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Goh LH, Szücs A, Siah CJR, Lazarus MA, Tai ES, Valderas JM, Young DYL. Patient perspectives of diabetes care in primary care networks in Singapore: a mixed-methods study. BMC Health Serv Res 2023; 23:1445. [PMID: 38124081 PMCID: PMC10734143 DOI: 10.1186/s12913-023-10310-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/09/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) remains an important chronic condition worldwide requiring integrated patient-centred care as advocated by the Chronic Care Model (CCM). The Primary Care Networks (PCNs) in Singapore organise general practitioners (GPs) with nurses and care coordinators to deliver team-based care for patients with chronic conditions. This study examined the quality of care in the PCNs as defined by the CCM from the patients' perspective. METHODS This study followed a cross-sectional convergent mixed-method design with T2D patients across three PCN types (GP-led, Group, and Cluster). The Patient Assessment of Chronic Illness Care (PACIC, range 1-5) was completed by a convenience sample of 343 patients. Multivariate linear regression was performed to estimate the associations between patient and service characteristics and PACIC summary score. Twenty-four participants were purposively recruited for interviews on the experienced care until thematic saturation was reached. Quantitative and qualitative data were collected concurrently and independently. Integration occurred during study design and data analysis using the CCM as guidance. Quantitative and qualitative results were compared side-by-side in a joint comparison table to develop key concepts supported by themes, subthemes, and patients' quotes. RESULTS The PACIC mean summary score of 3.21 for 343 patients evidenced that some have received CCM consistent care in the PCNs. Being younger and spending more time with the GP were associated with higher PACIC summary scores. PACIC summary scores did not differ across PCN types. The 24 patients interviewed in the qualitative study reported receiving team-based care, nurse services, good continuity of care, as well as patient-centred care, convenient access, and affordable care. Key concepts showed that integrated care consistent with the CCM was sometimes received by patients in the PCNs. Patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling were sometimes received by patients, while follow-up/coordination was generally not received. CONCLUSIONS Patients with T2D from the Singapore Primary Care Networks received integrated care consistent with the Chronic Care Model, particularly in patient activation, delivery system design/decision support, goal setting/tailoring, and problem-solving/contextual counselling. Follow-up/coordination needed improvement to ensure higher quality of diabetes care.
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Affiliation(s)
- Lay Hoon Goh
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
| | - Anna Szücs
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Chiew Jiat Rosalind Siah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Clinical Research Centre, Block MD11, level 2, 10 Medical Drive, Singapore, 117597, Singapore
| | - Monica A Lazarus
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - E Shyong Tai
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 10, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Jose M Valderas
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
| | - Doris Yee Ling Young
- Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore
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Liao YS, Tsai WC, Chiu LT, Kung PT. Educational attainment affects the diagnostic time in type 2 diabetes mellitus and the mortality risk of those enrolled in the diabetes pay-for-performance program. Health Policy 2023; 138:104917. [PMID: 37776765 DOI: 10.1016/j.healthpol.2023.104917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/02/2023]
Abstract
Most patients are diagnosed as having diabetes only after experiencing diabetes complications. Educational attainment might have a positive relationship with diabetes prognosis. The diabetes pay-for-performance (P4P) program-providing comprehensive, continuous medical care-has improved diabetes prognosis in Taiwan. This retrospective cohort study investigated how educational attainment affects the presence of diabetes complications at diabetes diagnosis and mortality risk in patients with diabetes enrolled in the P4P program. From the National Health Insurance Research Database, we identified patients aged >45 years who had received a new diagnosis of type 2 diabetes during 2002-2015; they were followed up until the end of 2017. We next used logistic regression analysis to explore whether the patients with different educational attainments had varied diabetic complication risks at diabetes diagnosis. The Cox proportional hazard model was employed to examine the association of different educational attainments in people with diabetes with mortality risk after their enrollment in the P4P program. The results indicated that as educational attainment increased, the risk of diabetes complications at type 2 diabetes diagnosis decreased gradually. When type 2 diabetes with different educational attainments joined the P4P program, high school education had the highest effect on reducing mortality risk; however, those with ≤ 6th grade education had the lowest impact.
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Affiliation(s)
- Yi-Shu Liao
- Department of Pathology, Taichung Armed Forces General Hospital, National Defense Medical Center, Taiwan; Department of Public Health, China Medical University, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taiwan; Department of Medical Research, China Medical University Hospital, Taiwan.
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Chen YC, Liao YH, Ku LJE, Wang JD. Pay-for-performance and continuity of care synergistically reduced amputation of lower extremity in patients with diabetes: a population-based cohort study. BMC Health Serv Res 2022; 22:748. [PMID: 35659668 PMCID: PMC9167521 DOI: 10.1186/s12913-022-08075-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 05/11/2022] [Indexed: 12/14/2022] Open
Abstract
Abstracts
Background
Diabetic foot is a common and costly complication of diabetes. No existing study has looked at the effect of continuity of care on amputations of diabetes (DM) patients while considering pay-for-performance (P4P) participation. We investigated the impact of the P4P program and the continuity of care index (COCI) on the incidence of lower extremity amputations (LEA) among diabetics in Taiwan.
Methods
This was a population-based cohort study using insurance claims data from 1997 to 2013. We selected 15,650 DM patients in the P4P program along with age- and sex-matched non-P4P participants at a 1:4 ratio. Time-weighted average (TWA) of the COCI was calculated and included in the time-dependent Cox proportional hazard models to examine the impact of P4P and COCI on the risk of LEA, while controlling for individual and area level characteristics.
Results
During four-year follow-up, 1816 subjects experienced LEA. The cumulative LEA hazard rate of the P4P group (n = 153) was significantly lower than that of the non-P4P group (n = 1663) (hazard ratio = 0.37, 95% CI = 0.31–0.43, p < 0.0001, by log-rank test). In the time-dependent Cox proportional hazard model, the adjusted hazard ratios (aHR) for the P4P group was 0.35, (p < 0.0001). With the low COCI (< 0.360) group as the reference, the aHR of LEA was 0.49 (p < 0.0001) for the middle COCI group, (p < 0.0001), and the aHR of LEA for the high COCI (≥0.643) group was 0.23 (p < 0.0001).
Conclusions
Participating in the P4P program and increasing COCI might reduce the risk of amputation for DM patients, independently and synergistically.
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Nordin N, Hairon SM, Yaacob NM, Hamid AA, Isa SAM, Hassan N. Perceived quality of care among people with type 2 diabetes mellitus in the north east region of peninsular Malaysia. BMC Public Health 2021; 21:268. [PMID: 33568119 PMCID: PMC7874640 DOI: 10.1186/s12889-021-10320-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 01/24/2021] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND People with type 2 diabetes mellitus (T2DM) are best managed by a chronic care model that is associated with enhanced quality of care and improved patient outcome. Assessing patients' perceived quality of care is crucial in improving the healthcare delivery system. Hence, this study determined the perceived quality of care among people with T2DM and explored its associations with (i) sociodemographic and clinical characteristics and (ii) types of healthcare clinics to guide future planning. METHODS A cross-sectional study involving 20 primary healthcare clinics in the North East Region of Peninsular Malaysia and people with T2DM as the sampling unit was conducted from February to May 2019. The pro forma checklist, interview-guided Skala Kepuasan Interaksi Perubatan-11, and Patient Assessment of Chronic Illness Care (Malay version; PACIC-M) questionnaire were used for data collection. Univariate analysis and linear regression were used to determine the status of perceived quality of care and the factors associated with the perceived quality of care, respectively. RESULTS Overall, data from 772 participants were analyzed. The majority was from the Malay ethnic group (95.6%) with a mean (standard deviation [SD]) glycated hemoglobin A1c (HbA1c) level of 8.91% (2.30). The median (interquartile range [IQR]) of the number of medical officers available at each clinic was 6 (7), with Family Doctor Concept (FDC) clinics having a higher number of medical officers than non-FDC clinics (p = 0.001). The overall mean (SD) PACIC-M score was 2.65 (0.54) with no significant difference between scores of patients treated in the two clinic types (p = 0.806). Higher perceived quality of care was associated with lower number of medical officers (adjusted regression coefficient [Adj.β], - 0.021; p-value [p], 0.001), and greater doctor-patient interaction in all domains: distress relief (Adj.β, 0.033; p, < 0.001), rapport (Adj.β, 0.056; p, < 0.001), and interaction outcome (Adj.β, 0.022; p, 0.003). CONCLUSION Although there was no significant difference found between clinic type, this study reflects that patients are comfortable when managed by the same doctor, which may support a better doctor-patient interaction. A larger specialized primary care workforce could improve diabetes care in Malaysia.
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Affiliation(s)
- Noorfariza Nordin
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Suhaily Mohd Hairon
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Anees Abdul Hamid
- Primer Health Unit, Kelantan State Health Department, Aras 5, Wisma Persekutuan Kota Bharu, Jalan Bayam, 15590, Kota Bharu, Kelantan, Malaysia
| | - Seoparjoo Azmel Mohd Isa
- Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia.,Hospital Universiti Sains Malaysia, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Norzaihan Hassan
- Kota Bharu Health Clinic, Jalan Hospital, Bandar Kota Bharu, 15000, Kota Bharu, Kelantan, Malaysia
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Kung FP, Tsai CF, Lu CL, Huang LC, Lu CH. Diabetes pay-for-performance program can reduce all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Medicine (Baltimore) 2020; 99:e19139. [PMID: 32049836 PMCID: PMC7035087 DOI: 10.1097/md.0000000000019139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This study aimed to examine the effect of a diabetes pay-for-performance (P4P) program on all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Using a Taiwanese representative nationwide cohort, we recruited 5478 patients with newly diagnosed type 2 diabetes enrolled in the P4P program within 5 years after a diagnosis of diabetes between January 1, 2002 and December 31, 2010 and individuals not enrolled in the P4P program were recruited as the control group matched 1:1 with the study group. We used multivariate Cox proportional hazard models analysis to investigate the effect of the P4P program and adherence on all-cause mortality. A total of 250 patients died in the P4P group compared to 395 in the control group (mortality rate 104 vs 169 per 10,000 person-years, respectively, P < .0001). The control group also had more comorbidities. Patients enrolled in the P4P program demonstrated significant long-term survival benefits, of which the adjusted hazard ratio (aHR) for all-cause mortality was 0.58 [95% CI (0.48-0.69)]. In the study group, better adherence to the P4P program resulted in a greater reduction in mortality, with aHRs [95% CI] of 0.48 [0.38-0.62] and 0.36 [0.26-0.49] in subjects with a minimum 1-year and 2-year good P4P adherence, respectively. Participating in the P4P program within 5 years after the diagnosis of diabetes resulted in a significant reduction in all-cause mortality, and this effect was particularly pronounced in the patients with better adherence to the P4P program.
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Affiliation(s)
- Fang-Ping Kung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
| | - Chin-Li Lu
- Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung-Hsing University, Taichung
| | - Li-Chung Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
- Division of Psychiatry, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
| | - Chieh-Hsiang Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
- Kaohsiung Christian Hospital, Kaohsiung City, Taiwan
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Lee IT, Hsu CC, Sheu WHH, Su SL, Wu YL, Lin SY. Pay-for-performance for shared care of diabetes in Taiwan. J Formos Med Assoc 2019; 118 Suppl 2:S122-S129. [PMID: 31471222 DOI: 10.1016/j.jfma.2019.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/04/2019] [Accepted: 08/12/2019] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND/PURPOSE Comprehensive and continuous care is crucial for patients with diabetes. The diabetes pay-for-performance (P4P) program launched by the National Health Insurance (NHI) administration in Taiwan provides a financial incentive to facilitate this goal. In this study, we explored the characteristics of patients in the P4P program between 2005 and 2014. METHODS Data of patients with diabetes enrolled in the NHI program between 2005 and 2014 were extracted from the NHI research database. Patients were classed as having diabetes if they had three or more outpatient visits within 365 calendar days with an International Classification of Diseases, 9th Revision, Clinical Modification diagnostic code of 250 or hospitalization one or more times with such a diagnosis. The trends of participating in the P4P program were analyzed. RESULTS Participation rate of the P4P program increased from 12.1% to 19% between 2005 and 2014. Participants were younger and more likely to be female than those not participating in the program. Lower risks of cancer-related mortality, annual mortality and heart failure were seen in patients participating in the P4P program than in those not participating. CONCLUSION Older, male patients with a high disease severity may be less likely to enroll in the P4P program. Although participation rate is increasing, a broad enrollment is expected.
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Affiliation(s)
- I-Te Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; College of Science, Tunghai University, Taichung, Taiwan
| | - Chih-Cheng Hsu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Shih-Li Su
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Ling Wu
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Shih-Yi Lin
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.
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Arditi C, Iglesias K, Peytremann-Bridevaux I. The use of the Patient Assessment of Chronic Illness Care (PACIC) instrument in diabetes care: a systematic review and meta-analysis. Int J Qual Health Care 2019; 30:743-750. [PMID: 29733366 DOI: 10.1093/intqhc/mzy091] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 04/13/2018] [Indexed: 02/05/2023] Open
Abstract
Purpose The Patient Assessment of Chronic Illness Care (PACIC) was created to assess whether provided care is congruent with the Chronic Care Model, according to patients. We aimed to identify all studies using the PACIC in diabetic patients to explore (i) how overall PACIC scores varied across studies and (ii) whether scores varied according to healthcare delivery, patient and instrument characteristics. Data sources MEDLINE, Embase, PsycINFO, CINAHL and PubMed Central (PMC), from 2005 to 2016. Study selection Studies of any design using the PACIC in diabetic patients. Data extraction and synthesis We extracted data on healthcare delivery, patient, and instrument characteristics, and overall PACIC score and standard deviation. We performed random-effects meta-analyses and meta-regressions. Results We identified 34 studies including 25 942 patients from 13 countries, mostly in North America and Europe, using different versions of the PACIC in 11 languages. The overall PACIC score fluctuated between 1.7 and 4.2, with a pooled score of 3.0 (95% confidence interval 2.8-3.2, 95% predictive interval 1.9-4.2), with very high heterogeneity (I2 = 99%). The PACIC variance was not explained by healthcare delivery or patient characteristics, but by the number of points on the response scale (5 vs. 11) and the continent (Asia vs. others). Conclusion The PACIC is a widely used instrument, but the direct comparison of PACIC scores between studies should be performed with caution as studies may employ different versions and the influence of cultural norms and language on the PACIC score remains unknown.
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Affiliation(s)
- Chantal Arditi
- Health Care Evaluation Unit (UES), Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Lausanne, Switzerland
| | - Katia Iglesias
- Applied Research and Development Unit, School of Health Sciences Fribourg (HEdS‑FR), University of Applied Sciences and Arts Westrn Switzerland (HES-SO), Route des Cliniques 15, Fribourg, Switzerland.,Center for the Understanding of Social Processes University of Neuchâtel, Breguet 1, Neuchâtel, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Health Care Evaluation Unit (UES), Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Lausanne, Switzerland
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Hsieh HM, Chiu HC, Lin YT, Shin SJ. A diabetes pay-for-performance program and the competing causes of death among cancer survivors with type 2 diabetes in Taiwan. Int J Qual Health Care 2018; 29:512-520. [PMID: 28531317 DOI: 10.1093/intqhc/mzx057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 05/06/2017] [Indexed: 12/19/2022] Open
Abstract
Objective To examine associations between a diabetes pay-for-performance (P4P) program in Taiwan and all-cause of mortality and competing causes of death in cancer survivors with type 2 diabetes. Design A longitudinal observational intervention and comparison group study design. Setting and participants Cancer survivors with type 2 diabetes who enrolled in the P4P program compared with survivors who did not participate (non-P4P) under the Taiwan National Health Insurance program. Intervention(s) A nationwide diabetes P4P program. Main outcome measures The main outcome was a comparison of all-cause, diabetes-related and cancer mortality in P4P and non-P4P patients during a 5-year follow-up period. Total person-years and mortality rates per 1000 person-years for causes of death were calculated. Multivariate Cox proportional hazard models and competing risk regression were used in the analysis. Results Overall, our results indicate that P4P cancer survivors had lower risk of all-cause mortality and diabetes-related mortality than non-P4P survivors. Specifically, the hazard ratio (95% confidence interval) was 0.581 (0.447-0.756) for all-cause mortality; SHRs were 0.451 (0.266-0.765) for diabetes-related mortality and 0.791 (0.558-1.121) for cancer mortality. Conclusions Our empirical findings provide evidence of potential benefits of diabetes P4P programs in reducing risks of deaths due to diabetes or cardiovascular diseases among cancer survivors, compared with survivors who did not enroll in the P4P program. In consideration of recommended care for long-term survival, the diabetes P4P program can serve as a care model for cancer survivors for reducing mortality due to diabetes or cardiovascular diseases.
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Affiliation(s)
- Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Department of Community Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Herng-Chia Chiu
- Research Education and Epidemiology Center, Changhua Christian Hospital, 135 Nan-Hsiao St., Changhua City 50006, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Yi-Ting Lin
- Division of Family Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Shyi-Jang Shin
- Graduate Institute of Medical Genetics, College of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Division of Endocrinology and Metabolism, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
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Silva LB, Soares SM, Silva PAB, Santos JFG, Miranda LCV, Santos RM. Assessment of the quality of primary care for the elderly according to the Chronic Care Model. Rev Lat Am Enfermagem 2018; 26:e2987. [PMID: 29538582 PMCID: PMC5863273 DOI: 10.1590/1518-8345.2331.2987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 11/07/2017] [Indexed: 12/07/2022] Open
Abstract
OBJECTIVE to evaluate the quality of care provided to older people with diabetes mellitus and/or hypertension in the Primary Health Care (PHC) according to the Chronic Care Model (CCM) and identify associations with care outcomes. METHOD cross-sectional study involving 105 older people with diabetes mellitus and/or hypertension. The Patient Assessment of Chronic Illness Care (PACIC) questionnaire was used to evaluate the quality of care. The total score was compared with care outcomes that included biochemical parameters, body mass index, pressure levels and quality of life. Data analysis was based on descriptive statistics and multiple logistic regression. RESULTS there was a predominance of females and a median age of 72 years. The median PACIC score was 1.55 (IQ 1.30-2.20). Among the PACIC dimensions, the "delivery system design/decision support" was the one that presented the best result. There was no statistical difference between the medians of the overall PACIC score and individual care outcomes. However, when the quality of life and health satisfaction were simultaneously evaluated, a statistical difference between the medians was observed. CONCLUSION the low PACIC scores found indicate that chronic care according to the CCM in the PHC seems still to fall short of its assumptions.
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Affiliation(s)
- Líliam Barbosa Silva
- Doctoral student, Escola de Enfermagem, Universidade Federal de Minas
Gerais, Belo Horizonte, MG, Brazil. Scholarship holder at Coordenação de Aperfeiçoamento
Pessoal de Nível Superior (CAPES), Brazil
| | - Sônia Maria Soares
- PhD, Associated Professor, Escola de Enfermagem, Universidade Federal
de Minas Gerais, Belo Horizonte, MG, Brazil
| | | | | | | | - Raquel Melgaço Santos
- Undergraduate student in Nursing, Escola de Enfermagem, Universidade
Federal de Minas Gerais, Belo Horizonte, MG, Brazil
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Gijs E, Zuercher E, Henry V, Morin D, Bize R, Peytremann-Bridevaux I. Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument. J Eval Clin Pract 2017; 23:803-811. [PMID: 28251768 DOI: 10.1111/jep.12720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 01/14/2017] [Accepted: 01/16/2017] [Indexed: 12/07/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVE Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments. METHODS Two independent samples, patients with diabetes (n = 395) and HCPs (including primary and secondary care physicians and nurses; n = 287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1 = never to 5 = always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC. RESULTS Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs. CONCLUSION Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.
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Affiliation(s)
- E Gijs
- Lausanne University Hospital, Lausanne, Switzerland
| | - E Zuercher
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - V Henry
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - D Morin
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Faculty of Nursing Science, Laval University, Quebec, Canada
| | - R Bize
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - I Peytremann-Bridevaux
- Institute of social and preventive medicine, Lausanne University Hospital, Lausanne, Switzerland
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Cykert DM, Williams JS, Walker RJ, Davis KS, Egede LE. The association of cumulative discrimination on quality of care, patient-centered care, and dissatisfaction with care in adults with type 2 diabetes. J Diabetes Complications 2017; 31:175-179. [PMID: 27769800 PMCID: PMC5209248 DOI: 10.1016/j.jdiacomp.2016.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/07/2022]
Abstract
AIMS Discrimination is linked to negative health outcomes, but little research has investigated how the cumulative effect of discrimination impacts perceptions of care. This study investigated the influence of cumulative perceived discrimination on quality of care, patient-centeredness, and dissatisfaction with care in adults with type 2 diabetes. METHODS Six hundred two patients from two primary care clinics in Charleston, SC. Linear regression models assessed associations between perceived discrimination and quality of care, patient-centered care, and dissatisfaction with care. The models control for race, site, age, gender, marital status, duration of diabetes, education, hours worked weekly, income, and health status. RESULTS The mean age was 61.5years, with 66.3% non-Hispanic blacks, and 41.9% earning less than $20,000 annually. In final adjusted analyses, lower patient-centered care was associated with a higher discrimination score (β=-0.28; p=0.006), reporting at least 1 category of discrimination (β=-1.47; p=0.002), and reporting at least 2 categories of discrimination (β=-1.34; p=0.004). Dissatisfaction with care was associated with at least 2 categories of discrimination (β=0.45; p=0.002). No significant associations were seen with quality of care indicators. CONCLUSIONS Increased cumulative discrimination was associated with decreased feeling of patient-centeredness and increased dissatisfaction with care. However, these perceptions of discrimination were not significantly associated with quality indicators.
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Affiliation(s)
- David M Cykert
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA.
| | - Joni S Williams
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA.
| | - Rebekah J Walker
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
| | - Kimberly S Davis
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA.
| | - Leonard E Egede
- Center for Health Disparities Research, Medical University of South Carolina, 135 Rutledge Avenue, P.O. Box 250593, Charleston, SC 29425, USA; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, 96 Jonathan Lucas Street, Suite 803, MSC 623, Charleston, SC 29425, USA; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, 109 Bee Street, Charleston, SC 29401, USA.
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Yang JH, Kim SM, Han SJ, Knaak M, Yang GH, Lee KD, Yoo YH, Ha G, Kim EJ, Yoo MS. The impact of Value Incentive Program (VIP) on the quality of hospital care for acute stroke in Korea. Int J Qual Health Care 2016; 28:580-585. [PMID: 27650012 DOI: 10.1093/intqhc/mzw081] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 05/24/2016] [Accepted: 06/10/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aims to analyze the impact of Value Incentive Program (VIP) on the quality improvement of acute stroke care, and to determine the difference of effect by the size of hospitals. INTERVENTIONS Adopting the VIP on the fifth acute stroke quality assessment. DESIGN/SETTING/PARTICIPANTS Using paired t-test and student t-test, we compared the quality assessment results of the third assessment, which was publicly reported without the VIP implementation and the fifth assessment, on which the VIP was applied. The subjects of the third assessment were acute stroke admissions in 201 hospitals (44 tertiary and 157 general hospitals) from January to March 2010. The fifth assessment included 201 hospitals (42 tertiary and 159 general hospitals) from March to May 2013. MAIN OUTCOME MEASURES Seven process indicators of acute stroke quality assessment and in-hospital mortality rate. RESULT In comparison to the third assessment, five of the seven process indicators showed statistically significant improvement in the fifth assessment. Also, there were significant decreases in the interquartile ranges of five process indicators. This phenomenon was more notable in general hospitals. The in-hospital mortality rate of hemorrhagic stroke in general hospitals showed a statistically significant decrease from 20.8% in the third assessment to 11.6% (P < 0.05) in the fifth assessment. CONCLUSION This study demonstrated that the VIP was effective in improving quality of acute stroke care. The improvement was more prominent in general hospitals, and led to reduced quality gaps among hospitals.
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Affiliation(s)
- Ju Hyun Yang
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Sun Min Kim
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Seung Jin Han
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Meredith Knaak
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Gi Hwa Yang
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Kyoo Duck Lee
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Young Hee Yoo
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Guja Ha
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Eun Jung Kim
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
| | - Myung Sook Yoo
- Health Insurance Review and Assessment Service of Korea, 60 Hyeoksin-ro, Wonju-si, Gangwon-do 26465, Republic of Korea
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