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Quantifying the expected versus the observed return on investment in healthcare policy and programming in populations over 65 years in England - case study in diabetes mellitus

Meier, Genevieve 2023. Quantifying the expected versus the observed return on investment in healthcare policy and programming in populations over 65 years in England - case study in diabetes mellitus. PhD Thesis, Cardiff University.
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Rationale: Clinical guidelines (CG) are created to guide therapy, improve clinical outcomes, reduce costs and resource use, and are used to measure quality of care. However, the effectiveness of clinical guidelines in achieving these goals is not consistently measured or reported in the literature. Objective: To analyse the real-world influence of clinical guidelines on clinical outcomes, using a before-and-after study in diabetes management in those older than 65 years. Method: Systematically identify all the present policies and clinical guidelines that directly and significantly impact those older than 65 with type-2 diabetes in terms of quality of care, the date and rationale of their introduction. A retrospective before-and-after analysis was performed using the Clinical Practice Research Datalink (CPRD) database pre and post-introduction of each policy/guideline since 2000 in a stepwise manner. The outcomes of interest were hospitalisations, cases of cardiovascular events, cases of type-2 diabetes microvascular complications, cases of cancer and mortality. Results: The literature review on the use of before-and-after studies done to evaluate clinical guideline effectivenessreturned 10 studies in this area of analysis. The analysis of the data shows that the clinical guidelines had mixed results in managing diabetes complications, cardiac events, cancer events, hospitalisations, and mortality. The all patient cohort showed a decrease in HbA1c, cholesterol, and blood pressure, but an increase in body weight and BMI. The trends for mortality, hospitalisations and complications and cancer were mostly unchanged for CG2002, while in CG2008 trends were mostly negative or unchanged and CG2012 while also mixed showed the best possible trends. In addition, overall there was no statistically significant reduction in resource use. Conclusion: The CGs appear to have had some success in reducing uncontrolled blood glucose levels but had limited success in terms of body weight management and reducing diabetesrelated complications and mortality. Overall, the study suggests that there is room for improvement in the clinical guidelines to reduce healthcare resource use and improve patient outcomes. Therefore, if done in a timely manner, before-and-after real-world studies could aid in the review of clinical guidelines and support their ongoing development. Future research would be to use the data generated to develop a cost-effectiveness model to investigate the full costs associated with the CG updates.

Item Type: Thesis (PhD)
Date Type: Completion
Status: Unpublished
Schools: Medicine
Date of First Compliant Deposit: 18 December 2023
Last Modified: 18 Dec 2023 11:48

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