A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study
Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address thes...
Ausführliche Beschreibung
Gespeichert in:
| Autor*in: |
Emma Villeneuve [verfasserIn] Paolo Landa [verfasserIn] Michael Allen [verfasserIn] Anne Spencer [verfasserIn] Sue Prosser [verfasserIn] Andrew Gibson [verfasserIn] Katie Kelsey [verfasserIn] Ruben Mujica-Mota [verfasserIn] Brad Manktelow [verfasserIn] Neena Modi [verfasserIn] Steve Thornton [verfasserIn] Martin Pitt [verfasserIn] |
|---|
| Format: |
E-Artikel |
|---|---|
| Sprache: |
Englisch |
| Erschienen: |
2018 |
|---|
| Schlagwörter: |
|---|
| Übergeordnetes Werk: |
In: Health Services and Delivery Research - National Institute for Health Research, 2017, 6(2018), 35 |
|---|---|
| Übergeordnetes Werk: |
volume:6 ; year:2018 ; number:35 |
| Links: |
Link aufrufen |
|---|
| DOI / URN: |
10.3310/hsdr06350 |
|---|
| Katalog-ID: |
DOAJ029824575 |
|---|
| LEADER | 01000caa a22002652 4500 | ||
|---|---|---|---|
| 001 | DOAJ029824575 | ||
| 003 | DE-627 | ||
| 005 | 20230307141147.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 230226s2018 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.3310/hsdr06350 |2 doi | |
| 035 | |a (DE-627)DOAJ029824575 | ||
| 035 | |a (DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 050 | 0 | |a RA1-1270 | |
| 050 | 0 | |a R5-920 | |
| 100 | 0 | |a Emma Villeneuve |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a Computermedien |b c |2 rdamedia | ||
| 338 | |a Online-Ressource |b cr |2 rdacarrier | ||
| 520 | |a Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. | ||
| 650 | 4 | |a neonatal services | |
| 650 | 4 | |a geographic information systems | |
| 650 | 4 | |a choice behaviour | |
| 650 | 4 | |a economic analysis | |
| 650 | 4 | |a infant mortality | |
| 650 | 4 | |a parental preferences | |
| 650 | 4 | |a qualitative research | |
| 650 | 4 | |a computer heuristics | |
| 650 | 4 | |a computer simulation | |
| 653 | 0 | |a Public aspects of medicine | |
| 653 | 0 | |a Medicine (General) | |
| 700 | 0 | |a Paolo Landa |e verfasserin |4 aut | |
| 700 | 0 | |a Michael Allen |e verfasserin |4 aut | |
| 700 | 0 | |a Anne Spencer |e verfasserin |4 aut | |
| 700 | 0 | |a Sue Prosser |e verfasserin |4 aut | |
| 700 | 0 | |a Andrew Gibson |e verfasserin |4 aut | |
| 700 | 0 | |a Katie Kelsey |e verfasserin |4 aut | |
| 700 | 0 | |a Ruben Mujica-Mota |e verfasserin |4 aut | |
| 700 | 0 | |a Brad Manktelow |e verfasserin |4 aut | |
| 700 | 0 | |a Neena Modi |e verfasserin |4 aut | |
| 700 | 0 | |a Steve Thornton |e verfasserin |4 aut | |
| 700 | 0 | |a Martin Pitt |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i In |t Health Services and Delivery Research |d National Institute for Health Research, 2017 |g 6(2018), 35 |w (DE-627)1760647098 |x 20504357 |7 nnns |
| 773 | 1 | 8 | |g volume:6 |g year:2018 |g number:35 |
| 856 | 4 | 0 | |u https://doi.org/10.3310/hsdr06350 |z kostenfrei |
| 856 | 4 | 0 | |u https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7 |z kostenfrei |
| 856 | 4 | 0 | |u https://doi.org/10.3310/hsdr06350 |z kostenfrei |
| 856 | 4 | 2 | |u https://doaj.org/toc/2050-4349 |y Journal toc |z kostenfrei |
| 856 | 4 | 2 | |u https://doaj.org/toc/2050-4357 |y Journal toc |z kostenfrei |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a SYSFLAG_A | ||
| 912 | |a GBV_DOAJ | ||
| 912 | |a GBV_ILN_20 | ||
| 912 | |a GBV_ILN_22 | ||
| 912 | |a GBV_ILN_23 | ||
| 912 | |a GBV_ILN_24 | ||
| 912 | |a GBV_ILN_31 | ||
| 912 | |a GBV_ILN_39 | ||
| 912 | |a GBV_ILN_40 | ||
| 912 | |a GBV_ILN_60 | ||
| 912 | |a GBV_ILN_62 | ||
| 912 | |a GBV_ILN_63 | ||
| 912 | |a GBV_ILN_65 | ||
| 912 | |a GBV_ILN_69 | ||
| 912 | |a GBV_ILN_73 | ||
| 912 | |a GBV_ILN_74 | ||
| 912 | |a GBV_ILN_95 | ||
| 912 | |a GBV_ILN_110 | ||
| 912 | |a GBV_ILN_151 | ||
| 912 | |a GBV_ILN_161 | ||
| 912 | |a GBV_ILN_170 | ||
| 912 | |a GBV_ILN_206 | ||
| 912 | |a GBV_ILN_213 | ||
| 912 | |a GBV_ILN_230 | ||
| 912 | |a GBV_ILN_285 | ||
| 912 | |a GBV_ILN_293 | ||
| 912 | |a GBV_ILN_602 | ||
| 912 | |a GBV_ILN_2014 | ||
| 912 | |a GBV_ILN_4012 | ||
| 912 | |a GBV_ILN_4037 | ||
| 912 | |a GBV_ILN_4112 | ||
| 912 | |a GBV_ILN_4125 | ||
| 912 | |a GBV_ILN_4126 | ||
| 912 | |a GBV_ILN_4249 | ||
| 912 | |a GBV_ILN_4305 | ||
| 912 | |a GBV_ILN_4306 | ||
| 912 | |a GBV_ILN_4322 | ||
| 912 | |a GBV_ILN_4323 | ||
| 912 | |a GBV_ILN_4324 | ||
| 912 | |a GBV_ILN_4325 | ||
| 912 | |a GBV_ILN_4367 | ||
| 912 | |a GBV_ILN_4700 | ||
| 951 | |a AR | ||
| 952 | |d 6 |j 2018 |e 35 | ||
| author_variant |
e v ev p l pl m a ma a s as s p sp a g ag k k kk r m m rmm b m bm n m nm s t st m p mp |
|---|---|
| matchkey_str |
article:20504357:2018----::faeokodrskysusfentlevccniuainnnlnt |
| hierarchy_sort_str |
2018 |
| callnumber-subject-code |
RA |
| publishDate |
2018 |
| allfields |
10.3310/hsdr06350 doi (DE-627)DOAJ029824575 (DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Emma Villeneuve verfasserin aut A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. neonatal services geographic information systems choice behaviour economic analysis infant mortality parental preferences qualitative research computer heuristics computer simulation Public aspects of medicine Medicine (General) Paolo Landa verfasserin aut Michael Allen verfasserin aut Anne Spencer verfasserin aut Sue Prosser verfasserin aut Andrew Gibson verfasserin aut Katie Kelsey verfasserin aut Ruben Mujica-Mota verfasserin aut Brad Manktelow verfasserin aut Neena Modi verfasserin aut Steve Thornton verfasserin aut Martin Pitt verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 6(2018), 35 (DE-627)1760647098 20504357 nnns volume:6 year:2018 number:35 https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7 kostenfrei https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 6 2018 35 |
| spelling |
10.3310/hsdr06350 doi (DE-627)DOAJ029824575 (DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Emma Villeneuve verfasserin aut A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. neonatal services geographic information systems choice behaviour economic analysis infant mortality parental preferences qualitative research computer heuristics computer simulation Public aspects of medicine Medicine (General) Paolo Landa verfasserin aut Michael Allen verfasserin aut Anne Spencer verfasserin aut Sue Prosser verfasserin aut Andrew Gibson verfasserin aut Katie Kelsey verfasserin aut Ruben Mujica-Mota verfasserin aut Brad Manktelow verfasserin aut Neena Modi verfasserin aut Steve Thornton verfasserin aut Martin Pitt verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 6(2018), 35 (DE-627)1760647098 20504357 nnns volume:6 year:2018 number:35 https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7 kostenfrei https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 6 2018 35 |
| allfields_unstemmed |
10.3310/hsdr06350 doi (DE-627)DOAJ029824575 (DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Emma Villeneuve verfasserin aut A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. neonatal services geographic information systems choice behaviour economic analysis infant mortality parental preferences qualitative research computer heuristics computer simulation Public aspects of medicine Medicine (General) Paolo Landa verfasserin aut Michael Allen verfasserin aut Anne Spencer verfasserin aut Sue Prosser verfasserin aut Andrew Gibson verfasserin aut Katie Kelsey verfasserin aut Ruben Mujica-Mota verfasserin aut Brad Manktelow verfasserin aut Neena Modi verfasserin aut Steve Thornton verfasserin aut Martin Pitt verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 6(2018), 35 (DE-627)1760647098 20504357 nnns volume:6 year:2018 number:35 https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7 kostenfrei https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 6 2018 35 |
| allfieldsGer |
10.3310/hsdr06350 doi (DE-627)DOAJ029824575 (DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Emma Villeneuve verfasserin aut A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. neonatal services geographic information systems choice behaviour economic analysis infant mortality parental preferences qualitative research computer heuristics computer simulation Public aspects of medicine Medicine (General) Paolo Landa verfasserin aut Michael Allen verfasserin aut Anne Spencer verfasserin aut Sue Prosser verfasserin aut Andrew Gibson verfasserin aut Katie Kelsey verfasserin aut Ruben Mujica-Mota verfasserin aut Brad Manktelow verfasserin aut Neena Modi verfasserin aut Steve Thornton verfasserin aut Martin Pitt verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 6(2018), 35 (DE-627)1760647098 20504357 nnns volume:6 year:2018 number:35 https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7 kostenfrei https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 6 2018 35 |
| allfieldsSound |
10.3310/hsdr06350 doi (DE-627)DOAJ029824575 (DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7 DE-627 ger DE-627 rakwb eng RA1-1270 R5-920 Emma Villeneuve verfasserin aut A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. neonatal services geographic information systems choice behaviour economic analysis infant mortality parental preferences qualitative research computer heuristics computer simulation Public aspects of medicine Medicine (General) Paolo Landa verfasserin aut Michael Allen verfasserin aut Anne Spencer verfasserin aut Sue Prosser verfasserin aut Andrew Gibson verfasserin aut Katie Kelsey verfasserin aut Ruben Mujica-Mota verfasserin aut Brad Manktelow verfasserin aut Neena Modi verfasserin aut Steve Thornton verfasserin aut Martin Pitt verfasserin aut In Health Services and Delivery Research National Institute for Health Research, 2017 6(2018), 35 (DE-627)1760647098 20504357 nnns volume:6 year:2018 number:35 https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7 kostenfrei https://doi.org/10.3310/hsdr06350 kostenfrei https://doaj.org/toc/2050-4349 Journal toc kostenfrei https://doaj.org/toc/2050-4357 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 AR 6 2018 35 |
| language |
English |
| source |
In Health Services and Delivery Research 6(2018), 35 volume:6 year:2018 number:35 |
| sourceStr |
In Health Services and Delivery Research 6(2018), 35 volume:6 year:2018 number:35 |
| format_phy_str_mv |
Article |
| institution |
findex.gbv.de |
| topic_facet |
neonatal services geographic information systems choice behaviour economic analysis infant mortality parental preferences qualitative research computer heuristics computer simulation Public aspects of medicine Medicine (General) |
| isfreeaccess_bool |
true |
| container_title |
Health Services and Delivery Research |
| authorswithroles_txt_mv |
Emma Villeneuve @@aut@@ Paolo Landa @@aut@@ Michael Allen @@aut@@ Anne Spencer @@aut@@ Sue Prosser @@aut@@ Andrew Gibson @@aut@@ Katie Kelsey @@aut@@ Ruben Mujica-Mota @@aut@@ Brad Manktelow @@aut@@ Neena Modi @@aut@@ Steve Thornton @@aut@@ Martin Pitt @@aut@@ |
| publishDateDaySort_date |
2018-01-01T00:00:00Z |
| hierarchy_top_id |
1760647098 |
| id |
DOAJ029824575 |
| language_de |
englisch |
| fullrecord |
<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">DOAJ029824575</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230307141147.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230226s2018 xx |||||o 00| ||eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.3310/hsdr06350</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ029824575</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">RA1-1270</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">R5-920</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Emma Villeneuve</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="2"><subfield code="a">A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2018</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">neonatal services</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">geographic information systems</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">choice behaviour</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">economic analysis</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">infant mortality</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">parental preferences</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">qualitative research</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">computer heuristics</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">computer simulation</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Public aspects of medicine</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Medicine (General)</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Paolo Landa</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Michael Allen</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Anne Spencer</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Sue Prosser</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Andrew Gibson</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Katie Kelsey</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Ruben Mujica-Mota</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Brad Manktelow</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Neena Modi</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Steve Thornton</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Martin Pitt</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">In</subfield><subfield code="t">Health Services and Delivery Research</subfield><subfield code="d">National Institute for Health Research, 2017</subfield><subfield code="g">6(2018), 35</subfield><subfield code="w">(DE-627)1760647098</subfield><subfield code="x">20504357</subfield><subfield code="7">nnns</subfield></datafield><datafield tag="773" ind1="1" ind2="8"><subfield code="g">volume:6</subfield><subfield code="g">year:2018</subfield><subfield code="g">number:35</subfield></datafield><datafield tag="856" ind1="4" ind2="0"><subfield code="u">https://doi.org/10.3310/hsdr06350</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="856" ind1="4" ind2="0"><subfield code="u">https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="856" ind1="4" ind2="0"><subfield code="u">https://doi.org/10.3310/hsdr06350</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="856" ind1="4" ind2="2"><subfield code="u">https://doaj.org/toc/2050-4349</subfield><subfield code="y">Journal toc</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="856" ind1="4" ind2="2"><subfield code="u">https://doaj.org/toc/2050-4357</subfield><subfield code="y">Journal toc</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_USEFLAG_A</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">SYSFLAG_A</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_DOAJ</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_20</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_22</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_23</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_24</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_31</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_39</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_40</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_60</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_62</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_63</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_65</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_69</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_73</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_74</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_95</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_110</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_151</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_161</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_170</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_206</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_213</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_230</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_285</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_293</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_602</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_2014</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4012</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4037</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4112</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4125</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4126</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4249</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4305</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4306</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4322</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4323</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4324</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4325</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4367</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4700</subfield></datafield><datafield tag="951" ind1=" " ind2=" "><subfield code="a">AR</subfield></datafield><datafield tag="952" ind1=" " ind2=" "><subfield code="d">6</subfield><subfield code="j">2018</subfield><subfield code="e">35</subfield></datafield></record></collection>
|
| callnumber-first |
R - Medicine |
| author |
Emma Villeneuve |
| spellingShingle |
Emma Villeneuve misc RA1-1270 misc R5-920 misc neonatal services misc geographic information systems misc choice behaviour misc economic analysis misc infant mortality misc parental preferences misc qualitative research misc computer heuristics misc computer simulation misc Public aspects of medicine misc Medicine (General) A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study |
| authorStr |
Emma Villeneuve |
| ppnlink_with_tag_str_mv |
@@773@@(DE-627)1760647098 |
| format |
electronic Article |
| delete_txt_mv |
keep |
| author_role |
aut aut aut aut aut aut aut aut aut aut aut aut |
| collection |
DOAJ |
| remote_str |
true |
| callnumber-label |
RA1-1270 |
| illustrated |
Not Illustrated |
| issn |
20504357 |
| topic_title |
RA1-1270 R5-920 A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study neonatal services geographic information systems choice behaviour economic analysis infant mortality parental preferences qualitative research computer heuristics computer simulation |
| topic |
misc RA1-1270 misc R5-920 misc neonatal services misc geographic information systems misc choice behaviour misc economic analysis misc infant mortality misc parental preferences misc qualitative research misc computer heuristics misc computer simulation misc Public aspects of medicine misc Medicine (General) |
| topic_unstemmed |
misc RA1-1270 misc R5-920 misc neonatal services misc geographic information systems misc choice behaviour misc economic analysis misc infant mortality misc parental preferences misc qualitative research misc computer heuristics misc computer simulation misc Public aspects of medicine misc Medicine (General) |
| topic_browse |
misc RA1-1270 misc R5-920 misc neonatal services misc geographic information systems misc choice behaviour misc economic analysis misc infant mortality misc parental preferences misc qualitative research misc computer heuristics misc computer simulation misc Public aspects of medicine misc Medicine (General) |
| format_facet |
Elektronische Aufsätze Aufsätze Elektronische Ressource |
| format_main_str_mv |
Text Zeitschrift/Artikel |
| carriertype_str_mv |
cr |
| hierarchy_parent_title |
Health Services and Delivery Research |
| hierarchy_parent_id |
1760647098 |
| hierarchy_top_title |
Health Services and Delivery Research |
| isfreeaccess_txt |
true |
| familylinks_str_mv |
(DE-627)1760647098 |
| title |
A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study |
| ctrlnum |
(DE-627)DOAJ029824575 (DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7 |
| title_full |
A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study |
| author_sort |
Emma Villeneuve |
| journal |
Health Services and Delivery Research |
| journalStr |
Health Services and Delivery Research |
| callnumber-first-code |
R |
| lang_code |
eng |
| isOA_bool |
true |
| recordtype |
marc |
| publishDateSort |
2018 |
| contenttype_str_mv |
txt |
| author_browse |
Emma Villeneuve Paolo Landa Michael Allen Anne Spencer Sue Prosser Andrew Gibson Katie Kelsey Ruben Mujica-Mota Brad Manktelow Neena Modi Steve Thornton Martin Pitt |
| container_volume |
6 |
| class |
RA1-1270 R5-920 |
| format_se |
Elektronische Aufsätze |
| author-letter |
Emma Villeneuve |
| doi_str_mv |
10.3310/hsdr06350 |
| author2-role |
verfasserin |
| title_sort |
framework to address key issues of neonatal service configuration in england: the neonet multimethods study |
| callnumber |
RA1-1270 |
| title_auth |
A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study |
| abstract |
Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. |
| abstractGer |
Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. |
| abstract_unstemmed |
Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme. |
| collection_details |
GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4367 GBV_ILN_4700 |
| container_issue |
35 |
| title_short |
A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study |
| url |
https://doi.org/10.3310/hsdr06350 https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7 https://doaj.org/toc/2050-4349 https://doaj.org/toc/2050-4357 |
| remote_bool |
true |
| author2 |
Paolo Landa Michael Allen Anne Spencer Sue Prosser Andrew Gibson Katie Kelsey Ruben Mujica-Mota Brad Manktelow Neena Modi Steve Thornton Martin Pitt |
| author2Str |
Paolo Landa Michael Allen Anne Spencer Sue Prosser Andrew Gibson Katie Kelsey Ruben Mujica-Mota Brad Manktelow Neena Modi Steve Thornton Martin Pitt |
| ppnlink |
1760647098 |
| callnumber-subject |
RA - Public Medicine |
| mediatype_str_mv |
c |
| isOA_txt |
true |
| hochschulschrift_bool |
false |
| doi_str |
10.3310/hsdr06350 |
| callnumber-a |
RA1-1270 |
| up_date |
2024-07-04T00:33:24.295Z |
| _version_ |
1803606508761513984 |
| fullrecord_marcxml |
<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000caa a22002652 4500</leader><controlfield tag="001">DOAJ029824575</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230307141147.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230226s2018 xx |||||o 00| ||eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.3310/hsdr06350</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)DOAJ029824575</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-599)DOAJ7b5da73408a14e2ca23ee81c42a6edf7</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">RA1-1270</subfield></datafield><datafield tag="050" ind1=" " ind2="0"><subfield code="a">R5-920</subfield></datafield><datafield tag="100" ind1="0" ind2=" "><subfield code="a">Emma Villeneuve</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="2"><subfield code="a">A framework to address key issues of neonatal service configuration in England: the NeoNet multimethods study</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2018</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Background: There is an inherent tension in neonatal services between the efficiency and specialised care that comes with centralisation and the provision of local services with associated ease of access and community benefits. This study builds on previous work in South West England to address these issues at a national scale. Objectives: (1) To develop an analytical framework to address key issues of neonatal service configuration in England, (2) to investigate visualisation tools to facilitate the communication of findings to stakeholder groups and (3) to assess parental preferences in relation to service configuration alternatives. Main outcome measures: The ability to meet nurse staffing guidelines, volumes of units, costs, mortality, number and distance of transfers, travel distances and travel times for parents. Design: Descriptive statistics, location analysis, mathematical modelling, discrete event simulation and economic analysis were used. Qualitative methods were used to interview policy-makers and parents. A parent advisory group supported the study. Setting: NHS neonatal services across England. Data: Neonatal care data were sourced from the National Neonatal Research Database. Information on neonatal units was drawn from the National Neonatal Audit Programme. Geographic and demographic data were sourced from the Office for National Statistics. Travel time data were retrieved via a geographic information system. Birth data were sourced from Hospital Episode Statistics. Parental cost data were collected via a survey. Results: Location analysis shows that to achieve 100% of births in units with ≥ 6000 births per year, the number of birth centres would need to be reduced from 161 to approximately 72, with more parents travelling < 30 minutes. The maximum number of neonatal intensive care units (NICUs) needed to achieve 100% of very low-birthweight infants attending high-volume units is 36 with existing NICUs, or 48 if NICUs are located wherever there is currently a neonatal unit of any level. Simulation modelling further demonstrated the workforce implications of different configurations. Mortality modelling shows that the birth of very preterm infants in high-volume hospitals reduces mortality (a conservative estimate of a 1.2-percentage-point lower risk) relative to these births in other hospitals. It is currently not possible to estimate the impact of mortality for infants transferred into NICUs. Cost modelling shows that the mean length of stay following a birth in a high-volume hospital is 9 days longer and the mean cost is £5715 more than for a birth in another neonatal unit. In addition, the incremental cost per neonatal life saved is £460,887, which is comparable to other similar life-saving interventions. The analysis of parent costs identified unpaid leave entitlement, food, travel, accommodation, baby care and parking as key factors. The qualitative study suggested that central concerns were the health of the baby and mother, communication by medical teams and support for families. Limitations: The following factors could not be modelled because of a paucity of data – morbidity outcomes, the impact of transfers and the maternity/neonatal service interface. Conclusions: An evidence-based framework was developed to inform the configuration of neonatal services and model system performance from the perspectives of both service providers and parents. Future work: To extend the modelling to encompass the interface between maternity and neonatal services. Funding: The National Institute for Health Research Health Services and Delivery Research programme.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">neonatal services</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">geographic information systems</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">choice behaviour</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">economic analysis</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">infant mortality</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">parental preferences</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">qualitative research</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">computer heuristics</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">computer simulation</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Public aspects of medicine</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Medicine (General)</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Paolo Landa</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Michael Allen</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Anne Spencer</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Sue Prosser</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Andrew Gibson</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Katie Kelsey</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Ruben Mujica-Mota</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Brad Manktelow</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Neena Modi</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Steve Thornton</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="0" ind2=" "><subfield code="a">Martin Pitt</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">In</subfield><subfield code="t">Health Services and Delivery Research</subfield><subfield code="d">National Institute for Health Research, 2017</subfield><subfield code="g">6(2018), 35</subfield><subfield code="w">(DE-627)1760647098</subfield><subfield code="x">20504357</subfield><subfield code="7">nnns</subfield></datafield><datafield tag="773" ind1="1" ind2="8"><subfield code="g">volume:6</subfield><subfield code="g">year:2018</subfield><subfield code="g">number:35</subfield></datafield><datafield tag="856" ind1="4" ind2="0"><subfield code="u">https://doi.org/10.3310/hsdr06350</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="856" ind1="4" ind2="0"><subfield code="u">https://doaj.org/article/7b5da73408a14e2ca23ee81c42a6edf7</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="856" ind1="4" ind2="0"><subfield code="u">https://doi.org/10.3310/hsdr06350</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="856" ind1="4" ind2="2"><subfield code="u">https://doaj.org/toc/2050-4349</subfield><subfield code="y">Journal toc</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="856" ind1="4" ind2="2"><subfield code="u">https://doaj.org/toc/2050-4357</subfield><subfield code="y">Journal toc</subfield><subfield code="z">kostenfrei</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_USEFLAG_A</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">SYSFLAG_A</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_DOAJ</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_20</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_22</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_23</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_24</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_31</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_39</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_40</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_60</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_62</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_63</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_65</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_69</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_73</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_74</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_95</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_110</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_151</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_161</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_170</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_206</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_213</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_230</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_285</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_293</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_602</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_2014</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4012</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4037</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4112</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4125</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4126</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4249</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4305</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4306</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4322</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4323</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4324</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4325</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4367</subfield></datafield><datafield tag="912" ind1=" " ind2=" "><subfield code="a">GBV_ILN_4700</subfield></datafield><datafield tag="951" ind1=" " ind2=" "><subfield code="a">AR</subfield></datafield><datafield tag="952" ind1=" " ind2=" "><subfield code="d">6</subfield><subfield code="j">2018</subfield><subfield code="e">35</subfield></datafield></record></collection>
|
| score |
7.401947 |