1
|
Monpellier VM, Geurten RJ, Janssen IMC, Ruwaard D, Struijs JN, van Dijk PR, Bilo HJG, Elissen AMJ. Evaluation of Healthcare Utilisation and Expenditures in Persons with Type 2 Diabetes Undergoing Bariatric-Metabolic Surgery. Obes Surg 2024; 34:723-732. [PMID: 38198097 PMCID: PMC10899363 DOI: 10.1007/s11695-023-06849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/15/2023] [Accepted: 09/24/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE Changes in healthcare utilisation and expenditures after bariatric-metabolic surgery (BMS) for people with type 2 diabetes mellitus (T2DM) are unclear. We used the Dutch national all-payer claims database (APCD) to evaluate utilisation and expenditures in people with T2DM who underwent BMS. METHODS In this cohort study, patients with T2DM who had BMS in 2016 were identified in the APCD. This group was matched 1:2 to a control group with T2DM who did not undergo BMS based on age, gender and healthcare expenditures. Data on healthcare expenditures and utilisation were collected for 2013-2019. RESULTS In total, 1751 patients were included in the surgery group and 3502 in the control group. After BMS, total median expenditures in the surgery group stabilised (€ 3156 to € 3120) and increased in the control group (€ 3174 to € 3434). Total pharmaceutical expenditures decreased 28% in the surgery group (€957 to €494) and increased 55% in the control group (€605 to €936). In the surgery group, 67.1% did not use medication for T2DM in 2019 compared to 13.3% in the control group. Healthcare use for microvascular complications increased in the control group, but not in the surgery group. CONCLUSION BMS in people with T2DM stabilises healthcare expenditures and decreases medication use and care use for microvascular complications. In contrast, healthcare use and expenditures in T2DM patients who do not undergo surgery gradually increase over time. Due to the progressive nature of T2DM, it is expected that these differences will become larger in the long-term.
Collapse
Affiliation(s)
- Valerie M Monpellier
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, The Netherlands
| | - Rose J Geurten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Huis ter Heide, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department Public Health and Primary Care, Leiden University Medical Centre, Campus The Hague, The Hague, The Netherlands
| | - Peter R van Dijk
- Department of Endocrinology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
2
|
Scheefhals ZTM, de Vries EF, Struijs JN, Numans ME, van Exel J. Stakeholder perspectives on payment reform in maternity care in the Netherlands: A Q-methodology study. Soc Sci Med 2024; 340:116413. [PMID: 38000174 DOI: 10.1016/j.socscimed.2023.116413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
Based on theoretical notions, there is consensus that alternative payment models to the common fee-for-service model have the potential to improve healthcare quality through increased collaboration and reduced under- and overuse. This is particularly relevant for maternity care in the Netherlands because perinatal mortality rates are relatively high in comparison to other Western countries. Therefore, an experiment with bundled payments for maternity care was initiated in 2017. However, the uptake of this alternative payment model remains low, as also seen in other countries, and fee-for-service models prevail. A deeper understanding of stakeholders' perspectives on payment reform in maternity care is necessary to inform policy makers about the obstacles to implementing alternative payment models and potential ways forward. We conducted a Q-methodology study to explore perspectives of stakeholders (postpartum care managers, midwives, gynecologists, managers, health insurers) in maternity care in the Netherlands on payment reform. Participants were asked to rank a set of statements relevant to payment reform in maternity care and explain their ranking during an interview. Factor analysis was used to identify patterns in the rankings of statements. We identified three distinct perspectives on payment reform in maternity care. One general perspective, broadly supported within the sector, focusing mainly on outcomes, and two complementary perspectives, one focusing more on equality and one focusing more on collaboration. This study shows there is consensus among stakeholders in maternity care in the Netherlands that payment reform is required. However, stakeholders have different views on the purpose and desired design of the payment reform and set different conditions. Working towards payment reform in co-creation with all involved parties may improve the general attitude towards payment reform, may enhance the level of trust among stakeholders, and may contribute to a higher uptake in practice.
Collapse
Affiliation(s)
- Zoë T M Scheefhals
- Department of National Health and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Eline F de Vries
- Department of Health Economics and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Jeroen N Struijs
- Department of National Health and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands.
| |
Collapse
|
3
|
Geurten RJ, Struijs JN, Bilo HJG, Ruwaard D, Elissen AMJ. Disentangling Population Health Management Initiatives in Diabetes Care: A Scoping Review. Int J Integr Care 2024; 24:3. [PMID: 38312481 PMCID: PMC10836183 DOI: 10.5334/ijic.7512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction Population Health Management (PHM) focusses on keeping the whole population as healthy as possible. As such, it could be a promising approach for long-term health improvement in type 2 diabetes. This scoping review aimed to examine the extent to which and how PHM is used in the care for people with type 2 diabetes. Methods PubMed, Web of Science, and Embase were searched between January 2000 and September 2021 for papers on self-reported PHM initiatives for type 2 diabetes. Eligible initiatives were described using the analytical framework for PHM. Results In total, 25 studies regarding 18 PHM initiatives for type 2 diabetes populations were included. There is considerable variation in whether and how the PHM steps are operationalized in existing PHM initiatives. Population identification, impact evaluation, and quality improvement processes were generally part of the PHM initiatives. Triple Aim assessment and risk stratification actions were scarce or explained in little detail. Moreover, cross-sector integration is key in PHM but scarce in practice. Conclusion Operationalization of PHM in practice is limited compared to the PHM steps described in the analytical framework. Extended risk stratification and integration efforts would contribute to whole-person care and further health improvements within the population.
Collapse
Affiliation(s)
- Rose J Geurten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Leiden University Medical Centre, Department Public Health and Primary Care - Campus The Hague, The Hague, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, Diabetes Research Center, Mondriaangebouw, Dokter van Deenweg 1-10, 8025BP Zwolle, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| |
Collapse
|
4
|
Scheefhals ZTM, de Vries EF, Molenaar JM, Numans ME, Struijs JN. Observational Data for Integrated Maternity Care: Experiences with a Data-Infrastructure for Parents and Children in the Netherlands. Int J Integr Care 2023; 23:20. [PMID: 38145057 PMCID: PMC10742107 DOI: 10.5334/ijic.7012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 11/30/2023] [Indexed: 12/26/2023] Open
Abstract
Introduction Observational data are increasingly seen as a valuable source for integrated care research. Especially since the growing availability of routinely collected data and quasi-experimental methods. The aim of this paper is to describe the potentials and challenges when using observational data for integrated maternity care research, based on our experience from developing and working with the Data-InfrAstructure for ParEnts and childRen (DIAPER). Methods and Results We provide a description of DIAPER, which is a linked data-infrastructure on the individual level based on maternity care claims data, quality and utilization of maternity care and data from municipal registries, covering the life course from preconception to adulthood. We then discuss potentials and practical applications of DIAPER such as to evaluate alternative payment models for integrated maternity care, to set the policy agenda regarding postpartum care, to provide insights into value of care and into provider variation, and to evaluate (policy) interventions designed to promote and support integrated maternity care. This is relevant for several stakeholders: policy makers, payers, providers and clients/patients. Based on experiences with DIAPER, we identify remaining challenges: missing data sources (especially self-reported outcomes), suboptimal quality of data, privacy concerns and potential biases introduced during data linkage, and describe how these challenges were tackled within the applications of DIAPER. Conclusions With DIAPER we demonstrated that using observational data can be of added value for integrated care research, but also that challenges remain. It is essential to keep exploring and developing the possibilities of observational data and continue the discussions in the scientific community. Learning from each other's successes and failures will be critical.
Collapse
Affiliation(s)
- Zoë T. M. Scheefhals
- Department of National Health and Healthcare, National Institute for Public Health and the Environment (RIVM), The Netherlands
- Department of Public Health and Primary Care, LUMC Health Campus The Hague, The Netherlands
| | - Eline F. de Vries
- Department of Health Economics and Healthcare, National Institute for Public Health and the Environment (RIVM), The Netherlands
| | - Joyce M. Molenaar
- Department of National Health and Healthcare, National Institute for Public Health and the Environment (RIVM), The Netherlands
- Department of Public Health and Primary Care, LUMC Health Campus The Hague, The Netherlands
| | - Mattijs E. Numans
- Department of Public Health and Primary Care, LUMC Health Campus The Hague, The Netherlands
| | - Jeroen N. Struijs
- Department of National Health and Healthcare, National Institute for Public Health and the Environment (RIVM), The Netherlands
- Department of Public Health and Primary Care, LUMC Health Campus The Hague, The Netherlands
| |
Collapse
|
5
|
van Deursen L, Aardoom JJ, Alblas EE, Struijs JN, Chavannes NH, van der Vaart R. Exploring colorectal cancer survivors' perspectives on improving care delivery and the role of e-health technology: a qualitative study. Support Care Cancer 2023; 31:544. [PMID: 37650936 PMCID: PMC10471668 DOI: 10.1007/s00520-023-08007-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The purpose of this study was to gather insights from colorectal cancer (CRC) survivors on how to improve care for CRC survivors and how e-health technology could be utilized to improve CRC care delivery. METHODS Three semi-structured focus groups were held with sixteen CRC survivors. To initiate the discussion, an online registration form and two vignettes were used. The data was analyzed using the framework method. RESULTS Based on survivors' experiences, five themes were identified as opportunities for improving CRC care delivery. These themes include better recognition of complaints and faster referrals, more information as part of the care delivery, more guidance and monitoring of health outcomes, more collaboration between practitioners, and more attention for partners and relatives. In addition, survivors expressed opportunities for using e-health to facilitate information provision, improve communication, and monitor survivors' health conditions. CONCLUSION Several suggestions for improvement of CRC care delivery were identified. These often translated into possibilities for e-health to support or improve CRC care delivery. The ideas of survivors align with the vast array of existing e-health resources that can be utilized to enhance CRC care delivery. Therefore, the next step involves addressing the implementation gap between the needs of stakeholders, such as CRC survivors and healthcare providers, and the e-health tools currently available in clinical practice.
Collapse
Affiliation(s)
- Liza van Deursen
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands.
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
- National eHealth Living Lab, Leiden, the Netherlands.
| | - Jiska J Aardoom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- National eHealth Living Lab, Leiden, the Netherlands
| | - Eva E Alblas
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands
- National eHealth Living Lab, Leiden, the Netherlands
- Health Campus The Hague, Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, the Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
- National eHealth Living Lab, Leiden, the Netherlands
| | - Rosalie van der Vaart
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention, and Health Services, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, the Netherlands
| |
Collapse
|
6
|
Molenaar JM, Boesveld IC, Struijs JN, Kiefte-de Jong JC. The Dutch Solid Start program: describing the implementation and experiences of the program's first thousand days. BMC Health Serv Res 2023; 23:926. [PMID: 37649017 PMCID: PMC10470180 DOI: 10.1186/s12913-023-09873-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND In 2018, the Dutch government initiated the Solid Start program to provide each child the best start in life. The program focuses on the crucial first thousand days of life, which span from preconception to a child's second birthday, and has a specific focus towards (future) parents and young children in vulnerable situations. A key program element is improving collaboration between the medical and social sector by creating Solid Start coalitions. This study aimed to describe the implementation of the Dutch Solid Start program, in order to learn for future practice and policy. Specifically, this paper describes to what extent Solid Start is implemented within municipalities and outlines stakeholders' experiences with the implementation of Solid Start and the associated cross-sectoral collaboration. METHODS Quantitative and qualitative data were collected from 2019 until 2021. Questionnaires were sent to all 352 Dutch municipalities and analyzed using descriptive statistics. Qualitative data were obtained through focus group discussions(n = 6) and semi-structured interviews(n = 19) with representatives of care and support organizations, knowledge institutes and professional associations, Solid Start project leaders, advisors, municipal officials, researchers, clients and experts-by-experience. Qualitative data were analyzed using the Rainbow Model of Integrated Care. RESULTS Findings indicated progress in the development of Solid Start coalitions(n = 40 in 2019, n = 140 in 2021), and an increase in cross-sectoral collaboration. According to the stakeholders, initiating Solid Start increased the sense of urgency concerning the importance of the first thousand days and stimulated professionals from various backgrounds to get to know each other, resulting in more collaborative agreements on cross-sectoral care provision. Important elements mentioned for effective collaboration within coalitions were an active coordinator as driving force, and a shared societal goal. However, stakeholders experienced that Solid Start is not yet fully incorporated into all professionals' everyday practice. Most common barriers for collaboration related to systemic integration at macro-level, including limited resources and collaboration-inhibiting regulations. Stakeholders emphasized the importance of ensuring Solid Start and mentioned various needs, including sustainable funding, supportive regulations, responsiveness to stakeholders' needs, ongoing knowledge development, and client involvement. CONCLUSION Solid Start, as a national program with strong local focus, has led to various incremental changes that supported cross-sectoral collaboration to improve care during the first thousand days, without major transformations of systemic structures. However, to ensure the program's sustainability, needs such as sustainable funding should be addressed.
Collapse
Affiliation(s)
- Joyce M Molenaar
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), 3721, MA, Bilthoven, the Netherlands.
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Centre, 2511, DP, The Hague, the Netherlands.
| | - Inge C Boesveld
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), 3721, MA, Bilthoven, the Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), 3721, MA, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Centre, 2511, DP, The Hague, the Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care/ Health Campus The Hague, Leiden University Medical Centre, 2511, DP, The Hague, the Netherlands
| |
Collapse
|
7
|
Nieuwenhuijse EA, van Hof TB, Numans ME, Struijs JN, Vos RC. Are social determinants of health associated with the development of early complications among young adults with type 2 diabetes? A population based study using linked databases. Prim Care Diabetes 2023; 17:168-174. [PMID: 36658030 DOI: 10.1016/j.pcd.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 01/08/2023] [Indexed: 01/19/2023]
Abstract
AIMS To quantify the impact of social determinants of health (SDOH) on top of medical determinants on the development of diabetes-related complications in young adults with type 2 diabetes. METHODS In this observational population-based study, SDOH (income and origin) were linked to routine primary care data. Young adults (18-45 years) with incident type 2 diabetes between 2007 and 2013 were included. The main outcome, the development of the first micro- or macrovascular complication, was analyzed by multivariate Cox regression. Medical determinants included antidiabetic treatment, HbA1c in the year after diagnosis, body mass index, comorbidity and smoking. RESULTS Of 761 young adults (median age: 39 years (IQR 33-42), men: 49%, Western origin: 36%, low income: 48%), 154 developed at least one complication (median follow-up 99 months (IQR 73-123)). Young men of non-Western origin were more likely to develop a complication (HR 1.98 (1.19-3.30)), as were young adults with HbA1c > 7% (>53 mmol/mol) (HR: 1.72 95% CI: 1.15-2.57). No associations were found with income. Being women was protective. CONCLUSION In this multi-ethnic population, non-Western origin was associated with the development of complications, but only in men. Low income was not associated with developing complications. The importance of adequate HbA1c regulation was re-emphasized by this study.
Collapse
Affiliation(s)
- Emma A Nieuwenhuijse
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands.
| | - Teske B van Hof
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands
| | - Jeroen N Struijs
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands; National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Rimke C Vos
- Department of Public Health and Primary Care / Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands
| |
Collapse
|
8
|
Nieuwenhuijse EA, Vos RC, van den Hout WB, Struijs JN, Verkleij SM, Busch K, Numans ME, Bonten TN. The Effect and Cost-Effectiveness of Offering a Combined Lifestyle Intervention for the Prevention of Cardiovascular Disease in Primary Care: Results of the Healthy Heart Stepped-Wedge Trial. Int J Environ Res Public Health 2023; 20:5040. [PMID: 36981949 PMCID: PMC10048996 DOI: 10.3390/ijerph20065040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/04/2023] [Accepted: 03/05/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To evaluate the effectiveness and cost-effectiveness of offering the combined lifestyle programme "Healthy Heart", addressing overweight, diet, physical activity, smoking and alcohol, to improve lifestyle behaviour and reduce cardiovascular risk. DESIGN A practice-based non-randomised stepped-wedge cluster trial with two-year follow-up. Outcomes were obtained via questionnaires and routine care data. A cost-utility analysis was performed. During the intervention period, "Healthy Heart" was offered during regular cardiovascular risk management consultations in primary care in The Hague, The Netherlands. The period prior to the intervention period served as the control period. RESULTS In total, 511 participants (control) and 276 (intervention) with a high cardiovascular risk were included (overall mean ± SD age 65.0 ± 9.6; women: 56%). During the intervention period, 40 persons (15%) participated in the Healthy Heart programme. Adjusted outcomes did not differ between the control and intervention period after 3-6 months and 12-24 months. Intervention versus control (95% CI) 3-6 months: weight: β -0.5 (-1.08-0.05); SBP β 0.15 (-2.70-2.99); LDL-cholesterol β 0.07 (-0.22-0.35); HDL-cholesterol β -0.03 (-0.10-0.05); physical activity β 38 (-97-171); diet β 0.95 (-0.93-2.83); alcohol OR 0.81 (0.44-1.49); quit smoking OR 2.54 (0.45-14.24). Results were similar for 12-24 months. Mean QALYs and mean costs of cardiovascular care were comparable over the full study period (mean difference (95% CI) QALYs: -0.10 (-0.20; 0.002); costs: EUR 106 (-80; 293)). CONCLUSIONS For both the shorter (3-6 months) and longer term (12-24 months), offering the Healthy Heart programme to high-cardiovascular-risk patients did not improve their lifestyle behaviour nor cardiovascular risk and was not cost-effective on a population level.
Collapse
Affiliation(s)
- Emma A. Nieuwenhuijse
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Rimke C. Vos
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Wilbert B. van den Hout
- Department of Medical Decision Making, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jeroen N. Struijs
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment, 3720 MA Bilthoven, The Netherlands
| | - Sanne M. Verkleij
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
| | - Karin Busch
- Hadoks Chronische Zorg BV, 2517 JK The Hague, The Netherlands
| | - Mattijs E. Numans
- Health Campus the Hague, Leiden University Medical Center, 2511 DP The Hague, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Tobias N. Bonten
- Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| |
Collapse
|
9
|
Kist JM, Vos RC, Mairuhu AT, Struijs JN, van Peet PG, Vos HM, van Os HJ, Beishuizen ED, Sijpkens YW, Faiq MA, Numans ME, Groenwold RH. SCORE2 cardiovascular risk prediction models in an ethnic and socioeconomic diverse population in the Netherlands: an external validation study. EClinicalMedicine 2023; 57:101862. [PMID: 36864978 PMCID: PMC9971516 DOI: 10.1016/j.eclinm.2023.101862] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Socioeconomic status and ethnicity are not explicitly incorporated as risk factors in the four SCORE2 cardiovascular disease (CVD) risk models developed for country-wide implementation across Europe (low, moderate, high and very-high model). The aim of this study was to evaluate the performance of the four SCORE2 CVD risk prediction models in an ethnic and socioeconomic diverse population in the Netherlands. METHODS The SCORE2 CVD risk models were externally validated in socioeconomic and ethnic (by country of origin) subgroups, from a population-based cohort in the Netherlands, with GP, hospital and registry data. In total 155,000 individuals, between 40 and 70 years old in the study period from 2007 to 2020 and without previous CVD or diabetes were included. Variables (age, sex, smoking status, blood pressure, cholesterol) and outcome first CVD event (stroke, myocardial infarction, CVD death) were consistent with SCORE2. FINDINGS 6966 CVD events were observed, versus 5495 events predicted by the CVD low-risk model (intended for use in the Netherlands). Relative underprediction was similar in men and women (observed/predicted (OE-ratio), 1.3 and 1.2 in men and women, respectively). Underprediction was larger in low socioeconomic subgroups of the overall study population (OE-ratio 1.5 and 1.6 in men and women, respectively), and comparable in Dutch and the combined "other ethnicities" low socioeconomic subgroups. Underprediction in the Surinamese subgroup was largest (OE-ratio 1.9, in men and women), particularly in the low socioeconomic Surinamese subgroups (OE-ratio 2.5 and 2.1 in men and women). In the subgroups with underprediction in the low-risk model, the intermediate or high-risk SCORE2 models showed improved OE-ratios. Discrimination showed moderate performance in all subgroups and the four SCORE2 models, with C-statistics between 0.65 and 0.72, similar to the SCORE2 model development study. INTERPRETATION The SCORE 2 CVD risk model for low-risk countries (as the Netherlands are) was found to underpredict CVD risk, particularly in low socioeconomic and Surinamese ethnic subgroups. Including socioeconomic status and ethnicity as predictors in CVD risk models and implementing CVD risk adjustment within countries is desirable for adequate CVD risk prediction and counselling. FUNDING Leiden University Medical Centre and Leiden University.
Collapse
Affiliation(s)
- Janet M. Kist
- Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
- Corresponding author.
| | - Rimke C. Vos
- Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - Albert T.A. Mairuhu
- Department of Internal Medicine, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Jeroen N. Struijs
- Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Petra G. van Peet
- Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - Hedwig M.M. Vos
- Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - Hendrikus J.A. van Os
- Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Yvo W.J. Sijpkens
- Department of Internal Medicine, HMC Hospital, The Hague, The Netherlands
| | - Mohammad A. Faiq
- Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - Mattijs E. Numans
- Health Campus The Hague, Leiden University Medical Centre, The Hague, The Netherlands
| | - Rolf H.H. Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Biomedical Data Science, Leiden University Medical Centre, Leiden, The Netherlands
| |
Collapse
|
10
|
Molenaar JM, van der Meer L, Bertens LCM, de Vries EF, Waelput AJM, Knight M, Steegers EAP, Kiefte-de Jong JC, Struijs JN. Defining vulnerability subgroups among pregnant women using pre-pregnancy information: a latent class analysis. Eur J Public Health 2023; 33:25-34. [PMID: 36515418 PMCID: PMC10263266 DOI: 10.1093/eurpub/ckac170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Early detection of vulnerability during or before pregnancy can contribute to optimizing the first 1000 days, a crucial period for children's development and health. We aimed to identify classes of vulnerability among pregnant women in the Netherlands using pre-pregnancy data on a wide range of social risk and protective factors, and validate these classes against the risk of adverse outcomes. METHODS We conducted a latent class analysis based on 42 variables derived from nationwide observational data sources and self-reported data. Variables included individual, socioeconomic, lifestyle, psychosocial and household characteristics, self-reported health, healthcare utilization, life-events and living conditions. We compared classes in relation to adverse outcomes using logistic regression analyses. RESULTS In the study population of 4172 women, we identified five latent classes. The largest 'healthy and socioeconomically stable'-class [n = 2040 (48.9%)] mostly shared protective factors, such as paid work and positively perceived health. The classes 'high care utilization' [n = 485 (11.6%)], 'socioeconomic vulnerability' [n = 395 (9.5%)] and 'psychosocial vulnerability' [n = 1005 (24.0%)] were characterized by risk factors limited to one specific domain and protective factors in others. Women classified into the 'multidimensional vulnerability'-class [n = 250 (6.0%)] shared multiple risk factors in different domains (psychosocial, medical and socioeconomic risk factors). Multidimensional vulnerability was associated with adverse outcomes, such as premature birth and caesarean section. CONCLUSIONS Co-existence of multiple risk factors in various domains is associated with adverse outcomes for mother and child. Early detection of vulnerability and strategies to improve parental health and well-being might benefit from focussing on different domains and combining medical and social care and support.
Collapse
Affiliation(s)
- J M Molenaar
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - L van der Meer
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - L C M Bertens
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - E F de Vries
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - A J M Waelput
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - M Knight
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - E A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - J C Kiefte-de Jong
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| | - J N Struijs
- Department of Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention and Health Services, Bilthoven, the Netherlands
- Department of Public Health and Primary Care/Health Campus The Hague, Leiden University Medical Centre, the Hague, the Netherlands
| |
Collapse
|
11
|
Nieuwenhuijse EA, Struijs JN, Sutch SP, Numans ME, Vos RC. Achieving diabetes treatment targets in people with registered mental illness is similar or improved compared with those without: Analyses of linked observational datasets. Diabet Med 2022; 39:e14835. [PMID: 35342984 PMCID: PMC9325400 DOI: 10.1111/dme.14835] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/25/2022] [Indexed: 11/29/2022]
Abstract
AIMS To determine the association between registered mental illness and type 2 diabetes mellitus treatment targets, while taking into account the effects of health expenditure and social determinants of health. METHODS This observational cross-sectional study was based on routine primary care data, linked to socio-economic and medical claims data. The main outcomes, analysed by multivariate logistic regression, were achieving primary care guideline treatment targets for HbA1c , systolic blood pressure (SBP) and LDL-cholesterol in 2017. We examined the association with diagnosed mental illness registered by the general practitioner (GP) or treated via specialist' mental healthcare between 2016 and 2018, adjusting for, medication use, body mass index, co-morbidity, smoking, and additionally examining effect-modification of healthcare expenditures, migration status, income and demographics. RESULTS Overall (N = 2862), 64.0% of participants achieved their treatment targets for HbA1c , 65.1% for SBP and 53.0% for LDL-cholesterol. Adjusted for migrant background, income and care expenditures, individuals <65 years of age with mental illness achieved their HbA1c treatment target more often than those without (OR (95% CI)): treatment by GP: 1.46 (1.01, 2.11), specialist care: 1.61 (1.11, 2.34), as did men with mental illness for SBP: GP OR 1.61 (1.09, 2.40), specialist care OR 1.59 (1.09, 2.45). LDL-cholesterol target was not associated with mental illness. A migrant background or low income lowered the likelihood of reaching HbA1c targets. CONCLUSIONS People with registered mental illness appear comparable or better able to achieve diabetes treatment targets than those without. Achieving HbA1c targets is influenced by social disadvantage.
Collapse
Affiliation(s)
- Emma A. Nieuwenhuijse
- Department of Public Health and Primary CareLUMC‐Campus The HagueLeiden University Medical CentreThe HagueThe Netherlands
| | - Jeroen N. Struijs
- Department of Public Health and Primary CareLUMC‐Campus The HagueLeiden University Medical CentreThe HagueThe Netherlands
- National Institute for Public Health and the EnvironmentBilthovenThe Netherlands
| | - Stephen P. Sutch
- Department of Public Health and Primary CareLUMC‐Campus The HagueLeiden University Medical CentreThe HagueThe Netherlands
- Health Policy and ManagementJohns Hopkins University Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Mattijs. E. Numans
- Department of Public Health and Primary CareLUMC‐Campus The HagueLeiden University Medical CentreThe HagueThe Netherlands
| | - Rimke C. Vos
- Department of Public Health and Primary CareLUMC‐Campus The HagueLeiden University Medical CentreThe HagueThe Netherlands
| |
Collapse
|
12
|
Geurten RJ, Struijs JN, Elissen AMJ, Bilo HJG, van Tilburg C, Ruwaard D. Delineating the Type 2 Diabetes Population in the Netherlands Using an All-Payer Claims Database: Specialist Care, Medication Utilization and Expenditures 2016-2018. Pharmacoecon Open 2022; 6:219-229. [PMID: 34862962 PMCID: PMC8864033 DOI: 10.1007/s41669-021-00308-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The aim of this study was to describe the healthcare utilization and expenditures related to medical specialist care and medication of the entire type 2 diabetes population in the Netherlands in detail. METHODS For this retrospective, observational study, we used an all-payer claims database. Comprehensive data on specialist care and medication utilization and expenditures of the type 2 diabetes population (n = 900,522 in 2018) were obtained and analyzed descriptively. Data were analyzed across medical specialties and for various types of diabetes medication (or glucose-lowering drugs [GLDs]) and other medication. RESULTS Specialist care utilization was diverse: different medical specialties were visited by a considerable fraction of the type 2 diabetes population. Total expenditures on specialist care were €2498 million in 2018 (i.e., 10.6% of the national specialist care expenditures). In total, 97.8% of patients used other medication (not GLDs) and 81.8% used GLDs; 25.6% of medication expenditures were for GLDs. For both specialist care and medication, mean expenditures per treated patient were higher than median expenditures, indicating a skewed distribution of spending. CONCLUSION Use of and expenditures on specialist care and medication of the type 2 diabetes population is diverse. These heterogeneous healthcare use patterns are likely caused by the presence of comorbidities. Additionally, we found that a small fraction of the population is responsible for a large share of the expenditures. A shift towards more patient-centered care could lead to health improvements and a reduction in overall costs, subsequently promoting the sustainability of healthcare systems.
Collapse
Affiliation(s)
- Rose J Geurten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Campus The Hague, The Hague, The Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
13
|
Geurten RJ, Elissen AMJ, Bilo HJG, Struijs JN, van Tilburg C, Ruwaard D. Identifying and delineating the type 2 diabetes population in the Netherlands using an all-payer claims database: characteristics, healthcare utilisation and expenditures. BMJ Open 2021; 11:e049487. [PMID: 34876422 PMCID: PMC8655569 DOI: 10.1136/bmjopen-2021-049487] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to identify and delineate the Dutch type 2 diabetes population and the distribution of healthcare utilisation and expenditures across the health system from 2016 to 2018 using an all-payer claims database. DESIGN Retrospective observational cohort study based on an all-payer claims database of the Dutch population. SETTING The Netherlands. PARTICIPANTS The whole Dutch type 2 diabetes population (n=900 522 in 2018), determined based on bundled payment codes for integrated diabetes care and medication use indicating type 2 diabetes. OUTCOME MEASURES Annual prevalence of type 2 diabetes, comorbidities and characteristics of the type 2 diabetes population, as well as the distribution of healthcare utilisation and expenditures were analysed descriptively. RESULTS In 2018, 900 522 people (6.5% of adults) were identified as having type 2 diabetes. The most common comorbidity in the population was heart disease (12.1%). Additionally, 16.2% and 5.6% of patients received specialised care for microvascular and macrovascular diabetes-related complications, respectively. Most patients with type 2 diabetes received pharmaceutical care (99.1%), medical specialist care (97.0%) and general practitioner consultations (90.5%). In total, €8173 million, 9.4% of total healthcare expenditures, was reimbursed for the type 2 diabetes population. Medical specialist care accounted for the largest share of spending (38.1%), followed by district nursing (12.4%), and pharmaceutical care (11.5%). CONCLUSIONS All-payer claims databases can be used to delineate healthcare use: this insight can inform health policy and practice and, thereby, support better decisions to promote long-term sustainability of healthcare systems. The healthcare utilisation of the Dutch type 2 diabetes population is distributed across the health system and utilisation of medical specialist care is high. This is likely to be due to presence of concurrent morbidities and complications. Therefore, a shift from a disease-specific approach to a person-centred and integrated care approach could be beneficial in the treatment of type 2 diabetes.
Collapse
Affiliation(s)
- Rose J Geurten
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Arianne M J Elissen
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department Public Health and Primary Care, Leiden University Medical Center Campus The Hague, The Hague, The Netherlands
| | - Chantal van Tilburg
- Department Intelligence, Vektis Healthcare Information Center, Zeist, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
14
|
Kist JM, Smit GW, Mairuhu AT, Struijs JN, Vos RC, van Peet PG, Vos HM, Beishuizen ED, Sijpkens YW, Groenwold RH, Numans ME. Large health disparities in cardiovascular death in men and women, by ethnicity and socioeconomic status in an urban based population cohort. EClinicalMedicine 2021; 40:101120. [PMID: 34485880 PMCID: PMC8408518 DOI: 10.1016/j.eclinm.2021.101120] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/11/2021] [Accepted: 08/17/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Socioeconomic status and ethnicity are not incorporated as predictors in country-level cardiovascular risk charts on mainland Europe. The aim of this study was to quantify the sex-specific cardiovascular death rates stratified by ethnicity and socioeconomic factors in an urban population in a universal healthcare system. METHODS Age-standardized death rates (ASDR) were estimated in a dynamic population, aged 45-75 in the city of The Hague, the Netherlands, over the period 2007-2018, using data of Statistics Netherlands. Results were stratified by sex, ethnicity (country of birth) and socioeconomic status (prosperity) and compared with a European cut-off for high-risk countries (ASDR men 225/100,000 and women 175/100,000). FINDINGS In total, 3073 CVD deaths occurred during 1·76 million person years follow-up. Estimated ASDRs (selected countries of birth) ranged from 126 (95%CI 89-174) in Moroccan men to 379 (95%CI 272-518) in Antillean men, and from 86 (95%CI 50-138) in Moroccan women to 170 (95%CI 142-202) in Surinamese women. ASDRs in the highest and lowest prosperity quintiles were 94 (95%CI 90-98) and 343 (95%CI 334-351) for men, and 43 (95%CI 41-46) and 140 (95%CI 135-145), for women, respectively. INTERPRETATION In a diverse urban population, large health disparities in cardiovascular ASDRs exists across ethnic and socioeconomic subgroups. Identifying these high-risk subgroups followed by targeted preventive efforts, might provide a basis for improving cardiovascular health equity within communities. Instead of classifying countries as high-risk or low-risk, a shift towards focusing on these subgroups within countries might be needed. FUNDING Leiden University Medical Center and Leiden University.
Collapse
Affiliation(s)
- Janet M. Kist
- Department of Public Health & Primary Care, Leiden University Medical Center, Campus The Hague, the Netherlands
- Corresponding author.
| | - Gideon W.G. Smit
- Department of Public Health & Primary Care, Leiden University Medical Center, Campus The Hague, the Netherlands
| | - Albert T.A. Mairuhu
- Department of Internal Medicine, HAGA Teaching Hospital, The Hague, the Netherlands
| | - Jeroen N. Struijs
- Department of Public Health & Primary Care, Leiden University Medical Center, Campus The Hague, the Netherlands
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Rimke C. Vos
- Department of Public Health & Primary Care, Leiden University Medical Center, Campus The Hague, the Netherlands
| | - Petra G. van Peet
- Department of Public Health & Primary Care, Leiden University Medical Center, Campus The Hague, the Netherlands
| | - Hedwig M.M. Vos
- Department of Public Health & Primary Care, Leiden University Medical Center, Campus The Hague, the Netherlands
| | | | - Yvo W.J. Sijpkens
- Department Internal Medicine, HMC Hospital, The Hague, the Netherlands
| | - Rolf H.H. Groenwold
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, the Netherlands
| | - Mattijs E. Numans
- Department of Public Health & Primary Care, Leiden University Medical Center, Campus The Hague, the Netherlands
| |
Collapse
|
15
|
de Vries EF, Scheefhals ZT, de Bruin-Kooistra M, Baan CA, Struijs JN. A Scoping Review of Alternative Payment Models in Maternity Care: Insights in Key Design Elements and Effects on Health and Spending. Int J Integr Care 2021; 21:6. [PMID: 33981187 PMCID: PMC8086739 DOI: 10.5334/ijic.5535] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 01/19/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Although effects of alternative payment models on health outcomes and health spending are unclear, they are increasingly implemented in maternity care. We aimed to provide an overview of alternative payment models implemented in maternity care, describing their key design elements among which the type of APM, the care providers that participate in the model, populations and care services that are included and the applied risk mitigation strategies. Next to that, we made an inventory of the empirical evidence on the effects of APMs on maternal and neonatal health outcomes and spending on maternity care. METHODS We searched PubMed, Embase and Scopus databases for articles published from January 2007 through October 2020. Search key words included 'alternative payment model', 'value based payment model', 'obstetric', 'maternity'. English or Dutch language articles were included if they described or empirically evaluated initiatives implementing alternative payment models in maternity care in high-income countries. Additional relevant documents were identified through reference tracking. We systematically analyzed the initiatives found and examined the evidence regarding health outcomes and health spending. The process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) to ensure validity and reliability. RESULTS We identified 17 initiatives that implemented alternative payment models in maternity care. Thirteen in the United States, two in the United Kingdom, one in New Zealand and one in the Netherlands. Within these initiatives three types of alternative payment models were implemented; pay-for-performance (n = 2), shared savings models (n = 7) and bundled payment models (n = 8). Alternative payment models that shifted more financial accountability towards providers seemed to include more strategies that mitigated those risks. Risk mitigation strategies were applied to the included population, included services or at the level of total expenditures. Of these seventeen initiatives, we found four empirical effect studies published in peer-reviewed journals. Three of them were of moderate quality and one weak. Two studies described an association of the alternative payment model with an improvement of specific health outcomes and two studies described a reduction in medical spending. CONCLUSIONS This study shows that key design elements of alternative payment models including risk mitigation strategies vary highly. Risk mitigation strategies seem to be relevant tools to increase APM uptake and protect providers from (initially) bearing too much (perceived) financial risk. Empirical evidence on the effects of APMs on health outcomes and spending is still limited. A clear definition of key design elements and a further, in-depth, understanding of key design elements and how they operate into different health settings is required to shape payment reform that aligns with its goals.
Collapse
Affiliation(s)
- Eline F. de Vries
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University
- Department of Quality of Care and Health Economics, Center of Prevention, Nutrition and Health Services Research, National Institute for Public Health and the Environment; Mailing address: PO Box 1, 3720 BA Bilthoven, the Netherlands
| | - Zoë T.M. Scheefhals
- Department of Quality of Care and Health Economics, Center of Prevention, Nutrition and Health Services Research, National Institute for Public Health and the Environment; Mailing address: PO Box 1, 3720 BA Bilthoven, the Netherlands
- Department for Public Health and Primary Care, LUMC Campus The Hague, Leiden University Medical Center
| | - Mieneke de Bruin-Kooistra
- Department of Quality of Care and Health Economics, Center of Prevention, Nutrition and Health Services Research, National Institute for Public Health and the Environment; Mailing address: PO Box 1, 3720 BA Bilthoven, the Netherlands
| | - Caroline A. Baan
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University
- Ministry of Health, Welfare and Sport; the Netherlands
| | - Jeroen N. Struijs
- Department of Quality of Care and Health Economics, Center of Prevention, Nutrition and Health Services Research, National Institute for Public Health and the Environment; Mailing address: PO Box 1, 3720 BA Bilthoven, the Netherlands
- Department for Public Health and Primary Care, LUMC Campus The Hague, Leiden University Medical Center
| |
Collapse
|
16
|
Eggleston K, Chen BK, Chen CH, Chen YI, Feenstra T, Iizuka T, Lam JTK, Leung GM, Lu JFR, Rodriguez-Sanchez B, Struijs JN, Quan J, Newhouse JP. Are quality-adjusted medical prices declining for chronic disease? Evidence from diabetes care in four health systems. Eur J Health Econ 2020; 21:689-702. [PMID: 32078719 DOI: 10.1007/s10198-020-01164-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
Improvements in medical treatment have contributed to rising health spending. Yet there is relatively little evidence on whether the spending increase is "worth it" in the sense of producing better health outcomes of commensurate value-a critical question for understanding productivity in the health sector and, as that sector grows, for deriving an accurate quality-adjusted price index for an entire economy. We analyze individual-level panel data on medical spending and health outcomes for 123,548 patients with type 2 diabetes in four health systems: Japan, The Netherlands, Hong Kong and Taiwan. Using a "cost-of-living" method that measures value based on improved survival, we find a positive net value of diabetes care: the value of improved survival outweighs the added costs of care in each of the four health systems. This finding is robust to accounting for selective survival, end-of-life spending, and a range of values for a life-year or fraction of benefits attributable to medical care. Since the estimates do not include the value from improved quality of life, they are conservative. We, therefore, conclude that the increase in medical spending for management of diabetes is offset by an increase in quality.
Collapse
Affiliation(s)
| | | | | | | | - Talitha Feenstra
- National Institute for Public Health and Environment and University of Groningen, Groningen, The Netherlands
| | | | - Janet Tin Kei Lam
- University of Hong Kong, Patrick Manson Building, 7 Sassoon Road, Hong Kong SAR, China
| | - Gabriel M Leung
- University of Hong Kong, Patrick Manson Building, 7 Sassoon Road, Hong Kong SAR, China
| | | | | | - Jeroen N Struijs
- National Institute for Public Health and Environment and Leiden University Medical Center, Campus The Hague, The Hague, The Netherlands
| | - Jianchao Quan
- University of Hong Kong, Patrick Manson Building, 7 Sassoon Road, Hong Kong SAR, China.
| | | |
Collapse
|
17
|
Lambooij MS, Veldwijk J, van Gils PF, Suijkerbuijk AWM, Struijs JN. Trading patients' choice in providers for quality of maternity care? A discrete choice experiment amongst pregnant women. PLoS One 2020; 15:e0232098. [PMID: 32330182 PMCID: PMC7182251 DOI: 10.1371/journal.pone.0232098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The introduction of bundled payment for maternity care, aimed at improving the quality of maternity care, may affect pregnant women's choice in providers of maternity care. This paper describes a Dutch study which examined pregnant women's preferences when choosing a maternity care provider. The study focused on factors that enhance the quality of maternity care versus (restricted) provider choice. METHODS A discrete choice experiment was conducted amongst 611 pregnant women living in the Netherlands using an online questionnaire. The data were analysed with Latent Class Analyses. The outcome measure consisted of stated preferences in the discrete choice experiment. Included factors were: information exchange by care providers through electronic medical records, information provided by midwife, information provided by friends, freedom to choose maternity care provider and travel distance. RESULTS Four different preference structures were found. In two of those structures, respondents found aspects of the maternity care related to quality of care more important than being able to choose a provider (provider choice). In the two other preference structures, respondents found provider choice more important than aspects related to quality of maternity care. CONCLUSIONS In a country with presumed high-quality maternity care like the Netherlands, about half of pregnant women prefer being able to choose their maternity care provider over organisational factors that might imply better quality of care. A comparable amount of women find quality-related aspects most important when choosing a maternity care provider and are willing to accept limitations in their choice of provider. These insights are relevant for policy makers in order to be able to design a bundled payment model which justify the preferences of all pregnant women.
Collapse
Affiliation(s)
- Mattijs S. Lambooij
- Centre of Food, National Institute for Public Health and the Environment, Prevention and Health care (VPZ), Bilthoven, the Netherlands
| | - Jorien Veldwijk
- Erasmus Choice Modelling Center (ECMC), Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Paul F. van Gils
- Centre of Food, National Institute for Public Health and the Environment, Prevention and Health care (VPZ), Bilthoven, the Netherlands
| | - Anita W. M. Suijkerbuijk
- Centre of Food, National Institute for Public Health and the Environment, Prevention and Health care (VPZ), Bilthoven, the Netherlands
| | - Jeroen N. Struijs
- Centre of Food, National Institute for Public Health and the Environment, Prevention and Health care (VPZ), Bilthoven, the Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center Campus The Hague, Leiden, the Netherlands
| |
Collapse
|
18
|
Quanjel TCC, Spreeuwenberg MD, Struijs JN, Baan CA, Ruwaard D. Substituting hospital-based outpatient cardiology care: The impact on quality, health and costs. PLoS One 2019; 14:e0217923. [PMID: 31150520 PMCID: PMC6544378 DOI: 10.1371/journal.pone.0217923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 05/21/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Many Western countries face the challenge of providing high-quality care while keeping the healthcare system accessible and affordable. In an attempt to deal with this challenge a new healthcare delivery model called primary care plus (PC+) was introduced in the Netherlands. Within the PC+ model, medical specialists perform consultations in a primary care setting. PC+ aims to support the general practitioners in gatekeeping and prevent unnecessary referrals to hospital care. The aim of this study was to examine the effects of a cardiology PC+ intervention on the Triple Aim outcomes, which were operationalized by patient-perceived quality of care, health-related quality of life (HRQoL) outcomes, and healthcare costs per patient. METHODS This is a quantitative study with a longitudinal observational design. The study population consisted of patients, with non-acute and low-complexity cardiology-related health complaints, who were referred to the PC+ centre (intervention group) or hospital-based outpatient care (control group; care-as-usual). Patient-perceived quality of care and HRQoL (EQ-5D-5L, EQ-VAS and SF-12) were measured through questionnaires at three different time points. Healthcare costs per patient were obtained from administrative healthcare data and patients were followed for nine months. Chi-square tests, independent t-tests and multilevel linear models were used to analyse the data. RESULTS The patient-perceived quality of care was significantly higher within the intervention group for 26 out of 27 items. HRQoL outcomes did significantly increase in both groups (P <0.05) but there was no significant interaction between group and time. At baseline and also at three, six and nine months' follow-up the healthcare costs per patient were significantly lower for patients in the intervention group (P<0.001). CONCLUSIONS While this study showed no improvements on HRQoL outcomes, PC+ seemed to be promising as it results in improved quality of care as experienced by patients and lower healthcare costs per patient.
Collapse
Affiliation(s)
- Tessa C. C. Quanjel
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Marieke D. Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
| | - Jeroen N. Struijs
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department for Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Caroline A. Baan
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
19
|
Struijs JN, Hargreaves DS. Turning a crisis into a policy opportunity: lessons learned so far and next steps in the Dutch early years strategy. Lancet Child Adolesc Health 2019; 3:66-68. [PMID: 30660207 DOI: 10.1016/s2352-4642(18)30384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Jeroen N Struijs
- Netherlands National Institute for Public Health and Environment, Bilthoven, Netherlands; Department of Public Health and Primary Care, Campus The Hague, Leiden University Medical Center, The Hague, Netherlands
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London W6 6RP, UK.
| |
Collapse
|
20
|
Hendrikx RJP, Spreeuwenberg MD, Drewes HW, Struijs JN, Ruwaard D, Baan CA. Harvesting the wisdom of the crowd: using online ratings to explore care experiences in regions. BMC Health Serv Res 2018; 18:801. [PMID: 30342518 PMCID: PMC6195971 DOI: 10.1186/s12913-018-3566-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background Regional population health management (PHM) initiatives need an understanding of regional patient experiences to improve their services. Websites that gather patient ratings have become common and could be a helpful tool in this effort. Therefore, this study explores whether unsolicited online ratings can provide insight into (differences in) patient’s experiences at a (regional) population level. Methods Unsolicited online ratings from the Dutch website Zorgkaart Nederland (year = 2008–2017) were used. Patients rated their care providers on six dimensions from 1 to 10 and these ratings were geographically aggregated based on nine PHM regions. Distributions were explored between regions. Multilevel analyses per provider category, which produced Intraclass Correlation Coefficients (ICC), were performed to determine clustering of ratings of providers located within regions. If ratings were clustered, then this would indicate that differences found between regions could be attributed to regional characteristics (e.g. demographics or regional policy). Results In the nine regions, 70,889 ratings covering 4100 care providers were available. Overall, average regional scores (range = 8.3–8.6) showed significant albeit small differences. Multilevel analyses indicated little clustering between unsolicited provider ratings within regions, as the regional level ICCs were low (ICC pioneer site < 0.01). At the provider level, all ICCs were above 0.11, which showed that ratings were clustered. Conclusions Unsolicited online provider-based ratings are able to discern (small) differences between regions, similar to solicited data. However, these differences could not be attributed to the regional level, making unsolicited ratings not useful for overall regional policy evaluations. At the provider level, ratings can be used by regions to identify under-performing providers within their regions.
Collapse
Affiliation(s)
- Roy J P Hendrikx
- Tranzo Scientific Center for Care and Welfare, Research Centre for Technology in Care, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands. .,Department for Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, PO Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - Marieke D Spreeuwenberg
- Zuyd University of Applied Sciences, PO Box 550, 6400, AN, Heerlen, The Netherlands.,Department of Health Services Research, Care and Public Health Research Institute (CAPHRI) , Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Hanneke W Drewes
- Department for Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, PO Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Jeroen N Struijs
- Department for Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, PO Box 1, 3720, BA, Bilthoven, The Netherlands.,Department of Public Health and Primary Care, LUMC Campus, Schouwburgstraat 2, 2522, VA, The Hague, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI) , Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands
| | - Caroline A Baan
- Tranzo Scientific Center for Care and Welfare, Research Centre for Technology in Care, Tilburg University, PO Box 90153, 5000, LE, Tilburg, The Netherlands.,Department for Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, PO Box 1, 3720, BA, Bilthoven, The Netherlands
| |
Collapse
|
21
|
Quanjel TCC, Struijs JN, Spreeuwenberg MD, Baan CA, Ruwaard D. Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands. BMC Fam Pract 2018; 19:55. [PMID: 29743021 PMCID: PMC5941471 DOI: 10.1186/s12875-018-0734-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/18/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. METHODS This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. RESULTS In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. CONCLUSIONS To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. TRIAL REGISTRATION NUMBER NTR6629 (Data registered: 25-08-2017) (registered retrospectively).
Collapse
Affiliation(s)
- Tessa C. C. Quanjel
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jeroen N. Struijs
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Marieke D. Spreeuwenberg
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Caroline A. Baan
- Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
22
|
Quanjel TCC, Winkens A, Spreeuwenberg MD, Struijs JN, Winkens RAG, Baan CA, Ruwaard D. Does an in-house internist at a GP practice result in reduced referrals to hospital-based specialist care? Scand J Prim Health Care 2018; 36:99-106. [PMID: 29376458 PMCID: PMC5901446 DOI: 10.1080/02813432.2018.1426147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 01/03/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Consistent evidence on the effects of specialist services in the primary care setting is lacking. Therefore, this study evaluated the effects of an in-house internist at a GP practice on the number of referrals to specialist care in the hospital setting. Additionally, the involved GPs and internist were asked to share their experiences with the intervention. DESIGN A retrospective interrupted times series study. SETTING Two multidisciplinary general practitioner (GP) practices. INTERVENTION An internist provided in-house patient consultations in two GP practices and participated in the multidisciplinary meetings. SUBJECTS The referral data extracted from the electronic medical record system of the GP practices, including all referral letters from the GPs to specialist care in the hospital setting. MAIN OUTCOME MEASURES The number of referrals to internal medicine in the hospital setting. This study used an autoregressive integrated moving average model to estimate the effect of the intervention taking account of a time trend and autocorrelation among the observations, comparing the pre-intervention period with the intervention period. RESULTS It was found that the referrals to internal medicine did not statistically significant decrease during the intervention period. CONCLUSIONS This small explorative study did not find any clues to support that an in-house internist at a primary care setting results in a decrease of referrals to internal medicine in the hospital setting. Key Points An in-house internist at a primary care setting did not result in a significant decrease of referrals to specialist care in the hospital setting. The GPs and internist experience a learning-effect, i.e. an increase of knowledge about internal medicine issues.
Collapse
Affiliation(s)
- Tessa C. C. Quanjel
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Anne Winkens
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marieke D. Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Jeroen N. Struijs
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department for Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ron A. G. Winkens
- Diagnostic Centre, Maastricht University Medical Centre (Maastricht UMC+), Maastricht, The Netherlands
| | - Caroline A. Baan
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
23
|
Spreeuwenberg M, Drewes HW, Struijs JN, Ruwaard D, Baan CA, Hendrikx R. Harvesting the wisdom of the crowd: creating insight in regional care experiences using web ratings. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - HW Drewes
- Zuyd University, Heerlen, Netherlands
| | - JN Struijs
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - D Ruwaard
- Maastricht University, Maastricht, Netherlands
| | - CA Baan
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - R Hendrikx
- National Institute for Public Health and the Environment, Bilthoven, Netherlands
| |
Collapse
|
24
|
Quanjel TCC, Spreeuwenberg MD, Struijs JN, Baan CA, Ruwaard D. Evaluating a Dutch cardiology primary care plus intervention on the Triple Aim outcomes: study design of a practice-based quantitative and qualitative research. BMC Health Serv Res 2017; 17:628. [PMID: 28874148 PMCID: PMC5585935 DOI: 10.1186/s12913-017-2580-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 08/29/2017] [Indexed: 01/17/2023] Open
Abstract
Background In an attempt to deal with the pressures on the health-care system and to guarantee sustainability, changes are needed. This study focuses on a cardiology primary care plus intervention. Primary care plus (PC+) is a new health-care delivery model focused on substitution of specialist care in the hospital setting with specialist care in the primary care setting. The intervention consists of a cardiology PC+ centre in which cardiologists, supported by other health-care professionals, provide consultations in a primary care setting. The PC+ centre aims to improve the health of the population and quality of care as experienced by patients, and reduce the number of referrals to hospital-based outpatient specialist care in order to reduce health-care costs. These aims reflect the Triple Aim principle. Hence, the objectives of the study are to evaluate the cardiology PC+ centre in terms of the Triple Aim outcomes and to evaluate the process of the introduction of PC+. Methods/Design The study is a practice-based, quantitative study with a longitudinal observational design, and an additional qualitative study to supplement, interpret and improve the quantitative study. The study population of the quantitative part will consist of adult patients (≥18 years) with non-acute and low-complexity cardiology-related health complaints, who will be referred to the cardiology PC+ centre (intervention group) or hospital-based outpatient cardiology care (control group). All eligible patients will be asked to complete questionnaires at three different time points consisting of questions about their demographics, health status and experience of care. Additionally, quantitative data will be collected about health-care utilization and related health-care costs at the PC+ centre and the hospital. The qualitative part, consisting of semi-structured interviews, focus groups, and observations, is designed to evaluate the process as well as to amplify, clarify and explain quantitative results. Conclusions This study will evaluate a cardiology PC+ centre using quantitative and supplementary qualitative methods. The findings of both sub-studies will fill a gap in knowledge about the effects of PC+ and in particular whether PC+ is able to pursue the Triple Aim outcomes. Trial registration NTR6629 (Data registered: 25-08-2017) (registered retrospectively). Electronic supplementary material The online version of this article (10.1186/s12913-017-2580-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tessa C C Quanjel
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands. .,Research Centre for Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands.
| | - Jeroen N Struijs
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Caroline A Baan
- Department for Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, P.O. Box 1, 3720 BA, Bilthoven, The Netherlands.,Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands
| |
Collapse
|
25
|
Steenkamer BM, Drewes HW, Heijink R, Baan CA, Struijs JN. Defining Population Health Management: A Scoping Review of the Literature. Popul Health Manag 2017; 20:74-85. [DOI: 10.1089/pop.2015.0149] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Betty M. Steenkamer
- Tilburg University, Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg, Netherlands
| | - Hanneke W. Drewes
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, Department of Quality of Care and Health Economics, Bilthoven, Netherlands
| | - Richard Heijink
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, Department of Quality of Care and Health Economics, Bilthoven, Netherlands
| | - Caroline A. Baan
- Tilburg University, Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg, Netherlands
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, Department of Quality of Care and Health Economics, Bilthoven, Netherlands
| | - Jeroen N. Struijs
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, Department of Quality of Care and Health Economics, Bilthoven, Netherlands
| |
Collapse
|
26
|
Hargreaves DS, Struijs JN, Schuster MA. US Children And Adolescents Had Fewer Annual Doctor And Dentist Contacts Than Their Dutch Counterparts, 2010-12. Health Aff (Millwood) 2017; 34:2113-20. [PMID: 26643632 DOI: 10.1377/hlthaff.2015.0709] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Children and adolescents in the United States have been found to be less healthy than their counterparts in other high-income countries. The contribution of pediatric health care use to health outcomes--either as an independent determinant or as a mediator of wider social factors--is not well understood. We found that, compared to their peers in the Netherlands, US children and adolescents had fewer annual doctor and dental contacts in 2012. In both countries, poorer health status was reported among low-income compared to high-income children; however, this status was accompanied by greater or equal number of doctor and dental contacts among low-income Dutch children compared to their higher-income Dutch peers. By contrast, low-income US children had 28-65 percent fewer care episodes than high-income US children. Further research is needed to investigate the potential impact of greater equity and use of pediatric services on US health outcomes. Possible policy responses might include a focus on improving the quality, coverage, and benefits of health insurance, as well as on the workforce implications of providing high-quality pediatric care to all.
Collapse
Affiliation(s)
- Dougal S Hargreaves
- Dougal S. Hargreaves is an associate professor in the Population, Policy, and Practice program at the Institute of Child Health, University College London, in England
| | - Jeroen N Struijs
- Jeroen N. Struijs is a senior researcher in the Department of Quality of Care and Health Economics at the National Institute of Public Health and the Environment (RIVM), in Bilthoven, the Netherlands
| | - Mark A Schuster
- Mark A. Schuster is the William Berenberg Professor of Pediatrics at Harvard Medical School and chief of the Division of General Pediatrics and vice chair for health policy in the Department of Medicine at Boston Children's Hospital, in Massachusetts
| |
Collapse
|
27
|
Mohnen SM, Molema CCM, Steenbeek W, van den Berg MJ, de Bruin SR, Baan CA, Struijs JN. [Cost variation in care groups?]. Ned Tijdschr Geneeskd 2017; 161:D701. [PMID: 28294924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Is the simple mean of the costs per diabetes patient a suitable tool with which to compare care groups? Do the total costs of care per diabetes patient really give the best insight into care group performance? DESIGN Cross-sectional, multi-level study. METHOD The 2009 insurance claims of 104,544 diabetes patients managed by care groups in the Netherlands were analysed. The data were obtained from Vektis care information centre. For each care group we determined the mean costs per patient of all the curative care and diabetes-specific hospital care using the simple mean method, then repeated it using the 'generalized linear mixed model'. We also calculated for which proportion the differences found could be attributed to the care groups themselves. RESULTS The mean costs of the total curative care per patient were €3,092 - €6,546; there were no significant differences between care groups. The mixed model method resulted in less variation (€2,884 - €3,511), and there were a few significant differences. We found a similar result for diabetes-specific hospital care and the ranking position of the care groups proved to be dependent on the method used. The care group effect was limited, although it was greater in the diabetes-specific hospital costs than in the total costs of curative care (6.7% vs. 0.4%). CONCLUSION The method used to benchmark care groups carries considerable weight. Simply stated, determining the mean costs of care (still often done) leads to an overestimation of the differences between care groups. The generalized linear mixed model is more accurate and yields better comparisons. However, the fact remains that 'total costs of care' is a faulty indicator since care groups have little impact on them. A more informative indicator is 'costs of diabetes-specific hospital care' as these costs are more influenced by care groups.
Collapse
Affiliation(s)
- S M Mohnen
- * Dit onderzoek werd eerder gepubliceerd in Health Services Research (16 maart 2016, doi:10.1111/1475-6773.12483) met als titel 'Cost variation in diabetes care across Dutch care groups'. Afgedrukt met toestemming
| | | | | | | | | | | | | |
Collapse
|
28
|
de Vries EF, Struijs JN, Heijink R, Hendrikx RJP, Baan CA. Are low-value care measures up to the task? A systematic review of the literature. BMC Health Serv Res 2016; 16:405. [PMID: 27539054 PMCID: PMC4990838 DOI: 10.1186/s12913-016-1656-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 08/10/2016] [Indexed: 01/24/2023] Open
Abstract
Background Reducing low-value care is a core component of healthcare reforms in many Western countries. A comprehensive and sound set of low-value care measures is needed in order to monitor low-value care use in general and in provider-payer contracts. Our objective was to review the scientific literature on low-value care measurement, aiming to assess the scope and quality of current measures. Methods A systematic review was performed for the period 2010–2015. We assessed the scope of low-value care recommendations and measures by categorizing them according to the Classification of Health Care Functions. Additionally, we assessed the quality of the measures by 1) analysing their development process and the level of evidence underlying the measures, and 2) analysing the evidence regarding the validity of a selected subset of the measures. Results Our search yielded 292 potentially relevant articles. After screening, we selected 23 articles eligible for review. We obtained 115 low-value care measures, of which 87 were concentrated in the cure sector, 25 in prevention and 3 in long-term care. No measures were found in rehabilitative care and health promotion. We found 62 measures from articles that translated low-value care recommendations into measures, while 53 measures were previously developed by institutions as the National Quality Forum. Three measures were assigned the highest level of evidence, as they were underpinned by both guidelines and literature evidence. Our search yielded no information on coding/criterion validity and construct validity for the included measures. Despite this, most measures were already used in practice. Conclusion This systematic review provides insight into the current state of low-value care measures. It shows that more attention is needed for the evidential underpinning and quality of these measures. Clear information about the level of evidence and validity helps to identify measures that truly represent low-value care and are sufficiently qualified to fulfil their aims through quality monitoring and in innovative payer-provider contracts. This will contribute to creating and maintaining the support of providers, payers, policy makers and citizens, who are all aiming to improve value in health care. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1656-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Eline F de Vries
- Department Tranzo (Scientific Center for Care and Welfare), Tilburg University, Tilburg School of Social and Behavioral Sciences, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands.
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, National Institute of Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Richard Heijink
- Department of Quality of Care and Health Economics, National Institute of Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands
| | - Roy J P Hendrikx
- Department Tranzo (Scientific Center for Care and Welfare), Tilburg University, Tilburg School of Social and Behavioral Sciences, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands
| | - Caroline A Baan
- Department Tranzo (Scientific Center for Care and Welfare), Tilburg University, Tilburg School of Social and Behavioral Sciences, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands.,Department of Quality of Care and Health Economics, National Institute of Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands
| |
Collapse
|
29
|
Mohnen SM, Molema CC, Steenbeek W, van den Berg MJ, de Bruin SR, Baan CA, Struijs JN. Cost Variation in Diabetes Care across Dutch Care Groups? Health Serv Res 2016; 52:93-112. [PMID: 26997514 DOI: 10.1111/1475-6773.12483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The introduction of bundled payment for diabetes care in the Netherlands led to the origination of care groups. This study explored to what extent variation in health care costs per patient can be attributed to the performance of care groups. Furthermore, the commonly applied simple mean aggregation was compared with the more advanced generalized linear mixed model (GLMM) to benchmark health care costs per patient between care groups. DATA SOURCE Dutch 2009 nationwide insurance claims data of diabetes type 2 patients (104,544 patients, 50 care groups). STUDY DESIGN Both a simple mean aggregation and a GLMM approach was applied to rank care groups, using two different health care costs variables: total treatment health care costs and diabetes-specific specialist care costs per diabetes patient. PRINCIPAL FINDINGS Care groups varied slightly in the first and mainly in the second indicator. Care group variation was not explained by composition. Although the ranking methods were correlated, some care groups' rank positions differed, with consequences on the top-10 and the low-10 positions. CONCLUSIONS Differences between care groups exist when an appropriate indicator and a sophisticated aggregation technique is used. Currently applied benchmarking may have unfair consequences for some care groups.
Collapse
Affiliation(s)
- Sigrid M Mohnen
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention, and Health Services, Bilthoven, the Netherlands
| | - Claudia C Molema
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention, and Health Services, Bilthoven, the Netherlands
| | - Wouter Steenbeek
- Netherlands Institute for the Study of Crime and Law Enforcement (NSCR), Amsterdam, the Netherlands
| | - Michael J van den Berg
- National Institute for Public Health and the Environment (RIVM), Centre for Health and Society, Bilthoven, the Netherlands
| | - Simone R de Bruin
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention, and Health Services, Bilthoven, the Netherlands
| | - Caroline A Baan
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention, and Health Services, Bilthoven, the Netherlands.,Scientific Centre for Transformation in Care and Welfare (Tranzo), University of Tilburg, Tilburg, the Netherlands
| | - Jeroen N Struijs
- National Institute for Public Health and the Environment (RIVM), Centre for Nutrition, Prevention, and Health Services, Bilthoven, the Netherlands
| |
Collapse
|
30
|
Hendrikx RJP, Drewes HW, Spreeuwenberg M, Ruwaard D, Struijs JN, Baan CA. Which Triple Aim related measures are being used to evaluate population management initiatives? An international comparative analysis. Health Policy 2016; 120:471-85. [PMID: 27066729 DOI: 10.1016/j.healthpol.2016.03.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 03/07/2016] [Accepted: 03/11/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Population management (PM) initiatives are introduced in order to create sustainable health care systems. These initiatives should focus on the continuum of health and well-being of a population by introducing interventions that integrate various services. To be successful they should pursue the Triple Aim, i.e. simultaneously improve population health and quality of care while reducing costs per capita. This study explores how PM initiatives measure the Triple Aim in practice. METHOD An exploratory search was combined with expert consultations to identify relevant PM initiatives. These were analyzed based on general characteristics, utilized measures and related selection criteria. RESULTS In total 865 measures were used by 20 PM initiatives. All quality of care domains were included by at least 11 PM initiatives, while most domains of population health and costs were included by less than 7 PM initiatives. Although their goals showed substantial overlap, the measures applied showed few similarities between PM initiatives and were predominantly selected based on local priority areas and data availability. CONCLUSION Most PM initiatives do not measure the full scope of the Triple Aim. Additionally, variety between measures limits comparability between PM initiatives. Consensus on the coverage of Triple Aim domains and a set of standardized measures could further both the inclusion of the various domains as well as the comparability between PM initiatives.
Collapse
Affiliation(s)
- Roy J P Hendrikx
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE Tilburg, The Netherlands.
| | - Hanneke W Drewes
- National Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health Services, Department for Quality of Care and Health Economics, PO Box 1, 3720 BA Bilthoven, The Netherlands.
| | - Marieke Spreeuwenberg
- Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Department of Health Services Research, PO Box 616, 6200 MD Maastricht, The Netherlands; Zuyd University of Applied Sciences, Research Centre for Technology in Care, PO Box 550, 6400 AN Heerlen, The Netherlands.
| | - Dirk Ruwaard
- Maastricht University, Faculty of Health, Medicine and Life Sciences, CAPHRI School for Public Health and Primary Care, Department of Health Services Research, PO Box 616, 6200 MD Maastricht, The Netherlands.
| | - Jeroen N Struijs
- National Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health Services, Department for Quality of Care and Health Economics, PO Box 1, 3720 BA Bilthoven, The Netherlands.
| | - Caroline A Baan
- Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, PO Box 90153, 5000 LE Tilburg, The Netherlands; National Institute for Public Health and the Environment, Center for Nutrition, Prevention and Health Services, Department for Quality of Care and Health Economics, PO Box 1, 3720 BA Bilthoven, The Netherlands.
| |
Collapse
|
31
|
Hayen AP, van den Berg MJ, Meijboom BR, Struijs JN, Westert GP. Incorporating shared savings programs into primary care: from theory to practice. BMC Health Serv Res 2015; 15:580. [PMID: 26715151 PMCID: PMC4696086 DOI: 10.1186/s12913-015-1250-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/19/2015] [Indexed: 11/30/2022] Open
Abstract
Background In several countries, health care policies gear toward strengthening the position of primary care physicians. Primary care physicians are increasingly expected to take accountability for overall spending and quality. Yet traditional models of paying physicians do not provide adequate incentives for taking on this new role. Under a so-called shared savings program physicians are instead incentivized to take accountability for spending and quality, as the program lets them share in cost savings when quality targets are met. We provide a structured approach to designing a shared savings program for primary care, and apply this approach to the design of a shared savings program for a Dutch chain of primary care providers, which is currently being piloted. Methods Based on the literature, we defined five building blocks of shared savings models that encompass the definition of the scope of the program, the calculation of health care expenditures, the construction of a savings benchmark, the assessment of savings and the rules and conditions under which savings are shared. We apply insights from a variety of literatures to assess the relative merits of alternative design choices within these building blocks. The shared savings program uses an econometric model of provider expenditures as an input to calculating a casemix-corrected benchmark. Results The minimization of risk and uncertainty for both payer and provider is pertinent to the design of a shared savings program. In that respect, the primary care setting provides a number of unique opportunities for achieving cost and quality targets. Accountability can more readily be assumed due to the relatively long-lasting relationships between primary care physicians and patients. A stable population furthermore improves the confidence with which savings can be attributed to changes in population management. Challenges arise from the institutional context. The Dutch health care system has a fragmented structure and providers are typically small in size. Conclusion Shared savings programs fit the concept of enhanced primary care. Incorporating a shared savings program into existing payment models could therefore contribute to the financial sustainability of this organizational form. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1250-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Arthur P Hayen
- Tilburg School of Social and Behavioral Sciences, dpt. Tranzo (Scientific center for care and welfare), Tilburg University, Address: PO Box 90153, 5000, Tilburg, LE, The Netherlands. .,National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Address: PO Box, 3720, Bilthoven, BA, The Netherlands.
| | - Michael J van den Berg
- National Institute for Public Health and the Environment, Centre for Health and Society, Address: PO Box 1, 3720, Bilthoven, BA, The Netherlands.
| | - Bert R Meijboom
- Tilburg School of Economics and Management, dpt. CentER (Center for Economic Research), Tilburg University, Address: PO Box 90153, 5000, Tilburg, LE, The Netherlands.
| | - Jeroen N Struijs
- National Institute for Public Health and the Environment, Centre for Nutrition, Prevention and Health Services, Address: PO Box, 3720, Bilthoven, BA, The Netherlands.
| | - Gert P Westert
- IQ Healthcare (Scientific Institute for Quality of Healthcare), Radboud University Medical Center, Address: PO Box 9101, 114, 6500, Nijmegen, HB, The Netherlands.
| |
Collapse
|
32
|
Adriaanse MC, Drewes HW, van der Heide I, Struijs JN, Baan CA. The impact of comorbid chronic conditions on quality of life in type 2 diabetes patients. Qual Life Res 2015; 25:175-82. [PMID: 26267523 PMCID: PMC4706581 DOI: 10.1007/s11136-015-1061-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 12/13/2022]
Abstract
Objective To study the prevalence, impact and dose–response relationship of comorbid chronic conditions on quality of life of type 2 diabetes patients. Research design and methods Cross-sectional data of 1676 type 2 diabetes patients, aged 31–96 years, and treated in primary care, were analyzed. Quality of life (QoL) was measured using the mental component summary (MCS) and the physical component summary (PCS) scores of the Short Form-12. Diagnosis of type 2 diabetes was obtained from medical records and comorbidities from self-reports. Results Only 361 (21.5 %) of the patients reported no comorbidities. Diabetes patients with comorbidities showed significantly lower mean difference in PCS [−8.5; 95 % confidence interval (CI) −9.8 to −7.3] and MCS scores (−1.9; 95 % CI −3.0 to −0.9), compared to diabetes patients without. Additional adjustments did not substantially change these associations. Both MCS and PCS scores decrease significantly with the number of comorbid conditions, yet most pronounced regarding physical QoL. Comorbidities that reduced physical QoL most significantly were retinopathy, heart diseases, atherosclerosis in abdomen or legs, lung diseases, incontinence, back, neck and shoulder disorder, osteoarthritis and chronic rheumatoid arthritis, using the backwards stepwise regression procedure. Conclusion Comorbidities are highly prevalent among type 2 diabetes patients and have a negative impact on the patient’s QoL. A strong dose–response relationship between comorbidities and physical QoL was found. Reduced physical QoL is mainly determined by musculoskeletal and cardiovascular disorders.
Collapse
Affiliation(s)
- Marcel C Adriaanse
- Department of Health Sciences and EMGO Institute for Health and Care Research, VU University Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - Hanneke W Drewes
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Iris van der Heide
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jeroen N Struijs
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Caroline A Baan
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
33
|
Elissen AMJ, Struijs JN, Baan CA, Ruwaard D. Estimating community health needs against a Triple Aim background: What can we learn from current predictive risk models? Health Policy 2015; 119:672-9. [PMID: 25542080 DOI: 10.1016/j.healthpol.2014.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 11/11/2014] [Accepted: 12/04/2014] [Indexed: 11/16/2022]
Affiliation(s)
- Arianne M J Elissen
- Maastricht University, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Duboisdomein 30, 6229GT Maastricht, The Netherlands.
| | - Jeroen N Struijs
- Harvard School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115, United States; National Institute for Public Health and the Environment, Centre of Nutrition, Prevention and Health Services, Antonie van Leeuwenhoeklaan 9, 3721MA Bilthoven, The Netherlands.
| | - Caroline A Baan
- National Institute for Public Health and the Environment, Centre of Nutrition, Prevention and Health Services, Antonie van Leeuwenhoeklaan 9, 3721MA Bilthoven, The Netherlands.
| | - Dirk Ruwaard
- Maastricht University, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Duboisdomein 30, 6229GT Maastricht, The Netherlands.
| |
Collapse
|
34
|
Valentijn PP, Boesveld IC, van der Klauw DM, Ruwaard D, Struijs JN, Molema JJW, Bruijnzeels MA, Vrijhoef HJ. Towards a taxonomy for integrated care: a mixed-methods study. Int J Integr Care 2015; 15:e003. [PMID: 25759607 PMCID: PMC4353214 DOI: 10.5334/ijic.1513] [Citation(s) in RCA: 124] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/09/2015] [Accepted: 01/20/2015] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Building integrated services in a primary care setting is considered an essential important strategy for establishing a high-quality and affordable health care system. The theoretical foundations of such integrated service models are described by the Rainbow Model of Integrated Care, which distinguishes six integration dimensions (clinical, professional, organisational, system, functional and normative integration). The aim of the present study is to refine the Rainbow Model of Integrated Care by developing a taxonomy that specifies the underlying key features of the six dimensions. METHODS First, a literature review was conducted to identify features for achieving integrated service delivery. Second, a thematic analysis method was used to develop a taxonomy of key features organised into the dimensions of the Rainbow Model of Integrated Care. Finally, the appropriateness of the key features was tested in a Delphi study among Dutch experts. RESULTS The taxonomy consists of 59 key features distributed across the six integration dimensions of the Rainbow Model of Integrated Care. Key features associated with the clinical, professional, organisational and normative dimensions were considered appropriate by the experts. Key features linked to the functional and system dimensions were considered less appropriate. DISCUSSION This study contributes to the ongoing debate of defining the concept and typology of integrated care. This taxonomy provides a development agenda for establishing an accepted scientific framework of integrated care from an end-user, professional, managerial and policy perspective.
Collapse
Affiliation(s)
- Pim P Valentijn
- Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands
| | - Inge C Boesveld
- The Netherlands Expert Centre Integrated Primary Care, Jan van Es Institute, Almere, The Netherlands
| | | | - Dirk Ruwaard
- Public Health and Health Care Innovation, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - Jeroen N Struijs
- Department of Quality of Care and Health Economics, Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | | | - Marc A Bruijnzeels
- The Netherlands Expert Centre Integrated Primary Care, Jan van Es Institute, Almere, The Netherlands
| | - Hubertus Jm Vrijhoef
- Chronic Care, Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
35
|
Struijs JN, Drewes HW, Heijink R, Baan CA. How to evaluate population management? Transforming the Care Continuum Alliance population health guide toward a broadly applicable analytical framework. Health Policy 2014; 119:522-9. [PMID: 25516015 DOI: 10.1016/j.healthpol.2014.12.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 01/17/2023]
Abstract
Many countries face the persistent twin challenge of providing high-quality care while keeping health systems affordable and accessible. As a result, the interest for more efficient strategies to stimulate population health is increasing. A possible successful strategy is population management (PM). PM strives to address health needs for the population at-risk and the chronically ill at all points along the health continuum by integrating services across health care, prevention, social care and welfare. The Care Continuum Alliance (CCA) population health guide, which recently changed their name in Population Health Alliance (PHA) provides a useful instrument for implementing and evaluating such innovative approaches. This framework is developed for PM specifically and describes the core elements of the PM-concept on the basis of six subsequent interrelated steps. The aim of this article is to transform the CCA framework into an analytical framework. Quantitative methods are refined and we operationalized a set of indicators to measure the impact of PM in terms of the Triple Aim (population health, quality of care and cost per capita). Additionally, we added a qualitative part to gain insight into the implementation process of PM. This resulted in a broadly applicable analytical framework based on a mixed-methods approach. In the coming years, the analytical framework will be applied within the Dutch Monitor Population Management to derive transferable 'lessons learned' and to methodologically underpin the concept of PM.
Collapse
Affiliation(s)
- Jeroen N Struijs
- Harvard School of Public Health, Department of Health Management and Policy, United States; National Institute of Public Health and the Environment, Center for Nutrition, Prevention and Health Services, Department for Quality of Care and Health Economics, The Netherlands.
| | - Hanneke W Drewes
- National Institute of Public Health and the Environment, Center for Nutrition, Prevention and Health Services, Department for Quality of Care and Health Economics, The Netherlands
| | - Richard Heijink
- National Institute of Public Health and the Environment, Center for Nutrition, Prevention and Health Services, Department for Quality of Care and Health Economics, The Netherlands
| | - Caroline A Baan
- National Institute of Public Health and the Environment, Center for Nutrition, Prevention and Health Services, Department for Quality of Care and Health Economics, The Netherlands
| |
Collapse
|
36
|
van der Heide I, Uiters E, Rademakers J, Struijs JN, Schuit AJ, Baan CA. Associations among health literacy, diabetes knowledge, and self-management behavior in adults with diabetes: results of a dutch cross-sectional study. J Health Commun 2014; 19 Suppl 2:115-131. [PMID: 25315588 DOI: 10.1080/10810730.2014.936989] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Various studies have examined the association between health literacy and self-management behavior, but few have explored ways through which this occurs. The present study examines to what extent health literacy is associated with diabetes self-management behavior and to what extent diabetes knowledge is a mechanism in this association. The study was based on cross-sectional data retrieved from patient registrations and questionnaires completed in 2010. The sample included 1,714 predominantly type 2 diabetes patients, with a mean age of 67 years. Diabetes self-management was indicated by HbA1c level, glucose self-control and self-reported monitoring of glucose levels, physical activity, and smoking. Multilevel analyses were applied based on multiple imputed data. Lower health literacy was significantly associated with less diabetes knowledge, higher HbA1c level, less self-control of glucose level, and less physical activity. Participants with more diabetes knowledge were less likely to smoke and more likely to control glucose levels. Diabetes knowledge was a mediator in the association between health literacy and glucose self-control and between health literacy and smoking. This study indicates that higher health literacy may contribute to participation in certain self-management activities, in some cases through diabetes knowledge. Diabetes knowledge and health literacy skills may be important targets for interventions promoting diabetes self-management.
Collapse
Affiliation(s)
- Iris van der Heide
- a Centre for Nutrition, Prevention and Health Services , National Institute for Public Health and the Environment , Bilthoven , The Netherlands
| | | | | | | | | | | |
Collapse
|
37
|
Veldwijk J, Lambooij MS, van Gils PF, Struijs JN, Smit HA, de Wit GA. Type 2 diabetes patients' preferences and willingness to pay for lifestyle programs: a discrete choice experiment. BMC Public Health 2013; 13:1099. [PMID: 24289831 PMCID: PMC3909291 DOI: 10.1186/1471-2458-13-1099] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 11/19/2013] [Indexed: 12/13/2022] Open
Abstract
Background Participation rates of lifestyle programs among type 2 diabetes mellitus (T2DM) patients are less than optimal around the globe. Whereas research shows notable delays in the development of the disease among lifestyle program participants. Very little is known about the relative importance of barriers for participation as well as the willingness of T2DM patients to pay for participation in such programs. The aim of this study was to identify the preferences of T2DM patients with regard to lifestyle programs and to calculate participants’ willingness to pay (WTP) as well as to estimate the potential participation rates of lifestyle programs. Methods A Discrete Choice Experiment (DCE) questionnaire assessing five different lifestyle program attributes was distributed among 1250 Dutch adults aged 35–65 years with T2DM, 391 questionnaires (31%) were returned and included in the analysis. The relative importance of the program attributes (i.e., meal plan, physical activity (PA) schedule, consultation structure, expected program outcome and out-of-pocket costs) was determined using panel-mixed logit models. Based on the retrieved attribute estimates, patients’ WTP and potential participation rates were determined. Results The out-of-pocket costs (β = −0.75, P < .001), consultation structure (β = −0.46, P < .001) and expected outcome (β = 0.72, P < .001) were the most important factors for respondents when deciding whether to participate in a lifestyle program. Respondents were willing to pay €128 per year for individual instead of group consultation and €97 per year for 10 kilograms anticipated weight loss. Potential participation rates for different lifestyle-program scenarios ranged between 48.5% and 62.4%. Conclusions When deciding whether to participate in a lifestyle program, T2DM patients are mostly driven by low levels of out-of-pocket costs. Thereafter, they prefer individual consultation and high levels of anticipated outcomes with respect to weight loss.
Collapse
Affiliation(s)
- Jorien Veldwijk
- National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1 (101), Bilthoven, BA 3720, The Netherlands.
| | | | | | | | | | | |
Collapse
|
38
|
de Bakker DH, Struijs JN, Baan CB, Raams J, de Wildt JE, Vrijhoef HJM, Schut FT. Early results from adoption of bundled payment for diabetes care in the Netherlands show improvement in care coordination. Health Aff (Millwood) 2012; 31:426-33. [PMID: 22323174 DOI: 10.1377/hlthaff.2011.0912] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In 2010 a bundled payment system for diabetes care, chronic obstructive pulmonary disease care, and vascular risk management was introduced in the Netherlands. Health insurers now pay a single fee to a contracting entity, the care group, to cover all of the primary care needed by patients with these chronic conditions. The initial evaluation of the program indicated that it improved the organization and coordination of care and led to better collaboration among health care providers and better adherence to care protocols. Negative consequences included dominance of the care group by general practitioners, large price variations among care groups that were only partially explained by differences in the amount of care provided, and an administrative burden caused by outdated information and communication technology systems. It is too early to draw conclusions about the effects of the new payment system on the quality or the overall costs of care. However, the introduction of bundled payments might turn out to be a useful step in the direction of risk-adjusted integrated capitation payments for multidisciplinary provider groups offering primary and specialty care to a defined group of patients.
Collapse
|
39
|
de Bruin SR, Baan CA, Struijs JN. Pay-for-performance in disease management: a systematic review of the literature. BMC Health Serv Res 2011; 11:272. [PMID: 21999234 PMCID: PMC3218039 DOI: 10.1186/1472-6963-11-272] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 10/14/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. METHODS A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. RESULTS Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. CONCLUSION The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs.
Collapse
Affiliation(s)
- Simone R de Bruin
- National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Caroline A Baan
- National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| | - Jeroen N Struijs
- National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
| |
Collapse
|
40
|
de Bruin SR, Heijink R, Lemmens LC, Struijs JN, Baan CA. Impact of disease management programs on healthcare expenditures for patients with diabetes, depression, heart failure or chronic obstructive pulmonary disease: A systematic review of the literature. Health Policy 2011; 101:105-21. [DOI: 10.1016/j.healthpol.2011.03.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 03/15/2011] [Accepted: 03/28/2011] [Indexed: 11/29/2022]
|
41
|
Affiliation(s)
- Jeroen N Struijs
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | | |
Collapse
|
42
|
van Gils PF, Lambooij MS, Flanderijn MHW, van den Berg M, de Wit GA, Schuit AJ, Struijs JN. Willingness to participate in a lifestyle intervention program of patients with type 2 diabetes mellitus: a conjoint analysis. Patient Prefer Adherence 2011; 5:537-46. [PMID: 22114468 PMCID: PMC3218115 DOI: 10.2147/ppa.s16854] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Several studies suggest that lifestyle interventions can be effective for people with, or at risk for, diabetes. The participation in lifestyle interventions is generally low. Financial incentives may encourage participation in lifestyle intervention programs. OBJECTIVE The main aim of this exploratory analysis is to study empirically potential effects of financial incentives on diabetes patients' willingness to participate in lifestyle interventions. One financial incentive is negative ("copayment") and the other incentive is positive ("bonus"). The key part of this research is to contrast both incentives. The second aim is to investigate the factors that influence participation in a lifestyle intervention program. METHODS Conjoint analysis techniques were used to empirically identify factors that influence willingness to participate in a lifestyle intervention. For this purpose diabetic patients received a questionnaire with descriptions of various forms of hypothetical lifestyle interventions. They were asked if they would be willing to participate in these hypothetical programs. RESULTS In total, 174 observations were rated by 46 respondents. Analysis showed that money was an important factor independently associated with respondents' willingness to participate. Receiving a bonus seemed to be associated with a higher willingness to participate, but having to pay was negatively associated with participation in the lifestyle intervention. CONCLUSION Conjoint analysis results suggest that financial considerations may influence willingness to participate in lifestyle intervention programs. Financial disincentives in the form of copayments might discourage participation. Although the positive impact of bonuses is smaller than the negative impact of copayments, bonuses could still be used to encourage willingness to participate.
Collapse
Affiliation(s)
- Paul F van Gils
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Correspondence: Paul F van Gils, Centre for Prevention and Health Services Research (pb 101), National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands, Tel +31 30 274 8581, Fax +31 30 274 4407, Email
| | - Mattijs S Lambooij
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Marloes HW Flanderijn
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - Matthijs van den Berg
- Centre for Public Health Forecasting, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| | - G Ardine de Wit
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Albertine J Schuit
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
- Department of Health Sciences, EMGO Institute for Health and Care Research, VU University, Amsterdam, the Netherlands
| | - Jeroen N Struijs
- Centre for Prevention and Health Services Research, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
| |
Collapse
|
43
|
Struijs JN, van Genugten MLL, Evers SMAA, Ament AJH, Baan CA, van den Bos GAM. Future costs of stroke in the Netherlands: The impact of stroke services. Int J Technol Assess Health Care 2006; 22:518-24. [PMID: 16984687 DOI: 10.1017/s0266462306051464] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives: In the next decades, the number of stroke patients is expected to increase. Furthermore, organizational changes, such as stroke services, are expected to be implemented on a large scale. The purpose of this study is to estimate the future healthcare costs by taking into account the expected increase of stroke patients and a nationwide implementation of stroke services.Methods: By means of a dynamic multistate life table, the total number of stroke patients can be projected. The model calculates the annual number of patients by age and gender. The total healthcare costs are calculated by multiplying the average healthcare costs specified by age, gender, and healthcare sector with the total number of stroke patients specified by age and gender.Results: In the year 2000, the healthcare costs for stroke amounted to €1.62 billion. This amount is approximately 4.4 percent of the total national healthcare budget. Projections of the total costs of stroke based on current practice result in an increase of 28 percent (€2.08 billion) in the year 2020. A nationwide implementation of stroke services in 2020 would result in a substantial reduction of the costs of stroke (€1.81 billion: 13 percent cost reduction) compared with the regular care scenario.Conclusions: A nationwide implementation of stroke services is a strong policy tool for cost containment of health care in an aging population like that in the Netherlands. Policy makers should optimize the organization of stroke care.
Collapse
Affiliation(s)
- Jeroen N Struijs
- Centre for Prevention and Health Services Research, National Institute of Public Health and the Environment, Bilthoven, The Netherlands.
| | | | | | | | | | | |
Collapse
|
44
|
Struijs JN, Baan CA, Schellevis FG, Westert GP, van den Bos GAM. Comorbidity in patients with diabetes mellitus: impact on medical health care utilization. BMC Health Serv Res 2006; 6:84. [PMID: 16820048 PMCID: PMC1534031 DOI: 10.1186/1472-6963-6-84] [Citation(s) in RCA: 141] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Accepted: 07/04/2006] [Indexed: 11/10/2022] Open
Abstract
Background Comorbidity has been shown to intensify health care utilization and to increase medical care costs for patients with diabetes. However, most studies have been focused on one health care service, mainly hospital care, or limited their analyses to one additional comorbid disease, or the data were based on self-reported questionnaires instead of health care registration data. The purpose of this study is to estimate the effects a broad spectrum of of comorbidities on the type and volume of medical health care utilization of patients with diabetes. Methods By linking general practice and hospital based registrations in the Netherlands, data on comorbidity and health care utilization of patients with diabetes (n = 7,499) were obtained. Comorbidity was defined as diabetes-related comorbiiabetes-related comorbidity. Multilevel regression analyses were applied to estimate the effects of comorbidity on health care utilization. Results Our results show that both diabetes-related and non diabetes-related comorbidity increase the use of medical care substantially in patients with diabetes. Having both diabeterelated and non diabetes-related comorbidity incrases the demand for health care even more. Differences in health care utilization patterns were observed between the comorbidities. Conclusion Non diabetes-related comorbidity increases the health care demand as much as diabetes-related comorbidity. Current single-disease approach of integrated diabetes care should be extended with additional care modules, which must be generic and include multiple diseases in order to meet the complex health care demands of patients with diabetes in the future.
Collapse
Affiliation(s)
- Jeroen N Struijs
- Department for Prevention and Health Services Research, National Institute of Public Health and the Environment, A.van Leeuwenhoekstraat 9, 3720 BA Bilthoven, The Netherlands
| | - Caroline A Baan
- Department for Prevention and Health Services Research, National Institute of Public Health and the Environment, A.van Leeuwenhoekstraat 9, 3720 BA Bilthoven, The Netherlands
| | - Francois G Schellevis
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118 – 124 3513 CR Utrecht, The Netherlands
| | - Gert P Westert
- Department for Prevention and Health Services Research, National Institute of Public Health and the Environment, A.van Leeuwenhoekstraat 9, 3720 BA Bilthoven, The Netherlands
| | - Geertrudis AM van den Bos
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| |
Collapse
|
45
|
Struijs JN, van Genugten MLL, Evers SMAA, Ament AJHA, Baan CA, van den Bos GAM. Modeling the future burden of stroke in The Netherlands: impact of aging, smoking, and hypertension. Stroke 2005; 36:1648-55. [PMID: 16002757 DOI: 10.1161/01.str.0000173221.37568.d2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE In the near future, the number of stroke patients and their related healthcare costs are expected to rise. The purpose of this study was to estimate this expected increase in stroke patients in the Netherlands. We sought to determine what the future developments in the number of stroke patients due to demographic changes and trends in the prevalence of smoking and hypertension in terms of the prevalence, incidence, and potential years of life lost might be. METHODS A dynamic, multistate life table was used, which combined demographic projections and existing stroke morbidity and mortality data. It projected future changes in the number of stroke patients in several scenarios for the Dutch population for the period 2000 to 2020. The model calculated the annual number of new patients by age and sex by using incidence rates, defined by age, sex, and major risk factors. The change in the annual number of stroke patients is the result of incident cases minus mortality numbers. RESULTS Demographic changes in the population suggest an increase of 27% in number of stroke patients per 1000 in 2020 compared with 2000. Extrapolating past trends in the prevalence of smoking behavior, hypertension, and stroke incidence resulted in an increase of 4%. CONCLUSIONS The number of stroke patients in the Netherlands will rise continuously until the year 2020. Our study demonstrates that a large part of this increase in the number of patients is an inevitable consequence of the aging of the population.
Collapse
Affiliation(s)
- Jeroen N Struijs
- Department for Prevention and Health Services Research, National Institute of Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, The Netherlands.
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
PURPOSE With the rapid international spread of interventions, there is a need to understand the economic implications of these changes and to interpret these economic implications on the international level. The purpose of this study is to systematically compare total health care expenditures on stroke, the costs of stroke per capita, and the distribution of stroke costs within different countries, with special attention to the allocation of resources among different health care facilities. METHODS Studies for this literature review were selected by conducting a literature search from January 1966 to July 2003. Key methodological, country-related, and monetary issues of the selected stroke cost studies were evaluated using a checklist. RESULTS After selection, 25 stroke cost studies were reviewed. Although the selected cost of illness studies used different methodologies, the estimated expenditures for stroke are approximately similar. The proportion of national health care in the 8 countries studied is unequivocal for the more recent studies, ie, approximately 3% of total health care expenditures. A shift is observed from the inpatient treatment costs (in the first year) toward outpatient treatment and long-term care costs (in the latter years). Furthermore, it is remarkable that in the studies, little attention is paid to costs borne by the patient and family or to the costs of comorbidity. CONCLUSIONS This study highlights the importance of studying the economic consequences of stroke and of interpreting the results on the international level. The results of stroke cost studies provide insight into the distribution of the costs of stroke and the impact of stroke on the national expenditure on health care.
Collapse
Affiliation(s)
- Silvia M A A Evers
- Care and Public Health Research Institute (CAPHRI) of Maastricht University, Maastricht University, Faculty of Health Sciences, Maastricht, The Netherlands.
| | | | | | | | | | | |
Collapse
|