title: Evaluation of modernisation of adult critical care services in England: time series and cost effectiveness analysis.
abstract: OBJECTIVE
  To evaluate the impact and cost effectiveness of a programme to transform adult critical care throughout England initiated in late 2000.
  
  
  METHODS
  Evaluation of trends in inputs, processes, and outcomes during 1998-2000 compared with last quarter of 2000-6.
  
  
  METHODS
  96 critical care units in England.
  
  
  METHODS
  349,817 admissions to critical care units.
  
  
  METHODS
  Adoption of key elements of modernisation and increases in capacity. Units were categorised according to when they adopted key elements of modernisation and increases in capacity.
  
  
  METHODS
  Trends in inputs (beds, costs), processes (transfers between units, discharge practices, length of stay, readmissions), and outcomes (unit and hospital mortality), with adjustment for case mix. Differences in annual costs and quality adjusted life years (QALYs) adjusted for case mix were used to calculate net monetary benefits (valuing a QALY gain at pound20,000 ($33,170, euro22 100)). The incremental net monetary benefits were reported as the difference in net monetary benefits after versus before 2000.
  
  
  RESULTS
  In the six years after 2000, the risk of unit mortality adjusted for case mix fell by 11.3% and hospital mortality by 13.4% compared with the steady state in the three preceding years. This was accompanied by substantial reductions both in transfers between units and in unplanned night discharges. The mean annual net monetary benefit increased significantly after 2000 (from pound402 ($667, euro445) to pound1096 ($1810, euro1210)), indicating that the changes were relatively cost effective. The relative contribution of the different initiatives to these improvements is unclear.
  
  
  CONCLUSIONS
  Substantial improvements in NHS critical care have occurred in England since 2000. While it is unclear which factors were responsible, collectively the interventions represented a highly cost effective use of NHS resources.
authors.affiliation: Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT. andrew.hutchings@lshtm.ac.uk
authors.forename: Andrew
authors.initials: A
authors.lastname: Hutchings
authors.forename: Mary Alison
authors.initials: MA
authors.lastname: Durand
authors.forename: Richard
authors.initials: R
authors.lastname: Grieve
authors.forename: David
authors.initials: D
authors.lastname: Harrison
authors.forename: Kathy
authors.initials: K
authors.lastname: Rowan
authors.forename: Judith
authors.initials: J
authors.lastname: Green
authors.forename: John
authors.initials: J
authors.lastname: Cairns
authors.forename: Nick
authors.initials: N
authors.lastname: Black
mesh_terms: D001509:Bed Occupancy / Q000191:economics / Q000639:trends; D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000191:economics* / Q000639:trends; D004739:England; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000191:economics / Q000639:trends; D010359:Patient Readmission / Q000191:economics / Q000639:trends; D010360:Patient Transfer; D011379:Prognosis; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment