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McGowan D, Morley C, Hansen E, Shaw K, Winzenberg T. Experiences of participants in the co-design of a community-based health service for people with high healthcare service use. BMC Health Serv Res 2024; 24:339. [PMID: 38486164 PMCID: PMC10938828 DOI: 10.1186/s12913-024-10788-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 02/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Incorporating perspectives of health consumers, healthcare workers, policy makers and stakeholders through co-design is essential to design services that are fit for purpose. However, the experiences of co-design participants are poorly understood. The aim of this study is to explore the experiences and perceptions of people involved in the co-design of a new service for people with high healthcare service utilisation. METHODS A methodology informed by the principles of grounded theory was used in this qualitative study to evaluate the experiences and perceptions of co-design participants. Participants were healthcare professionals, health managers and leaders and health consumers involved in the co-design of the new service in Tasmania, Australia. Semi-structured interviews were conducted, and data were iteratively and concurrently collected and analysed using constant comparative analysis. Audio/audio-visual recordings of interviews were transcribed verbatim. Transcripts, memos, and an audit trail were coded for experiences and perspectives of participants. RESULTS There were thirteen participants (5 health professionals, 6 health managers and leaders, and 2 health consumers). Codes were collapsed into six sub-themes and six themes. Themes were bureaucracy hinders co-design, importance of consumers and diversity, importance of a common purpose, relationships are integral, participants expectations inform their co-design experience and learning from co-design. CONCLUSION Most participants reported positive aspects such as having a common purpose, valuing relationships, and having a personal motivation for participating in co-design. However, there were factors which hindered the adaptation of co-design principles and the co-design process. Our research highlights that bureaucracy can hinder co-design, that including people with lived experience is essential and the need to consider various types of diversity when assembling co-design teams. Future co-design projects could use these findings to improve the co-design experience for participants, and ultimately the outcome for communities.
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Affiliation(s)
- Deirdre McGowan
- Menzies Institute for Medical Research University of Tasmania, Hobart, Australia.
| | - Claire Morley
- Menzies Institute for Medical Research University of Tasmania, Hobart, Australia
| | | | - Kelly Shaw
- Menzies Institute for Medical Research University of Tasmania, Hobart, Australia
- KP Health, Hobart, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research University of Tasmania, Hobart, Australia
- Primary Health Tasmania, Hobart, Australia
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Schuttner L, Guo R, Wong E, Jimenez E, Klein M, Roy S, Rosland AM, Chang ET. High-Risk Patient Experiences Associated With an Intensive Primary Care Management Program in the Veterans Health Administration. J Ambul Care Manage 2023; 46:45-53. [PMID: 36036980 PMCID: PMC9691513 DOI: 10.1097/jac.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intensive management programs may improve health care experiences among high-risk and complex patients. We assessed patient experience among (1) prior enrollees (n = 59) of an intensive management program (2014-2018); (2) nonenrollees (n = 356) at program sites; and (3) nonprogram site patients (n = 728), using a patient survey based on the Consumer Assessment of Healthcare Providers and Systems in 2019. Outcomes included patient ratings of patient-centered care; overall health care experience; and satisfaction with their usual outpatient care provider. In multivariate models, enrollees were more satisfied with their current provider versus nonenrollees within program sites (adjusted odds ratio 2.36; 95% confidence interval 1.15-4.85).
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Affiliation(s)
- Linnaea Schuttner
- Health Systems Research & Development, VA Puget Sound Health Care System, Seattle, WA
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Rong Guo
- VA Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA
- University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of General Internal Medicine, Los Angeles, CA
| | - Edwin Wong
- Health Systems Research & Development, VA Puget Sound Health Care System, Seattle, WA
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA
- University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of General Internal Medicine, Los Angeles, CA
| | - Melissa Klein
- VA Northeast Ohio Healthcare System, Cleveland, OH
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sudip Roy
- Salisbury W.G. Hefner VA Medical Center, Salisbury, NC
| | - Ann-Marie Rosland
- VA Center for Health Equity Research & Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA
- Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Evelyn T. Chang
- VA Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, CA
- University of California at Los Angeles, David Geffen School of Medicine, Department of Medicine, Division of General Internal Medicine, Los Angeles, CA
- VA Greater Los Angeles Healthcare System, Department of Medicine, Division of General Internal Medicine, Los Angeles, CA
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Association between service scope of primary care facilities and prevalence of high-cost population: a retrospective study in rural Guizhou, China. BMC PRIMARY CARE 2022; 23:301. [PMID: 36434547 PMCID: PMC9700956 DOI: 10.1186/s12875-022-01914-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 11/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND High-cost (HC) patients, defined as the small percentage of the population that accounts for a high proportion of health care expenditures, are a concern worldwide. Previous studies have found that the occurrence of HC population is partially preventable by providing a greater scope of primary health care services. However, no study has examined the association between the service scope of primary care facilities and the prevalence of HC populations. Therefore, this study aimed to investigate the association between the service scope of primary care facilities (PCFs) and the prevalence of HC populations within the same communities. METHODS A multistage, stratified, clustered sampling method was used to identify the service scope of PCFs as of 2017 in rural Guizhou, China. The claims data of 299,633 patients were obtained from the local information system of the New Rural Cooperation Medical Scheme. Patients were sorted by per capita inpatient medical expenditures in descending order, and the top 1%, top 5% and top 10% of patients who had incurred the highest costs were defined as the HC population. Logistic regression models were used to assess the association between the service scope of PCFs and the prevalence of the HC population. RESULTS Compared with those in the 95% of the sample deemed as the general population, those in the top 5% of the sample deemed as the HC population were more likely to be over the age of 30 (P < 0.001), to be female (P = 0.014) and to be referred to high-level hospitals (P < 0.001). After controlling for other covariates, patients who lived in the communities serviced by the PCFs with the smallest service scope were more likely to be in the top 1%, top 5% and top 10% of the HC population. CONCLUSION A greater PCF service scope was associated with a reduction in the prevalence of the HC population, which would mean that providing a broader PCF service scope could reduce some preventable costs, thus reducing the prevalence of the HC population. Future policy efforts should focus on expanding the service scope of primary care providers to achieve better patient outcomes.
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Gliske K, Berry KA, Ballard J, Evans-Chase M, Solomon PL, Fenkel C. Does Insurance Type Matter on the Computer Too? Comparing Outcomes for Youth with Public v Private Health Insurance Attending a Telehealth Intensive Outpatient Program: A Quality Improvement Analysis (Preprint). JMIR Form Res 2022; 6:e41721. [DOI: 10.2196/41721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
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Chang ET, Newberry S, Rubenstein LV, Motala A, Booth MJ, Shekelle PG. Quality Measures for Patients at Risk of Adverse Outcomes in the Veterans Health Administration: Expert Panel Recommendations. JAMA Netw Open 2022; 5:e2224938. [PMID: 35917129 DOI: 10.1001/jamanetworkopen.2022.24938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite longstanding efforts to improve health care quality for patients with complex needs who are at highest risk for hospitalization or death, to our knowledge, no guidance exists on what constitutes measurable high-quality care for this heterogeneous population. Identifying quality measures that are cross-cutting (ie, relevant to multiple chronic conditions and disease states) may enable health care professionals and health care systems to better design and report on quality improvement efforts for this patient population. OBJECTIVE To identify quality measures of care and prioritize quality-of-care concepts in the ambulatory primary care setting for patients in the Veterans Health Administration (VHA) who have complex care needs and are at high risk for adverse outcomes, such as hospitalization or death. EVIDENCE REVIEW In this expert panel assessment and prioritization, relevant measure concepts for future quality measure development in 3 care categories (assessment, management, and other features of health care) were extracted from a systematic review, conducted from June 2020 to June 2021, of published studies that suggested, evaluated, or used indicators of quality care for patients at high risk of adverse outcomes. Measure concepts associated with single conditions, surgical or other specialty care settings, and inpatient care were excluded. A panel of 14 experts (10 VHA leaders and staff, 2 non-VHA physician investigators, and 2 veterans) discussed and rated the importance of the remaining set of potentially relevant measure concepts using a modified RAND/UCLA Appropriateness Method on January 15, 2021. Measure concepts were rated on a scale of 1 to 9, with 9 being the highest priority. A median rating of 7.5 or greater was used as the cutoff to identify the highest-priority items. FINDINGS The systematic review identified 519 measure concepts, from which 15 domains and 49 measure concepts were proposed for expert panel consideration. After panel discussions and changes to measure concepts, the expert panel rated 63 measure concepts in 13 domains. The measure concepts with the highest median ratings focused on caregiver availability and support, COVID-19 vaccination, and pneumonia vaccination (all rated 9.0); housing instability (rated 8.5); and physical function, depression symptoms, cognitive impairment, prescription regimen, primary care follow-up after an emergency department visit or hospitalization, and timely transmission of discharge information to primary care (all rated 8.0). Recommendations to improve care included timely assessment of housing instability, caregiver support, physical function, depression symptoms, and cognitive impairment; annual prescription regimen review; coordinated transitions in care; and preventive care including vaccinations. CONCLUSIONS AND RELEVANCE The expert panelists identified a parsimonious set of high-priority, evidence-based, cross-cutting quality measure concepts for improving care of patients at high risk for adverse health outcomes in the VHA. These quality measures may inform both future research for patients at high risk and health care system quality improvement.
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Affiliation(s)
- Evelyn T Chang
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine at UCLA, Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles
| | | | | | - Aneesa Motala
- RAND Corporation, Santa Monica, California
- University of Southern California, Los Angeles
| | | | - Paul G Shekelle
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
- Division of General Internal Medicine, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine at UCLA, Division of General Internal Medicine, Department of Medicine, University of California, Los Angeles
- RAND Corporation, Santa Monica, California
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Chang E, Ali R, Berkman ND. Unpacking complex interventions that manage care for high-need, high-cost patients: a realist review. BMJ Open 2022; 12:e058539. [PMID: 35680272 PMCID: PMC9185578 DOI: 10.1136/bmjopen-2021-058539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Payers, providers and policymakers in the USA are interested in developing interventions that reduce preventable or modifiable healthcare use among high-need, high-cost (HNHC) patients. This study seeks to describe how and why complex interventions for HNHC patients lead to more appropriate use of healthcare services. DESIGN A realist review which develops programme theories from causal explanations generated and articulated through the creation of context-mechanism-outcome configurations. METHODS Electronic databases (including PubMed and Embase) and gray literature from January 2000 to March 2021 were searched. All study designs were included if the article provided data to develop our programme theories. Included studies were conducted in the USA and focused on interventions for adult, HNHC patients. RESULTS Data were synthesised from 48 studies. Identifying HNHC patients for inclusion in interventions requires capturing a combination of characteristics including their prior use of healthcare services, complexity of chronic disease(s) profile, clinician judgment and willingness to participate. Once enrolled, engaging HNHC patients in interventions requires intervention care providers and patients to build a trusting relationship. Tailored, individualised assistance for medical and non-medical needs, emotional support and self-management education empowers patients to increase their participation in managing their own care. Engagement of care providers in interventions to expand support of HNHC patients is facilitated by targeted outreach, adequate staffing support with shared values and regular and open communication. CONCLUSIONS Building relationships with HNHC patients and gaining their trust is a key component for interventions to successfully change HNHC patients' behaviors. Identifying HNHC patients for an intervention can be best achieved through a multipronged strategy that accounts for their clinical and psychosocial complexity and prior experiences with the healthcare system. Successful interventions recognise that relationships with HNHC patients require the sustained engagement of care providers. To succeed, providers need ongoing emotional, financial, logistical and practical resources. PROSPERO REGISTRATION NUMBER CRD42020161179.
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Affiliation(s)
- Eva Chang
- RTI-University of North Carolina Evidence-Based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
- Advocate Aurora Research Institute, Advocate Aurora Health Inc, Downers Grove, Illinois, USA
| | - Rania Ali
- RTI-University of North Carolina Evidence-Based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
| | - Nancy D Berkman
- RTI-University of North Carolina Evidence-Based Practice Center, RTI International, Research Triangle Park, North Carolina, USA
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Lu S, Zhang Y, Zhang L, Klazinga NS, Kringos DS. Characterizing Potentially Preventable Hospitalizations of High-Cost Patients in Rural China. Front Public Health 2022; 10:804734. [PMID: 35211444 PMCID: PMC8861072 DOI: 10.3389/fpubh.2022.804734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/17/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction High-cost patients are characterized by repeated hospitalizations, and inpatient cost accounts for a large proportion of their total health care spending. This study aimed to assess the occurrence and costs of potentially preventable hospitalizations and explore contributing factors among high-cost patients in rural China. Methods We examined a population-based sample of patients using the 2016 New Rural Cooperative Medical Scheme in Dangyang city, China. Eighteen thousand forty-three high-cost patients were identified. A validated tool and logistic regression analysis were used to determine preventable hospitalizations and their patient-level and supply-side factors. Results High-cost patients were older (average age of 54 years) than non-high-cost patients (50 years) and more likely to come from poverty-stricken families. The occurrence of preventable hospitalization was 21.65% among high-cost patients. The proportion of preventable inpatient cost in total inpatient and outpatient expenditure among high-cost patients (5.81%) was lower than that of non-high-cost patients (7.88%) but accounted for 75.87% of the overall preventable inpatient cost. High-cost patients with more hospitalizations were more likely to experience preventable hospitalization, and those with heart failure, COPD, diabetes and mixed conditions were at a higher risk of preventable hospitalization, while those with more outpatient visits were less likely to show preventable hospitalization. Conclusions The occurrence of preventable hospitalization among high-cost patients in rural China was sizeable. The preventable inpatient cost of the overall population was concentrated among high-cost patients. Interventions such as improving preventive care and disease management targeting high-cost patients within counties may improve patients' health outcomes and quality of life and reduce overall preventable inpatient cost.
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Affiliation(s)
- Shan Lu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Yan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, China
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Centre for Rural Health Service, Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, China.,School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Niek S Klazinga
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Dionne S Kringos
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
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