scholarly journals Modelling of hypothetical SARS-CoV-2 point of care tests for routine testing in residential care homes: rapid cost-effectiveness analysis

2021 ◽  
Vol 25 (39) ◽  
pp. 1-74
Author(s):  
Matt Stevenson ◽  
Andrew Metry ◽  
Michael Messenger
Keyword(s):  
Cost Effectiveness ◽  
Residential Care ◽  
Point Of Care ◽  
Care Home ◽  
Target Product ◽  
Residential Care Facilities ◽  
Monetary Benefit ◽  
Care Facilities ◽  
Net Monetary Benefit ◽  
Point Of Care Tests

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019 (COVID-19), which at the time of writing (January 2021) was responsible for more than 2.25 million deaths worldwide and over 100,000 deaths in the UK. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in residential care homes. Objective The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests in the setting of a hypothetical care home facility for elderly residents. Perspective/setting The perspective was that of the NHS in 2020. The setting was a hypothetical care home facility for elderly residents. Care homes with en suite rooms and with shared facilities were modelled separately. Methods A discrete event simulation model was constructed to model individual residents and simulate the spread of SARS-CoV-2 once it had entered the residential care facility. The numbers of COVID-19-related deaths and critical cases were recorded in addition to the number of days spent in isolation. Thirteen strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests and for hospital-based SARS-CoV-2 tests were modelled. Scenario analyses modelled early release from isolation based on receipt of a negative SARS-CoV-2 test result and the impact of vaccination. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits. Results Cost-effectiveness results depended on the proportion of residential care facilities penetrated by SARS-CoV-2. SARS-CoV-2 point-of-care tests with desirable target product profiles appear to have high net monetary benefit values. In contrast, SARS-CoV-2 point-of-care tests with acceptable target product profiles had low net monetary benefit values because of unnecessary isolations. The benefit of allowing early release from isolation depended on whether or not the facility had en suite rooms. The greater the assumed efficacy of vaccination, the lower the net monetary benefit values associated with SARS-CoV-2 point-of-care tests, when assuming that a vaccine lowers the risk of contracting SARS-CoV-2. Limitations There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. Some degree of Monte Carlo sampling error persists because of the timelines of the project. The example care home simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly the cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. Conclusions SARS-CoV-2 point-of-care tests have considerable potential for benefit for use in residential care facilities, but whether or not this materialises depends on the diagnostic accuracy and costs of forthcoming SARS-CoV-2 point-of-care tests. Future work More accurate results would be obtained when there is more certainty on the diagnostic accuracy of and the reduction in time to test result associated with SARS-CoV-2 point-of-care tests when used in the context of residential care facilities, the proportion of care home penetrated by SARS-CoV-2 and the levels of immunity once vaccination is administered. These parameters are currently uncertain. Funding This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 39. See the NIHR Journals Library website for further project information.

Design and colour preferences for older individuals in residential care

2016 ◽  
Vol 20 (2) ◽  
pp. 87-101
Author(s):  
Katy Stevens ◽  
Thomas Fröis ◽  
Sabrina Masal ◽  
Andrea Winder ◽  
Thomas Bechtold
Keyword(s):  
Residential Care ◽  
Care Home ◽  
Ageing Population ◽  
Older Individuals ◽  
Content Type ◽  
Residential Care Facilities ◽  
Care Facilities ◽  
Analysis Of Results ◽  
Positive Feelings ◽  
Colour Preferences

Purpose On a global level, the ageing population is increasing which will undoubtedly result in an increased demand for care facilities and more complex care requirements. Individuals living in permanent residential care facilities can often be subjected to a number of unnecessary stresses due to feelings of institutionalisation, with a change of surrounding and loss of possessions leading to confusion and exacerbation of pre-existing dementia problems. It is believed that creating environments that are as comfortable and homely as possible can help to relieve negative emotions and improve the quality of life of the individuals. This paper aims to investigate this issue. Design/methodology/approach This study brought together care home residents, interior designers and textile manufacturers to research pattern design and colour preferences for bedding for residents in a care home. Results were implemented in the design and building of a new care home in Dornbirn, Austria, with the intention that residents will feel happier in surroundings they prefer. Findings Following collection and analysis of results, it was seen that both residents and non-residents tended to prefer patterns that were representative of the era when they were young, perhaps because of the positive feelings they experienced during these times, and the positive memories the familiar patterns evoked of these times. Respondents preferred colour schemes that were bright and vibrant and linked these colours to feelings of happiness. Respondents did not like the muted colour schemes, which could have been related to reduced colour sensitivity with age, rendering the paler schemes dull and drab. Originality/value While the authors acknowledge that case study was carried out in Austria and reflected the thoughts and opinions of Austrian citizens, the research methodology is easily transferrable to other countries and areas of research.

scholarly journals Modelling of hypothetical SARS-CoV-2 point-of-care tests on admission to hospital from A&E: rapid cost-effectiveness analysis

2021 ◽  
Vol 25 (21) ◽  
pp. 1-68
Author(s):  
Matt Stevenson ◽  
Andrew Metry ◽  
Michael Messenger
Keyword(s):  
Cost Effectiveness ◽  
Patient Outcomes ◽  
Point Of Care ◽  
Clinical Effectiveness ◽  
Decision Makers ◽  
Target Product ◽  
Target Product Profile ◽  
Point Of Care Test ◽  
Product Profile ◽  
Point Of Care Tests

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus that causes coronavirus disease 2019. At the time of writing (October 2020), the number of cases of COVID-19 had been approaching 38 million and more than 1 million deaths were attributable to it. SARS-CoV-2 appears to be highly transmissible and could rapidly spread in hospital wards. Objective The work undertaken aimed to estimate the clinical effectiveness and cost-effectiveness of viral detection point-of-care tests for detecting SARS-CoV-2 compared with laboratory-based tests. A further objective was to assess occupancy levels in hospital areas, such as waiting bays, before allocation to an appropriate bay. Perspective/setting The perspective was that of the UK NHS in 2020. The setting was a hypothetical hospital with an accident and emergency department. Methods An individual patient model was constructed that simulated the spread of disease and mortality within the hospital and recorded occupancy levels. Thirty-two strategies involving different hypothetical SARS-CoV-2 tests were modelled. Recently published desirable and acceptable target product profiles for SARS-CoV-2 point-of-care tests were modelled. Incremental analyses were undertaken using both incremental cost-effectiveness ratios and net monetary benefits, and key patient outcomes, such as death and intensive care unit care, caused directly by COVID-19 were recorded. Results A SARS-CoV-2 point-of-care test with a desirable target product profile appears to have a relatively small number of infections, a low occupancy level within the waiting bays, and a high net monetary benefit. However, if hospital laboratory testing can produce results in 6 hours, then the benefits of point-of-care tests may be reduced. The acceptable target product profiles performed less well and had lower net monetary benefits than both a laboratory-based test with a 24-hour turnaround time and strategies using data from currently available SARS-CoV-2 point-of-care tests. The desirable and acceptable point-of-care test target product profiles had lower requirement for patients to be in waiting bays before being allocated to an appropriate bay than laboratory-based tests, which may be of high importance in some hospitals. Tests that appeared more cost-effective also had better patient outcomes. Limitations There is considerable uncertainty in the values for key parameters within the model, although calibration was undertaken in an attempt to mitigate this. The example hospital simulated will also not match those of decision-makers deciding on the clinical effectiveness and cost-effectiveness of introducing SARS-CoV-2 point-of-care tests. Given these limitations, the results should be taken as indicative rather than definitive, particularly cost-effectiveness results when the relative cost per SARS-CoV-2 point-of-care test is uncertain. Conclusions Should a SARS-CoV-2 point-of-care test with a desirable target product profile become available, this appears promising, particularly when the reduction on the requirements for waiting bays before allocation to a SARS-CoV-2-infected bay, or a non-SARS-CoV-2-infected bay, is considered. The results produced should be informative to decision-makers who can identify the results most pertinent to their specific circumstances. Future work More accurate results could be obtained when there is more certainty on the diagnostic accuracy of, and the reduction in time to test result associated with, SARS-CoV-2 point-of-care tests, and on the impact of these tests on occupancy of waiting bays and isolation bays. These parameters are currently uncertain. Funding This report was commissioned by the National Institute for Health Research (NIHR) Evidence Synthesis programme as project number 132154. This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 21. See the NIHR Journals Library website for further project information.

Providing care for older adults with extreme obesity in aged residential care facilities: An environmental scan

2020 ◽  
Vol 36 (3) ◽  
pp. 24-36
Author(s):  
Caz Hales ◽  
◽  
Isaac Amankwaa ◽  
Lesley Gray ◽  
Helen Rook ◽  
...  
Keyword(s):  
Older Adults ◽  
Residential Care ◽  
Service Provision ◽  
Aged Care ◽  
Extreme Obesity ◽  
Financial Barriers ◽  
Residential Care Facilities ◽  
Environmental Scan ◽  
Staffing Ratios ◽  
Care Facilities

Little is known about the level of service demand and preparedness of Aotearoa New Zealand’s aged residential care facilities to care for older adults with extreme obesity. The aim of this study was to assess the current state of bariatric (extreme obesity) services within aged residential care. An environmental scan was conducted to identify bariatric resident needs and gaps in service provision to inform the development of policy and service provision. Observational and interview data from three facilities in Aotearoa New Zealand was collected along with a retrospective review of national resident admissions over a three-year period. Poor environmental design that included infrastructure deficiencies and financial barriers impacted on the ability to deliver safe and equitable care for this population. Specifically, equipment procurement and safe staffing ratios were of concern to the sector. There is an increasing need for bariatric level support within aged care, necessitating more equipment and staff, adaptation of physical care environments, and enhanced funding. Significant investment is required to address care concerns of older adults with extreme obesity at government and organisational levels.

scholarly journals Diabetes in Residential Care Facilities: United States, 2010

Diabetes Care ◽  
2013 ◽  
Vol 36 (3) ◽  
pp. e37-e37 ◽  
Author(s):  
H. E. Resnick ◽  
G. L. Foster
Keyword(s):  
United States ◽  
Residential Care ◽  
Residential Care Facilities ◽  
Care Facilities
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