1. YHEC & Outcomes Research
Adam Smith – Project Director
Andria Hanbury – Senior Consultant
January 2016

2. York Health Economics Consortium
Established as a University research unit in 1986
YHEC is owned by the University of York, but…
…operates as an independent research consultancy
Board of Directors chaired by Professor Trevor Sheldon (Dean of Hull York Medical School)…
…with non–executive directors from University, NHS & industry

3. Delivering academic rigour & commercial acumen, on time, within budget
YHEC’s purpose
To provide consultancy & research to public health organisations (e.g. NHS, NICE), pharmaceutical & health care industries that combines rigorous research standards with efficient product delivery
Delivering academic rigour & commercial acumen, on time, within budget

4. Current and Recent Clients
NHS providers and commissioners
NHS Trusts
Airedale NHS Foundation Trust
Bart’s Health NHS Trust
Royal Liverpool University Hospitals
University College London Hospitals
Salford Royal NHSFT
Commissioning bodies
NHS Airedale, Bradford and Leeds
Bradford City CCG/Bradford Districts CCG
North Kirklees CCG
North Staffordshire CGG/Stoke on Trent CCG
Sandwell and West Birmingham CCG

5. Current and Recent Clients
Other public/third sector bodies
National/regional NHS bodies
Greater Manchester AHSN
National Institute for Health and Care Excellence (NICE)
National Institute for Health Research
NHS Improving Quality
NHS Shared Business Services
NHS Supply Chain
Yorkshire & Humber AHSN
Yorkshire & Humber CSU
Third sector/local government
Crisis
Dudley Metropolitan Borough Council
Macmillan Cancer Research
Together for Short Lives

6. Our services Our Clients
Private / Public sector Health technology assessment
Outcomes research
Information services & Systematic reviews
NHS consulting (service design & evaluation)
RH start

7. Outcomes Research Work
Advice on identifying & selecting PROMs
Developing patient-reported experience measures (PREMs)
Analysis & interpretation of PROM / PREM data for QI
Capturing service-user preferences for treatments
Informing the use of PROM/PREM data in service design and evaluation, and in commissioning services
Advice on use of PROMs / PREMs in clinical settings
Advice on the implementation of PROMs into routine clinical practice

8. Patient preference for scanning modalities: DCE
NICE Medical Technologies Evaluation Programme (MTEP) – External Assessment Centre
SonoVue (sulphur hexafluoride microbubbles) recommended by NICE for contrast-enhanced ultrasound imaging of the liver
Do patients have a preference for scanning modality following incidental detection of a liver lesion?

9. Patient preference for scanning modalities: DCE
Two-stage approach:
Stage 1:
Clinician interview:
Patients rarely experience >2 modalities therefore difficult to assess all 3 with patients
Patient-reported experience survey:
Patient responses: Claustrophobia, waiting times, anxiety, side-effects, immediacy of results
Stage 2:
Discrete Choice Experiment (DCE)

10. Patient preference for scanning modalities: DCE
Choice sets
Comparison of different variables
Implicitly reveal patient preference

11. Patient preference for scanning modalities: DCE
Respondents preferred shorter waiting times
Procedure to be undertaken with a handheld scanner on a couch instead of within a body scanner
No side-effects
No follow‑up scans
The average respondent was willing to wait:
An additional 2 weeks for the scan if it resulted in avoiding side- effects,
1.5 weeks to avoid further procedures or to be told the results immediately, and
1 week to have the scan performed on a couch with a handheld scanner.
Patient perspective: Prefer US to MRI and CT, therefore where other imaging modalities would not add to the diagnostic picture, and indeed would potentially lead to patient anxiety and distress CEUS could be offered as an alternative scan option.

12. Other DCEs Patient preference for testosterone-replacement therapies
Patient preferences for cancer diagnostic services
Patient preferences for specialist clinics for Autosomal Dominant Polycystic Kidney Disease (ADPKD)

13. Tool selection, implementation and quality improvement
Mental Health Payment System (clusters & packages, outcomes and incentives)
PROMs (generic and specific); Patient Reported Experience Measure, CROM (HoNOS)
Change in clinical practice; data collection & optimal feedback; tool selection: reliability, validity, sensitivity to detect change, suitability; analysis to inform meaningful and robust quality improvement: getting the most out of your data
Introduction & implementation

14. Thank you adam.smith@york.ac.uk / andria.hanbury@york.ac.uk
Telephone: +44 (0)
Website: