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Biomedical subjects

M Mugford

Publications and source records attributed to M Mugford.

48 records · Page 3Linked to original sources
PubMed1988

Factors affecting the outcome of maternity care. 1. Relationship between staffing and perinatal deaths at the hospital of birth.

This is the first of two papers describing a retrospective study of maternity hospitals in an English health region using data for the years 1977-83. The research was designed to investigate the relationship between resources (such as staff and equipment) and the outcomes of births at maternity units. Considerable variation in medical and nursing staffing levels in the units in the study was observed. Regression analysis suggests that, after taking account of differences in very low weight births at each unit, the level of paediatric staffing at a maternity unit is a significant factor in explaining differences in "in house" mortality. There was no identifiable relationship between staff categories other than paediatricians and the rate of perinatal death at the hospital of delivery. As selective referral and transfers between hospitals may affect the interpretation of these findings, a second paper follows presenting the results of a further analysis that adjusts both resources and outcomes to take account of neonatal transfers.

Birth Weight↗
PubMed1988

Factors affecting the outcome of maternity care. II. Neonatal outcomes and resources beyond the hospital of birth.

Analysis of data about perinatal mortality and indicators of resources at maternity hospitals in the West Midlands region between 1977 and 1983 showed that paediatric staff ratios were inversely related to in-house mortality rates. In this paper, the outcomes for and resources used by transferred babies are added to those of the hospital of birth for three of the study years--1978, 1980, and 1982. Patterns of transfer differ between units and over time in the region, and a regional neonatal intensive care policy was introduced in 1980. Analysis of the new variables showed that in 1978 paediatric staffing was significantly inversely related to neonatal mortality. In later years, neonatal mortality of births at maternity units is explained entirely by the proportion of low or very low weight births.

England↗
PubMed1987

Information for managers in hospitals: representing maternity unit statistics graphically.

Staff who organise and run maternity units contribute many statistics to their health authority but do not find it easy to obtain information about their unit from these statistics. Data that are collected routinely, however, can be used to provide each unit with a graphical profile of its activity and resources. The method described here was derived from the personality profiles used by psychologists and allows staff in one unit to assess the outcome, activity, and use of resources in their unit in relation to similar units, to explain some of the differences when these occur, or to highlight potential problems. Examples are taken from a study of maternity units in the West Midlands. It is concluded that the technique can indicate potential problems and usefully be adopted by those who monitor maternity care in districts or hospitals.

Data Collection↗
PubMedDate not supplied

An exercise on the feasibility of carrying out secondary economic analyses.

Purchasers of health services need up to date information on cost-effectiveness of interventions to help in prioritising spending. But economists have not yet developed a formal methodology for reviewing and summing up evidence from individual economic evaluations which may have been conducted at different times and in different places, or indeed for assessing whether such systematic reviews are possible in this context. This paper discusses the problems of reviewing available economic information, using a body of literature on the economics of influenza vaccination to illustrate some relevant issues. First, the paper examines alternative methods for adjusting prices to take into account differences in currency and time periods: Retail Price Indices are compared with health specific inflation indices, and exchange rates are compared with Purchasing Power Parity (PPP) data. For the studies reviewed, the choice of conversion method made little practical difference. Secondly, the paper explores the possibility of summarising the results of a review in terms of quantities of resources used, rather than prices. This method is constrained by the available data, but could be more generally useful as it allows direct comparison of underlying technologies, and calculation of costs by attaching local unit costs to the resources associated with an intervention. These two exercises highlight many of the problems that arise in generalising from economic studies. Both methods need to be developed further if they are to be useful to decision makers.

Cost-Benefit Analysis↗
PubMedDate not supplied

QALY league tables.

Explore the source record for details and available documents.

Cost-Benefit Analysis↗
PubMedDate not supplied

Costing neonatal care alongside the Collaborative ECMO trial: how much primary research is required?

Researchers working on economic evaluations alongside trials have to balance minimising data collection with maximising the ability to measure differences in costs. Using existing data sources may keep the costs of research down, but these data may not be entirely appropriate to the evaluation question. When evaluating technologies in intensive care it is particularly important to be able to classify patients correctly by their resource requirements especially when those requirements vary considerably from day to day. This paper describes and justifies methods for costing the care provided for babies in (one arm of) an on-going multi-centre trial, the Collaborative ECMO trial. This trial is evaluating alternative policies of life support for mature (full term) newborn babies with severe respiratory failure. The most reliable cost information on neonatal intensive care is available from a study, conducted independently from the trial, which has used simple cost apportionment on a large sample of units. By drawing on clinical opinion and carrying out a case note exercise we assessed whether this available information was appropriate to estimate 'baseline' costs for the control group during their initial 'acute' phase of illness. We concluded that the available cost estimates would need to be weighted to reflect the additional costs of drugs and investigations for this group of babies during the acute phase. Multidisciplinary collaboration on trials can help economists and other researchers to balance the requirement for simple cost measurements with more detailed primary research.

Cost-Benefit Analysis↗