{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T23:09:56Z","timestamp":1780528196212,"version":"3.54.1"},"reference-count":41,"publisher":"BMJ","issue":"11","funder":[{"DOI":"10.13039\/501100000659","name":"Research Trainees Coordinating Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,10,13]]},"published-print":{"date-parts":[[2017,11]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The aim of this study was to examine the impact of transient ischaemic attack (TIA) service modification in two hospitals on costs and clinical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Discrete event simulation model using data from routine electronic health records from 2011.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Participants<\/jats:title>\n                  <jats:p>Patients with suspected TIA were followed from symptom onset to presentation, referral to specialist clinics, treatment and subsequent stroke.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>Included existing versus previous (less same day clinics) and hypothetical service reconfiguration (7-day service with less availability of clinics per day).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Outcome measures<\/jats:title>\n                  <jats:p>The primary outcome of the model was the prevalence of major stroke after TIA. Secondary outcomes included service costs (including those of treating subsequent stroke) and time to treatment and attainment of national targets for service provision (proportion of high-risk patients (according to ABCD<jats:sup>2<\/jats:sup> score) seen within 24\u2009hours).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The estimated costs of previous service provision for 490 patients (aged 74\u00b112 years, 48.9% female and 23.6% high risk) per year at each site were \u00a3340\u2009000 and \u00a3368\u2009000, respectively. This resulted in 31% of high-risk patients seen within 24\u2009hours of referral (47\/150) with a median time from referral to clinic attendance\/treatment of 1.15 days (IQR 0.93\u20132.88). The costs associated with the existing and hypothetical services decreased by \u00a35000 at one site and increased \u00a321\u2009000 at the other site. Target attainment was improved to 79% (118\/150). However, the median time to clinic attendance was only reduced to 0.85 days (IQR 0.17\u20130.99) and thus no appreciable impact on the modelled incidence of major stroke was observed (10.7 per year, 99%\u2009CI 10.5 to 10.9 (previous service) vs 10.6 per year, 99%\u2009CI 10.4 to 10.8 (existing service)).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Reconfiguration of services for TIA is effective at increasing target attainment, but in services which are already working efficiently (treating patients within 1\u20132 days), it has little estimated impact on clinical outcomes and increased investment may not be worthwhile.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-018189","type":"journal-article","created":{"date-parts":[[2017,11,25]],"date-time":"2017-11-25T04:40:15Z","timestamp":1511584815000},"page":"e018189","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["When has service provision for transient ischaemic attack improved enough? A discrete event simulation economic modelling study"],"prefix":"10.1136","volume":"7","author":[{"given":"Pelham","family":"Barton","sequence":"first","affiliation":[{"name":"Health Economics Unit, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4461-8756","authenticated-orcid":false,"given":"James P","family":"Sheppard","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina M","family":"Penaloza-Ramos","sequence":"additional","affiliation":[{"name":"Health Economics Unit, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Jowett","sequence":"additional","affiliation":[{"name":"Health Economics Unit, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary A","family":"Ford","sequence":"additional","affiliation":[{"name":"Oxford Academic Health Science Network, Oxford University Hospitals NHS Foundation Trust, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Lasserson","sequence":"additional","affiliation":[{"name":"Nuffield Department of Medicine, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Mant","sequence":"additional","affiliation":[{"name":"Primary Care Unit, University of Cambridge, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth M","family":"Mellor","sequence":"additional","affiliation":[{"name":"Department of Public Health, NHS Lanarkshire, Bothwell, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Quinn","sequence":"additional","affiliation":[{"name":"Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, St George\u2019s University of London, Kingston University, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter M","family":"Rothwell","sequence":"additional","affiliation":[{"name":"Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Sandler","sequence":"additional","affiliation":[{"name":"Geriatric Medicine, Heart of England NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Don","family":"Sims","sequence":"additional","affiliation":[{"name":"Stroke Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3638-028X","authenticated-orcid":false,"given":"Richard J","family":"McManus","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, NIHR School for Primary Care Research, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,11,25]]},"reference":[{"key":"2025101813312825000_7.11.e018189.1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000195209.26543.8f"},{"key":"2025101813312825000_7.11.e018189.2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.612705"},{"key":"2025101813312825000_7.11.e018189.3","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.31.1.9"},{"key":"2025101813312825000_7.11.e018189.4","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.111.645101"},{"key":"2025101813312825000_7.11.e018189.5","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000158917.59233.b7"},{"key":"2025101813312825000_7.11.e018189.6","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)16405-2"},{"key":"2025101813312825000_7.11.e018189.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.37991.635266.44"},{"key":"2025101813312825000_7.11.e018189.8","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.0000080935.01264.91"},{"key":"2025101813312825000_7.11.e018189.9","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61448-2"},{"key":"2025101813312825000_7.11.e018189.10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66702-5"},{"key":"2025101813312825000_7.11.e018189.11","unstructured":"Intercollegiate Stroke Working Party. National clinical guideline for stroke. London: Royal College of Physicians, 2012."},{"key":"2025101813312825000_7.11.e018189.12","unstructured":"National Institute for Health and Clinical Excellence (NICE). Diagnosis and intial management of acute stroke and transient ischemic attack (TIA). NICE clinical guideline, 2008."},{"key":"2025101813312825000_7.11.e018189.13","unstructured":"Royal College of Physicians. Sentinel Stroke National Audit Programme (SSNAP) acute organisational audit report 2014, 2014."},{"key":"2025101813312825000_7.11.e018189.14","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-003359","article-title":"Clinical and imaging services for TIA and minor stroke: results of two surveys of practice across the UK","volume":"3","author":"Brazzelli","year":"2013","journal-title":"BMJ Open"},{"key":"2025101813312825000_7.11.e018189.15","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2012-001430","article-title":"Protocol for an observation and implementation study investigating optimisation of the management of stroke and transient ischaemic attack (TIA)","volume":"2","author":"Sheppard","year":"2012","journal-title":"BMJ Open"},{"key":"2025101813312825000_7.11.e018189.16","unstructured":"Mant J , Barton P , McManus RJ , et al . What is the optimum model of service delivery for transient ischaemic attack? National Co-ordinating Centre for NHS Service Delivery and Organisation R&D (NCCSDO), 2008."},{"key":"2025101813312825000_7.11.e018189.17","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1569"},{"key":"2025101813312825000_7.11.e018189.18","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(04)15785-1"},{"key":"2025101813312825000_7.11.e018189.19","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181dad63e"},{"key":"2025101813312825000_7.11.e018189.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2009.05.002"},{"key":"2025101813312825000_7.11.e018189.21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.324.7336.S71"},{"key":"2025101813312825000_7.11.e018189.22","article-title":"Oral anticoagulants for preventing stroke in patients with non-valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks","volume":"3","author":"Aguilar","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"key":"2025101813312825000_7.11.e018189.23","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67394-1"},{"key":"2025101813312825000_7.11.e018189.24","doi-asserted-by":"crossref","unstructured":"Ebrahim S , Harwood R . Stroke epidemiology, evidence, and clinical practice. Oxford: Oxford University Press, 1999.","DOI":"10.1093\/oso\/9780192630759.001.0001"},{"key":"2025101813312825000_7.11.e018189.25","unstructured":"MacMahon S . BP and the risks of CV disease. In: Swales J , ed. Textbook of hypertension. Oxford: Blackwell Scientific Publications, 1994."},{"key":"2025101813312825000_7.11.e018189.26","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.22.8.983"},{"key":"2025101813312825000_7.11.e018189.27","unstructured":"Department of Health. 2011\u201312 Reference costs. 2013 https:\/\/www.gov.uk\/government\/publications\/2011-12-reference-costspublication (accessed Jun 2013)."},{"key":"2025101813312825000_7.11.e018189.28","unstructured":"Curtis L . Unit costs in health and social care 2011: personal social services research unit (PSSRU). 2012 http:\/\/www.pssru.ac.uk\/project-pages\/unit-costs\/2011\/index.php (accessed Nov 2012)."},{"key":"2025101813312825000_7.11.e018189.29","unstructured":"British National Formulary (BNF). Authoritative and practical. Pharmaceutical Press, 2012. https:\/\/www.bnf.org\/ (accessed Nov 2012)."},{"key":"2025101813312825000_7.11.e018189.30","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000001780"},{"key":"2025101813312825000_7.11.e018189.31","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.113.003216"},{"key":"2025101813312825000_7.11.e018189.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2012.05.004"},{"key":"2025101813312825000_7.11.e018189.33","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31826356bf"},{"key":"2025101813312825000_7.11.e018189.34","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hcs036"},{"key":"2025101813312825000_7.11.e018189.35","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e31823d763f"},{"key":"2025101813312825000_7.11.e018189.36","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000187067.93321.fa"},{"key":"2025101813312825000_7.11.e018189.37","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1212\/WNL.0000000000001635","article-title":"Hospital costs of ischemic stroke and TIA in the Netherlands","volume":"84","author":"Buisman","year":"2015","journal-title":"Neurology"},{"key":"2025101813312825000_7.11.e018189.38","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1212\/WNL.0000000000001651","article-title":"Health economics of cerebrovascular disease: can we do better?","volume":"84","author":"Ranta","year":"2015","journal-title":"Neurology"},{"key":"2025101813312825000_7.11.e018189.39","doi-asserted-by":"publisher","DOI":"10.1212\/CPJ.0000000000000095"},{"key":"2025101813312825000_7.11.e018189.40","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2753.2006.00714.x"},{"key":"2025101813312825000_7.11.e018189.41","doi-asserted-by":"crossref","unstructured":"Ranta A , Barber PA . Transient ischemic attack service provision: a review of available service models. Neurology 2016;86.doi:10.1212\/WNL.0000000000002339","DOI":"10.1212\/WNL.0000000000002339"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-018189","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T20:31:35Z","timestamp":1760819495000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-018189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,11]]},"references-count":41,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,11,25]]},"published-print":{"date-parts":[[2017,11]]}},"alternative-id":["10.1136\/bmjopen-2017-018189"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-018189","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11]]}}}