Developing Effective and Efficient care pathways in chronic Pain: DEEP study protocol.
BACKGROUND
Pain affecting the face or mouth and lasting longer than three months ("chronic orofacial pain", COFP) is relatively common in the UK. This study aims to describe and model current care pathways for COFP patients, identify areas where current pathways could be modified, and model whether these changes would improve outcomes for patients and use resources more efficiently.


METHODS
The study takes a prospective operations research approach. A cohort of primary and secondary care COFP patients (n = 240) will be recruited at differing stages of their care in order to follow and analyse their journey through care. The cohort will be followed for two years with data collected at baseline 6, 12, 18, and 24 months on: 1) experiences of the care pathway and its impacts; 2) quality of life; 3) pain; 4) use of health services and costs incurred; 5) illness perceptions. Qualitative in-depth interviews will be used to collect data on patient experiences from a purposive sub-sample of the total cohort (n = 30) at baseline, 12 and 24 months. Four separate appraisal groups (public, patient, clincian, service manager/commissioning) will then be given data from the pathway analysis and asked to determine their priority areas for change. The proposals from appraisal groups will inform an economic modelling exercise. Findings from the economic modelling will be presented as incremental costs, Quality Adjusted Life Years (QALYs), and the incremental cost per QALY gained. At the end of the modelling a series of recommendations for service change will be available for implementation or further trial if necessary.


CONCLUSIONS
The recent white paper on health and the report from the NHS Forum identified chronic conditions as priority areas and whilst technology can improve outcomes, so can simple, appropriate and well-defined clinical care pathways. Understanding the opportunity cost related to care pathways benefits the wider NHS. This research develops a method to help design efficient systems built around one condition (COFP), but the principles should be applicable to a wide range of other chronic and long-term conditions.
Institute of Health & Society, Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK. Justin.durham@ncl.ac.uk.
Justin
J
Durham
Matthew
M
Breckons
Vera
V
Araujo-Soares
Catherine
C
Exley
Jimmy
J
Steele
Luke
L
Vale
D001294:Attitude to Health; D059350:Chronic Pain / Q000191:economics / Q000523:psychology / Q000628:therapy*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D019091:Critical Pathways / Q000191:economics; D003729:Dental Care / Q000191:economics / Q000706:statistics & numerical data; D005157:Facial Pain / Q000191:economics / Q000523:psychology / Q000628:therapy*; D005500:Follow-Up Studies; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D018803:Models, Economic; D009874:Operations Research; D010147:Pain Measurement; D018579:Patient Selection; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D011446:Prospective Studies; D036301:Qualitative Research; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D063127:Secondary Health Care / Q000191:economics / Q000706:statistics & numerical data; D016896:Treatment Outcome