scholarly journals An evaluation of a multifaceted, local Quality Improvement Framework for long-term conditions in UK primary care

2018 ◽  
Vol 36 (5) ◽  
pp. 607-613 ◽  
Author(s):  
Frank Gabel ◽  
Ruth Chambers ◽  
Tracey Cox ◽  
Stefan Listl ◽  
Neal Maskrey
Keyword(s):  
Coronary Heart Disease ◽  
Quality Improvement ◽  
Heart Disease ◽  
Fixed Effects ◽  
Pay For Performance ◽  
Unintended Consequences ◽  
Mortality Data ◽  
Periodic Review ◽  
Long Term Conditions ◽  
National Quality

Abstract Background The evidence that large pay-for-performance schemes improve the health of populations is mixed—evidence regarding locally implemented schemes is limited. Objective This study evaluates the effects in Stoke-on-Trent of a local, multifaceted Quality Improvement Framework including pay for performance in general practice introduced in 2009 in the context of the national Quality and Outcomes Framework that operated from 2004. Methods We compared age-standardized mortality data from all 326 local authorities in England with the rates in Stoke-on-Trent using Difference-in-Differences, estimating a fixed-effects linear regression model with an interaction effect. Results In addition to the existing downward trend in cardiovascular deaths, we find an additional annual reduction of 36 deaths compared with the national mean for coronary heart disease and 13 deaths per 100000 from stroke in Stoke-on-Trent. Compared with the national mean, there was an additional reduction of 9 deaths per 100000 people per annum for coronary heart disease and 14 deaths per 100000 people per annum for stroke following the introduction of the 2009 Stoke-on-Trent Quality Improvement Framework. Conclusion There are concerns about the unintended consequences of large pay-for-performance schemes in health care, but in a population with a high prevalence of disease, they may at least initially be beneficial. This study also provides evidence that a local, additional scheme may further improve the health of populations. Such schemes, whether national or local, require periodic review to evaluate the balance of their benefits and risks.

Abstract 15016: Peak Oxygen Consumption Achieved at the End of Cardiac Rehabilitation Predicts Survival in Patients With Coronary Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Salvatore Carbone ◽  
Youngdeok Kim ◽  
Sergey Kachur ◽  
Alban De Schutter ◽  
Hayley E Billingsley ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Oxygen Consumption ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Peak Oxygen Consumption ◽  
Mortality Data ◽  
Term Survival ◽  
Long Term Survival ◽  
Peak Vo2

Introduction: Several patients with coronary heart disease (CHD) present reduced survival despite completing cardiac rehabilitation (CR), suggesting that the level of cardiorespiratory fitness (CRF) achieved might remain suboptimal. The purposes of this study were: 1) to examine the independent association of peak oxygen consumption (VO 2 ), a measure of CRF, at post-CR with long-term survival; and 2) to establish an optimal cut-off for peak VO 2 at post-CR that best predicts mortality risk. Methods: 853 patients with CHD (mean age of 64±10 years old) who were referred to CR between January 1, 2000, and June 30, 2013, at Ochsner Medical Center were analyzed for this study. We measured pre- and post-CR peak VO 2 . Mortality data were collected using National Death Index. Cox proportional hazard regression model was used to examine the risk of all-cause mortality associated with peak VO 2 at post-CR, independent of peak VO 2 at pre-CR and related changes during CR. Contal and O’Quigley’s method were used to determine the optimal cut-off for peak VO 2 at post-CR based on a split-sample approach. Results: Mean peak VO 2 at post-CR was 21.01±6.25 mL/kg/min (75% and 51% predicted peak VO2 using Wasserman and FRIEND Registry equations, respectively). During a mean follow-up of 6.55 years, 106 subjects (12.4%) died. Peak VO 2 at post-CR independently predicted mortality (Hazard Ratio: 0.82 [0.77-0.87], p<0.001). We identified peak VO 2 of ≥17.6 kg/mL/min as optimal cut-off best predicting survival ( Figure 1, Panel A ) and the %predicted peak VO2 at post-CR ≥62.1% using Wasserman ( Figure 1, Panel B ) and ≥41.4% using FRIEND Registry ( Figure 1, Panel C ) as the alternative optimal cut-offs. Conclusions: In patients with CHD undergoing CR, post-CR peak VO 2 independently predicts long-term survival. These results suggest that patients with CHD presenting a peak VO 2 lower than the cut-off identified herein may benefit from additional sessions of CR or higher intensity exercise training.

scholarly journals Quality improvement of nurse-led aftercare to outpatients with coronary heart disease: report of a case study

2012 ◽  
Vol 24 (3) ◽  
pp. 286-292 ◽  
Author(s):  
H. R. Voogdt-Pruis ◽  
H. J. M. Vrijhoef ◽  
G. H. M. I. Beusmans ◽  
A. P. M. Gorgels
Keyword(s):  
Coronary Heart Disease ◽  
Quality Improvement ◽  
Heart Disease

scholarly journals Distinct Distress Symptom Trajectories Over 3 Years Are Associated With Baseline Illness Perceptions in Individuals With Coronary Heart Disease

2019 ◽  
Vol 54 (5) ◽  
pp. 374-379 ◽  
Author(s):  
Joseph Chilcot ◽  
Ester Lee ◽  
Andre Tylee ◽  
June Brown ◽  
John Weinman ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Illness Perceptions ◽  
Multinomial Logistic Regression ◽  
Depression Scale ◽  
Treatment Control ◽  
Long Term Conditions ◽  
Symptom Trajectories ◽  
High Distress ◽  
Perceived Consequences

Abstract Background Depression and anxiety symptoms (termed distress) are common among coronary heart disease (CHD) patients and associated with poor outcomes. Illness perceptions predict distinct outcome trajectories in other long-term conditions, yet it is not known how they relate to distress trajectories in CHD. Purpose This study aimed to examine whether baseline illness perceptions are associated with distress symptom trajectories among primary care CHD patients. Methods This is a secondary analysis of 803 CHD patients from the UPBEAT-UK study, who completed the Hospital Anxiety and Depression Scale every 6 months for 3 years. Baseline assessments included the Brief Illness Perception Questionnaire. Using latent class growth analysis, Palacios et al. (2018) identified five distinct distress symptom trajectories (“stable low,” “chronic high,” “improving,” “worsening,” and “fluctuating”) in this cohort. Adjusted multinomial logistic regression analyses were used to test the association between baseline illness perceptions and distress symptom trajectories. Results Compared with the stable low distress trajectory, stronger illness identity (odds ratio [OR] = 1.31, p &lt; .01), higher perceived consequences (OR = 1.47, p &lt; .01), illness-related emotion (OR = 1.66, p &lt; .01), and illness concerns (OR = 1.36, p &lt; .01) increased the odds of having chronic high distress. Stronger illness coherence (OR = 0.89, p &lt; .05) and personal (OR = 0.77, p &lt; .01) and treatment control (OR = 0.75, p &lt; .01) reduced the odds of chronic high distress. Worsening distress symptoms were associated with weaker perceptions of treatment control, higher perceived consequences, and greater illness-related concerns and emotions. Conclusions Illness perceptions of CHD are associated with distress symptom trajectories. Therapeutically modifying unhelpful illness perceptions in CHD patients who experience high levels of distress could potentially improve mental health outcomes.

scholarly journals Health and productivity burden of coronary heart disease in the working Indonesian population using life-table modelling

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e039221 ◽  
Author(s):  
Regina E Uli ◽  
Regina P U Satyana ◽  
Ella Zomer ◽  
Dianna Magliano ◽  
Danny Liew ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Life Table ◽  
Secondary Outcome ◽  
Mortality Data ◽  
Retirement Age ◽  
Years Of Life Lost ◽  
Life Years ◽  
Working Age ◽  
The Impact

ObjectivesThe impact of coronary heart disease (CHD) and its effect on work productivity at a population level remains unknown in Indonesia. This study estimates the health and productivity lost to CHD in terms of years of life, quality-adjusted life years (QALYs) and productivity-adjusted life years (PALYs).Setting and participantsA life-table model was constructed to simulate the experiences of Indonesians currently aged 15–54 years (working age) with CHD, followed-up to 55 years (retirement age). The life-table analysis was then repeated assuming that the cohort did not have CHD. Differences in the results reflected the impact of CHD. Demographical, prevalence and mortality data were based on the 2017 Global Burden of Disease study and 2018 Indonesian National Health Survey. Costs, productivity indices and utilities were derived from published sources. The cost of each PALY was assumed to be equivalent to gross domestic product per equivalent full-time worker (US$11 765). Future costs and outcomes were discounted by 3% annually.Primary and secondary outcome measuresDifferences in total deaths, years of life and PALYs represented the impact of CHD.ResultsAt present, 1 954 543 (1.45%) Indonesians of working-age have CHD. By retirement age, it was estimated that CHD resulted in 32 492 (36.6%) excess deaths, 128 132 (0.5%) years of life lost, 2 331 495 (10.5%) QALYs lost and 1 589 490 (6.9%) PALYs lost. The economic impact of lost productivity amounted to US$33.3 billion, and healthcare costs to US$139 billion.ConclusionThe health and economic burden of CHD in Indonesia looms large. This highlights the importance of its prevention and control, strategies for which, if effective, will deliver financial return.

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