Development and Implementation of a Person-Centered, Technology-Enhanced Care Model For Managing Chronic Conditions: Cohort Study (Preprint)

BACKGROUND Caring for individuals with chronic conditions is labor intensive, requiring ongoing appointments, treatments, and support. The growing number of individuals with chronic conditions makes this support model unsustainably burdensome on health care systems globally. Mobile health technologies are increasingly being used throughout health care to facilitate communication, track disease, and provide educational support to patients. Such technologies show promise, yet they are not being used to their full extent within US health care systems. OBJECTIVE The purpose of this study was to examine the use of staff and costs of a remote monitoring care model in persons with and without a chronic condition. METHODS At Dartmouth-Hitchcock Health, 2894 employees volunteered to monitor their health, transmit data for analysis, and communicate digitally with a care team. Volunteers received Bluetooth-connected consumer-grade devices that were paired to a mobile phone app that facilitated digital communication with nursing and health behavior change staff. Health data were collected and automatically analyzed, and behavioral support communications were generated based on those analyses. Care support staff were automatically alerted according to purpose-developed algorithms. In a subgroup of participants and matched controls, we used difference-in-difference techniques to examine changes in per capita expenditures. RESULTS Participants averaged 41 years of age; 72.70% (2104/2894) were female and 12.99% (376/2894) had at least one chronic condition. On average each month, participants submitted 23 vital sign measurements, engaged in 1.96 conversations, and received 0.25 automated messages. Persons with chronic conditions accounted for 39.74% (8587/21,607) of all staff conversations, with higher per capita conversation rates for all shifts compared to those without chronic conditions (P<.001). Additionally, persons with chronic conditions engaged nursing staff more than those without chronic conditions (1.40 and 0.19 per capita conversations, respectively, P<.001). When compared to the same period in the prior year, per capita health care expenditures for persons with chronic conditions dropped by 15% (P=.06) more than did those for matched controls. CONCLUSIONS The technology-based chronic condition management care model was frequently used and demonstrated potential for cost savings among participants with chronic conditions. While further studies are necessary, this model appears to be a promising solution to efficiently provide patients with personalized care, when and where they need it.

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PHP42 THE ANNUAL HEALTH CARE EXPENDITURES PER CAPITA IN BRAZIL: A COMPARISON BETWEEN THE PUBLIC AND THE PRIVATE HEALTH CARE SYSTEMS

Value in Health ◽

10.1016/s1098-3015(10)72423-2 ◽

2010 ◽

Vol 13 (3) ◽

pp. A89

Author(s):

MG Saggia

Keyword(s):

Health Care ◽

Health Care Systems ◽

Health Care Expenditures ◽

Private Health Care ◽

The Public ◽

Care Systems ◽

Per Capita

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Trends in the kidney cancer mortality-to-incidence ratios according to health care expenditures of 56 countries

Scientific Reports ◽

10.1038/s41598-020-79367-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Wen-Wei Sung ◽

Po-Yun Ko ◽

Wen-Jung Chen ◽

Shao-Chuan Wang ◽

Sung-Lang Chen

Keyword(s):

Health Care ◽

Clinical Outcomes ◽

Kidney Cancer ◽

Health Care Disparities ◽

Health Care Systems ◽

Health Care Expenditures ◽

Incidence And Mortality ◽

Care Systems ◽

Per Capita ◽

Systemic Therapies

AbstractThe incidence and mortality rates in kidney cancer (KC) are increasing. However, the trends for mortality have varied among regions over the past decade, which may be due to the disparities in medical settings, such as the availability of frequent imaging examinations and effective systemic therapies. The availability of these two medical options has been proven to be positively correlated with a favorable prognosis in KC and may be more common in countries with better health care systems and greater expenditures. The delicate association between the trends in clinical outcomes in KC and health care disparities warrant detailed observation. We applied a delta-mortality-to-incidence ratio (δMIR) for KC to compare two years as an index for the improvement in clinical outcomes and the mortality-to-incidence ratio (MIR) of a single year to evaluate their association with the Human Development Index (HDI), current health expenditure (CHE) per capita, and CHE as a percentage of gross domestic product (CHE/GDP) by using linear regression analyses. A total of 56 countries were included based on data quality reports and missing data. We discovered that the HDI, CHE per capita, and CHE/GDP were negatively correlated with the MIRs for KC (p < 0.001, p < 0.001, and p < 0.001, respectively). No significant association was observed between the δMIRs and the HDI, CHE per capita, and CHE/GDP among the included countries, and only the CHE/GDP shows a trend toward significance. Interestingly, the δMIRs related with an increase in relative health care investment include δCHE per capita and δCHE/GDP.

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Development of Multimorbidity Over Time: An Analysis of Belgium Primary Care Data Using Markov Chains and Weighted Association Rule Mining

The Journals of Gerontology Series A ◽

10.1093/gerona/glaa278 ◽

2020 ◽

Author(s):

Xi Shi ◽

Gorana Nikolic ◽

Gijs Van Pottelbergh ◽

Marjan van den Akker ◽

Rein Vos ◽

...

Keyword(s):

Health Care ◽

Markov Chains ◽

Association Rule ◽

Chronic Conditions ◽

Association Rule Mining ◽

Musculoskeletal Diseases ◽

Current Knowledge ◽

Health Care Systems ◽

Rule Mining ◽

Care Systems

Abstract Background The prevalence of multimorbidity is increasing in recent years, and patients with multimorbidity often have a decrease in quality of life and require more health care. The aim of this study was to explore the evolution of multimorbidity taking the sequence of diseases into consideration. Methods We used a Belgian database collected by extracting coded parameters and more than 100 chronic conditions from the Electronic Health Records of general practitioners to study patients older than 40 years with multiple diagnoses between 1991 and 2015 (N = 65 939). We applied Markov chains to estimate the probability of developing another condition in the next state after a diagnosis. The results of Weighted Association Rule Mining (WARM) allow us to show strong associations among multiple conditions. Results About 66.9% of the selected patients had multimorbidity. Conditions with high prevalence, such as hypertension and depressive disorder, were likely to occur after the diagnosis of most conditions. Patterns in several disease groups were apparent based on the results of both Markov chain and WARM, such as musculoskeletal diseases and psychological diseases. Psychological diseases were frequently followed by irritable bowel syndrome. Conclusions Our study used Markov chains and WARM for the first time to provide a comprehensive view of the relations among 103 chronic conditions, taking sequential chronology into consideration. Some strong associations among specific conditions were detected and the results were consistent with current knowledge in literature, meaning the approaches were valid to be used on larger data sets, such as National Health care Systems or private insurers.

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Revisiting Health Regionalization in Canada

International Journal of Health Services ◽

10.1177/0020731416681229 ◽

2016 ◽

Vol 47 (2) ◽

pp. 333-351 ◽

Cited By ~ 8

Author(s):

Paul Barker ◽

John Church

Keyword(s):

Health Care ◽

Health Services ◽

Health Care Systems ◽

Health Care Expenditures ◽

Regional Health ◽

Health Authorities ◽

Care Systems ◽

Physician Care ◽

Regional Health Authorities ◽

Regional Authorities

Twenty years ago, many of Canada’s provinces began to introduce regional health authorities to address problems with their health care systems. With this action, the provinces sought to achieve advances in community decision-making, the integration of health services, and the provision of care in the home and community. The authorities were also to help restrict health care costs. An assessment of the authorities indicates, however, that over the past two decades they have been unable to meet their objectives. Community representatives continue to play little role in determining the appropriate health services for their regions. Gains have been made towards integrating health services, but the plan for a near seamless set of health services has not been realized. Funding for health services remains focused on hospital and physician care, and health care expenditures have until very recently been little affected by regional authorities. This disappointing performance has caused some provinces to abandon their regional authorities, but this article argues that the provision of greater autonomy and a better public appreciation of their role and potential may lead to more successful regional authorities. Accordingly, the objective of this article is to reveal the shortcomings of regional health authorities in Canada while at the same time arguing that changes can be made to increase the chances of more workable authorities.

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Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters (Preprint)

10.2196/preprints.21815 ◽

2020 ◽

Author(s):

Francesco Petracca ◽

Oriana Ciani ◽

Maria Cucciniello ◽

Rosanna Tarricone

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Health Care Services ◽

Organizational Context ◽

Digital Health ◽

Health Care Systems ◽

Health Technologies ◽

Digital Reconstruction ◽

Depth Analysis ◽

Care Systems

UNSTRUCTURED A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after.

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Health Risk Factors And Health Care Systems In Latin America And The Caribbean: A Cross-Sectional Multiple Regression And ANOVA Analysis

American Journal of Health Sciences (AJHS) ◽

10.19030/ajhs.v5i2.8956 ◽

2014 ◽

Vol 5 (2) ◽

pp. 117-128

Author(s):

Rina Samant ◽

Sonia Samant

Keyword(s):

Risk Factors ◽

Health Care ◽

Life Expectancy ◽

Health Risk ◽

Child Mortality ◽

Health Care Systems ◽

Health Risk Factors ◽

Care Systems ◽

The Caribbean ◽

Per Capita

The purpose of this research is to examine the effect of health risk factors and health care systems on child mortality and life expectancy in Latin America and the Caribbean (LAC). Cross-sectional multiple regression and Analysis of Variance (ANOVA) are used to study the association between health risk factors such as incidence of tuberculosis and diabetes, and health care systems such as number of hospital beds per capita, and number of physicians per capita on life expectancy and child mortality. Data are obtained from the World Bank. For the purpose of this study, the LAC region is defined as the area from Mexico to the southern end of South America, as well as islands in the Caribbean Sea and the Gulf of Mexico. The conclusions of the study are that higher life expectancy is associated with higher per capita incomes and health expenditures. On the other hand, higher child mortality is associated with greater prevalence of communicable diseases and poor maternal pre-natal conditions. The macro policy implication is to focus on economic development and health care expenditure. The micro policy implication is to allocate more resources for maternal care, preventive care and eradication of communicable diseases.

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The Role of Health Technology and Informatics in a Global Public Health Emergency: Practices and Implications From the COVID-19 Pandemic

JMIR Medical Informatics ◽

10.2196/19866 ◽

2020 ◽

Vol 8 (7) ◽

pp. e19866 ◽

Cited By ~ 5

Author(s):

Jiancheng Ye

Keyword(s):

Health Care ◽

Large Scale ◽

Health Care Systems ◽

Strong Support ◽

Global Public Health ◽

Infected People ◽

Health Technologies ◽

Care Systems ◽

Delivery Services ◽

And Control

At present, the coronavirus disease (COVID-19) is spreading around the world. It is a critical and important task to take thorough efforts to prevent and control the pandemic. Compared with severe acute respiratory syndrome and Middle East Respiratory Syndrome, COVID-19 spreads more rapidly owing to increased globalization, a longer incubation period, and unobvious symptoms. As the coronavirus has the characteristics of strong transmission and weak lethality, and since the large-scale increase of infected people may overwhelm health care systems, efforts are needed to treat critical patients, track and manage the health status of residents, and isolate suspected patients. The application of emerging health technologies and digital practices in health care, such as artificial intelligence, telemedicine or telehealth, mobile health, big data, 5G, and the Internet of Things, have become powerful “weapons” to fight against the pandemic and provide strong support in pandemic prevention and control. Applications and evaluations of all of these technologies, practices, and health delivery services are highlighted in this study.

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Unfavorable Mortality-To-Incidence Ratio of Lung Cancer Is Associated with Health Care Disparity

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15122889 ◽

2018 ◽

Vol 15 (12) ◽

pp. 2889 ◽

Cited By ~ 2

Author(s):

Cheng-Yu Huang ◽

Kwong-Kwok Au ◽

Sung-Lang Chen ◽

Shao-Chuan Wang ◽

Chi-Yu Liao ◽

...

Keyword(s):

Lung Cancer ◽

Health Care ◽

Health Care Systems ◽

Health Care Expenditures ◽

Good Health ◽

World Health ◽

Incidence And Mortality ◽

Care Systems ◽

Adequate Quality ◽

Health Organization

The mortality-to-incidence ratio (MIR) is associated with the clinical outcome of cancer treatment. For several cancers, countries with relatively good health care systems have favorable MIRs. However, the association between lung cancer MIR and health care expenditures or rankings has not been evaluated. We used linear regression to analyze the correlation between lung cancer MIRs and the total expenditures on health/gross domestic product (e/GDP) and the World Health Organization (WHO) rankings. We included 57 countries, for which data of adequate quality were available, and we found high rates of incidence and mortality but low MIRs in more developed regions. Among the continents, North America had the highest rates of incidence and mortality, whereas the highest MIRs were in Africa, Asia, Latin America, and the Caribbean. Globally, favorable MIRs correlated with high e/GDP and good WHO ranking (regression coefficient, −0.014 and 0.001; p = 0.004, and p = 0.014, respectively). In conclusion, the MIR for lung cancer in different countries varies with the expenditure on health care and health system rankings.

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Umverteilungseffekte in der Finanzierung von Gesundheitsleistungen / Redistribution Effects of Health Care Financing

Jahrbücher für Nationalökonomie und Statistik ◽

10.1515/jbnst-2007-5-617 ◽

2007 ◽

Vol 227 (5-6) ◽

Author(s):

Florian Buchner ◽

Rebecca Deppisch ◽

Jürgen Wasem

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Systems ◽

Health Care Financing ◽

Social Health Insurance ◽

Health Care Expenditures ◽

Social Health ◽

Financing System ◽

Out Of Pocket Payments ◽

Care Systems

SummaryHealth care systems are financed through a mixture of different components: taxes, contributions to social health insurance, premiums to private health insurance, out of pocket payments by patients. These components can be combined differently leading to specific effects of interpersonal redistribution. This can be compared between different countries. In such a comparison the redistributional impact of the German health care systems is rather regressive - which is basically caused by the opportunity for people with high income to leave social health insurance. In comparison to a health insurance system with risk rated premiums, financing of the German social health insurance leads to interpersonal redistribution from higher to lower income, from the young to the elderly, from healthy to sick and from singles to families with children. The pay-as-you-go character of the system leads especially in combination with an aging population and technological change to burden for future generations. In comparison to a system in which each region finances its own health care expenditures, there are also considerable interregional redistributions. The financing system in Germany is not conceptually consistent. Reform proposals (unified health insurance for all; flat rate premiums) tackle these inconsistencies.

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