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Pei J, Meng J, Xue Y, Zhang L. Disease Experience of Patients With Differentiated Thyroid Cancer at Different Phases Based on Timing It Right Framework: A Qualitative Longitudinal Study. Cancer Nurs 2024; 47:388-396. [PMID: 36907952 DOI: 10.1097/ncc.0000000000001233] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND As the incidence of differentiated thyroid cancer (DTC) continues to rise globally, it is important to gain insight into the disease experience of cancer patients at different phases of the disease. However, surveys addressing the longitudinal disease experience and specific needs of this population are lacking. OBJECTIVE The aim of this study was to explore the disease experience of people with DTC at key time points in their cancer trajectory so support can be rendered for "patient-centered" supportive care services. METHODS On the basis of the Timing It Right framework, a semistructured in-depth interview was conducted with 14 patients with DTC at 5 key phases from initial diagnosis to 6 months postoperatively, and data were analyzed using the Colaizzi 7-step analysis. RESULTS The themes of disease experience at different phases were as follows: (1) diagnostic phase: differences in acceptance; (2) perioperative phase: physical and mental distress; (3) discharge preparation phase: anxiety and helplessness, and gap of disease knowledge; (4) discharge adjustment phase: fear of recurrence and proactive health; and (5) discharge adaptation phase: multiple needs. CONCLUSION The experience, care needs, and nature of the needs of patients with DTC change dynamically with the different phases of the disease. Capturing the most appropriate time throughout the continuum of care to implement supportive care that patients need most will help to improve the continuity and precision of cancer care. IMPLICATIONS FOR PRACTICE Healthcare providers should provide a continuum of dynamic care by scientifically and systematically assessing the actual supportive care needs of patients with DTC according to their different phases of disease.
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Affiliation(s)
- Jiaqin Pei
- Author Affiliations: School of Nursing, Nanjing University of Chinese Medicine (Mss Pei, Meng, and Xue); and Department of Nursing, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine (Ms Zhang)
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Mathew NV, Liu C, Khalil H. Factors associated with health CEO turnover - a scoping review. BMC Health Serv Res 2024; 24:861. [PMID: 39075443 PMCID: PMC11288093 DOI: 10.1186/s12913-024-11246-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/25/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Chief Executive Officer's (CEO) are integral leaders of health care organisation. Over the last two decades in United States (US) hospitals, it has been noted that CEO turnover rates are increasing, and it was reported that the CEO turnover rates have augmented from 14% in 2008 to 18% in 2017 in the private sector. In Australia, it was discovered that during two years, 41 executives had 18 distinct positions. It has been highlighted that the increasing CEO turnover is a major issue for Australian and international health care organisations. Some of the negative consequences of CEO turnover include organisational instability, high financial costs, loss of human capital and adverse effects on staff morale and patient care. OBJECTIVE Our scoping review aimed to map and summarise the evidence associated with CEO turnovers in both health and non-health setting, and answer the following questions: 1. What are the reasons for CEO departure?, 2. What are the strategies to minimise CEO turnover? RESULTS A protocol explaining the objectives, inclusion criteria and methods for this scoping review were specified in advance and published. This scoping review included 17 studies (13 health and 4 non-health setting) published over a 31-year period that investigated and described the increasing CEO turnover rates. All 17 studies identified causes of CEO turnover along with certain studies identifying facilitators of CEO retention. We classified CEO's departure reasons into three major themes: organizational, performance, and personal. Organisational factors include CEO departures due to issues within the organisation, performance factors include issues with CEO's work and personal factors captures personal reasons for CEO's leaving their job. CONCLUSION CEOs are under immense pressure to deliver good results and drive growth while satisfying the interests of internal and external stakeholders. There are various reasons for CEO's departure however the most common factor identified is organisational.
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Affiliation(s)
| | - Chaojie Liu
- La Trobe University, Melbourne, VIC, 3086, Australia
| | - Hanan Khalil
- La Trobe University, Melbourne, VIC, 3086, Australia
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Appel KS, Lee CH, Nunes de Miranda SM, Maier D, Reese JP, Anton G, Bahmer T, Ballhausen S, Balzuweit B, Bellinghausen C, Blumentritt A, Brechtel M, Chaplinskaya-Sobol I, Erber J, Fiedler K, Geisler R, Heyder R, Illig T, Kohls M, Kollek J, Krist L, Lorbeer R, Miljukov O, Mitrov L, Nürnberger C, Pape C, Pley C, Schäfer C, Schaller J, Schattschneider M, Scherer M, Schulze N, Stahl D, Stubbe HC, Tamminga T, Tebbe JJ, Vehreschild MJGT, Wiedmann S, Vehreschild JJ. A precise performance-based reimbursement model for the multi-centre NAPKON cohorts - development and evaluation. Sci Rep 2024; 14:13607. [PMID: 38871878 PMCID: PMC11176345 DOI: 10.1038/s41598-024-63945-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/03/2024] [Indexed: 06/15/2024] Open
Abstract
Fair allocation of funding in multi-centre clinical studies is challenging. Models commonly used in Germany - the case fees ("fixed-rate model", FRM) and up-front staffing and consumables ("up-front allocation model", UFAM) lack transparency and fail to suitably accommodate variations in centre performance. We developed a performance-based reimbursement model (PBRM) with automated calculation of conducted activities and applied it to the cohorts of the National Pandemic Cohort Network (NAPKON) within the Network of University Medicine (NUM). The study protocol activities, which were derived from data management systems, underwent validation through standardized quality checks by multiple stakeholders. The PBRM output (first funding period) was compared among centres and cohorts, and the cost-efficiency of the models was evaluated. Cases per centre varied from one to 164. The mean case reimbursement differed among the cohorts (1173.21€ [95% CI 645.68-1700.73] to 3863.43€ [95% CI 1468.89-6257.96]) and centres and mostly fell short of the expected amount. Model comparisons revealed higher cost-efficiency of the PBRM compared to FRM and UFAM, especially for low recruitment outliers. In conclusion, we have developed a reimbursement model that is transparent, accurate, and flexible. In multi-centre collaborations where heterogeneity between centres is expected, a PBRM could be used as a model to address performance discrepancies.Trial registration: https://clinicaltrials.gov/ct2/show/NCT04768998 ; https://clinicaltrials.gov/ct2/show/NCT04747366 ; https://clinicaltrials.gov/ct2/show/NCT04679584 .
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Affiliation(s)
- Katharina S Appel
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany.
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany.
| | - Chin Huang Lee
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Susana M Nunes de Miranda
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Daniel Maier
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt/Mainz and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jens-Peter Reese
- University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for medical Data Science, Würzburg, Würzburg, Germany
| | - Gabriele Anton
- Medical School OWL, Bielefeld University, Bielefeld, Germany
| | - Thomas Bahmer
- Internal Medicine Department I, Pneumology Section, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
- German Center for Lung Research (DZL), Airway Research Center North (ARCN), Grosshansdorf, Germany
| | - Sabrina Ballhausen
- Internal Medicine Department I, Pneumology Section, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Beate Balzuweit
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Berlin, Germany
| | - Carla Bellinghausen
- Department I of Internal Medicine, Goethe University Frankfurt, University Hospital Frankfurt, Frankfurt, Germany
| | - Arne Blumentritt
- Independent Trusted Third Party of the University Medicine Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Markus Brechtel
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Irina Chaplinskaya-Sobol
- Department of Medical Informatics at the University Medical Center Göttingen, Göttingen, Germany
| | - Johanna Erber
- TUM School of Medicine and Health, Department of Clinical Medicine, Clinical Department for Internal Medicine II, Technical University of Munich, University Medical Center, Munich, Germany
| | - Karin Fiedler
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Ramsia Geisler
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Ralf Heyder
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NUM Coordination Office, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Illig
- Hannover Medical School, Hannover Unified Biobank, Hannover, Germany
| | - Mirjam Kohls
- University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
| | - Jenny Kollek
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Infectious Diseases, Respiratory Medicine and Critical Care, Clinical Trial Unit Berlin, Berlin, Germany
| | - Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roberto Lorbeer
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Department of Radiology, Ludwig-Maximilians-University Hospital, Munich, Germany
| | - Olga Miljukov
- University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for medical Data Science, Würzburg, Würzburg, Germany
| | - Lazar Mitrov
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Cologne, Germany
| | - Carolin Nürnberger
- University of Würzburg, Institute for Clinical Epidemiology and Biometry, Würzburg, Germany
- University Hospital Würzburg, Institute for medical Data Science, Würzburg, Würzburg, Germany
| | - Christian Pape
- Department of Medical Informatics at the University Medical Center Göttingen, Göttingen, Germany
| | - Christina Pley
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Clinical Trial Office, Berlin, Germany
| | - Christian Schäfer
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Jens Schaller
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Mario Schattschneider
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Margarete Scherer
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
| | - Nick Schulze
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany
| | - Dana Stahl
- Independent Trusted Third Party of the University Medicine Greifswald, Ellernholzstraße 1-2, 17475, Greifswald, Germany
| | - Hans Christian Stubbe
- Department of Medicine II, University Hospital, LMU Munich, Munich, Germany
- German Center for Infection Research (DZIF), Partner-Site Munich, Munich, Germany
| | - Thalea Tamminga
- Internal Medicine Department I, Pneumology Section, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Johannes Josef Tebbe
- Hospital Lippe, Department of Gastroenterology and Infectious Diseases, Lippe, Germany
- Bielefeld University, Medical School OWL, Bielefeld, Germany
| | - Maria J G T Vehreschild
- Goethe University Frankfurt, University Hospital Frankfurt, Department II of Infectious Diseases, Frankfurt, Germany
| | - Silke Wiedmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NUM Coordination Office, Charitéplatz 1, 10117, Berlin, Germany
| | - Jörg Janne Vehreschild
- Goethe University Frankfurt, University Hospital, Center for Internal Medicine, Medical Department 2 (Hematology/Oncology and Infectious Diseases), Theodor-Stern-Kai 7, 60596, Frankfurt, Germany.
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I for Internal Medicine, Cologne, Germany.
- German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany.
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Valentelyte G, Keegan C, Sorensen J. Hospital response to Activity-Based Funding and price incentives: Evidence from Ireland. Health Policy 2023; 137:104915. [PMID: 37741112 DOI: 10.1016/j.healthpol.2023.104915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/25/2023]
Abstract
Activity-Based Funding (ABF) is a funding policy incentivising hospitals to deliver more efficient care. ABF can be complemented by additional price incentives to further drive hospital efficiency. In 2016, ABF was introduced for public patients admitted to Irish public hospitals. Additionally, a price incentive to perform laparoscopic cholecystectomy as day-case surgery was introduced in 2018. Private patient activity in public hospitals was subject to neither ABF nor price incentive. Using national Hospital In-Patient-Enquiry activity data 2013-2019, we evaluated the impact of ABF and the price incentive for laparoscopic cholecystectomy surgery in Ireland. We exploit variation in hospital payment for public and private patients treated in public acute Irish hospitals and employ a Propensity Score Matching Difference-in-Differences approach. We estimate the funding change impacts across outcomes measuring the proportion of day-case admissions and length of stay. We found no significant impact for either outcomes linked to ABF introduction. Similarly, no impacts linked to the price incentive were observed. It appears providers of laparoscopic cholecystectomy in Irish public hospitals did not react to the new funding mechanisms. The implementation of the funding policies did not improve hospital efficiency. Further strengthening of these new funding mechanisms are required to deliver more efficient care.
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Affiliation(s)
- Gintare Valentelyte
- Structured Population and Health services Research Education (SPHeRE) Programme, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Healthcare Outcome Research Centre (HORC), School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Conor Keegan
- Economic and Social Research Institute (ESRI), Whitaker Square, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcome Research Centre (HORC), School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Stormon N, Do L, Hopcraft M, Sexton C. Geographic patterns of dental service use in the Child Dental Benefits Schedule: 6 years of claims in the Longitudinal Study of Australian Children. Health Promot J Austr 2023. [PMID: 37839800 DOI: 10.1002/hpja.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/04/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
ISSUE ADDRESSED This article explores the geographic patterns of claims within the Australian Government's Child Dental Benefits Schedule (CDBS). BACKGROUND The CDBS is a means-tested schedule implemented in 2014 to improve access to dental services for children. Under the schedule, eligible children receive funding to subsidise dental services. METHODS This study used data from the Longitudinal Study of Australian Children and linked data from the Medicare universal healthcare system, to examine dental service use amongst a subset of children aged 10 and 14 years. Dental service items were classified using Two-step Cluster Analysis, and appointments were analysed using multinomial logistic regression. Geographic characteristics were included as predictor variables. RESULTS The study found that the majority of dental appointments were non-operative (70.7%, n = 5808), with diagnostic, radiographic, and preventive items being the most common. There were slightly higher proportions of operative appointments (fillings and extractions) compared with non-operative appointments in remote and very remote areas, low socio-economic areas, and Queensland and Northern Territory. Cluster analysis identified eight groups of non-operative appointments and four groups of operative appointments. New South Wales had a higher proportion of 'prophylactic IV' appointments than any other State and Territory, which included debridement and topical fluoride services. CONCLUSION Cluster analysis identified distinct groups of non-operative and operative appointments, each with unique characteristics. The distribution of appointments varied by State/Territory and region. SO WHAT Further research and interventions are needed to ensure equitable access to services and a shift to preventive care for disadvantaged populations of Australian children. Exploring alternative funding models that support clinically relevant claims, rather than maximising financial benefits such as time-based renumeration models should be explored.
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Affiliation(s)
- Nicole Stormon
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
- Queensland Health, Metro North Health Service, Community and Oral Health, Brisbane, Queensland, Australia
| | - Loc Do
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Matthew Hopcraft
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
- eviDent Foundation, Melbourne, Victoria, Australia
| | - Christopher Sexton
- School of Dentistry, UQ Oral Health Centre, The University of Queensland, Brisbane, Queensland, Australia
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Carter HE, Allen MJ, Toohey LA, McPhail SM, Drew MK. Alternative Reimbursement Models for Health Providers in High-Performance Sport: Stakeholder Experiences and Perceptions. SPORTS MEDICINE - OPEN 2023; 9:53. [PMID: 37432643 DOI: 10.1186/s40798-023-00600-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Value-based healthcare provider reimbursement models have been proposed as an alternative to traditional fee-for-service arrangements that can align financial reimbursement more closely to the outcomes of value to patients and society. This study aimed to investigate stakeholder perceptions and experiences of different reimbursement systems for healthcare providers in high-performance sport, with a focus on fee-for-service versus salaried provider models. METHODS Three in-depth semi-structured focus group discussions and one individual interview were conducted with key stakeholders across the Australian high-performance sport system. Participants included healthcare providers, health managers, sports managers and executive personnel. An interview guide was developed using the Exploration, Preparation, Implementation, Sustainment framework, with key themes deductively mapped to the innovation, inner context and outer context domains. A total of 16 stakeholders participated in a focus group discussion or interview. RESULTS Participants identified several key advantages of salaried provider models over fee-for-service arrangements, including: the potential for more proactive and preventive models of care; enhanced inter-disciplinary collaboration; and the ability for providers to have a deeper understanding of context and how their role aligns with a broader set of priorities for an athlete and the organisation. Noted challenges of salaried provider models included the potential for providers to revert to reactive care delivery when not afforded adequate capacity to provide services, and difficulties for providers in demonstrating and quantifying the value of their work. CONCLUSIONS Our findings suggest that high-performance sporting organisations seeking to improve primary prevention and multidisciplinary care should consider salaried provider arrangements. Further research to confirm these findings using prospective, experimental study designs remains a priority.
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Affiliation(s)
- Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia.
| | - Michelle J Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
| | - Liam A Toohey
- Athlete Performance Health, Australian Institute of Sport, Canberra, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, Faculty of Health, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Ave, Kelvin Grove, QLD, 4059, Australia
- Digital Health and Informatics Directorate, Metro South Health, Brisbane, Australia
| | - Michael K Drew
- University of Canberra Research Institute for Sport and Exercise (UCRISE), Canberra, Australia
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Effects of performance based financing on facility autonomy and accountability: Evidence from Zambia. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2021.100061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Predicting the Annual Funding for Public Hospitals with Regression Analysis on Hospital’s Operating Costs: Evidence from the Greek Public Sector. Healthcare (Basel) 2022; 10:healthcare10091634. [PMID: 36141250 PMCID: PMC9498543 DOI: 10.3390/healthcare10091634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 12/01/2022] Open
Abstract
The funding of public hospitals is an issue that has been of great concern to health systems in the past decades. Public hospitals are owned and fully funded by the government, providing in most countries medical care to patients free of charge, covering expenses and wages by government reimbursement. Several studies in different countries have attempted to investigate the potential role and contribution of hospital and clinical data to their overall financial requirements. Many of them have suggested the necessity of implementing DRGs (Diagnosis Related Groups) and activity-based funding, whereas others identify flaws and difficulties with these methods. What was attempted in this study is to find an alternative way of estimating the necessary fundings for public hospitals, regardless the case mix managed by each of them, based on their characteristics (size, specialty, location, intensive care units, number of employees, etc.) and its annual output (patients, days of hospitalization, number of surgeries, laboratory tests, etc.). We used financial and operational data from 121 public hospitals in Greece for a 2-years period (2018–2019) and evaluated with regression analysis the contribution of descriptive and operational data in the total operational cost. Since we had repeated measures from the same hospitals over the years, we used methods suitable for longitudinal data analysis and developed a model for calculating annual operational costs with an R²≈0.95. The main conclusion is that the type of hospital in combination with the number of beds, the existence of an intensive care unit, the number of employees, the total number of inpatients, their days of hospitalization and the total number of laboratory tests are the key factors that determine the hospital’s operating costs. The significant implication of this model that emerged from this study is its potential to form the basis for a national system of economic evaluation of public hospitals and allocation of national resources for public health.
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Smith SL, Mockeridge BR, van Zundert AA. Demystifying the role of anaesthetists in clinical coding in the Australian healthcare system. Anaesth Intensive Care 2022; 50:480-488. [PMID: 35899791 DOI: 10.1177/0310057x221082665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the self-evident importance of hospital funding, many anaesthetists remain unsure of exactly how their daily work relates to hospital reimbursement. A lack of awareness of the nuances of the Australian hospital activity-based funding system has the potential to affect anaesthetic department reimbursement and thus resourcing. Activity-based funding relies on clinical coders reviewing clinical documentation and quantifying the care given to a patient during an admission. Errors in funding allocation may arise when there is a disconnect between the work performed and the information coded. In anaesthesia, there are several factors impeding this process, including clinical understanding of coding, system setup and coders' understanding of anaesthesia. This article explores these factors from the clinical anaesthetist's point of view and suggests solutions, such as awareness and education, clinician-coder cooperation and redesign of documentation systems at a systems level that anaesthetic departments can incorporate.
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Affiliation(s)
- Samuel L Smith
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Brydie R Mockeridge
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Department of Anaesthesia, Princess Alexandra Hospital, Woolloongabba, Australia
| | - André Aj van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
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Laberge M, Brundisini FK, Champagne M, Daniel I. Hospital funding reforms in Canada: a narrative review of Ontario and Quebec strategies. Health Res Policy Syst 2022; 20:76. [PMID: 35761397 PMCID: PMC9235246 DOI: 10.1186/s12961-022-00879-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background In the early 2000s, Ontario and Quebec, two provinces of Canada, began to introduce hospital payment reforms to improve quality and access to care. This paper (1) critically reviews patient-based funding (PBF) implementation approaches used by Quebec and Ontario over 15 years, and (2) identifies factors that support or limit PBF implementation to inform future decisions regarding the use of PBF models in both provinces. Methods We adopted a narrative review approach to document and critically analyse Quebec and Ontario experiences with the implementation of patient-based funding. We searched for documents in the scientific and grey literature and contacted key stakeholders to identify relevant policy documents. Results Both provinces targeted similar hospital services—aligned with nationwide policy goals—fulfilling in part patient-based funding programmes’ objectives. We identified four factors that played a role in ensuring the successful—or not—implementation of these strategies: (1) adoption supports, (2) alignment with programme objectives, (3) funding incentives and (4) stakeholder engagement. Conclusions This review provides lessons in the complexity of implementing hospital payment reforms. Implementation is enabled by adoption supports and funding incentives that align with policy objectives and by engaging stakeholders in the design of incentives.
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Affiliation(s)
- Maude Laberge
- Department of Operations and Decision Systems, Faculty of Administration, Université Laval, 2325, rue de la Terrasse, Bureau #2519, Quebec City, QC, G1V 0A6, Canada. .,Vitam, centre de recherche en santé durable, Université Laval, Quebec City, Canada. .,Centre de Recherche du CHU de Québec, Université Laval, Quebec City, Canada.
| | - Francesca Katherine Brundisini
- Department of Operations and Decision Systems, Faculty of Administration, Université Laval, 2325, rue de la Terrasse, Bureau #2519, Quebec City, QC, G1V 0A6, Canada.,Vitam, centre de recherche en santé durable, Université Laval, Quebec City, Canada
| | - Myriam Champagne
- Department of Operations and Decision Systems, Faculty of Administration, Université Laval, 2325, rue de la Terrasse, Bureau #2519, Quebec City, QC, G1V 0A6, Canada
| | - Imtiaz Daniel
- Institute of Health Policy, Management and Evaluation, University of Toronto Health Sciences Building, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada.,Ontario Hospital Association, Toronto, Canada
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Changing Invisible Landscapes - Financial Reform of Health and Care Systems: Ten Issues to Consider. Int J Integr Care 2021; 21:21. [PMID: 34824570 PMCID: PMC8603852 DOI: 10.5334/ijic.6461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
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Valentelyte G, Keegan C, Sorensen J. Analytical methods to assess the impacts of activity-based funding (ABF): a scoping review. HEALTH ECONOMICS REVIEW 2021; 11:17. [PMID: 34003386 PMCID: PMC8132407 DOI: 10.1186/s13561-021-00315-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/04/2021] [Indexed: 05/14/2023]
Abstract
BACKGROUND Activity-Based Funding (ABF) has been implemented across many countries as a means to incentivise efficient hospital care delivery and resource use. Previous reviews have assessed the impact of ABF implementation on a range of outcomes across health systems. However, no comprehensive review of the methods used to generate this evidence has been undertaken. The aim of this review is to identify and assess the analytical methods employed in research on ABF hospital performance outcomes. METHODS We conducted a scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Five academic databases and reference lists of included studies were used to identify studies assessing the impact of ABF on hospital performance outcomes. Peer-reviewed quantitative studies published between 2000 and 2019 considering ABF implementation outside the U.S. were included. Qualitative studies, policy discussions and commentaries were excluded. Abstracts and full text studies were double screened to ensure consistency. All analytical approaches and their relative strengths and weaknesses were charted and summarised. RESULTS We identified 19 studies that assessed hospital performance outcomes from introduction of ABF in England, Korea, Norway, Portugal, Israel, the Netherlands, Canada, Italy, Japan, Belgium, China, and Austria. Quasi-experimental methods were used across most reviewed studies. The most commonly used assessment methods were different forms of interrupted time series analyses. Few studies used difference-in-differences or similar methods to compare outcome changes over time relative to comparator groups. The main hospital performance outcome measures examined were case numbers, length of stay, mortality and readmission. CONCLUSIONS Non-experimental study designs continue to be the most widely used method in the assessment of ABF impacts. Quasi-experimental approaches examining the impact of ABF implementation on outcomes relative to comparator groups not subject to the reform should be applied where possible to facilitate identification of effects. These approaches provide a more robust evidence-base for informing future financing reform and policy.
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Affiliation(s)
- Gintare Valentelyte
- Structured Population and Health services Research Education (SPHeRE) Programme, Division of Population Health Sciences, Mercer Street Lower, Royal College of Surgeons in Ireland, Dublin, Ireland
- Healthcare Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conor Keegan
- Economic and Social Research Institute (ESRI), Whitaker Square, Dublin, Ireland
| | - Jan Sorensen
- Healthcare Outcome Research Centre (HORC), Royal College of Surgeons in Ireland, Dublin, Ireland
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Rodríguez-Fernández M, Herrera J, de las Heras-Rosas C. Model of Organizational Commitment Applied to Health Management Systems. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4496. [PMID: 33922667 PMCID: PMC8122969 DOI: 10.3390/ijerph18094496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/15/2021] [Accepted: 04/22/2021] [Indexed: 12/17/2022]
Abstract
In this paper, we try to build on the problems surrounding the management of human resources in health care organizations worldwide. After the analysis of the reviewed literature, we detected that the scientific community considers several recurring themes that need attention: stress, burnout, and turnover intention. Based on this, we developed a model of organizational commitment that aims to achieve performance and health quality, its main result the establishment of the appropriate management policies in order to avoid the abandonment of the organization through the search for commitment and job satisfaction. Amongst our main conclusions, we highlight the need to implement a human resources model for hospital administrators based on the relationships with "patients" not "clients" through the maintenance of a positive and strong atmosphere of staff participation. It is important to develop innovative practices related to clear job design that eliminate reasons for ambiguity and stress in executing the tasks of the healthcare system. Finally, we urge training programs in transformational leadership to promote the well-being and organizational commitment of employees.
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Affiliation(s)
| | - Juan Herrera
- Department of Economics and Business Administration, Universidad de Málaga, 29071 Málaga, Spain
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Mousaloo A, Amir-Behghadami M, Janati A, Gholizadeh M. Exploring the challenges and features of implementing performance-based payment plan in hospitals: a protocol for a systematic review. Syst Rev 2021; 10:114. [PMID: 33863372 PMCID: PMC8052724 DOI: 10.1186/s13643-021-01657-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 03/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementing performance-based payment (PBP) plan has led to developing a number of significant potentialities such as performance improvement and effectiveness, quality improvement of provided services, and decline in health system expenditure in hospitals. Despite the fact that PBP plan has a variety of potential advantages, its implementation still may face some challenges. Hence, it seems crucial to identify these barriers and challenges in order to devise some strategies and interventions to pave the way for better implementation of PBP in hospitals. The aim of this proposed protocol is to identify, summarize, and synthesize the existing evidence by undertaking a systematic review to explore the challenges, barriers, and features of implementing PBP in hospitals. METHODS AND ANALYSIS An inclusive search of the literature will be conducted in seven international and national databases including PubMed/MEDLINE, Scopus, Cochrane Library and Web of Science, Magiran, Scientific Information Database (SID), and Barakat knowledge network system (BKNS). The search will be limited to the studies published in English or Persian language. Database search will be supplemented by hand-search of citation, reference lists, and grey literature sources. Based on the pre-established criteria in all steps of the review, two researchers will independently screen all of the retrieved studies. Any discrepancies will be resolved through a discussion between two researchers. In cases where consensus is not reached, it will be referred to a third researcher. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). The data will be extracted by means of using a data extraction form, which will be developed and piloted by the research team. The findings will be synthesized through directed content analysis method. DISCUSSION With the growth and development of payment systems all over the world, it is expected that recognizing the challenges of implementing a PBP plan in hospitals will be useful in developing and designing strategies to better implement this plan. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42020152569.
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Affiliation(s)
- Asieh Mousaloo
- Student Research Committee (SRC), Tabriz University of Medical Sciences, Tabriz, Iran
- Iranian Center of Excellence in Health Management (IceHM), Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, University Rd, Golbad, EAZN, Tabriz, 5165665811, Iran
| | - Mehrdad Amir-Behghadami
- Student Research Committee (SRC), Tabriz University of Medical Sciences, Tabriz, Iran.
- Iranian Center of Excellence in Health Management (IceHM), Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, University Rd, Golbad, EAZN, Tabriz, 5165665811, Iran.
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Janati
- Student Research Committee (SRC), Tabriz University of Medical Sciences, Tabriz, Iran
- Iranian Center of Excellence in Health Management (IceHM), Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, University Rd, Golbad, EAZN, Tabriz, 5165665811, Iran
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoumeh Gholizadeh
- Student Research Committee (SRC), Tabriz University of Medical Sciences, Tabriz, Iran
- Iranian Center of Excellence in Health Management (IceHM), Department of Health Service Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, University Rd, Golbad, EAZN, Tabriz, 5165665811, Iran
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Alonazi WB. Identifying Healthcare Professional Roles in Developing Palliative Care: A Mixed Method. Front Public Health 2021; 9:615111. [PMID: 33748064 PMCID: PMC7966514 DOI: 10.3389/fpubh.2021.615111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background: Creating a holistic approach in healthcare services is the ultimate aim for the integrated healthcare system. Theoretically, healthcare policy makers constantly expected optimal operations within the hospitals through capitalizing the maximum potential of healthcare expertise, professionals, practitioners, and supporting staff. The objective of this study is to explore the role of healthcare individuals to sustain effective palliative care programs in a safe environment with high-quality of care. Methods: This study employed a mixed method (qualitative and quantitative) to accomplish the set objective. For this purpose, a balanced sampling technique was adopted and 28 healthcare professionals were selected in two stages (last week of January and the 1st week of February, 2020). These respondents were playing significant role in palliative care policy making process. In the first stage, respondents were classified into three parallel groups to document the major factors affecting palliative care reforms. To minimize the chance of individual biases, each group was supervised by an independent healthcare professional who was not involved in the study. Then, in the second stage, respondents were divided into two clusters for further abstraction of themes to analysis the data. In this phase, each group was comprised on 14 individuals. Data were transcribed, coded, and analyzed (subjectively and objectively) by using NVivo 12 to extract the final themes. These themes were described and analyzed quantitatively for further catchphrases abstraction to identify significant components. Findings: The initial results incorporated 36 key factors in building effective and sustained palliative healthcare centers. The domains were feasible and practical as they homogeneously patterned within cultural change. These were quality of care, effective management, institute of medicine criteria, and health governance. The Spearman correlation matrix showed significant relationships between the four critical components (P < 0.01 and P < 0.05). Conclusions: This study explored and identified the significant factors that healthcare professional might consider to make their role more productive and effective in palliative care centers. The key findings also indicated the need of comprehensive periodic assessment especially from the perspective of managerial implications and quality of care.
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Affiliation(s)
- Wadi B Alonazi
- King Saud University, Health Administration Department, Riyadh, Saudi Arabia
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Kjøstolfsen GH, Baheerathan J, Martinussen PE, Magnussen J. Financial incentives and patient selection: Hospital physicians' views on cream skimming and economic management focus in Norway. Health Policy 2020; 125:98-103. [PMID: 33208250 DOI: 10.1016/j.healthpol.2020.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/09/2020] [Accepted: 10/18/2020] [Indexed: 11/25/2022]
Abstract
This paper uses survey data to analyse physician views on the risk of cream skimming under a system with activity based financing (ABF) for hospital services. We used data from two nation-wide physician surveys. A survey undertaken in 2006 captures views following a large NPM-inspired structural reform in 2002. In contrast, a survey undertaken in 2016 captures views after a period of a higher degree of institutional and financial stability. We find that the majority of physicians believed that the 2002 reform both provided incentives for and led to more cream skimming. In 2016, however there is less consensus among physicians about the extent of cream skimming. Looking at different types of physicians we find some indications that physicians in leading positions are less likely to view cream skimming as a problem. However, there is concern that hospital management in general puts too much emphasis on economic issues.
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Affiliation(s)
- Gjertrud Hole Kjøstolfsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Janusha Baheerathan
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Pål E Martinussen
- Department of Sociology and Political Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jon Magnussen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Gualtieri AP, Yoo A, Philips MS, Bosco J, Slover J. Variability of patient and surgical risk factors for infection in a single, urban, academic total joint replacement center. J Orthop 2020; 19:178-183. [PMID: 32025129 DOI: 10.1016/j.jor.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/02/2019] [Indexed: 10/25/2022] Open
Abstract
Background We describe surgeon-specific patient and procedure variability in a single center to determine how much variability exists between surgeons. Methods Data was analyzed from 2009 to 2013 at a single center. The total number of primary and revision hip and knee arthroplasty surgeries were quantified for each surgeon. Results Surgeon caseload varied significantly, with the largest differences observed in primary TKA caseload. The largest patient differences were in regards to percentage of patients with diabetes mellitus amongst primary TKA patients. Conclusion Significant differences in patient characteristics that could significantly impact outcomes after total joint arthroplasty were found amongst surgeons.
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Affiliation(s)
- Anthony P Gualtieri
- New York University Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA
| | - Andrew Yoo
- University of California San Diego Department of Orthopedics, 350 Dickinson St, Suite 121, MC8894, San Diego, CA, 92103, USA
| | - Michael S Philips
- New York University Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA
| | - Joseph Bosco
- New York University Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA
| | - James Slover
- New York University Langone Orthopedic Hospital, 301 E 17th St, Suite 1402, New York, NY, 10003, USA
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Heslop L. Activity-based funding for safety and quality: A policy discussion of issues and directions for nursing-focused health services outcomes research. Int J Nurs Pract 2019; 25:e12775. [PMID: 31414554 PMCID: PMC9285712 DOI: 10.1111/ijn.12775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 06/25/2019] [Accepted: 07/17/2019] [Indexed: 12/19/2022]
Abstract
Aims A discussion of the implications and opportunities arising from the Commonwealth of Australia health care reform agenda; linking pricing with quality, with particular reference to directions for nursing‐focused health services outcomes research directed to improve the safety and quality of health care practices. Background National activity‐based funding in Australia is a policy‐focused development. As the relationship between cost and quality becomes apparent, the role of clinicians and their contribution to high quality care has become a pressing issue for leadership, teaching, and research. Design Discussion paper Data Sources This paper is based on seven years' experience as a member of a Commonwealth of Australia statutory committee—the Clinical Advisory Committee of the Independent Hospital Pricing Authority—and is supported by relevant literature and theory. Implications for Nursing To date, unravelling the linkage, especially causal relationships, between direct care nursing and patient safety outcomes has not been well established. New activity‐based funding data elements developed for national implementation in Australia provide accessible and meaningful standardised data for measurement of never events, hospital‐acquired complications, and preventable readmissions. What is already known about this topic?
The advancement of research directed towards finding causal associations attributing nursing interventions to patient outcomes has been constrained by, amongst other things, methodological challenges The attribution of nursing care interventions to specific patient‐related outcomes is difficult to isolate Investigating how nursing care interventions contribute to safety and quality health care outcomes is often referred to as the “black box” of nursing‐focused health services outcomes research
What this paper adds?
Research into the impact of nursing interventions on patient outcomes, such as hospital‐acquired complications, remains immature Activity‐based funding data provide safety and quality measures relevant to nursing‐focused health services outcomes research Building clinical‐decision support, based on the Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures, may assist nurses engage with quality improvement as nurses are likely to act on data relevant to their practice
The implications of this paper:
The Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures have enhanced data specifications, useful to support development of nursing‐focused health services outcomes research The potential for benchmarking of hospital‐acquired complications is high at least in Australia and in other countries that apply activity‐based funding models linked to ICD‐10‐AM codes
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Affiliation(s)
- Liza Heslop
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
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Ellegård LM, Glenngård AH. Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019838367. [PMID: 30983464 PMCID: PMC6466459 DOI: 10.1177/0046958019838367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022]
Abstract
Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body's use of other management controls did not change; (4) incentives bypassing the purchasing body's controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.
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Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica 24020, Italy
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica 24020, Italy
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Culhane-Pera KA, Ortega LM, Thao MS, Pergament SL, Pattock AM, Ogawa LS, Scandrett M, Satin DJ. Primary care clinicians' perspectives about quality measurements in safety-net clinics and non-safety-net clinics. Int J Equity Health 2018; 17:161. [PMID: 30404635 PMCID: PMC6222992 DOI: 10.1186/s12939-018-0872-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Quality metrics, pay for performance (P4P), and value-based payments are prominent aspects of the current and future American healthcare system. However, linking clinic payment to clinic quality measures may financially disadvantage safety-net clinics and their patient population because safety-net clinics often have worse quality metric scores than non-safety net clinics. The Minnesota Safety Net Coalition's Quality Measurement Enhancement Project sought to collect data from primary care providers' (PCPs) experiences, which could assist Minnesota policymakers and state agencies as they create a new P4P system. Our research study aims are to identify PCPs' perspectives about 1) quality metrics at safety net clinics and non-safety net clinics, 2) how clinic quality measures affect patients and patient care, and 3) how payment for quality measures may influence healthcare. METHODS Qualitative interviews with 14 PCPs (4 individual interviews and 3 focus groups) who had worked at both safety net and non-safety net primary care clinics in Minneapolis-St Paul Minnesota USA metropolitan area. Qualitative analyses identified major themes. RESULTS Three themes with sub-themes emerged. Theme #1: Minnesota's current clinic quality scores are influenced more by patients and clinic systems than by clinicians. Theme #2: Collecting data for a set of specific quality measures is not the same as measuring quality healthcare. Subtheme #2.1: Current quality measures are not aligned with how patients and clinicians define quality healthcare. Theme #3: Current quality measures are a product of and embedded in social and structural inequities in the American health care system. Subtheme #3.1: The current inequitable healthcare system should not be reinforced with financial payments. Subtheme #3.2: Health equity requires new metrics and a new healthcare system. Overall, PCPs felt that the current inequitable quality metrics should be replaced by different metrics along with major changes to the healthcare system that could produce greater health equity. CONCLUSION Aligning payment with the current quality metrics could perpetuate and exacerbate social inequities and health disparities. Policymakers should consider PCPs' perspectives and create a quality-payment framework that does not disadvantage patients who are affected by social and structural inequities as well as the clinics and providers who serve them.
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Affiliation(s)
| | - Luis Martin Ortega
- West Side Community Health Services, Inc., 895 E 7th St., Saint Paul, MN 55106 USA
| | - Mai See Thao
- Family and Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, PO Box 26509, Milwaukee, WI 53226 USA
| | - Shannon L. Pergament
- West Side Community Health Services, Inc., 895 E 7th St., Saint Paul, MN 55106 USA
| | - Andrew M. Pattock
- Department of Family and Community Medicine, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455 USA
| | - Lynne S. Ogawa
- West Side Community Health Services, Inc., 895 E 7th St., Saint Paul, MN 55106 USA
| | - Michael Scandrett
- Minnesota Health Care Safety Net Coalition, 1113 East Franklin Ave #202B, Minneapolis, MN 55404 USA
| | - David J. Satin
- Department of Family and Community Medicine, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455 USA
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Burau V, Dahl HM, Jensen LG, Lou S. Beyond Activity Based Funding. An experiment in Denmark. Health Policy 2018; 122:714-721. [DOI: 10.1016/j.healthpol.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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Practice variation and practice guidelines: Attitudes of generalist and specialist physicians, nurse practitioners, and physician assistants. PLoS One 2018; 13:e0191943. [PMID: 29385203 PMCID: PMC5792011 DOI: 10.1371/journal.pone.0191943] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 01/13/2018] [Indexed: 11/21/2022] Open
Abstract
Objective To understand clinicians' beliefs about practice variation and how variation might be reduced. Methods We surveyed board-certified physicians (N = 178), nurse practitioners (N = 60), and physician assistants (N = 12) at an academic medical center and two community clinics, representing family medicine, general internal medicine, and cardiology, from February—April 2016. The Internet-based questionnaire ascertained clinicians' beliefs regarding practice variation, clinical practice guidelines, and costs. Results Respondents agreed that practice variation should be reduced (mean [SD] 4.5 [1.1]; 1 = strongly disagree, 6 = strongly agree), but agreed less strongly (4.1 [1.0]) that it can realistically be reduced. They moderately agreed that variation is justified by situational differences (3.9 [1.2]). They strongly agreed (5.2 [0.8]) that clinicians should help reduce healthcare costs, but agreed less strongly (4.4 [1.1]) that reducing practice variation would reduce costs. Nearly all respondents (234/249 [94%]) currently depend on practice guidelines. Clinicians rated differences in clinician style and experience as most influencing practice variation, and inaccessibility of guidelines as least influential. Time to apply standards, and patient decision aids, were rated most likely to help standardize practice. Nurse practitioners and physicians assistants (vs physicians) and less experienced (vs senior) clinicians rated more favorably several factors that might help to standardize practice. Differences by specialty and academic vs community practice were small. Conclusions Clinicians believe that practice variation should be reduced, but are less certain that this can be achieved. Accessibility of guidelines is not a significant barrier to practice standardization, whereas more time to apply standards is viewed as potentially helpful.
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Ashley DW, Nicholas JM, Dente CJ, Johns TJ, Garlow LE, Solomon G, Abston D, Ferdinand CH. Successful Incorporation of Performance Based Payments for Trauma Center Readiness Costs into the Georgia Trauma System. Am Surg 2017. [DOI: 10.1177/000313481708300933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
As quality and outcomes have moved to the fore front of medicine in this era of healthcare reform, a state trauma system Performance Based Payments (PBP) program has been incorporated into trauma center readiness funding. The purpose of this study was to evaluate the impact of a PBP on trauma center revenue. From 2010 to 2016, a percentage of readiness costs funding to trauma centers was placed in a PBP and withheld until the PBP criteria were completed. To introduce the concept, only three performance criteria and 10 per cent of readiness costs funding were tied to PBP in 2010. The PBP has evolved over the last several years to now include specific criteria by level of designation with an increase to 50 per cent of readiness costs funding being tied to PBP criteria. Final PBP distribution to trauma centers was based on the number of performance criteria completed. During 2016, the PBP criteria for Level I and II trauma centers included participation in official state meetings/conference calls, required attendance to American College of Surgeons state chapter meetings, Trauma Quality Improvement Program, registry reports, and surgeon participation in Peer Review Committee and trauma alert response times. Over the seven-year study period, $36,261,469 was available for readiness funds with $11,534,512 eligible for the PBP. Only $636,383 (6%) was withheld from trauma centers. A performance-based program was successfully incorporated into trauma center readiness funding, supporting state performance measures without adversely affecting the trauma center revenue. Future PBP criteria may be aligned to designation standards and clinical quality performance metrics.
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Girault A, Bellanger M, Lalloué B, Loirat P, Moisdon JC, Minvielle E. Implementing hospital pay-for-performance: Lessons learned from the French pilot program. Health Policy 2017; 121:407-417. [PMID: 28189271 DOI: 10.1016/j.healthpol.2017.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/12/2017] [Accepted: 01/20/2017] [Indexed: 01/02/2023]
Abstract
Despite a wide implementation of pay-for-performance (P4P) programs, evidence on their impact in hospitals is still limited. Our objective was to assess the implementation of the French P4P pilot program (IFAQ1) across 222 hospitals. The study consisted of a questionnaire among four leaders in each enrolled hospital, combined with a qualitative analysis based on 33 semi-structured interviews conducted with staff in four participating hospitals. For the questionnaire results, descriptive statistics were performed and responses were analyzed by job title. For the interviews, transcripts were analysed using coding techniques. Survey results showed that leaders were mostly positive about the program and reported a good level of awareness, in contrast to the frontline staff, who remained mostly unaware of the program's existence. The main barriers were attributed to lack of clarity in program rules, and to time constraints. Different strategies were then suggested by leaders. The qualitative results added further explanations for low program adoption among hospital staff, so far. Ultimately, although paying for quality is still an intuitive approach; gaps in program awareness within enrolled hospitals may pose an important challenge to P4P efficacy. Implementation evaluations are therefore necessary for policymakers to better understand P4P adoption processes among hospitals.
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Affiliation(s)
- Anne Girault
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Martine Bellanger
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Benoît Lalloué
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Philippe Loirat
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Jean-Claude Moisdon
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Etienne Minvielle
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
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Gourieux B, Duvernoy T, Tissier F, Garassus P. Les réformes en faveur du paiement à la qualité en Europe : état des lieux, analyse et propositions. ACTA ACUST UNITED AC 2017. [DOI: 10.3917/jgem.176.0287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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