scholarly journals The Linkages Between Reimbursement and Prevention: A Mixed-Methods Approach

2021 ◽  
Vol 9 ◽  
Author(s):  
Ellen Zwaagstra Salvado ◽  
Hilco J. van Elten ◽  
Erik M. van Raaij
Keyword(s):  
Mixed Methods ◽  
Chronic Disease ◽  
Disease Management ◽  
Healthcare Professionals ◽  
Chronic Disease Management ◽  
Preventive Services ◽  
Population Based ◽  
Rapid Review ◽  
Effective Prevention ◽  
Mixed Methods Approach

Background: The benefits of prevention are widely recognized; ranging from avoiding disease onset to substantially reducing disease burden, which is especially relevant considering the increasing prevalence of chronic diseases. However, its delivery has encountered numerous obstacles in healthcare. While healthcare professionals play an important role in stimulating prevention, their behaviors can be influenced by incentives related to reimbursement schemes.Purpose: The purpose of this research is to obtain a detailed description and explanation of how reimbursement schemes specifically impact primary, secondary, tertiary, and quaternary prevention.Methods: Our study takes a mixed-methods approach. Based on a rapid review of the literature, we include and assess 27 studies. Moreover, we conducted semi-structured interviews with eight Dutch healthcare professionals and two representatives of insurance companies, to obtain a deeper understanding of healthcare professionals' behaviors in response to incentives.Results: Nor fee-for-service (FFS) nor salary can be unambiguously linked to higher or lower provision of preventive services. However, results suggest that FFS's widely reported incentive to increase production might work in favor of preventive services such as immunizations but provide less incentives for chronic disease management. Salary's incentive toward prevention will be (partially) determined by provider-organization's characteristics and reimbursement. Pay-for-performance (P4P) is not always necessarily translated into better health outcomes, effective prevention, or adequate chronic disease management. P4P is considered disruptive by professionals and our results expose how it can lead professionals to resort to (over)medicalization in order to achieve targets. Relatively new forms of reimbursement such as population-based payment may incentivize professionals to adapt the delivery of care to facilitate the delivery of some forms of prevention.Conclusion: There is not one reimbursement scheme that will stimulate all levels of prevention. Certain types of reimbursement work well for certain types of preventive care services. A volume incentive could be beneficial for prevention activities that are easy to specify. Population-based capitation can help promote preventive activities that require efforts that are not incentivized under other reimbursements, for instance activities that are not easily specified, such as providing education on lifestyle factors related to a patient's (chronic) disease.

scholarly journals Integrated displays to improve chronic disease management in ambulatory care: A SMART on FHIR application informed by mixed-methods user testing

2020 ◽  
Vol 27 (8) ◽  
pp. 1225-1234
Author(s):  
Rebecca L Curran ◽  
Polina V Kukhareva ◽  
Teresa Taft ◽  
Charlene R Weir ◽  
Thomas J Reese ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Chronic Disease ◽  
Disease Management ◽  
Cognitive Load ◽  
Chronic Disease Management ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
User Feedback ◽  
Chronic Obstructive ◽  
Recommended Care

Abstract Objective The study sought to evaluate a novel electronic health record (EHR) add-on application for chronic disease management that uses an integrated display to decrease user cognitive load, improve efficiency, and support clinical decision making. Materials and Methods We designed a chronic disease management application using the technology framework known as SMART on FHIR (Substitutable Medical Applications and Reusable Technologies on Fast Healthcare Interoperability Resources). We used mixed methods to obtain user feedback on a prototype to support ambulatory providers managing chronic obstructive pulmonary disease. Each participant managed 2 patient scenarios using the regular EHR with and without access to our prototype in block-randomized order. The primary outcome was the percentage of expert-recommended ideal care tasks completed. Timing, keyboard and mouse use, and participant surveys were also collected. User experiences were captured using a retrospective think-aloud interview analyzed by concept coding. Results With our prototype, the 13 participants completed more recommended care (81% vs 48%; P < .001) and recommended tasks per minute (0.8 vs 0.6; P = .03) over longer sessions (7.0 minutes vs 5.4 minutes; P = .006). Keystrokes per task were lower with the prototype (6 vs 18; P < .001). Qualitative themes elicited included the desire for reliable presentation of information which matches participants’ mental models of disease and for intuitive navigation in order to decrease cognitive load. Discussion Participants completed more recommended care by taking more time when using our prototype. Interviews identified a tension between using the inefficient but familiar EHR vs learning to use our novel prototype. Concept coding of user feedback generated actionable insights. Conclusions Mixed methods can support the design and evaluation of SMART on FHIR EHR add-on applications by enhancing understanding of the user experience.

scholarly journals Conversational Agents as Mediating Social Actors in Chronic Disease Management Involving Healthcare Professionals, Patients, and Family Members (Preprint)

2020 ◽  
Author(s):  
Tobias Kowatsch ◽  
Theresa Schachner ◽  
Samira Harperink ◽  
Filipe Barata ◽  
Ullrich Dittler ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Family Member ◽  
Working Alliance ◽  
Healthcare Professionals ◽  
Chronic Disease Management ◽  
Family Members ◽  
Inhalation Technique ◽  
Conversational Agents ◽  
Behavioral Skills

BACKGROUND Successful management of chronic diseases requires a trustful collaboration between healthcare professionals, patients, and family members. Scalable conversational agents (CAs), designed to assist healthcare professionals, may play a significant role in supporting this collaboration in a scalable way by reaching out into the everyday lives of patients and their family members. Until now, however, it has not been clear whether CAs, in such a role, would be accepted and whether they can support this multi-stakeholder collaboration. OBJECTIVE With asthma in children representing a relevant target of chronic disease management, this work has two objectives: (1) To describe the design of MAX, a CA-delivered asthma intervention that supports healthcare professionals targeting child-parent teams in their everyday lives; (2) To assess the (a) reach of MAX, (b) CA-patient working alliance, (c) acceptance of MAX, (d) intervention completion rate, (e) cognitive and behavioral outcomes, and (f) human effort and responsiveness of healthcare professionals in primary and secondary care settings. METHODS MAX was designed to increase cognitive skills (i.e. knowledge about asthma) and behavioral skills (i.e. inhalation technique) in 10-15-year-olds with asthma and enables support by a health professional and a family member. To this end, three design goals guided the development: (1) To build a CA-patient working alliance; (2) To offer hybrid (human- and CA-supported) ubiquitous coaching; (3) To provide an intervention with a high experiential value. An interdisciplinary team of computer scientists, asthma experts, and young patients with their parents developed the intervention collaboratively. The CA communicates with healthcare professionals via email, with patients via a mobile chat app and with a family member via SMS. A single-arm feasibility study in primary and secondary care settings was conducted to assess MAX. RESULTS Results indicate an overall positive evaluation of MAX with respect to its reach (49.5% (49 out of 99) of recruited and eligible patient-family member teams participated), a strong patient-CA working alliance, and a high acceptance by all relevant stakeholders. Moreover, MAX led to improved cognitive and behavioral skills and an intervention completion rate of 75.5%. Family members supported the patients in 269 out of 275 (97.8%) coaching sessions. Most of the conversational turns (99.5%) were conducted between patients and the CA as opposed to between patient and healthcare professional, thus indicating the scalability of MAX. In addition, it took healthcare professionals less than four minutes to assess the inhalation technique and three days to deliver that feedback to the patients. Several suggestions for improvement were made. CONCLUSIONS For the first time, this work provides evidence that CAs, designed as mediating social actors involving healthcare professionals, patients and family members, are not only accepted in such a “team player” role, but also show potential to improve health-relevant outcomes in chronic disease management.

scholarly journals Optimizing smartphone intervention features to improve chronic disease management: A rapid review

2019 ◽  
Vol 26 (3) ◽  
pp. 1795-1809 ◽  
Author(s):  
Arieh Gomolin ◽  
Bertrand Lebouché ◽  
Kim Engler ◽  
Isabelle Vedel
Keyword(s):  
Chronic Disease ◽  
Disease Management ◽  
Patient Outcomes ◽  
Chronic Disease Management ◽  
Data Entry ◽  
Rapid Review ◽  
Self Management ◽  
App Development ◽  
Mobile Health Applications ◽  
Health Applications

While there are an increasing number of mobile health applications to facilitate self-management in patients with chronic disease, little is known about which application features are responsible for impact. The objective was to uncover application features associated with increased usability or improved patient outcomes. A rapid review was conducted in MEDLINE for recent studies on smartphone applications. Eligible studies examined applications for adult chronic disease populations, with self-management content, and assessed specific features. The features studied and their impacts on usability and patient outcomes were extracted. From 3661 records, 19 studies were eligible. Numerous application features related to interface (e.g. reduced number of screens, limited manual data entry) and content (e.g. simplicity, self-tracking features) were linked to improved usability. Only three studies examined patient outcomes. Specific features were shown to have a higher impact. Implementing them can improve chronic disease management and reduce app development efforts.

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