The right measure

The new NHS framework for patient experience offers, suggests Jocelyn Cornwall of the King's Fund, a secure evidence base for measuring and improving this key aspect of healthcare. She also argues that measures of patient experience should be aligned with clinical level data on processes and outcomes and embedded in the new NICE quality standard. A discussion paper from NHS Confederation aims to stimulate debate on what it calls the uneasy consensus between patients, citizens and the NHS. While patient experience is not entirely about keeping people happy, some research on the shape of happiness over the lifecourse may be of interest: a survey by ONS shows that happiness is a U-shaped curve, highest amonst teens and people in their 70s.

What's the risk

Pulse reveals that there is pressure from DH for NICE to recommend lowering the threshold for diabetes testing for adults. Draft guidance on prevention of type 2 diabetes, published last year, proved unpopular when it recommended a case finding approach, whereby GPs would be expected to assess risk of patients and offer lifestyle advice and testing to high risk patients. At this stage, the threshold was set at HbA1c levels of 6.0- 6.4%; according to Pulse, the new proposals suggest a level below 6.0% for high risk patients. A modelling study has recently suggested that using this lower threshold would prevent more cases but with a "disproportionately higher workload". Much reported was the study on variation in incidence of lower limb amputation in England, which suggested that multidisciplinary teams could be a better way of dealing with the issue.

Clean break

Fragility fractures are often linked to osteoporosis. NICE has just opened consultation on draft guidance to assess the risk of fragility fractures in adults. Responses are due in by 8 March. There's a comparison of UK case-finding strategies for management of hip fractures in the latest issue of Osteoporosis International, looking at the Royal College of Physicians strategy and the newer National Osteoporosis Guideline Group approach. Some more detail is provided on the SCOOP trial of community based screening for osteoporosis. Finally, Value in Health offers a systematic review of cost-effectiveness in strategies for selecting and treating people at risk of osteoporosis and osteopenia.

Risk assessments are the key

Not a popular position to take, but this is exactly what a clinical review in the BMJ proposes, as regards falls prevention. Falls risk screening, as recommended by NICE and the American British Geriatric Society guidelines, really works. The review also includes some video footage of assessments. A study from King's College London's Institute of Gerontology considers the possibility of a community partnership with the fire and rescue services.

Counting the cost

Prescribing analogue insulin, rather than human insulin, is an expensive option for the NHS. A recent study suggests that, between 2000 and 2009, this was something like £625 million. NICE guidelines recommend human insulin as the first choice of therapy, however. An interesting study in Social Science and Medicine looks at how NHS managers evaluate exceptional requests for high-cost drugs, based on the work of a Welsh individual patient commissioning panel.

Cheap at half the price?

The lack of rigorous cost effectiveness data for public health interventions has often been noted. This, coupled with the rather colder funding climate has lead NICE (the National Institute of Health and Clinical Excellence) to offer a meta-analysis of cost effectiveness data produced in the development of NICE's own public health guidance. Unsurprisingly, NICE has found that the majority of interventions assessed "are highly cost effective."