经历及其影响；2）生活质量；3）疼痛；4）卫生服务的使用和所产生的费用；5）疾病认知。将对总队列的一个特定亚组（n=30）在基线、12 和 24 个月时使用定性深入访谈收集有关患者经历的数据。然后，四个单独的评估小组（公众、患者、临床医生、服务经理/决策者）将获得途径分析的数据，并被要求确定其优先变更领域。评估小组的提案将为经济建模提供信息。经济建模的结果将以增量成本、质量调整生命年（QALY）和每获得一个 QALY 的增量成本呈现。在建模结束时，将根据需要为服务变更提供一系列建议以供实施或进一步试用。
最近的健康白皮书和 NHS 论坛的报告将慢性疾病确定为优先领域，虽然技术可以改善预后，但简单、适当和明确的临床治疗途径也可以。了解与治疗途径相关的机会成本使更广泛的 NHS 受益。这项研究开发了一种方法来帮助设计围绕一种疾病（COFP）构建的高效系统，但这些原则应适用于广泛的其他慢性和长期疾病。
