scholarly journals Relationship between physician financial incentives and clinical pathway compliance: a cross-sectional study of 18 public hospitals in China

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027540
Author(s):  
Jie Bai ◽  
Kate Bundorf ◽  
Fei Bai ◽  
Huiqin Tang ◽  
Di Xue
Keyword(s):  
Heart Failure ◽  
Financial Incentives ◽  
Clinical Pathways ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Public Hospitals ◽  
Sectional Study ◽  
Cross Sectional ◽  
Physician Compliance ◽  
The Relationship

ObjectivesMany strategies have been either used or recommended to promote physician compliance with clinical practice guidelines and clinical pathways (CPs). This study examines the relationship between hospitals’ use of financial incentives to encourage physician compliance with CPs and physician adherence to CPs.DesignA retrospectively cross-sectional study of the relationship between the extent to which patient care was consistent with CPs and hospital’s use of financial incentives to influence CP compliance.SettingEighteen public hospitals in three provinces in China.ParticipantsStratified sample of 2521 patients discharged between 3 January 2013 and 31 December 2014.Primary outcome measuresThe proportion of key performance indicators (KPIs) met for patients with (1) community-acquired pneumonia (pneumonia), (2) acute myocardial infarction (AMI), (3) acute left ventricular failure (heart failure), (4) planned caesarean section (C-section) and (5) gallstones associated with acute cholecystitis and associated cholecystectomy (cholecystectomy).ResultsThe average implementation rate of CPs for five conditions (pneumonia, AMI, heart failure, C-section and cholecystectomy) based on 2521 cases in 18 surveyed hospitals was 57% (ranging from 44% to 67%), and the overall average compliance rate for the KPIs for the five conditions was 69.48% (ranging from 65.07% to 77.36%). Implementation of CPs was associated with greater compliance within hospitals only when hospitals adopted financial incentives directed at physicians to promote compliance.ConclusionCPs are viewed as important strategies to improve medical care in China, but they have not been widely implemented or adhered to in Chinese public hospitals. In addition to supportive resources, education/training and better administration in general, hospitals should provide financial incentives to encourage physicians to adhere to CPs.

A Cross-Sectional Study on the Relationship between Depression and Left Ventricular Hypertrophy

1998 ◽  
Vol 27 (6) ◽  
pp. 787-791 ◽  
Author(s):  
Yousuke Takemura ◽  
Shogo Kikuchi ◽  
Hirofumi Takagi ◽  
Yutaka Inaba ◽  
Katsuya Nakagawa
Keyword(s):  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Relationship

scholarly journals Burden of out-of-pocket payments among patients with cardiovascular disease in public and private hospitals in Ibadan, South West, Nigeria: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044044
Author(s):  
Folashayo Adeniji
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Financial Burden ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Health Coverage ◽  
Sectional Study ◽  
Cross Sectional ◽  
Out Of Pocket Payments ◽  
Ibadan Nigeria

ObjectiveGiven that the mechanism for financial protection is underdeveloped in Nigeria, out-of-pocket (OOP) payment for treating cardiovascular disease could impose substantial financial burden on individuals and their families. This study estimated the burden of OOP expenditures incurred by a cohort of patients with cardiovascular disease (CVD) in Ibadan, Nigeria.Design and settingsThis study used a descriptive cross-sectional study design. A standardised survey questionnaire originally developed by Initiative for Cardiovascular Health Research in Developing Countries was used to electronically collect data from all the 744 patients with CVD who accessed healthcare between 4 November 2019 and 31 January 2020 in the cardiology departments of private and public hospitals in Ibadan, Nigeria. Baseline characteristics of respondents were presented using percentages and proportions. The OOP payments were reported as means±SDs. Costs/OOP payments were in Nigerian Naira (NGN). The average US dollar to NGN at the time of data collection was ₦362.12 per $1. All quantitative data were analysed using STATA V.15.Outcome measuresThe burden of outpatient, inpatient and rehabilitative care OOP payments.ResultsMajority of the patients with CVD were within the age range of 45–74 years and 68.55% of them were women. The diagnostic conditions reported among patients with CVD were hypertensive heart failure (84.01%), dilated cardiomyopathy (4.44%), ischaemic heart disease (3.9%) and anaemic heart failure (2.15%). Across all the hospital facilities, the annual direct and indirect outpatient costs were ₦421 595.7±₦855 962.0 ($1164.2±$2363.8) and ₦19 146.5±₦53 610.1 ($52.87±$148.05). Similarly, the average direct and indirect OOP payments per hospitalisation across all facilities were ₦182 302.4±₦249 090.4 ($503.43±$687.87) and ₦14 700.8±₦ 69 297.1 ($40.60±$191.37), respectively. The average rehabilitative cost after discharge from index hospitalisation was ₦30 012.0 ($82.88).ConclusionThe burden of OOP payment among patients with CVD is enormous. There is a need to increase efforts to achieve universal health coverage in Nigeria.

Symptom Clusters and Their Impacts on Hospital Readmission in Patients With Heart Failure: A Cross-Sectional Study

2018 ◽  
Vol 32 (3) ◽  
pp. 311-327 ◽  
Author(s):  
Youn-Jung Son ◽  
Mi Hwa Won
Keyword(s):  
Heart Failure ◽  
Hospital Readmission ◽  
Multiple Logistic Regression Analysis ◽  
Bodily Pain ◽  
Cross Sectional Study ◽  
Symptom Clusters ◽  
Care Providers ◽  
Sectional Study ◽  
Cross Sectional ◽  
The Relationship

Background and Purpose:Readmissions after hospitalization due to multiple symptoms in heart failure (HF) are common and costly. Patients have difficulty differentiating HF symptoms from comorbid illness or aging. Therefore, early identification of symptom clusters could improve symptom recognition and reduce hospital readmission. However, little is known about the relationship between symptom clusters and readmission in HF patients. This study aimed to identify symptom clusters among Korean patients with HF and the relationship between symptom clusters and hospital readmission.Methods:This cross-sectional study included 306 HF outpatients within 12 months after discharge. Exploratory factor analysis was used to identify the symptom clusters. Multiple logistic regression analysis was used to examine the effect of symptom clusters on readmission, after adjusting for sociodemographic and clinical characteristics.Results:Three symptom clusters were identified in HF patients: the “respiratory distress” cluster, “bodily pain and energy insufficiency” cluster, and “circulatory and gastrointestinal distress” cluster. Patients with class III or IV of HF functional class experienced three symptom clusters at a higher level. This study showed that the “bodily pain and energy insufficiency” cluster was the strongest predictor of hospital readmission in HF patients (adjusted odds ratio = 6.59, 95% confidence interval (CI) [1.29, 32.79]).Implications for Practice:A higher level of “bodily pain and energy insufficiency” cluster was associated with hospital readmission in Korean HF patients. Health-care providers should be encouraged to consider patients’ cultural backgrounds to recognize differences in symptom clusters. Further studies are needed to evaluate symptom clusters across international cohorts and their impacts on patients’ outcomes.

scholarly journals Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care

2017 ◽  
Vol 67 (658) ◽  
pp. e314-e320 ◽  
Author(s):  
Bosco Baron-Franco ◽  
Gary McLean ◽  
Frances S Mair ◽  
Veronique L Roger ◽  
Bruce Guthrie ◽  
...  
Keyword(s):  
Mental Health ◽  
Heart Failure ◽  
Primary Care ◽  
Chronic Heart Failure ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Cross Sectional Study ◽  
Left Ventricular ◽  
Sectional Study ◽  
Cross Sectional

BackgroundComorbidity is common in heart failure, but previous prevalence estimates have been based on a limited number of conditions using mainly non-primary care data sources.AimTo compare prevalence rates of comorbidity and polypharmacy in those with and without chronic heart failure due to left ventricular systolic dysfunction (LVSD).Design and settingA cross-sectional study of 1.4 million patients in primary care in Scotland.MethodData on the presence of LVSD, 31 other physical, and seven mental health comorbidities, and prescriptions were extracted from a database of 1 424 378 adults. Comorbidity prevalence was compared in patients with and without LVSD, standardised by age, sex, and deprivation. Pharmacology data were also compared between the two groups.ResultsThere were 17 285 patients (1.2%) who had a diagnosis of LVSD. Compared with standardised controls, the LVSD group had greater comorbidity, with the biggest difference found for seven or more conditions (odds ratio [OR] 4.10; 95% confidence interval (CI] = 3.90 to 4.32). Twenty-five physical conditions and six mental health conditions were significantly more prevalent in those with LVSD relative to standardised controls. Polypharmacy was higher in the LVSD group compared with controls, with the biggest difference found for ≥11 repeat prescriptions (OR 4.81; 95% CI = 4.60 to 5.04). However, these differences in polypharmacy were attenuated after controlling for the number of morbidities, indicating that much of the additional prescribing was accounted for by multimorbidity rather than LVSD per se.ConclusionExtreme comorbidity and polypharmacy is significantly more common in patients with chronic heart failure due to LVSD. The efficient management of such complexity requires the integration of general and specialist expertise.

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