Hip fracture in the elderly multidisciplinary rehabilitation (FEMuR) feasibility study: testing the use of routinely collected data for future health economic evaluations

Nefyn H Williams,Zoe Hoare,Nafees Ud Din,Joanna M Charles,Nicola Totton,Rhiannon T Edwards,Jessica L Roberts,Kevin Mawdesley

doi:10.1186/s40814-018-0269-5

Abstract

BackgroundHealth economic evaluations rely on the accurate measurement of health service resource use in order to calculate costs. These are usually measured with patient completed questionnaires using instruments such as the Client Service Receipt Inventory (CSRI). These rely on participants’ recall and can be burdensome to complete. Health service activity data are routinely captured by electronic databases.The aim was to test methods for obtaining these data and compare with those data collected using the CSRI, within a feasibility study of an enhanced rehabilitation intervention following hip fracture (Fracture in the Elderly Multidisciplinary Rehabilitation: FEMuR).MethodsPrimary care activity including prescribing data was obtained from the Secure Anonymised Information Linkage (SAIL) Databank and secondary care activity (Emergency Department attendances, out-patient visits and in-patient days) directly from Betsi Cadwaladr University Health Board (BCUHB), North Wales, UK. These data were compared with patient responses from the CSRI using descriptive statistics and the intraclass correlation coefficient (ICC).ResultsIt was possible to compare health service resource use data for 49 out of 61 participants in the FEMuR study. For emergency department (ED) attendances, records matched in 23 (47%) cases, 21 (43%) over-reported on electronic records compared with CSRI and five participants (10%) under-reported, with an overall ICC of 0.42. For out-patient episodes, records matched in only six cases, 28 participants over-reported on electronic records compared with CSRI and 15 (12%) under-reported, with an overall ICC of only 0.27. For in-patient days, records matched exactly in only five cases (10%), but if an error margin of 7 days was allowed, then agreement rose to 39 (66%) cases, and the overall ICC for all data was 0.88.It was only possible to compare prescribing data for 12 participants. For prescribing data, the SAIL data reported 117 out of 118 items (99%) and the CSRI only 89 (79%) items.ConclusionsThe use of routinely collected data has the potential to improve the efficiency of trials and other studies. Although the methodology to make the data available has been demonstrated, the data obtained was incomplete and the validity of using this method remains to be demonstrated.Trial registrationTrial registration: ISRCTN22464643 Registered 21 July 2014.

Highlights

Health economic evaluations rely on the accurate measurement of health service resource use in order to calculate costs
Costs are typically obtained by measuring health service resource use and multiplying this by unit costs obtained from national and local sources [2, 3]
In the case of health service use, participants are asked about the number of consultations with primary care services, for example general practitioners (GPs), nurses, pharmacists; the number of consultations with community services, for example district nurses, therapists; secondary care out-patient appointments; attendance at the emergency department (ED); in-patient days and procedures and prescribed drugs and dosage

Summary

Introduction

Health economic evaluations rely on the accurate measurement of health service resource use in order to calculate costs These are usually measured with patient completed questionnaires using instruments such as the Client Service Receipt Inventory (CSRI). The Client Service Receipt Inventory (CSRI) [5,6,7] is an example of a patient completed questionnaire, which collects retrospective information about study participants’ use of health services and other services such as social care, voluntary services from charities, etc. Other examples can be found at the Database of Instruments for Resource Use Measurement (DIRUM) [8] Proponents of this approach argue that it offers an opportunity to ask participants about their contacts with a wide range of services spanning health care, social care and the voluntary sector. Critics argue that the disadvantage of gathering such resource use data in this way is that it can be time consuming to complete, requires accurate recall by participants, which is difficult for those with cognitive impairment, and can be burdensome [9]

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