The ACA Medicaid Expansion And Perinatal Insurance, Health Care Use, And Health Outcomes: A Systematic Review

2022 ◽  
Vol 41 (1) ◽  
pp. 60-68
Author(s):  
Meghan Bellerose ◽  
Lauren Collin ◽  
Jamie R. Daw
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Outcomes ◽  
Health Care Use ◽  
Medicaid Expansion

Predictors of Health Care Use of Women with Breast Cancer: A Systematic Review

2015 ◽  
Vol 21 (5) ◽  
pp. 508-513 ◽  
Author(s):  
Deborah N. N. Lo-Fo-Wong ◽  
Kate Sitnikova ◽  
Mirjam A. G. Sprangers ◽  
Hanneke C. J. M. de Haes
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Health Care ◽  
Health Care Use

scholarly journals Systematic Review of the Impact of Cancer Survivorship Care Plans on Health Outcomes and Health Care Delivery

2018 ◽  
Vol 36 (20) ◽  
pp. 2088-2100 ◽  
Author(s):  
Paul B. Jacobsen ◽  
Antonio P. DeRosa ◽  
Tara O. Henderson ◽  
Deborah K. Mayer ◽  
Chaya S. Moskowitz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Outcomes ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Cochrane Library ◽  
Survivorship Care Plan ◽  
Satisfaction With Care ◽  
Survivorship Care ◽  
Care Plans

Purpose Numerous organizations recommend that patients with cancer receive a survivorship care plan (SCP) comprising a treatment summary and follow-up care plans. Among current barriers to implementation are providers’ concerns about the strength of evidence that SCPs improve outcomes. This systematic review evaluates whether delivery of SCPs has a positive impact on health outcomes and health care delivery for cancer survivors. Methods Randomized and nonrandomized studies evaluating patient-reported outcomes, health care use, and disease outcomes after delivery of SCPs were identified by searching MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Cochrane Library. Data extracted by independent raters were summarized on the basis of qualitative synthesis. Results Eleven nonrandomized and 13 randomized studies met inclusion criteria. Variability was evident across studies in cancer types, SCP delivery timing and method, SCP recipients and content, SCP-related counseling, and outcomes assessed. Nonrandomized study findings yielded descriptive information on satisfaction with care and reactions to SCPs. Randomized study findings were generally negative for the most commonly assessed outcomes (ie, physical, functional, and psychological well-being); findings were positive in single studies for other outcomes, including amount of information received, satisfaction with care, and physician implementation of recommended care. Conclusion Existing research provides little evidence that SCPs improve health outcomes and health care delivery. Possible explanations include heterogeneity in study designs and the low likelihood that SCP delivery alone would influence distal outcomes. Findings are limited but more positive for proximal outcomes (eg, information received) and for care delivery, particularly when SCPs are accompanied by counseling to prepare survivors for future clinical encounters. Recommendations for future research include focusing to a greater extent on evaluating ways to ensure SCP recommendations are subsequently acted on as part of ongoing care.

scholarly journals Fluoroquinolone-Related Adverse Events Resulting In Health Care Use And Costs: A Systematic Review

2017 ◽  
Vol 20 (9) ◽  
pp. A669-A670
Author(s):  
LS Saarukka ◽  
KM Viljemaa ◽  
JT Backman ◽  
M Blom
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Adverse Events ◽  
Health Care Use

scholarly journals Rotavirus disease and health care utilisation among children under 5 years of age in highly developed countries: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Cristina Ardura-Garcia ◽  
Christian Kreis ◽  
Milenko Rakic ◽  
Manon Jaboyedoff ◽  
Maria Christina Mallet ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Care ◽  
Nosocomial Infections ◽  
Meta Analysis ◽  
Developed Countries ◽  
Incidence Rates ◽  
Health Care Use ◽  
Ed Visits ◽  
Children Under 5

AbstractBackgroundRotavirus (RV) infection is the leading cause of diarrhoea-associated morbidity and mortality globally among children under 5 years of age. RV vaccination is available, but has not been implemented in many national immunisation plans, especially in highly developed countries. This systematic review aimed to estimate the prevalence and incidence of health care use for RV gastroenteritis (RVGE) among children aged under 5 years in highly developed countries without routine RV vaccination.MethodsWe searched MEDLINE and Embase databases from January 1st 2000 to December 17th 2018 for publications reporting on incidence or prevalence of RVGE-related health care use in children below 5 years of age: primary care and emergency department (ED) visits, hospitalisations, nosocomial infections and deaths. We included only studies with laboratory-confirmed RV infection, undertaken in highly developed countries with no RV routine vaccination plans. We used random effects meta-analysis to generate summary estimates with 95% confidence intervals (CI) and prediction intervals.ResultsWe screened 4033 abstracts and included 74 studies from 21 countries. Average incidence rates of RVGE per 100 000 person-years were: 2484 (95% CI 697-5366) primary care visits, 1890 (1597-2207) ED visits, 500 (422-584) hospitalisations, 34 (20-51) nosocomial infections and 0.04 (0.02-0.07) deaths. Average proportions of cases of acute gastroenteritis caused by RV were: 21% (95% CI 16-26%) for primary care visits; 32% (25-38%) for ED visits; 41% (36-47%) for hospitalisations, 29% (25-34%) for nosocomial infections and 12% (8-18%) for deaths. Results varied widely between and within countries, and heterogeneity was high (I2>90%) in most models.ConclusionRV in children under 5 years causes many healthcare visits and hospitalisations, with low mortality, in highly developed countries without routine RV vaccination. The health care use estimates for RVGE obtained by this study can be used to model RV vaccine cost-effectiveness in highly developed countries.Take home messageRV-caused illness leads to a high burden of health care usage in highly developed countries who have not introduced RV vaccination.

scholarly journals Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review (Preprint)

2018 ◽  
Author(s):  
Ronald Dendere ◽  
Christine Slade ◽  
Andrew Burton-Jones ◽  
Clair Sullivan ◽  
Andrew Staib ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Outcomes ◽  
Electronic Medical Records ◽  
Patient Engagement ◽  
Medical Records ◽  
Provider Communication ◽  
Patient Portals ◽  
High Quality ◽  
Patient Provider Communication

BACKGROUND Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. OBJECTIVE The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research. METHODS A systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed). RESULTS The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes. CONCLUSIONS While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

scholarly journals Informing the NHS Outcomes Framework: evaluating meaningful health outcomes for children with neurodisability using multiple methods including systematic review, qualitative research, Delphi survey and consensus meeting

2014 ◽  
Vol 2 (15) ◽  
pp. 1-224 ◽  
Author(s):  
Christopher Morris ◽  
Astrid Janssens ◽  
Amanda Allard ◽  
Joanne Thompson Coon ◽  
Valerie Shilling ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Young People ◽  
Health Outcomes ◽  
Well Being ◽  
Consensus Meeting ◽  
Delphi Survey ◽  
Children And Young People ◽  
Psychometric Performance ◽  
Important Health

BackgroundThe identification of suitable outcome measures will improve the evaluation of integrated NHS care for the large number of children affected by neurodisability, and has the potential to encourage the provision of more appropriate and effective health care. This research sought to appraise the potential of patient-reported outcome measures (PROMs) for children and young people with neurodisability.AimThis research aimed (i) to identify key outcomes of health care for children with neurodisability, beyond morbidity and mortality, from the perspectives of children, parents and professionals; (ii) to critically appraise existing generic multidimensional PROMs; and (iii) to examine whether or not the key outcomes might be measured by existing PROMs. We also sought agreement on a definition of neurodisability.MethodsData were gathered in three main ways, (i) a systematic review identified eligible generic multidimensional PROMs and peer-reviewed studies evaluating psychometric performance using English-language questionnaires. Studies were appraised for methodological quality and psychometric performance was appraised using standard criteria. (ii) Focus groups and interviews with children and young people with neurodisability, and separately with parents, sought to identify important outcomes of NHS care, and their feedback on example PROM questionnaires. (iii) An online Delphi survey was conducted with a multidisciplinary sample of health professionals to seek agreement on appropriate NHS outcomes. In addition, we convened a consensus meeting with a small nominal group of young people, parents and professionals; the group sought agreement on a core set of important health outcomes.ResultsFrom the systematic review, we identified 126 papers that reported eligible evidence regarding the psychometric performance of 25 PROMs. Evidence of psychometric robustness was more favourable for a small number of PROMs: KIDSCREEN (generic), DISABKIDS (chronic-generic) and Child Health Utility 9D (preference-based measure). The Pediatric Quality of Life Inventory and KINDL offer both self-report and a proxy report version for a range of age bands, but evidence of their psychometric performance was weaker. Evidence was lacking in one or more respects for all candidate PROMs, in both general populations and those with neurodisability. Proxy reporting was found generally to be poorly correlated with self-report. Focus groups and interviews included 54 children and young people, and 53 parents. The more important health outcomes were felt to be communication, emotional well-being, pain, mobility, independence/self-care, worry/mental health, social activities and sleep. In addition, parents of children with intellectual impairment identified behaviour, toileting and safety as important outcomes. Participants suggested problems with the face validity of example PROM questionnaires for measuring NHS care. In the Delphi survey, 276 clinicians from a wide range of professions contributed to at least one of four rounds. Professionals rated pain, hearing, seeing, sleep, toileting, mobility and communication as key goals for the NHS but also identified treating neurological symptoms as important. Professionals in the Delphi survey and parents working with the research team agreed a proposed definition for neurodisability. The consensus meeting confirmed overlap between the outcomes identified as important by young people, parents and professionals, but not complete agreement.ConclusionsThere was agreement between young people, parents and professionals regarding a core suite of more important health outcomes: communication, emotional well-being, pain, mobility, independence/self-care, worry/mental health, social activities and sleep. In addition, behaviour, toileting and safety were identified as important by parents. This research suggests that it would be appropriate to measure these constructs using PROMs to assess health care. None of the candidate PROMs in the review adequately captures all of the identified constructs, and there is inadequate evidence that candidate PROMs are psychometrically robust for use across children with neurodisability. Further consultation with young people, families and professionals is warranted to support the use of PROMs to measure NHS outcomes. Research to test potential PROMs with different age groups and conditions would be valuable.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

scholarly journals The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jessica J. Wong ◽  
Andrea C. Tricco ◽  
Pierre Côté ◽  
Laura C. Rosella
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Depressive Symptoms ◽  
Health Outcomes ◽  
Risk Of Bias ◽  
Considerable Proportion ◽  
Low Back ◽  
The Impact

Abstract Background A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcomes in adults with LBP with or without radiculopathy. Methods Electronic databases including MEDLINE, Embase, CINAHL, and PsycINFO will be searched from inception to April 2019 to identify relevant studies. Additional citations will be identified by searching reference lists of included studies and related systematic reviews. Cohort and case-control studies assessing the association between depressive symptoms/depression and health outcomes in adults aged 16 years and older with LBP with or without radiculopathy will be included. The following will be included: depressive symptoms as measured on standardized questionnaires (e.g., Center for Epidemiologic Studies Depression Scale, Beck Depression Index), and depression as standardized diagnoses (e.g., International Classification of Diseases codes) or self-reported depression diagnosis on standardized questionnaires. Outcomes of interest are standardized measures for pain, disability, overall health status, satisfaction with care, and health care utilization. These are informed by core outcome domains that international expert panels consider important for LBP research. Pairs of reviewers will screen articles retrieved from the search, extract data, and assess risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E) tool. Reviewers will use these criteria to inform their judgment on the internal validity of studies (e.g., low, moderate, or high risk of bias). If studies are deemed homogeneous, a random effects meta-analysis on the association between depressive symptoms and health outcomes will be performed. The results of the included studies will be descriptively outlined if studies are deemed heterogeneous. Discussion The impact of depressive symptoms and depression on health- and health care-related outcomes for LBP with or without radiculopathy will be assessed and quantified. Findings of this systematic review will advance our understanding of LBP prognosis, and guide decision-making and improve quality of care for adults with LBP. Systematic review registration PROSPERO CRD42019130047

scholarly journals MEETING SOCIAL NEEDS TO IMPROVE HEALTH OUTCOMES: PARTNERSHIPS BETWEEN COMMUNITY-BASED ORGS AND HEALTH CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S499-S500
Author(s):  
Traci L Wilson ◽  
Suzanne R Kunkel ◽  
Jane Straker ◽  
Marisa Scala-Foley ◽  
Elizabeth Blair
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Social Services ◽  
Health Care Providers ◽  
Health Care Use ◽  
Social Needs ◽  
Care Providers ◽  
Community Based ◽  
Cross Sectional ◽  
Improve Health

Abstract Unmet social needs negatively affect individual and population health, and better integration of community-based supports and health systems is a promising approach to improve health outcomes and avoid unnecessary health care use. Community-based organizations (CBOs) such as Area Agencies on Aging (AAAs) and Centers for Independent Living (CILs), as providers and coordinators of social services, are well-positioned within their communities to coordinate care and provide for unmet social needs. Partnerships between CBOs and health care entities have clear potential to improve health care outcomes while also reducing expenditures. This paper will present a cross-sectional analysis of a national survey of AAAs, CILS, and other CBOs at two time points (2017: n=593; 2018: n=763) to understand the extent, type, and evolution of CBO engagement with health care providers. In addition, longitudinal analysis (n=374) shows movement at the organization level: 33% of organizations who did not have a contract at T1 but were pursuing one had achieved a contract by T2. This presentation will: describe details of the services delivered, contracting arrangements, and populations served under CBO/health care contracts, as well as challenges experienced by CBOs; examine differences by state and organizational structure; and discuss the implications of state policy on integrated care and contracting.

Sign in / Sign up

Export Citation Format

Share Document