Assessing the Challenges of Economic Evaluation of Critical Care Outreach Services (CCOS): A Typology Approach

  • Sara Pickett

    Student thesis: Doctoral Thesis


    There is a paucity of evaluative research into Critical Care Outreach Services (CCOS) with somewhat contradictory findings. A literature review revealed structural and functional heterogeneity between CCOS in England. Yet it remained unknown how the services are configured in Wales. Numerous measures have been used to evaluate effectiveness. However, no economic evaluation has been conducted for CCOS as a whole service. Given the complexity, heterogeneity and multiple aims associated with CCOS, economic evaluation will be challenging. Which standard method of economic evaluation is most appropriate for CCOS remains unexplored.

    This thesis addresses the primary and secondary research questions: What are the challenges of conducting an economic evaluation of CCOS? and Is a typology approach to economic evaluation an appropriate methodology for CCOS? This exploratory mixed methods research was characterised by two distinct phases: a survey captured service delivery configurations, which together with the literature review enabled the development of an empirically grounded typology of models for CCOS; followed by multiple case studies that facilitated more in-depth analyses. The case studies were guided by two additional secondary research questions: Do local factors influence the effectiveness of CCOS? and What outcome measures are most appropriate for the economic evaluation of CCOS?

    This research ultimately revealed how assigning costs to CCOS is complex, and highlighted just how wide-ranging the benefits of the service can be. It uncovered factors that can potentially influence CCOS effectiveness, and how CCOS in Wales continue to evolve - having a tendency to become more educationalist with maturity. Cost-utility analysis alone is therefore likely to be too narrowly focused to capture the full effects of CCOS. Cost-consequence analysis should additionally be conducted to ensure that decisions makers are fully informed when they consider allocating resources to the delivery of CCOS. The tendency of CCOS to evolve as they mature, and the potential influence of contextual factors will also need to be accounted for in the design of future evaluations.
    Date of Award14 Oct 2016
    Original languageEnglish
    SupervisorDavid Cohen (Supervisor) & Allyson Lipp (Supervisor)


    • Rapid Response Team
    • Sub-optimal care of deteriorating patients
    • Intensive Care Outreach
    • Critical Care Outreach in Wales
    • Economic evaluation of complex services

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