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Barrio-Cortes J, Castaño-Reguillo A, Benito-Sánchez B, Beca-Martínez MT, Ruiz-Zaldibar C. Utilization of Primary Healthcare Services in Patients with Multimorbidity According to Their Risk Level by Adjusted Morbidity Groups: A Cross-Sectional Study in Chamartín District (Madrid). Healthcare (Basel) 2024; 12:270. [PMID: 38275550 PMCID: PMC10815081 DOI: 10.3390/healthcare12020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30-2.01), female sex (BC = 1.04; CI = 0.30-1.78), having a caregiver (BC = 8.70; CI = 6.72-10.69), complexity (B-coefficient = 0.46; CI = 0.38-0.55), high-risk (B-coefficient = 2.29; CI = 1.26-3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37-2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00-6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.
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Affiliation(s)
- Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), 28003 Madrid, Spain
- Faculty of Health, Camilo José Cela University, 28692 Madrid, Spain
| | | | - Beatriz Benito-Sánchez
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), 28003 Madrid, Spain
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Ataga KI. The challenge of clinical end points in sickle cell disease. Blood 2023; 142:2047-2054. [PMID: 37890140 PMCID: PMC10733825 DOI: 10.1182/blood.2023021220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/05/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
As most patients with sickle cell disease (SCD) do not have access to curative therapies, the availability of drug therapies that can modify disease severity remains highly desirable. Despite an increased understanding of the pathophysiology of SCD, only 4 drugs are approved by the US Food and Drugs Administration. Most drug trials in SCD have involved the use of acute pain episodes as the primary clinical end point. These studies have typically been to prevent or shorten the duration of such episodes. To date, no drug has received regulatory approval for shortening the duration of acute vaso-occlusive complications, likely highlighting the complex pathophysiology of acute pain episodes. Trials to prevent acute pain episodes have largely evaluated those episodes requiring health care use as a surrogate end point. However, with differences in culture and health care practices among countries, health care use may not reliably predict clinically important effects on acute pain episodes. This article discusses issues related to the use of health care use as the primary end point for prevention trials of acute pain episodes and highlights the importance of evaluating patient-reported outcomes as well as other SCD-related complications as outcome measures.
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Affiliation(s)
- Kenneth I. Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
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Roberts JM, Goyal V, Kularatna S, Chang AB, Kapur N, Chalmers JD, Goeminne PC, Hernandez F, Marchant JM, McPhail SM. The Economic Burden of Bronchiectasis: A Systematic Review. Chest 2023; 164:1396-1421. [PMID: 37423293 DOI: 10.1016/j.chest.2023.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/20/2023] [Accepted: 06/19/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Bronchiectasis, a previously neglected condition, now has renewed research interest. There are a few systematic reviews that have reported on the economic and societal burden of bronchiectasis in adults, but none have reported on children. We undertook this systematic review to estimate the economic burden of bronchiectasis in children and adults. RESEARCH QUESTION What is the health care resource utilization and economic burden of bronchiectasis in adults and children? STUDY DESIGN AND METHODS We performed a systematic review identifying publications from Embase, PubMed, Web of Science, Cochrane (trials, reviews, and editorials), and EconLit about the economic burden and health care utilization in adults and children with bronchiectasis between January 1, 2001, and October 10, 2022. We used a narrative synthesis approach and estimated aggregate costs for several countries. RESULTS We identified 53 publications reporting on the economic burden and/or health care utilization of people with bronchiectasis. Total annual health care costs per adult patient ranged from 2021 $3,579 to $82,545 USD and were predominantly driven by hospitalization costs. Annual indirect costs including lost income because of illness (reported in only five studies) ranged from $1,311 to $2,898 USD. Total health care costs in children with bronchiectasis were $23,687 USD annually in the one study that estimated them. Additionally, one publication found that children with bronchiectasis missed 12 school days per year. We estimated aggregate annual health care costs for nine countries, ranging from $101.6 million per year in Singapore to $14.68 billion per year in the United States. We also estimated the aggregate cost of bronchiectasis in Australian children to be $17.77 million per year. INTERPRETATION This review highlights the substantial economic burden of bronchiectasis for patients and health systems. To our knowledge, it is the first systematic review to include the costs for children with bronchiectasis and their families. Future research to examine the economic impact of bronchiectasis in children and economically disadvantaged communities, and to further understand the indirect burden of bronchiectasis on individuals and the community, is needed.
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Affiliation(s)
- Jack M Roberts
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
| | - Vikas Goyal
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Anne B Chang
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia; NHMRC Centre for Research Excellence in Paediatric Bronchiectasis (AusBREATHE) and Menzies School of Health Research, Darwin, NT, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - James D Chalmers
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, Dundee, Scotland
| | - Pieter C Goeminne
- Department of Respiratory and Sleep Medicine, VITAZ, Sint-Niklaas, Belgium
| | | | - Julie M Marchant
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, QLD, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation, Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Digital Health and Informatics Directorate, Metro South Health, Brisbane, QLD, Australia.
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Walsan R, Mitchell RJ, Braithwaite J, Westbrook J, Hibbert P, Mumford V, Harrison R. Is there an association between out-of-pocket hospital costs, quality and care outcomes? A systematic review of contemporary evidence. BMC Health Serv Res 2023; 23:984. [PMID: 37705006 PMCID: PMC10500869 DOI: 10.1186/s12913-023-09941-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Out of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking. METHODS The current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763). FINDINGS A total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes. INTERPRETATION The review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs. FUNDING This study was funded by Medibank Better Health Foundation.
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Affiliation(s)
- Ramya Walsan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Rebecca J Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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Alsaleh MM, Allery F, Choi JW, Hama T, McQuillin A, Wu H, Thygesen JH. Prediction of disease comorbidity using explainable artificial intelligence and machine learning techniques: A systematic review. Int J Med Inform 2023; 175:105088. [PMID: 37156169 DOI: 10.1016/j.ijmedinf.2023.105088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/23/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Disease comorbidity is a major challenge in healthcare affecting the patient's quality of life and costs. AI-based prediction of comorbidities can overcome this issue by improving precision medicine and providing holistic care. The objective of this systematic literature review was to identify and summarise existing machine learning (ML) methods for comorbidity prediction and evaluate the interpretability and explainability of the models. MATERIALS AND METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to identify articles in three databases: Ovid Medline, Web of Science and PubMed. The literature search covered a broad range of terms for the prediction of disease comorbidity and ML, including traditional predictive modelling. RESULTS Of 829 unique articles, 58 full-text papers were assessed for eligibility. A final set of 22 articles with 61 ML models was included in this review. Of the identified ML models, 33 models achieved relatively high accuracy (80-95%) and AUC (0.80-0.89). Overall, 72% of studies had high or unclear concerns regarding the risk of bias. DISCUSSION This systematic review is the first to examine the use of ML and explainable artificial intelligence (XAI) methods for comorbidity prediction. The chosen studies focused on a limited scope of comorbidities ranging from 1 to 34 (mean = 6), and no novel comorbidities were found due to limited phenotypic and genetic data. The lack of standard evaluation for XAI hinders fair comparisons. CONCLUSION A broad range of ML methods has been used to predict the comorbidities of various disorders. With further development of explainable ML capacity in the field of comorbidity prediction, there is a significant possibility of identifying unmet health needs by highlighting comorbidities in patient groups that were not previously recognised to be at risk for particular comorbidities.
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Affiliation(s)
- Mohanad M Alsaleh
- Institute of Health Informatics, University College London, London, UK; Department of Health Informatics, College of Public Health and Health Informatics, Qassim University, Al Bukayriyah, Saudi Arabia.
| | - Freya Allery
- Institute of Health Informatics, University College London, London, UK
| | - Jung Won Choi
- Institute of Health Informatics, University College London, London, UK
| | - Tuankasfee Hama
- Institute of Health Informatics, University College London, London, UK
| | | | - Honghan Wu
- Institute of Health Informatics, University College London, London, UK
| | - Johan H Thygesen
- Institute of Health Informatics, University College London, London, UK
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Bell C, Prior A, Appel CW, Frølich A, Pedersen AR, Vedsted P. Multimorbidity and determinants for initiating outpatient trajectories: A population-based study. BMC Public Health 2023; 23:739. [PMID: 37085788 PMCID: PMC10120141 DOI: 10.1186/s12889-023-15453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/15/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Individuals with multimorbidity often receive high numbers of hospital outpatient services in concurrent trajectories. Nevertheless, little is known about factors associated with initiating new hospital outpatient trajectories; identified as the continued use of outpatient contacts for the same medical condition. PURPOSE To investigate whether the number of chronic conditions and sociodemographic characteristics in adults with multimorbidity is associated with entering a hospital outpatient trajectory in this population. METHODS This population-based register study included all adults in Denmark with multimorbidity on January 1, 2018. The exposures were number of chronic conditions and sociodemographic characteristics, and the outcome was the rate of starting a new outpatient trajectory during 2018. Analyses were stratified by the number of existing outpatient trajectories. We used Poisson regression analysis, and results were expressed as incidence rates and incidence rate ratios with 95% confidence intervals. We followed the individuals during the entire year of 2018, accounting for person-time by hospitalization, emigration, and death. RESULTS Incidence rates for new outpatient trajectories were highest for individuals with low household income and ≥3 existing trajectories and for individuals with ≥3 chronic conditions and in no already established outpatient trajectory. A high number of chronic conditions and male gender were found to be determinants for initiating a new outpatient trajectory, regardless of the number of existing trajectories. Low educational level was a determinant when combined with 1, 2, and ≥3 existing trajectories, and increasing age, western ethnicity, and unemployment when combined with 0, 1, and 2 existing trajectories. CONCLUSION A high number of chronic conditions, male gender, high age, low educational level and unemployment were determinants for initiation of an outpatient trajectory. The rate was modified by the existing number of outpatient trajectories. The results may help identify those with multimorbidity at greatest risk of having a new hospital outpatient trajectory initiated.
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Affiliation(s)
- Cathrine Bell
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark.
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
| | - Charlotte Weiling Appel
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Asger Roer Pedersen
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
| | - Peter Vedsted
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
- Research Unit for General Practice, Aarhus, Denmark
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Landon BE, Hatfield LA, Bakx P, Banerjee A, Chen YC, Fu C, Gordon M, Heine R, Huang N, Ko DT, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, Uyl-de Groot C, Yan L, Weinreb G, Cram P. Differences in Treatment Patterns and Outcomes of Acute Myocardial Infarction for Low- and High-Income Patients in 6 Countries. JAMA 2023; 329:1088-1097. [PMID: 37014339 PMCID: PMC10074220 DOI: 10.1001/jama.2023.1699] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/01/2023] [Indexed: 04/05/2023]
Abstract
Importance Differences in the organization and financing of health systems may produce more or less equitable outcomes for advantaged vs disadvantaged populations. We compared treatments and outcomes of older high- and low-income patients across 6 countries. Objective To determine whether treatment patterns and outcomes for patients presenting with acute myocardial infarction differ for low- vs high-income individuals across 6 countries. Design, Setting, and Participants Serial cross-sectional cohort study of all adults aged 66 years or older hospitalized with acute myocardial infarction from 2013 through 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population-representative administrative data. Exposures Being in the top and bottom quintile of income within and across countries. Main Outcomes and Measures Thirty-day and 1-year mortality; secondary outcomes included rates of cardiac catheterization and revascularization, length of stay, and readmission rates. Results We studied 289 376 patients hospitalized with ST-segment elevation myocardial infarction (STEMI) and 843 046 hospitalized with non-STEMI (NSTEMI). Adjusted 30-day mortality generally was 1 to 3 percentage points lower for high-income patients. For instance, 30-day mortality among patients admitted with STEMI in the Netherlands was 10.2% for those with high income vs 13.1% for those with low income (difference, -2.8 percentage points [95% CI, -4.1 to -1.5]). One-year mortality differences for STEMI were even larger than 30-day mortality, with the highest difference in Israel (16.2% vs 25.3%; difference, -9.1 percentage points [95% CI, -16.7 to -1.6]). In all countries, rates of cardiac catheterization and percutaneous coronary intervention were higher among high- vs low-income populations, with absolute differences ranging from 1 to 6 percentage points (eg, 73.6% vs 67.4%; difference, 6.1 percentage points [95% CI, 1.2 to 11.0] for percutaneous intervention in England for STEMI). Rates of coronary artery bypass graft surgery for patients with STEMI in low- vs high-income strata were similar but for NSTEMI were generally 1 to 2 percentage points higher among high-income patients (eg, 12.5% vs 11.0% in the US; difference, 1.5 percentage points [95% CI, 1.3 to 1.8 ]). Thirty-day readmission rates generally also were 1 to 3 percentage points lower and hospital length of stay generally was 0.2 to 0.5 days shorter for high-income patients. Conclusions and Relevance High-income individuals had substantially better survival and were more likely to receive lifesaving revascularization and had shorter hospital lengths of stay and fewer readmissions across almost all countries. Our results suggest that income-based disparities were present even in countries with universal health insurance and robust social safety net systems.
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Affiliation(s)
- Bruce E. Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Laura A. Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Pieter Bakx
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, England
- Department of Cardiology, University College London Hospitals, London, England
| | - Yu-Chin Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Renaud Heine
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Dennis T. Ko
- Schulich Heart Program, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lisa M. Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Victor Novack
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, England
| | - Feng Qiu
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Therese A. Stukel
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Carin Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Canada
| | - Gabe Weinreb
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Peter Cram
- ICES, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Texas Medical Branch, Galveston
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LeBlanc M, McGaughey T, Peters PA. Characteristics of High-Resource Health System Users in Rural and Remote Regions: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5385. [PMID: 37047999 PMCID: PMC10094250 DOI: 10.3390/ijerph20075385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
A small proportion of health care users are recognized to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterized as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which i arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterized rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviors.
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Affiliation(s)
- Michele LeBlanc
- School of Nursing, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Tomoko McGaughey
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Paul A. Peters
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
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Epidemiology of cardiac amyloidosis in Germany: a retrospective analysis from 2009 to 2018. Clin Res Cardiol 2023; 112:401-408. [PMID: 36241897 PMCID: PMC9998316 DOI: 10.1007/s00392-022-02114-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/04/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Improved imaging modalities contributed to increasing awareness of cardiac amyloidosis. Contemporary data on frequency trends in Germany are lacking. METHODS In a retrospective study using health claims data of a German statutory health insurance, patients with diagnostic codes of amyloidosis and concomitant heart failure between 2009 and 2018 were identified. RESULTS Prevalence increased from 15.5 to 47.6 per 100,000 person-years, and incidence increased from 4.8 to 11.6 per 100,000 person-years, with a continuous steepening in the slope of incidence trend. In patients with amyloidosis and heart failure age and proportion of men significantly increased, whereas the frequency of myeloma and nephrotic syndrome significantly decreased over time. Median (IQR) survival time after first diagnosis was 2.5 years (0.5-6 years), with a 9% (95% CI 2-15%, p = 0.008) reduced risk of death in the second compared to the first 5 years of observation. In the 2 years prior and 1 year after diagnosis, mean total health care costs were 6568 €, 11,872 € and 21,955 € per person and year. CONCLUSION The rise in cardiac amyloidosis has continuously accelerated in the last decade. Considering the adverse outcome and high health care burden, further effort should be put on early detection of the disease to implement available treatment.
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Lorenzoni L, Marino A, Or Z, Blankart CR, Shatrov K, Wodchis W, Janlov N, Figueroa JF, Bowden N, Bernal-Delgado E, Papanicolas I. Why the US spends more treating high-need high-cost patients: a comparative study of pricing and utilization of care in six high-income countries. Health Policy 2023; 128:55-61. [PMID: 36529552 DOI: 10.1016/j.healthpol.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
One of the most pressing challenges facing most health care systems is rising costs. As the population ages and the demand for health care services grows, there is a growing need to understand the drivers of these costs across systems. This paper attempts to address this gap by examining utilization and spending of the course of a year for two specific high-need high-cost patient types: a frail older person with a hip fracture and an older person with congestive heart failure and diabetes. Data on utilization and expenditure is collected across five health care settings (hospital, post-acute rehabilitation, primary care, outpatient specialty and drugs), in six countries (Canada (Ontario), France, Germany, Spain (Aragon), Sweden and the United States (fee for service Medicare) and used to construct treatment episode Purchasing Power Parities (PPPs) that compare prices using baskets of goods from the different care settings. The treatment episode PPPs suggest other countries have more similar volumes of care to the US as compared to other standardization approaches, suggesting that US prices account for more of the differential in US health care expenditures. The US also differs with regards to the share of expenditures across care settings, with post-acute rehab and outpatient speciality expenditures accounting for a larger share of the total relative to comparators.
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Affiliation(s)
- Luca Lorenzoni
- Organisation for Economic Co-operation and Development (OECD), Paris, France
| | - Alberto Marino
- Department of Health Policy, London School of Economics, London, UK
| | - Zeynep Or
- Institute for Research and Documentation in Health Economics (IRDES), Paris, France
| | - Carl Rudolf Blankart
- KPM Center for Public Management, University of Bern, Bern, Switzerland; Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany; Swiss Institute for Translational and Entrepreneurial Medicine (sitem-insel), Bern, Switzerland
| | - Kosta Shatrov
- KPM Center for Public Management, University of Bern, Bern, Switzerland; Swiss Institute for Translational and Entrepreneurial Medicine (sitem-insel), Bern, Switzerland
| | - Walter Wodchis
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Canada
| | - Nils Janlov
- The Swedish Agency for Health and Care Services Analysis, Stockholm, Sweden
| | - Jose F Figueroa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicholas Bowden
- Dunedin School of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | | | - Irene Papanicolas
- Department of Health Policy, London School of Economics, London, UK; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, RI, USA.
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11
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O’neil JC, Geisler BP, Rusinak D, Bassett IV, Triant VA, Mckenzie R, Mattison ML, Baughman AW. Discharge to post-acute care and other predictors of prolonged length of stay during the initial COVID-19 surge: a single site analysis. Int J Qual Health Care 2022; 35:6883863. [PMID: 36477564 PMCID: PMC9806864 DOI: 10.1093/intqhc/mzac098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 11/18/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND During the initial surge of coronavirus disease 2019 (COVID-19), health-care utilization fluctuated dramatically, straining acute hospital capacity across the USA and potentially contributing to excess mortality. METHODS This was an observational retrospective study of patients with COVID-19 admitted to a large US urban academic medical center during a 12-week COVID-19 surge in the Spring of 2020. We describe patterns in length of stay (LOS) over time. Our outcome of interest was prolonged LOS (PLOS), which we defined as 7 or more days. We performed univariate analyses of patient characteristics, clinical outcomes and discharge disposition to evaluate the association of each variable with PLOS and developed a final multivariate model via backward elimination, wherein all variables with a P-value above 0.05 were eliminated in a stepwise fashion. RESULTS The cohort included 1366 patients, of whom 13% died and 29% were readmitted within 30 days. The LOS (mean: 12.6) fell over time (P < 0.0001). Predictors of PLOS included discharge to a post-acute care (PAC) facility (odds ratio [OR]: 11.9, 95% confidence interval [CI] 2.6-54.0), uninsured status (OR 3.2, CI 1.1-9.1) and requiring intensive care and intubation (OR 18.4, CI 11.5-29.6). Patients had a higher readmission rate if discharged to PAC facilities (40%) or home with home health agency (HHA) services (38%) as compared to patients discharged home without HHA services (26%) (P < 0.0001). CONCLUSION Patients hospitalized with COVID-19 during a US COVID-19 surge had a PLOS and high readmission rate. Lack of insurance, an intensive care unit stay and a decision to discharge to a PAC facility were associated with a PLOS. Efforts to decrease LOS and optimize hospital capacity during COVID-19 surges may benefit from focusing on increasing PAC and HHA capacity and resources.
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Affiliation(s)
- Jessica C O’neil
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Benjamin P Geisler
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA,Institute for Medical Information Processing, Biometry and Epidemiology, Marchioninistr, 15, München 81377, Germany
| | - Donna Rusinak
- Performance Analysis and Improvement, Massachusetts General Hospital, 125 Nashua Street, Boston, MA 02114, USA
| | - Ingrid V Bassett
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Virginia A Triant
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Rachael Mckenzie
- Department of Case Management, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Melissa L Mattison
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
| | - Amy W Baughman
- Address reprint requests to: Amy W. Baughman, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA. E-mail:
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12
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Haller G. Changes in healthcare utilisation after surgical treatment: mitigating risk through multidisciplinary and collaborative care. Br J Anaesth 2022; 129:840-842. [DOI: 10.1016/j.bja.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 11/17/2022] Open
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13
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Sinha A, Kerketta S, Ghosal S, Kanungo S, Lee JT, Pati S. Multimorbidity and Complex Multimorbidity in India: Findings from the 2017-2018 Longitudinal Ageing Study in India (LASI). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159091. [PMID: 35897461 PMCID: PMC9332385 DOI: 10.3390/ijerph19159091] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/18/2022] [Accepted: 07/24/2022] [Indexed: 12/18/2022]
Abstract
Complex multimorbidity refers to the co-occurrence of three or more chronic illnesses across >2 body systems, which may identify persons in need of additional medical support and treatment. There is a scarcity of evidence on the differences in patient outcomes between non-complex (≥2 conditions) and complex multimorbidity groups. We evaluated the prevalence and patient outcomes of complex multimorbidity and compared them to non-complex multimorbidity. We included 30,489 multimorbid individuals aged ≥45 years from the Longitudinal Ageing Study in India (LASI) from wave-1 conducted in 2017−2018. We employed a log link in generalised linear models (GLM) to identify possible risk factors presenting the adjusted prevalence−risk ratio (APRR) and adjusted prevalence−risk difference (APRD) with 95% confidence interval. The prevalence of complex multimorbidity was 34.5% among multimorbid individuals. Participants residing in urban areas [APRR: 1.10 (1.02, 1.20)], [APRD: 0.04 (0.006, 0.07)] were more likely to report complex multimorbidity. Participants with complex multimorbidity availed significantly higher inpatient department services and had higher expenditure as compared to the non-complex multimorbidity group. Our findings have major implications for healthcare systems in terms of meeting the requirements of people with complicated multimorbidity, as they have significantly higher inpatient health service utilisation, higher medical costs, and poorer self-rated health.
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Affiliation(s)
- Abhinav Sinha
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
| | - Sushmita Kerketta
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
| | - Shishirendu Ghosal
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
| | - Srikanta Kanungo
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
- Correspondence: (S.K.); (S.P.)
| | - John Tayu Lee
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC 3010, Australia;
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London SW7 2AZ, UK
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar 751023, India; (A.S.); (S.K.); (S.G.)
- Correspondence: (S.K.); (S.P.)
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14
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Tran PB, Kazibwe J, Nikolaidis GF, Linnosmaa I, Rijken M, van Olmen J. Costs of multimorbidity: a systematic review and meta-analyses. BMC Med 2022; 20:234. [PMID: 35850686 PMCID: PMC9295506 DOI: 10.1186/s12916-022-02427-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multimorbidity is a rising global phenomenon, placing strains on countries' population health and finances. This systematic review provides insight into the costs of multimorbidity through addressing the following primary and secondary research questions: What evidence exists on the costs of multimorbidity? How do costs of specific disease combinations vary across countries? How do multimorbidity costs vary across disease combinations? What "cost ingredients" are most commonly included in these multimorbidity studies? METHODS We conducted a systematic review (PROSPERO: CRD42020204871) of studies published from January 2010 to January 2022, which reported on costs associated with combinations of at least two specified conditions. Systematic string-based searches were conducted in MEDLINE, The Cochrane Library, SCOPUS, Global Health, Web of Science, and Business Source Complete. We explored the association between costs of multimorbidity and country Gross Domestic Product (GDP) per capita using a linear mixed model with random intercept. Annual mean direct medical costs per capita were pooled in fixed-effects meta-analyses for each of the frequently reported dyads. Costs are reported in 2021 International Dollars (I$). RESULTS Fifty-nine studies were included in the review, the majority of which were from high-income countries, particularly the United States. (1) Reported annual costs of multimorbidity per person ranged from I$800 to I$150,000, depending on disease combination, country, cost ingredients, and other study characteristics. (2) Our results further demonstrated that increased country GDP per capita was associated with higher costs of multimorbidity. (3) Meta-analyses of 15 studies showed that on average, dyads which featured Hypertension were among the least expensive to manage, with the most expensive dyads being Respiratory and Mental Health condition (I$36,840), Diabetes and Heart/vascular condition (I$37,090), and Cancer and Mental Health condition in the first year after cancer diagnosis (I$85,820). (4) Most studies reported only direct medical costs, such as costs of hospitalization, outpatient care, emergency care, and drugs. CONCLUSIONS Multimorbidity imposes a large economic burden on both the health system and society, most notably for patients with cancer and mental health condition in the first year after cancer diagnosis. Whether the cost of a disease combination is more or less than the additive costs of the component diseases needs to be further explored. Multimorbidity costing studies typically consider only a limited number of disease combinations, and few have been conducted in low- and middle-income countries and Europe. Rigorous and standardized methods of data collection and costing for multimorbidity should be developed to provide more comprehensive and comparable evidence for the costs of multimorbidity.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
| | - Joseph Kazibwe
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden.,Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ismo Linnosmaa
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Mieke Rijken
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.,Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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15
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Johansen A, Ojeda-Thies C, Poacher AT, Hall AJ, Brent L, Ahern EC, Costa ML. Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons. Bone Joint J 2022; 104-B:721-728. [PMID: 35638208 PMCID: PMC9948447 DOI: 10.1302/0301-620x.104b6.bjj-2022-0080.r1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIMS The aim of this study was to explore current use of the Global Fragility Fracture Network (FFN) Minimum Common Dataset (MCD) within established national hip fracture registries, and to propose a revised MCD to enable international benchmarking for hip fracture care. METHODS We compared all ten established national hip fracture registries: England, Wales, and Northern Ireland; Scotland; Australia and New Zealand; Republic of Ireland; Germany; the Netherlands; Sweden; Norway; Denmark; and Spain. We tabulated all questions included in each registry, and cross-referenced them against the 32 questions of the MCD dataset. Having identified those questions consistently used in the majority of national audits, and which additional fields were used less commonly, we then used consensus methods to establish a revised MCD. RESULTS A total of 215 unique questions were used across the ten registries. Only 72 (34%) were used in more than one national audit, and only 32 (15%) by more than half of audits. Only one registry used all 32 questions from the 2014 MCD, and five questions were only collected by a single registry. Only 21 of the 32 questions in the MCD were used in the majority of national audits. Only three fields (anaesthetic grade, operation, and date/time of surgery) were used by all ten established audits. We presented these findings at the Asia-Pacific FFN meeting, and used an online questionnaire to capture feedback from expert clinicians from different countries. A draft revision of the MCD was then presented to all 95 nations represented at the Global FFN conference in September 2021, with online feedback again used to finalize the revised MCD. CONCLUSION The revised MCD will help aspirant nations establish new registry programmes, facilitate the integration of novel analytic techniques and greater multinational collaboration, and serve as an internationally-accepted standard for monitoring and improving hip fracture services. Cite this article: Bone Joint J 2022;104-B(6):721-728.
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Affiliation(s)
- Antony Johansen
- University Hospital of Wales and School of Medicine, Cardiff University, Cardiff, UK,National Hip Fracture Database, Royal College of Physicians, London, UK
| | | | | | | | - Louise Brent
- National Office of Clinical Audit, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Matt L. Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK,Correspondence should be sent to Matt L. Costa. E-mail:
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16
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Cram P, Hatfield LA, Bakx P, Banerjee A, Fu C, Gordon M, Heine R, Huang N, Ko D, Lix LM, Novack V, Pasea L, Qiu F, Stukel TA, de Groot CU, Yan L, Landon B. Variation in revascularisation use and outcomes of patients in hospital with acute myocardial infarction across six high income countries: cross sectional cohort study. BMJ 2022; 377:e069164. [PMID: 35508312 PMCID: PMC9066381 DOI: 10.1136/bmj-2021-069164] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare treatment and outcomes for patients admitted to hospital with a primary diagnosis of ST elevation or non-ST elevation myocardial infarction (STEMI or NSTEMI) in six high income countries with very different healthcare delivery systems. DESIGN Retrospective cross sectional cohort study. SETTING Patient level administrative data from the United States, Canada (Ontario and Manitoba), England, the Netherlands, Israel, and Taiwan. PARTICIPANTS Adults aged 66 years and older admitted to hospital with STEMI or NSTEMI between 1 January 2011 and 31 December 2017. OUTCOMES MEASURES The three categories of outcomes were coronary revascularisation (percutaneous coronary intervention or coronary artery bypass graft surgery), mortality, and efficiency (hospital length of stay and 30 day readmission). Rates were standardised to the age and sex distribution of the US acute myocardial infarction population in 2017. Outcomes were assessed separately for STEMI and NSTEMI. Performance was evaluated longitudinally (over time) and cross sectionally (between countries). RESULTS The total number of hospital admissions ranged from 19 043 in Israel to 1 064 099 in the US. Large differences were found between countries for all outcomes. For example, the proportion of patients admitted to hospital with STEMI who received percutaneous coronary intervention in hospital during 2017 ranged from 36.9% (England) to 78.6% (Canada; 71.8% in the US); use of percutaneous coronary intervention for STEMI increased in all countries between 2011 and 2017, with particularly large rises in Israel (48.4-65.9%) and Taiwan (49.4-70.2%). The proportion of patients with NSTEMI who underwent coronary artery bypass graft surgery within 90 days of admission during 2017 was lowest in the Netherlands (3.5%) and highest in the US (11.7%). Death within one year of admission for STEMI in 2017 ranged from 18.9% (Netherlands) to 27.8% (US) and 32.3% (Taiwan). Mean hospital length of stay in 2017 for STEMI was lowest in the Netherlands and the US (5.0 and 5.1 days) and highest in Taiwan (8.5 days); 30 day readmission for STEMI was lowest in Taiwan (11.7%) and the US (12.2%) and highest in England (23.1%). CONCLUSIONS In an analysis of myocardial infarction in six high income countries, all countries had areas of high performance, but no country excelled in all three domains. Our findings suggest that countries could learn from each other by using international comparisons of patient level nationally representative data.
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Affiliation(s)
- Peter Cram
- Department of Medicine, University of Texas Medical Branch, Galveston, TX, USA
- ICES, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura A Hatfield
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Pieter Bakx
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, University College London Hospitals, London, UK
| | - Christina Fu
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Michal Gordon
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Renaud Heine
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Dennis Ko
- ICES, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Schulich Heart Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beersheba, Israel
| | - Laura Pasea
- Institute of Health Informatics, University College London, London, UK
| | | | - Therese A Stukel
- ICES, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Carin Uyl de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, Netherlands
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Bruce Landon
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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17
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Street A, Smith P. How can we make valid and useful comparisons of different health care systems? Health Serv Res 2021; 56 Suppl 3:1299-1301. [PMID: 34755335 PMCID: PMC8579199 DOI: 10.1111/1475-6773.13883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 09/18/2021] [Accepted: 09/24/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Andrew Street
- Department of Health PolicyLondon School of Economics and Political ScienceLondonUK
| | - Peter Smith
- Centre for Health EconomicsUniversity of YorkYorkUK
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18
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Papanicolas I, Figueroa JF. International comparison of patient care trajectories: Insights from the ICCONIC project. Health Serv Res 2021; 56 Suppl 3:1295-1298. [PMID: 34755338 PMCID: PMC8579200 DOI: 10.1111/1475-6773.13887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Jose F. Figueroa
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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19
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Figueroa JF, Horneffer KE, Riley K, Abiona O, Arvin M, Atsma F, Bernal‐Delgado E, Blankart CR, Bowden N, Deeny S, Estupiñán‐Romero F, Gauld R, Hansen TM, Haywood P, Janlov N, Knight H, Lorenzoni L, Marino A, Or Z, Pellet L, Orlander D, Penneau A, Schoenfeld AJ, Shatrov K, Skudal KE, Stafford M, van de Galien O, van Gool K, Wodchis WP, Tanke M, Jha AK, Papanicolas I. A methodology for identifying high-need, high-cost patient personas for international comparisons. Health Serv Res 2021; 56 Suppl 3:1302-1316. [PMID: 34755334 PMCID: PMC8579201 DOI: 10.1111/1475-6773.13890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. DATA SOURCES Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. STUDY DESIGN We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care-hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. DATA COLLECTION/EXTRACTION METHODS Data collected by ICCONIC partners. PRINCIPAL FINDINGS Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. CONCLUSION Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries.
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Affiliation(s)
- Jose F. Figueroa
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Kathryn E. Horneffer
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Kristen Riley
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Olukorede Abiona
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Mina Arvin
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of HealthcareNijmegenThe Netherlands
| | - Femke Atsma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of HealthcareNijmegenThe Netherlands
| | | | - Carl Rudolf Blankart
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Hamburg Center for Health EconomicsUniversität HamburgHamburgGermany
| | - Nicholas Bowden
- Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | | | | | - Robin Gauld
- Otago Business SchoolUniversity of OtagoDunedinNew Zealand
| | | | - Philip Haywood
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Nils Janlov
- The Swedish Agency for Health and Care Services AnalysisStockholmSweden
| | | | - Luca Lorenzoni
- Health DivisionOrganisation for Economic Co‐operation and Development (OECD)ParisFrance
| | - Alberto Marino
- Health DivisionOrganisation for Economic Co‐operation and Development (OECD)ParisFrance
- Department of Health PolicyLondon School of EconomicsLondonUK
| | - Zeynep Or
- Institute for Research and Documentation in Health Economics (IRDES)ParisFrance
| | - Leila Pellet
- Institute for Research and Documentation in Health Economics (IRDES)ParisFrance
| | - Duncan Orlander
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Anne Penneau
- Institute for Research and Documentation in Health Economics (IRDES)ParisFrance
| | - Andrew J. Schoenfeld
- Department of Orthopedic SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Kosta Shatrov
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
| | | | | | | | - Kees van Gool
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Walter P. Wodchis
- Institute of Health Policy Management & EvaluationUniversity of TorontoTorontoOntarioCanada
- Institute for Better Health, Trillium Health PartnersMississaugaOntarioCanada
| | - Marit Tanke
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of HealthcareNijmegenThe Netherlands
| | - Ashish K. Jha
- Brown School of Public HealthProvidenceRhode IslandUSA
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