scholarly journals Economic incentives and survival probabilities for chronic and multimorbidity patients - Do the relationships depend on patient pathways?

2020 ◽  
Author(s):  
M. Kamrul Islam ◽  
Egil Kjerstad ◽  
Jan Erik Askildsen
Keyword(s):  
Social Care ◽  
Economic Incentives ◽  
Care Providers ◽  
Available N ◽  
Survival Probabilities ◽  
Payment Scheme ◽  
Patient Pathway ◽  
Patient Pathways ◽  
Number Of Patients ◽  
Admission Type

Abstract Background: The Norwegian Coordination Reform (CR) in 2012 introduced new economic incentives aimed at weaknesses in interaction between primary care, social care and specialist care. This paper studies the association of a new co-payment scheme on the 30-day and 90-day survival probabilities for chronic and multimorbidity patients. We also analyse whether admission types ⸺ planned or emergency ⸺ matters for survival rates, and the importance of patient pathways. Several different pathways are possible, depending on where patients came from before being admitted to hospital and their destination after discharge from hospital. Methods: The study uses data from three different registers for the period 2010 to 2013. We consider 30 common chronic conditions for which administrative data are available (n=563,096 in-patient episodes). We look at three mutually exclusive pathways. They are relevant and important in terms of the number of patients depending on co-operation and co-ordination between health care providers. Using a quasi-experimental design—the difference-in-differences approach—we estimate the associations between the co-payment scheme and survival probability by admission type and by patient pathway. Results: We find that the change in survival probabilities are significant and positively associated with the co-payment scheme for emergency admissions, but no significant association is found for planned admissions for the 30-day survival. A positive and significant relationship is also found for emergency patients for two specific pathways. For planned admissions, the survival probabilities are significantly and negatively associated for patients coming from home and later discharged to social care institutions. Multimorbidity subgroup analysis shows that the positive (negative) association with the 90-day (30-day) survival is significant only for emergency (planned) admissions for the patients coming from home and later discharged to home or social care after in-patient hospitalization. Conclusion: We conclude that the survival probabilities are positively associated with the new economic incentives but the result depends on admission type, patient pathway and multimorbidity status. Without modelling admission type, pathway and multimorbidity explicitly, one may overlook important relationships associated with the economic incentives. Future policy evaluations in any pertinent context should envisage these aspects.

scholarly journals Economic incentives and survival probabilities for chronic and multimorbidity patients - Do the relationships depend on patient pathways?

2020 ◽  
Author(s):  
M. Kamrul Islam ◽  
Egil Kjerstad ◽  
Jan Erik Askildsen
Keyword(s):  
Economic Incentives ◽  
Care Providers ◽  
Available N ◽  
Emergency Admissions ◽  
Survival Probabilities ◽  
Payment Scheme ◽  
Patient Pathway ◽  
Patient Pathways ◽  
Number Of Patients ◽  
Admission Type

Abstract Background: The Norwegian Coordination Reform (CR) in 2012 introduced new economic incentives aimed at weaknesses in interaction between primary care, social care and specialist care. This paper studies the association of a new co-payment scheme on the 30-day and 90-day survival probabilities for chronic and multimorbidity patients. We also analyse whether admission types ⸺planned or emergency⸺ matters for survival rates, and the importance of patient pathways. Several different pathways are possible, depending on where patients came from before being admitted to hospital and their destination after discharge from hospital.Methods: The study uses data from three different registers for the period 2010 to 2013. We consider 30 common chronic conditions for which administrative data are available (n=563,096 in-patient episodes). We look at three mutually exclusive pathways. They are relevant and important in terms of the number of patients depending on co-operation and co-ordination between health care providers. Using a quasi-experimental design—the difference-in-differences approach—we estimate the associations between the co-payment scheme and survival probability by admission type and by patient pathway.Results: Overall, the changes in survival probabilities are found positively and significantly associated with the co-payment scheme. For emergency admissions such a significant positive association is observed for the 30-day survival only, whereas, for planned admissions a significant positive relationship is evident for the 90-day survival only. Pathway-specific results indicate positive and significant associations with survival probabilities (both the 30-and 90-day) for all admissions and emergency admissions for two specific pathways. Multimorbidity subgroup analysis generally shows no significant relationship with survival probabilities, but pathway-specific analyses show significant positive associations between emergency admissions and the 90-day survival for patients following two specific pathways. However, for planned admissions we find a significant negative association with the 30-day survival for multimorbidity patients following one specific pathway.Conclusion: We conclude that the survival probabilities are positively associated with the new economic incentives but the result depends on admission type, patient pathway and multimorbidity status. Without modelling admission type, pathway and multimorbidity explicitly, one may overlook important relationships associated with the economic incentives. Future policy evaluations in any pertinent context should envisage these aspects.

scholarly journals Economic incentives and survival probabilities for chronic and multimorbidity patients - Do the relationships depend on patient pathways?

2021 ◽  
Author(s):  
M. Kamrul Islam ◽  
Egil Kjerstad ◽  
Jan Erik Askildsen
Keyword(s):  
Economic Incentives ◽  
Care Providers ◽  
Available N ◽  
Emergency Admissions ◽  
Survival Probabilities ◽  
Payment Scheme ◽  
Patient Pathway ◽  
Patient Pathways ◽  
Number Of Patients ◽  
Admission Type

Abstract Background: The Norwegian Coordination Reform (CR) in 2012 introduced new economic incentives aimed at weaknesses in interaction between primary care, social care and specialist care. This paper studies the association of a new co-payment scheme on the 30-day and 90-day survival probabilities for chronic and multimorbidity patients. We also analyse whether admission types ⸺planned or emergency⸺ matters for survival rates, and the importance of patient pathways. Several different pathways are possible, depending on where patients came from before being admitted to hospital and their destination after discharge from hospital. Methods: The study uses data from three different registers for the period 2010 to 2013. We consider 30 common chronic conditions for which administrative data are available (n=563,096 in-patient episodes). We look at three mutually exclusive pathways. They are relevant and important in terms of the number of patients depending on co-operation and co-ordination between health care providers. Using a quasi-experimental design—the difference-in-differences approach—we estimate the associations between the co-payment scheme and survival probability by admission type and by patient pathway.Results: Overall, the changes in survival probabilities are found positively and significantly associated with the co-payment scheme. For emergency admissions such a significant positive association is observed for the 30-day survival only, whereas, for planned admissions a significant positive relationship is evident for the 90-day survival only. Pathway-specific results indicate positive and significant associations with survival probabilities (both the 30-and 90-day) for all admissions and emergency admissions for two specific pathways. Multimorbidity subgroup analysis generally shows no significant relationship with survival probabilities, but pathway-specific analyses show significant positive associations between emergency admissions and the 90-day survival for patients following two specific pathways. However, for planned admissions we find a significant negative association with the 30-day survival for multimorbidity patients following one specific pathway.Conclusion: We conclude that the survival probabilities are positively associated with the new economic incentives but the result depends on admission type, patient pathway and multimorbidity status. Without modelling admission type, pathway and multimorbidity explicitly, one may overlook important relationships associated with the economic incentives. Future policy evaluations in any pertinent context should envisage these aspects.

Economic incentives and survival probability for chronic and multimorbidity patients - Do the relationships depend on patient pathways?

2020 ◽  
Author(s):  
M. Kamrul Islam ◽  
Egil Kjerstad ◽  
Jan Erik Askildsen
Keyword(s):  
Health Care ◽  
Survival Probability ◽  
Social Care ◽  
Economic Incentives ◽  
Care Providers ◽  
Available N ◽  
Payment Scheme ◽  
Patient Pathway ◽  
Patient Pathways ◽  
Admission Type

Abstract Background The Norwegian Coordination Reform (CR) in 2012 introduced new economic incentives aimed at weaknesses in the way primary /social care and specialist care interacted. This paper studies the association of a new co-payment scheme on 30-day survival probability for chronic and multimorbidity patients. We also analyse whether or not admission types - planned or emergency - matters for survival rates. Furthermore, we examine the importance of patient pathways. Several different pathways are possible, depending on where patients came from before being admitted to hospital and their destination after discharge from hospital. Methods The study uses data from three different registers for the period 2010 to 2013. We consider 30 common chronic conditions for which administrative data are available (n=563,096). We look at three mutually exclusive pathways, pathways that are the important ones in terms of the number of patients dependent on co-operation and co-ordination between health care providers. Using a quasi-experimental design—the difference-in-differences approach—we estimate the associations between the co-payment scheme and survival probability by admission type and by patient pathway. Results We find that the change in survival probability is significant and positively associated with the co-payment scheme for emergency admissions, but no significant association is found for planned admissions. A positive and significant relationship is found for emergency patients for two specific pathways—patients coming from home and discharged to social care institutions after hospitalization, and patients coming from home and discharged to other health care institutions after hospitalization. For planned admissions, the survival probability is significantly and negatively associated for patients coming from home and later discharged to social care institutions. Multimorbidity subgroup analysis shows that the negative association with survival is significant for only planned admissions for the patients coming from home and later discharged to home after hospitalization. Conclusion We conclude that the 30-day survival probability is positively associated with the new economic incentives but the result depends on admission type, patient pathway and multimorbidity status. Without modelling admission type, pathway and multimorbidity explicitly, one may overlook important relationships associated with the economic incentives. Future policy evaluations in any pertinent context should envisage these aspects.

scholarly journals Crossing knowledge boundaries: health care providers’ perceptions and experiences of what is important to achieve more person-centered patient pathways for older people

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Cecilie Fromholt Olsen ◽  
Astrid Bergland ◽  
Asta Bye ◽  
Jonas Debesay ◽  
Anne G. Langaas
Keyword(s):  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Providers ◽  
Older Patient ◽  
Quality Improvement Collaborative ◽  
Patient Journey ◽  
Patient Pathway ◽  
Patient Pathways ◽  
Home Care Providers

Abstract Background Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Current research in the field highlights person-centered care as crucial; however, how to implement and enact this ideal in practice and thus achieve more person-centered patient pathways remains unclear. The aim of this study was to explore health care providers’ (HCPs’) perceptions and experiences of what is important to achieve more person-centered patient pathways for older people. Methods This was a qualitative study. We performed individual semistructured interviews with 20 HCPs who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. Results A thematic analysis resulted in five themes which outline central elements of the HCPs’ perceptions and experiences relevant to achieving more person-centered patient pathways: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathway; and 5) ambiguity toward checklists and practice implementation. Conclusions The findings can assist stakeholders in understanding factors important to practicing person-centered transitional care for older people. Through collaborative knowledge sharing the participants developed a more shared understanding of how to achieve person-centered patient pathways. The importance of assuming a shared responsibility and a more holistic understanding of the patient pathway by merging different ways of knowing was highlighted. Checklists incorporating the What matters to you? question and the mapping of the patient journey were important tools enabling the crossing of knowledge boundaries both between HCPs and between HCPs and the older patients. Home care providers were perceived to have important knowledge relevant to providing more person-centered patient pathways implying a central role for them as knowledge brokers during the patient’s journey. The study draws attention to the benefits of focusing on the older patients’ way of knowing the patient pathway as well as to placing what matters to the older patient at the heart of transitional care.

The certification of vision impairment: A regional 21st century perspective

2020 ◽  
pp. 026461962097215
Author(s):  
A J Jackson ◽  
L Cushley ◽  
R McCann ◽  
Máire Gallagher ◽  
J Witherow ◽  
...  
Keyword(s):  
Northern Ireland ◽  
Vision Loss ◽  
Social Care ◽  
Epidemiological Data ◽  
Vision Impairment ◽  
Care Providers ◽  
Patient Pathways ◽  
Health And Social Care ◽  
Before And After

Certification and registration of those who are sight impaired (SI) provides commissioners, and the providers of health and social care support to those with vision loss, with quantifiable data on the extent of blindness and sight impairment within a community. In this article, we outline the results of a comprehensive review of certification/registration pathways and processes in Northern Ireland and highlight achievements to date. The Developing Eyecare Partnership (DEP) CVI Task Group established by the Health and Social Care Board (HSCB) reviewed all certification/registration processes, pathways and issues that may have contributed to regional under certification/registration. This was undertaken to ensure timely certification/registration of those who may benefit from being certified as either Severely Sight Impaired (SSI) or SI, and in so doing improving patient pathways and access to services. Activity included a review of all available epidemiological data collected in the 2-year periods before and after the introduction of the new pathway (January 1, 2018). This work has resulted in changes to the terminology used in relevant Northern Ireland legislation and other documentation concerning certification/registration. It has also resulted in the creation of more timely and efficient referral pathways and improvements in the quality of information available on certification and the process. Increased awareness of the certification process by health and social care professionals has resulted in a 22.5% increase in certifications over the 2-year period, before COVID-19. Certification rates are now comparable with those from other areas of the United Kingdom. The workings of the DEP CVI group, over a 5-year period, have increased awareness about SI and SSI Certification among patients and Health and Social Care Providers and have improved the quality of local epidemiological data on vision impairment. A patient-based evaluation of the new pathway is planned for 2020.

Hämophilie-Zentrum Bonn 1980 – 2009

2011 ◽  
Vol 31 (S 01) ◽  
pp. S4-S10 ◽  
Author(s):  
I. Besmens ◽  
H.-H. Brackmann ◽  
J. Oldenburg
Keyword(s):  
Young Patients ◽  
Severe Form ◽  
Coagulation Disorder ◽  
Care Providers ◽  
Long Distance ◽  
Patient Age ◽  
Patient Âgé ◽  
Number Of Patients ◽  
Clotting Disorder ◽  
Regional Character

SummaryThe Bonn Haemophilia Care Center provides patient care on a superregional level. The centre’s large service area is, in part, due to the introduction of haemophilia home treatment and related to this the individualized prophylaxis in children and adults by Egli and Brack-mann in Bonn in the early 1970s, that represented a milestone in German haemophilia therapy. Epidemiologic patient data from the two selected time points, 1980 and 2009, are evaluated to illustrate the change in the composition of the patient clientele. In 1980 a total of 639 patients were treated at the Bonn Haemophilia Center. 529 patients exhibited a severe form and 110 a non-severe form of the respective clotting disorder. In 2009 the Bonn Haemophilia Center took care for a total of 837 patients. There were 445 patients who suffered from a severe form of the considered clotting disorder while 392 showed a non-severe course. The number of less severely affected patients has increased significantly in 2009. Patients in 1980 were predominantly suffering from a severe form and most had to travel more than 150 km from their homes to the treatment center. In 2009 the number of patients living a medium-long distance from the care provider has significantly increased while the number of patients living more than 150km from the center has decreased. Comparing 2009 to 1980 a growth of the center’s regional character becomes apparent, especially when patient age and severity of the coagulation disorder are taken into consideration. The regional character was more strongly pronounced with milder disease severity and lower patient age. Due to the existence of well established primary haemophilia care in CCCs in Germany, the trend for the recent years is that the proportion of young patients that choose haemophilia care providers closer to their homes is increasing.

scholarly journals Ownership Variation in Violated Regulations and National Care Standards: Evidence From Social Care Providers

2021 ◽  
pp. 089976402110014
Author(s):  
Anders M. Bach-Mortensen ◽  
Ani Movsisyan
Keyword(s):  
Social Care ◽  
Negative Binomial ◽  
Third Sector ◽  
Care Providers ◽  
Data Set ◽  
Logistic Regression Models ◽  
For Profit ◽  
Care Services ◽  
Significant Difference ◽  
Research Gap

Social care services are increasingly provisioned in quasi-markets in which for-profit, public, and third sector providers compete for contracts. Existing research has investigated the implications of this development by analyzing ownership variation in latent outcomes such as quality, but little is known about whether ownership predicts variation in more concrete outcomes, such as violation types. To address this research gap, we coded publicly available inspection reports of social care providers regulated by the Care Inspectorate in Scotland and created a novel data set enabling analysis of ownership variation in violations of (a) regulations, and (b) national care standards over an entire inspection year ( n = 4,178). Using negative binomial and logistic regression models, we find that for-profit providers are more likely to violate non-enforceable outcomes (national care standards) relative to other ownership types. We did not identify a statistically significant difference between for-profit and third sector providers with regard to enforceable outcomes (regulations).

scholarly journals PREPARE: protocol for a stepped wedge trial to evaluate whether a risk stratification model can reduce preterm deliveries among women with suspected or confirmed preterm pre-eclampsia

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Marcos Augusto Bastos Dias ◽  
◽  
Leandro De Oliveira ◽  
Arundhanthi Jeyabalan ◽  
Beth Payne ◽  
...  
Keyword(s):  
Knowledge Transfer ◽  
Adverse Events ◽  
Risk Stratification ◽  
Risk Reduction ◽  
Randomised Trial ◽  
Adverse Outcomes ◽  
Cluster Randomised Trial ◽  
Care Providers ◽  
Stepped Wedge ◽  
Number Of Patients

Abstract Background Preeclampsia (PE) is a major cause of short and long-term morbidity for affected infants, including consequences of fetal growth restriction and iatrogenic prematurity. In Brazil, this is a special problem as PE accounts for 18% of preterm births (PTB). In the PREPARE (Prematurity REduction by Pre-eclampsia cARE) study, we will test a novel system of integrated care based on risk stratification and knowledge transfer, to safely reduce PTB. Methods This is a stepped wedge cluster randomised trial that will include women with suspected or confirmed PE between 20 + 0 and 36 + 6 gestational weeks. All pregnant women presenting with these findings at seven tertiary centres in geographically dispersed sites, throughout Brazil, will be considered eligible and evaluated in terms of risk stratification at admission. At randomly allocated time points, sites will transition to risk stratification performed according to sFlt-1/PlGF (Roche Diagnostics) measurement and fullPIERS score with both results will be revealed to care providers. The healthcare providers of women stratified as low risk for adverse outcomes (sFlt-1/PlGF ≤38 AND fullPIERS< 10% risk) will receive the recommendation to defer delivery. sFlt-1/PlGF will be repeated once and fullPIERS score twice a week. Rates of prematurity due to preeclampsia before and after the intervention will be compared. Additionally, providers will receive an active program of knowledge transfer about WHO recommendations for preeclampsia, including recommendations regarding antenatal corticosteroids for foetal benefits, antihypertensive therapy and magnesium sulphate for seizure prophylaxis. This study will have 90% power to detect a reduction in PTB associated with PE from a population estimate of 1.5 to 1.0%, representing a 33% risk reduction, and 80% power to detect a reduction from 2.0 to 1.5% (25% risk reduction). The necessary number of patients recruited to achieve these results is 750. Adverse events, serious adverse events, both anticipated and unanticipated will be recorded. Discussion The PREPARE intervention expects to reduce PTB and improve care of women with PE without significant adverse side effects. If successful, this novel pathway of care is designed for rapid translation to healthcare throughout Brazil and may be transferrable to other low and middle income countries. Trial registration ClinicalTrials.gov: NCT03073317.

Primary Care of Opioid use Disorder: The End of “the French Model”?

2020 ◽  
Vol 26 (6) ◽  
pp. 346-354 ◽  
Author(s):  
Julie Dupouy ◽  
Sandy Maumus-Robert ◽  
Yohann Mansiaux ◽  
Antoine Pariente ◽  
Maryse Lapeyre-Mestre
Keyword(s):  
Primary Care ◽  
Private Practice ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Care Providers ◽  
Opioid Use ◽  
Access To Treatment ◽  
Cross Sectional ◽  
Number Of Patients ◽  
French Model

<b><i>Background:</i></b> In France, most patients with opioid use disorder (OUD) have been treated by buprenorphine, prescribed by general practitioners (GP) in private practice since 1996. This has contributed to building a ‘French model’ facilitating access to treatment based on the involvement of GPs in buprenorphine prescription. <b><i>Objectives:</i></b> Our study aimed to assess whether the involvement of primary care in OUD management has changed lately. <b><i>Materials and Methods:</i></b> Using data from the French National Health Insurance database, we conducted a yearly repeated cross-sectional study (2009–2015) and described proportion of opioid maintenance treatment (OMT)-prescribing GPs and OMT-dispensing community pharmacies (CP); and number of patients by GP or CP. <b><i>Results:</i></b> Whereas the number of buprenorphine-prescribing GPs in private practice remained quite stable (decrease of 3%), a substantial decrease in buprenorphine initial prescribers among private GPs was observed. In 2009, 10.3% of private GPs (6,297 from 61,301 French private GPs) prescribed buprenorphine for the initiation of a treatment, whereas they were 5.7% (<i>n</i> = 3,539 from 62,071 private GPs) in 2015 (43.8% decrease). GPs issuing initial prescriptions of buprenorphine tended to care for a higher number of patients treated by buprenorphine (14.6 ± 27.1 patients in 2009 to 16.0 ± 35.4 patients in 2015). The number of CPs dispensing buprenorphine remained quite stable (decrease of 2%), while there was a 7.5% decrease in the total number of French CPs across the study period. <b><i>Conclusions:</i></b> Our results suggest that primary care providers seem less engaged in buprenorphine initiation in OUD patients, while CPs have not modified their involvement towards these patients.

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