The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, Birmingham, UK
Faculty of Health Studies, University of Bradford, Bradford, UK.
BMJ Open. 2024 Oct 4;14(10):e084632. doi: 10.1136/bmjopen-2024-084632.
The planning process for a new hospital relies on assumptions about future levels of demand. Typically, such assumptions are characterised by point estimates, the flaw-of-averages, base-rate neglect and overoptimism from an inside view. To counteract these limitations, we elicited an outside view of probabilistic forecasts based on judgements of experts about the extent to which various types of hospital activity might be mitigated over 20 years, in support of the New Hospital Programme (NHP) in the English National Health Service.
A prospective online elicitation exercise, over two rounds, to forecast the reduction (0% no reduction to 100% total reduction) in 77 types of hospital activity across England via five types of activity mitigation: outpatient attendance avoidance (n=8); inpatient admission avoidance (n=31); A&E attendance avoidance (n=12); outpatient delivery mode (n=4); inpatient length of stay reduction (n=22) and eight types of activity groups.Primary outcomes are the aggregated forecasts representing the percentage reduction (0%-100%) in hospital activity across England based on 'surprisingly low' (10th percentile-P10) to 'surprisingly high' (90th percentile-P90) forecasts from 17 experts.
We had 657 forecasts from 17 experts. The most pessimistic forecast was for inpatient avoidance of frail elderly admissions (mean 5.71%, P10=0.43%, P90=16.40%). The most optimistic forecast was for inpatient admission avoidance for vascular surgery (mean 48.27%, P10=19.82%, P90=78.57%). The overall (n=77) aggregate means ranged from a low of 5.71% to a high of 48.27% with an average width of 50.08%. Experts highlighted mainly four types of mitigation mechanisms-prevention, displacement, quality improvement and de-adoption.
A national elicitation exercise has provided long-term aggregate forecasts across England that make explicit the wide variation and uncertainty associated with future mitigation activities from an outside perspective. These aggregate forecasts may now be incorporated into the NHP, providing a more robust foundation for planning.
新医院的规划过程依赖于对未来需求水平的假设。通常，这些假设的特点是点估计、平均缺陷、基数忽略和内部视角的过度乐观。为了克服这些局限性，我们征求了专家对未来 20 年各种类型的医院活动可能减轻程度的概率预测的外部意见，以支持英国国民保健制度的新医院计划（NHP）。
一项前瞻性的在线启发式练习，分两轮进行，通过五种活动缓解方式（门诊就诊回避、住院入院回避、急症就诊回避、门诊分娩模式、住院停留时间缩短）对英格兰 77 种医院活动的减少程度（0%无减少到 100%完全减少）进行预测：门诊就诊回避（n=8）；住院入院回避（n=31）；急症就诊回避（n=12）；门诊分娩模式（n=4）；住院停留时间缩短（n=22）和八种活动组。主要结果是根据 17 位专家的“非常低”（第 10 百分位数-P10）到“非常高”（第 90 百分位数-P90）预测得出的英格兰医院活动减少百分比（0%-100%）的综合预测。
我们收到了 17 位专家的 657 项预测。最悲观的预测是虚弱老年患者入院的住院回避（平均 5.71%，P10=0.43%，P90=16.40%）。最乐观的预测是血管外科住院入院回避（平均 48.27%，P10=19.82%，P90=78.57%）。总体（n=77）聚合平均值范围从 5.71%的低值到 48.27%的高值，平均宽度为 50.08%。专家主要强调了四种缓解机制——预防、转移、质量改进和不采用。
全国范围内的启发式练习提供了英格兰的长期综合预测，从外部视角明确了与未来缓解活动相关的广泛变化和不确定性。这些综合预测现在可以纳入 NHP，为规划提供更稳健的基础。
