The contribution of case mix, skill mix and care processes to the outcomes of community hospitals: a population-based observational study

AbstractBackgroundNew organizational models to face the unmet needs of frail patients are needed. Community hospitals (CHs) could foster integration between acute and primary care. The aim of this study was to investigate which patients’ characteristics and which care processes affect clinical outcomes, in order to identify who could benefit the most from CH care.MethodsThis study included all patients aged ≥65 and discharged in 2017 from the 16 CHs of Emilia-Romagna, Italy. Data sources were the regional CH informative system and hospital discharge records. CH skill mix and processes of care were collected with a survey. The study outcome was variation of the Barthel index (BI). We performed a 2-level random-intercept logistic regression analysis, and used the variance partition coefficient (VPC) to quantify the proportion of BI improvement that lay at CH level.ResultsOf the 13 CHs, 8 had a general practitioner medical support model, and 6 had >12 nurses’ working hours/week/bed. Overall, 53% of the patients had a BI improvement ≥10. The patient case mix explained a portion of variability across CHs. Skill mix and processes of care were not associated with BI change.ConclusionsPatients’ characteristics explained part of between-CH variation in BI improvement. Professional skill mix and processes of care, albeit fundamental to achieve appropriate care and respond to the unmet needs of the frail elderly, did not account for differences in CH-specific outcomes.

Download Full-text

The contribution of case mix, skill mix and care processes to the outcomes of community hospitals

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.463 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Lenzi ◽

K Y C Adja ◽

D Pianori ◽

C Reno ◽

M P Fantini

Keyword(s):

Older People ◽

Unmet Needs ◽

Working Hours ◽

Case Mix ◽

Community Hospitals ◽

Organizational Models ◽

Skill Mix ◽

Processes Of Care ◽

Hospital Variation ◽

Care Processes

Abstract Background The rapid increase in the proportion of older people underscores the need for new organizational models to face the unmet needs of frail patients with multiple conditions. Community hospitals (CHs) could be a solution to tackle these needs and foster integration between acute and primary care. The aim of this study was to investigate which patients' characteristics and which care processes affect clinical outcomes, in order to identify who could benefit the most from CH care and the best skill mix to deliver in this setting of care. Methods This study included all patients aged ≥65 and discharged in 2017 from the 16 CHs of Emilia-Romagna, northern Italy. Data sources were the regional CH informative system and hospital discharge records. CH skill mix and processes of care were collected with a survey; 3 non-respondent CHs were excluded. The study outcome was in-hospital variation of the Barthel index (BI) (≥10 vs. <10). We performed a 2-level random-intercept logistic regression analysis, and used the variance partition coefficient (VPC) to quantify the proportion of BI improvement that lay at CH level. Results Of the 13 CHs, 7 admitted ≥150 patients, 8 had a general practitioner medical support model, and 6 had >12 nurses' working hours/week/bed. Overall, 53% of the patients had a BI improvement ≥10 (4% to 71% across CHs). The patient case mix (i.e. baseline BI, female, older age, transfer from acute care) explained a portion of variability across CHs, as shown by the VPC that decreased from 0.32 to 0.26. Skill mix and processes of care were not associated with BI change, and the VPC resulting from controlling for these variables was virtually unchanged (0.28). Conclusions Patients' characteristics explained part of between-CH variation in BI improvement. Professional skill mix and processes of care, albeit fundamental to achieve appropriate care and respond to the unmet needs of the frail elderly, did not account for differences in CH-specific outcomes. Key messages A combination of quantitative and qualitative methods might better explain the outcome variability across intermediate care services. Multidisciplinary CH teams and services can be helpful to address the unmet needs of older people, but further studies are necessary.

Download Full-text

The Contribution of Case Mix, Skill Mix and Care Processes to the Outcomes of Community Hospitals: A Population-Based Observational Study

International Journal of Integrated Care ◽

10.5334/ijic.5566 ◽

2021 ◽

Vol 21 (2) ◽

pp. 25

Author(s):

Davide Pianori ◽

Kadjo Yves Cedric Adja ◽

Jacopo Lenzi ◽

Giulia Pieri ◽

Andrea Rossi ◽

...

Keyword(s):

Observational Study ◽

Population Based ◽

Case Mix ◽

Community Hospitals ◽

Skill Mix ◽

Care Processes

Download Full-text

Caring for Older Patients With Cancer: Estimates of the Prevalence, Burden, and Unmet Needs of Caregivers in the United States

Innovation in Aging ◽

10.1093/geroni/igaa057.2412 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 690-690

Author(s):

Erin Kent

Keyword(s):

Family Caregivers ◽

Older Patients ◽

Unmet Needs ◽

The United States ◽

Population Based ◽

Data Sources ◽

Behavioral Risk ◽

Ripple Effect ◽

The Us ◽

National Trends

Abstract In 2020, ~1.8 million Americans are expected to be newly diagnosed with cancer, with approximately 70% of cases diagnosed over the age of 65. Cancer can have a ripple effect, impacting not just patients themselves, but their family caregivers. This presentation will provide an overview of the estimates of the number of family caregivers caring for individuals with cancer in the US, focusing on older patients, from several population-based data sources: Caregiving in the US 2020, the Health Information National Trends Survey (HINTS, 2017-2019), the Behavioral Risk Factors Surveillance System (BRFSS, 2015-2019), and the National Health and Aging Trends (NHATS) Survey. The presentation will compare features of the data sources to give a comprehensive picture of the state of cancer caregiving. In addition, the presentation will highlight what is known about the experiences of cancer caregivers, including caregiving characteristics, burden, unmet needs, and ideas for improving support for family caregivers.

Download Full-text

Predictors of disordered eating in adolescence and young adulthood

International Journal of Behavioral Development ◽

10.1177/0165025413514871 ◽

2013 ◽

Vol 38 (2) ◽

pp. 128-138 ◽

Cited By ~ 9

Author(s):

Dawit Shawel Abebe ◽

Leila Torgersen ◽

Lars Lien ◽

Gertrud S. Hafstad ◽

Tilmann von Soest

Keyword(s):

Risk Factors ◽

Disordered Eating ◽

Young Adulthood ◽

Early Adolescence ◽

Developmental Psychopathology ◽

Population Based ◽

Specific Risk ◽

Random Intercept ◽

Developmental Phases ◽

Gender Specific

We investigated longitudinal predictors for disordered eating from early adolescence to young adulthood (12–34 years) across gender and different developmental phases among Norwegian young people. Survey data from a population-based sample were collected at four time points (T) over a 13-year time span. A population-based sample of 5,679 females and males at T1 and T2, 2,745 at T3 and 2,718 at T4 were included in analyses, and linear regression and random intercept models were applied. In adolescence, initial disordered eating and parental overprotectiveness were more strongly related to disordered eating among females, whereas loneliness was a stronger predictor for adolescent males. Initial disordered eating during early adolescence predicted later disordered eating more strongly in late- than mid-adolescence. In young adulthood, no significant gender-specific risk factors were found. The findings provide support for both shared and specific risk factors for the developmental psychopathology of disordered eating.

Download Full-text

Case Mix, Patterns of Care, and Inpatient Outcomes Among Ontario Kidney Transplant Centers: A Population-Based Study

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358117730053 ◽

2018 ◽

Vol 5 ◽

pp. 205435811773005 ◽

Cited By ~ 1

Author(s):

Anne Tsampalieros ◽

Greg A. Knoll ◽

Stephanie Dixon ◽

Shane English ◽

Douglas Manuel ◽

...

Keyword(s):

Kidney Transplant ◽

Population Based ◽

Patterns Of Care ◽

Case Mix ◽

Population Based Study ◽

Inpatient Outcomes

Download Full-text

Characteristics Contributing to Low- and Minimum-Wage Labour in Germany

Jahrbücher für Nationalökonomie und Statistik ◽

10.1515/jbnst-2018-0076 ◽

2020 ◽

Vol 240 (2-3) ◽

pp. 161-200

Author(s):

Matthias Dütsch ◽

Ralf Himmelreicher

Keyword(s):

Minimum Wage ◽

Descriptive Analysis ◽

Explanatory Power ◽

Working Hours ◽

Individual Characteristics ◽

Systematic Analysis ◽

Individual Level ◽

Wage Labour ◽

Random Intercept ◽

The Individual

AbstractIn this article we examine the correlation between characteristics of individuals, companies, and industries involved in low-wage labour in Germany and the risks workers face of earning hourly wages that are below the minimum-wage or low-wage thresholds. To identify these characteristics, we use the Structure of Earnings Survey (SES) 2014. The SES is a mandatory survey of companies which provides information on wages and working hours from about 1 million jobs and nearly 70,000 companies from all industries. This data allows us to present the first systematic analysis of the interaction of individual-, company-, and industry-level factors on minimum- and low-wage working in Germany. Using a descriptive analysis, we first give an overview of typical low-paying jobs, companies, and industries. Second, we use random intercept-only models to estimate the explanatory power of the individual, company, and industry levels. One main finding is that the influence of individual characteristics on wage levels is often overstated: Less than 25 % of the differences in the employment situation regarding being employed in minimum-wage or low-wage jobs can be attributed to the individual level. Third, we performed logistic and linear regression estimations to assess the risks of having a minimum- or low-wage job and the distance between a worker’s actual earnings and the minimum- or low-wage thresholds. Our findings allow us to conclude that several determinants related to individuals appear to suggest a high low-wage incidence, but in fact lose their explanatory power once controls are added for factors relating to the companies or industries that employ these individuals.

Download Full-text

Association between unmet needs and quality of life of cancer patients: A population-based study

Acta Oncologica ◽

10.3109/0284186x.2012.742204 ◽

2012 ◽

Vol 52 (2) ◽

pp. 391-399 ◽

Cited By ~ 50

Author(s):

Dorte Gilså Hansen ◽

Pia Veldt Larsen ◽

Lise Vilstrup Holm ◽

Nina Rottmann ◽

Stinne Holm Bergholdt ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Unmet Needs ◽

Population Based ◽

Population Based Study

Download Full-text

Hospital-Physician Integration: Case Studies of Community Hospitals

Health Services Management Research ◽

10.1177/095148489200500201 ◽

1992 ◽

Vol 5 (2) ◽

pp. 82-98 ◽

Cited By ~ 2

Author(s):

Louise Lemieux-Charles ◽

Peggy Leatt

Keyword(s):

Medical Staff ◽

Teaching Hospitals ◽

Future Research ◽

Hospital Physician ◽

Community Hospitals ◽

Organizational Models ◽

Study Results ◽

Efficiency And Effectiveness ◽

Physician Integration ◽

The Relationship

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.

Download Full-text