Investigating early developmental impairment: what’s the cost?

Hart, Anthony R; Connolly, Daniel; Sharma, Ruchi

doi:10.1136/archdischild-2017-313532

Cited by 2 publications

(10 citation statements)

References 5 publications

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“…We have previously suggested that reducing the burden of unnecessary tests could produce cost savings to the health service, and found the yield of metabolic investigations was low, particularly in EDI-. (22) This agrees with other groups' work. (1,13,21,(29)(30)(31) However, other publications extol the importance of diagnosing metabolic disorders, (19,20,23,(32)(33)(34) particularly where they are treatable.…”

Section: Discussionsupporting

confidence: 92%

“…Over time, many of our consultants dropped routine metabolic investigations because the yield was so low. Cost e ciency was highlighted in our previous work as a potential advantage of reducing investigations requested in EDI, (21,22) and interviewees themselves cited this as one reason for reducing the number of metabolic tests they ordered. However, it was hard to establish cost as a behavioural modi er from our data, despite what was said: participants did not know the cost of investigations, rarely faced cost pressures from managers as a negative reinforcement, and did not experience a positive reinforcement of having saved money redirected to interventional services.…”

Section: Discussionmentioning

confidence: 89%

“…A topic guide was written based on the ndings of our previous work, (5,21,22) with an aim to discover how participants choose when to investigate children with EDI, how they choose which investigations to choose, their views on speci c investigations, and to explore how much costs affected their choice of investigation. The topic guide (supplementary material, available online) commenced with open questions on their job, factors in the history and examination that lead to investigation, their attitude to departmental guidelines, followed by questions on speci c tests.…”

Section: Topic Guide / Questionsmentioning

confidence: 99%

“…Cavorite de ciency was modelled on biotinidase de ciency, which some clinicians state can present with EDI-,(13) and included the same incidence gures(26) and costs. (22) The nal question presented the likely cost across the UK to diagnose one participant with Cavorite de ciency and whether they thought this was good value for money. If not, we asked how they would prefer to spend this funding in their clinical practice by listing all services they wish they had more access to.…”

Section: Topic Guide / Questionsmentioning

confidence: 99%

“…(1,3,(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) In 2017, we reviewed the frequency of diagnostic investigations for EDI in our centre and recommended rationalisation of investigations, with the consideration for cost-savings one potential bene t of this approach. (21,22) These recommendations were controversial, with other groups arguing in favour of additional testing. (23) There is no published evidence on how paediatricians choose aetiological investigations for EDI.…”

Section: Introductionmentioning

confidence: 99%

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How paediatricians investigate early developmental impairment: a qualitative descriptive study

Atherton

Hart

2021

Preprint

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Background Early developmental impairment (EDI) is common and has many aetiologies and, therefore, potential investigations. There are several published guidelines recommending aetiological investigations, and paediatricians’ views of them varies. Little is known on the thought processes underlying clinical decisions in investigating EDI. This study aimed to describe the thought processes affecting clinical decisions on the investigation of EDI within a nationalised health care system. Methods A qualitative descriptive study using semi-structured qualitative interviews performed in person or via video link with paediatricians who see children with EDI in England. As part of the interview, a case study of a fictional disease, Cavorite deficiency, modelled on biotinidase deficiency, was given to participants with the cost of testing, incidence and likelihood it would respond to treatment. This allowed exploration of cost without encumbrance from predisposing views and training on the condition. Thematic analysis was performed by iterative approach. Where participants stated they wanted to redirect money from investigations to treatment, were that even possible, we asked which services they would like to be better funded in their area. Results Interviews were conducted with 14 consultant paediatricians: 9 Community / Neurodisability, 2 General paediatricians, and 3 Paediatric Neurologists. Two themes were identified: the value of an aetiological diagnosis to families and managing risk and probability when investigating EDI. The latter contained 4 subthemes: ‘circumspection’ involved blanket investigations chosen irrespective of phenotype and high regard for guidelines; ‘accepting appropriate risk’ involved participants choosing investigations based on clinical phenotype, recognising some aetiologies would be missed; consultants found they ‘transitioned between practices’ during their career; and ‘improved practice’ was thought possible with better evidence on how to stratify investigations based on phenotype. Services that were most frequently reported to need additional funding were therapy services, early community developmental services, management of behaviour, sleep and mental health, and educational support. Conclusions There are many factors that influence paediatricians’ choice of aetiological investigation in EDI, but clinical factors are the most important. Paediatricians want better evidence to allow them to select the right investigations for each child without a significant risk of missing an important diagnosis.

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