scholarly journals A universal outcome measure for headache treatments, care-delivery systems and economic analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Timothy J Steiner ◽  
Mattias Linde ◽  
Petra Schnell-Inderst
Keyword(s):  
Health Care ◽  
Outcome Measure ◽  
Care Delivery ◽  
Health Care Systems ◽  
Population Level ◽  
Disability Weight ◽  
Delivery Systems ◽  
System Level ◽  
Care Plans ◽  
Care Systems

Abstract Background The first manuscript in this series delineated a model of structured headache services, potentially cost-effective but requiring formal cost-effectiveness analysis (CEA). We envisaged a need for a new outcome measure for this purpose, applicable to all forms of treatment, care and care-delivery systems as opposed to comparisons of single-modality treatments. Conception and delineation A literature review confirmed the lack of any suitable established measure. We prioritised construct validity, simplicity, comprehensiveness and expression in intuitive units. We noted that pain was the key burdensome symptom of migraine and episodic tension-type headache (TTH), that pain above a certain level was disabling, that it was difficult to put economic value to pain but relatively easy to do this for time, a casualty of headache leading to lost productivity. Alleviation of pain to a non-disabling level would be expected to bring restoration of function. We therefore based the measure on time spent in the ictal state (TIS) of migraine or TTH, either as total TIS or proportion of all time. We expressed impact on health, in units of time, as TIS*DW, where DW was the disability weight for the ictal state supplied by the Global Burden of Disease (GBD) studies. If the time unit was hours, TIS*DW yielded hours lived with (or lost to) disability (HLDs), in analogy with GBD’s years lived with disability (YLDs). Utility assessment Acute treatments would reduce TIS by shortening attack duration, preventative treatments by reducing attack frequency; health-care systems such as structured headache services would have these effects by delivering these treatments. These benefits were all measurable as HLDs-averted. Population-level estimates would be derived by factoring in prevalence, but also taking treatment coverage and adherence into account. For health-care systems, additional gains from provider-training (promoting adherence to guidelines and, therefore, enhancing coverage) and consumer-education (improving adherence to care plans), increasing numbers within populations gaining the benefits of treatments, would be measurable by the same metric. Conclusions The new outcome measure expressed in intuitive units of time is applicable to treatments of all modalities and to system-level interventions for multiple headache types, with utility for CEA and for informing health policy.

A Comparison of Organized and Traditional Health Care

2005 ◽  
Vol 44 (02) ◽  
pp. 273-277
Author(s):  
D. M. Lawrence
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Health Care Systems ◽  
Delivery Systems ◽  
Traditional Health ◽  
Traditional Health Care ◽  
Care Systems ◽  
Health Care Delivery Systems

Summary Purpose: To compare organized and traditional health care delivery systems and their ability to meet several major challenges facing health care in the next 25 years. Approach: Analysis of traditional and organized health care systems based on a career spent in organized health care systems. Conclusions: The traditional health care system based on independent autonomous physicians is not able to meet the challenges of current healthcare. Stronger integration and coordination, i.e., organized health care delivery systems are required.

Assessing the role of GPs in Nordic health care systems

2016 ◽  
Vol 29 (2) ◽  
pp. 122-135
Author(s):  
Randolph K. Quaye
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Health Care Cost ◽  
Care Delivery ◽  
Health Care Systems ◽  
Delivery Systems ◽  
Content Type ◽  
Care Systems ◽  
Health Care Delivery Systems

Purpose This paper examines the changing role of general practitioners (GPs) in Nordic countries of Sweden, Norway and Denmark. It aims to explore the “gate keeping” role of GPs in the face of current changes in the health care delivery systems in these countries. Design/methodology/approach Data were collected from existing literature, interviews with GPs, hospital specialists and representatives of Danish regions and Norwegian Medical Association. Findings The paper contends that in all these changes, the position of the GPs in the medical division of labor has been strengthened, and patients now have increased and broadened access to choice. Research limitations/implications Health care cost and high cancer mortality rates have forced Nordic countries of Sweden, Norway and Denmark to rethink their health care systems. Several attempts have been made to reduce health care cost through market reform and by strenghtening the position of GPs. The evidence suggests that in Norway and Denmark, right incentives are in place to achieve this goal. Sweden is not far behind. The paper has limitations of a small sample size and an exclusive focus on GPs. Practical implications Anecdotal evidence suggests that physicians are becoming extremely unhappy. Understanding the changing status of primary care physicians will yield valuable information for assessing the effectiveness of Nordic health care delivery systems. Social implications This study has wider implications of how GPs see their role as potential gatekeepers in the Nordic health care systems. The role of GPs is changing as a result of recent health care reforms. Originality/value This paper contends that in Norway and Denmark, right incentives are in place to strengthen the position of GPs.

The Future of Health Care in South Korea and the UK

2006 ◽  
Vol 5 (3) ◽  
pp. 375-385 ◽  
Author(s):  
Bob Matthews ◽  
Yoonsoon Jung
Keyword(s):  
Health Care ◽  
South Korea ◽  
Care Delivery ◽  
Health Care Systems ◽  
Public Provision ◽  
Capitalist System ◽  
Private Provision ◽  
Care Systems ◽  
Health Care Delivery Systems ◽  
The Uk

This paper discusses and compares the origin and development of the health care systems of South Korea and the UK from the end of WW2 and endeavours to compare outcomes. The paper emphasises the importance of war as a stimulus to the development of national health services in both countries and argues that there is convergence between the UK's nationalised NHS and South Korea's US-modelled capitalist system. Overall, we conclude that there is a possibility not only that the financing and nature of the Korean and UK health care delivery systems may show convergence, but it is not impossible that they will ‘change places’ with the UK system dominated by private provision and South Korea's by public provision.

Developing and Measuring the Business Case for Health Information Technology

2017 ◽  
pp. 262-290 ◽  
Author(s):  
Duncan Wade Unwin ◽  
Louis Sanzogni ◽  
Kuldeep Sandhu
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Information Systems ◽  
Care Delivery ◽  
Health Care Systems ◽  
Business Case ◽  
It Adoption ◽  
Health It ◽  
Adoption Of Technology ◽  
Care Systems

This chapter examines the adoption of information technology and information systems to support the clinical process. It explores popular models of information systems adoption and success, and relates these to the health it context. The end result of successful adoption of technology should be the improvement in performance of health care delivery, yet measurement of performance is complex. The various approaches to performance measurement are discussed. As one of the challenges in predicting the outcomes of adoption is the lack of consistent taxonomy, a solution to which is proposed. The chapter then looks at evaluation of it projects and considers what special factors may affect health it adoption and benefits in developing health care systems.

Adult Care in Cystic Fibrosis

2019 ◽  
Vol 40 (06) ◽  
pp. 857-868 ◽  
Author(s):  
J. Stuart Elborn
Keyword(s):  
Health Care ◽  
Cystic Fibrosis ◽  
Care Delivery ◽  
Health Care Systems ◽  
Well Being ◽  
Models Of Care ◽  
Adult Care ◽  
Care Systems ◽  
Expanding Population ◽  
Almost All

AbstractCystic fibrosis (CF) is now more common in adults than children in countries with well-developed health care systems. The number of adults continues to increase and will further increase if the new cystic fibrosis transmembrane conductance regulator (CFTR) modulators are disease modifying. Most of the complex morbidity and almost all the mortality of CF occur in adults and will increasingly follow this pattern even with new effective modulator therapies. Maintaining good quality of life including social functioning and maximizing survival for adults are the key priorities. This requires a highly knowledgeable and adaptable multidisciplinary team, which, though focused on maintaining lung health, requires an increasing range of other disciplines and specialties to maximize well-being. Changes in health care systems will require current models of care to adapt to provide care for the large number of adult patients. With increasing survival and age, many are likely to have both CF morbidities and additional diseases of aging. New models are needed for health care delivery for this expanding population with complex medical conditions.

Toward More Patient-Centered and Prevention-Oriented Oral Health Care

2016 ◽  
Vol 2 (1) ◽  
pp. 5-9 ◽  
Author(s):  
H. Leggett ◽  
D. Duijster ◽  
G.V.A. Douglas ◽  
K. Eaton ◽  
G.J.M.G. van der Heijden ◽  
...  
Keyword(s):  
Health Care ◽  
Oral Health ◽  
Disease Prevention ◽  
Care Delivery ◽  
Health Care Systems ◽  
Oral Care ◽  
Oral Health Care ◽  
Patient Centered ◽  
Care Systems ◽  
European Union Member States

ADVOCATE (Added Value for Oral Care) is a project funded by the European Commission’s Horizon 2020 program, which aims to develop strategies for a system transition toward more patient-centered and prevention-oriented oral health care delivery within health care systems. This system should balance the restorative and preventive approaches in dental and oral health care. ADVOCATE is a partnership among 6 European Union member states, which involves collaboration among universities, state-funded health care providers, and private insurance companies in Denmark, Germany, Hungary, Ireland, the Netherlands, the United Kingdom, and Aridhia, a biomedical informatics company based in Scotland. There are 6 interrelated work packages, which aim to address the following objectives: 1) in-depth evaluation of oral health care systems in European Union member states to identify best system designs for oral disease prevention, 2) development of a set of measures to provide information on oral care delivery and oral health outcomes, 3) evaluation of a feedback approach in dental practice that aims to facilitate a change toward preventive oral health care delivery, and 4) economic evaluation of strategies to promote preventive oral health care and development of policy recommendations for oral health care systems. The project is novel in its use of data that are routinely collected by health insurance organizations, as well as the engagement of key stakeholders from dental teams, insurers, patients, and policy makers in guiding the development and progress of the project. This article outlines in detail the objectives and research methodology of the ADVOCATE project and its anticipated impact. Knowledge Transfer Statement: This commentary describes the development of policy options to promote a greater focus on disease prevention in general dental practice. The approach builds on identifying the comparative effectiveness of alternative incentive schemes, as well as methods to monitor clinical and patient-derived measures of success in creating health for patients. The article describes the development and application of the measures and the evaluation of their success in orienting clinical practice more toward disease prevention.

Rapid Process Optimization

2016 ◽  
Vol 32 (2) ◽  
pp. 172-177 ◽  
Author(s):  
Jennifer L. Wiler ◽  
Kelly Bookman ◽  
Derek B. Birznieks ◽  
Robert Leeret ◽  
April Koehler ◽  
...  
Keyword(s):  
Health Care ◽  
Length Of Stay ◽  
Process Optimization ◽  
Process Improvement ◽  
Care Delivery ◽  
Health Care Systems ◽  
Process Redesign ◽  
Rapid Process ◽  
Left Without Being Seen ◽  
Care Systems

Health care systems have utilized various process redesign methodologies to improve care delivery. This article describes the creation of a novel process improvement methodology, Rapid Process Optimization (RPO). This system was used to redesign emergency care delivery within a large academic health care system, which resulted in a decrease: (1) door-to-physician time (Department A: 54 minutes pre vs 12 minutes 1 year post; Department B: 20 minutes pre vs 8 minutes 3 months post), (2) overall length of stay (Department A: 228 vs 184; Department B: 202 vs 192), (3) discharge length of stay (Department A: 216 vs 140; Department B: 179 vs 169), and (4) left without being seen rates (Department A: 5.5% vs 0.0%; Department B: 4.1% vs 0.5%) despite a 47% increased census at Department A (34 391 vs 50 691) and a 4% increase at Department B (8404 vs 8753). The novel RPO process improvement methodology can inform and guide successful care redesign.

Countering Moral Hazard in Public and Private Health Care Systems: A Review of Recent Evidence

1989 ◽  
Vol 18 (2) ◽  
pp. 235-251 ◽  
Author(s):  
Cam Donaldson ◽  
Karen Gerard
Keyword(s):  
Health Care ◽  
Health Services ◽  
Moral Hazard ◽  
Financial Incentives ◽  
Care Delivery ◽  
Health Care Systems ◽  
Health Care Financing ◽  
General Effect ◽  
Health Maintenance ◽  
Care Systems

ABSTRACTWithin both publicly and privately financed health care Systems different funding mechanisms have evolved, or have been proposed, to deal with the problem of ‘moral hazard’. Moral hazard arises when financial incentives within the health care System lead to either inefficient demands for care by consumers or inefficient supply of care by providers. In this paper the problem of moral hazard is outlined in more detail, and different ways of countering moral hazard are reviewed in terms of three criteria: effect on patient utilisation of health services in general; effect on utilisation by different groups of patients; and effect on health status. It is concluded that evidence on different methods of funding health services can only be judged in the context of objectives. If the objectives of health care delivery are ‘maintenance or improvement of health’ and ‘equal access for equal need’ then charges and finance of care through health maintenance organisations both appear to be less favourable than ‘free’ care at the point of delivery whilst the latter is not necessarily more costly as a resuit. Research on other suggested alternatives is required, otherwise radical changes to health care financing in the UK will simply result in movement from one unproven system to another.

scholarly journals The Measurement of Health Care System Efficiency: Cross-country Comparison by Geographical Region

2014 ◽  
Vol 29 (1) ◽  
pp. 21-44
Author(s):  
Younhee Kim ◽  
Minah Kang
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Health Care Systems ◽  
Income Group ◽  
Data Envelopment ◽  
High Income Group ◽  
Country Level ◽  
Care Systems ◽  
Cross Country ◽  
The Given

Performance of health care delivery at the cross-country level has not often been directly evaluated by given inputs and outputs. This study estimates the efficiency of the health care systems of 170 countries by extending recent research using Simar and Wilson’s bootstrap data envelopment analysis with a sensitivity test. The 170 countries are divided into four groups to compute efficiency estimators necessary to attaining a homogeneity requirement. The major finding is that most countries were inefficient to maximize the use of their inputs at the given output level. Countries in the high-income group have a relatively high average efficiency, but only 16.7% of the countries performed efficiently in the management of their health care systems. Notably, Asian countries performed more efficiently among other regions in each group. This study suggests that inefficient countries should pay attention to benchmark health care best practices within their regional peer groups.

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