Developing methods to improve usefulness of economic Decision Analytical Models: case study in COPD telehealth monitoring

Background: In the light of a scarcity of health resources and the growing needs of the population, there is considerable interest in the potential of telehealth technology to assist patients in self-management of chronic conditions, such as Chronic Obstructive Pulmonary Disease (COPD), heart failure (HF), and diabetes. However, despite ongoing support for this technology from the UK government, the uptake of the technology has been slower than anticipated, with the research suggesting the lack of evidence for the cost-effectiveness of this technology is one of the major barriers. Economic modelling is one of techniques that could facilitate deeper understanding of the long-term consequences and financial outcomes of telehealth interventions. Objective: This thesis documents the process of doctoral research into the methods to enhance the use of decision analytical models in the NHS, using a case study of COPD telehealth. This research is predicated on understanding and challenging assumptions around the methods by which decision models are developed, used, disseminated, and evaluated. The study proposes the ‘end-user mode’ of model dissemination as an alternative to currently used practices. Methods: During the model development process, the conceptual modelling was undertaken using the existing conceptual framework. The framework was altered to suit the needs of the research, with 29 qualitative interviews conducted to elicit stakeholders’ requirements. A usability evaluation of the model was conducted with end-users in a series of 16 tests, with both qualitative and video data analysed. Finally, when the model was released in Open Access, the stakeholder satisfaction was evaluated, using the end-user satisfaction questionnaire to conduct seven further qualitative interviews. A number of specific requirements for the model were elicited during qualitative interviews and fed back to modellers during model development process. The usability evaluation resulted in several problems being identified and eradicated in consecutive phases of development; and the study led to the development of a decision tool that was well-received by NHS stakeholders. The user satisfaction evaluation revealed high satisfaction with the model. Conclusions: The findings suggest that the ‘end-user mode’ approach is viable in the development and the dissemination of a decision model for telehealth. Importantly, several potential areas for future research were identified, including the need to develop methods to improve the uptake and the use of modelling in the NHS, and the development of the concept and instruments for end-user satisfaction in modelling and simulation domain.