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Hengel P, Nimptsch U, Blümel M, Achstetter K, Busse R. Regional variation in access to and quality of acute stroke care: results of Germany's Health System Performance Assessment pilot, 2014-2020. RESEARCH IN HEALTH SERVICES & REGIONS 2024; 3:9. [PMID: 39177921 PMCID: PMC11281753 DOI: 10.1007/s43999-024-00045-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 06/18/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Health System Performance Assessments (HSPA) and analyses of unwarranted regional variation in health care both aim at identifying strengths and weaknesses of health systems to improve care. Applying HSPA's conceptual approach of interrelated health system dimensions (e.g., access, quality) to regional levels might help to better understand variation in care to reduce inequity and improve performance. METHODS We use four indicators identified and analysed in a pilot study for a German HSPA to assess variation in access to and quality of acute stroke care between Germany's 16 federal states and urban vs. rural regions from 2014 to 2020. Stroke unit (SU) density, share of the population reaching a SU within 30 min by car, share of inpatient stroke cases treated in a hospital with a SU, and inpatient mortality were computed based on hospital quality reports and discharge data covering all acute care hospitals. Inpatient mortality was adjusted for age, sex, stroke type, and comorbidities. RESULTS About 500 SU were identified, i.e., 2.0 per 1,000 inpatient stroke cases. Almost 95% of Germans could reach a SU hospital within 30 min (rural: 90%; urban: 99%; > 88% in all states but one). The share of inpatient stroke cases treated in a SU hospital increased to 93% with a decreasing span between rural (92%) and urban (95%) regions and between states (74-98%). Inpatient mortality stagnated around 8.5% and increased to 9.0% in 2020 (rural: 8.7%; urban: 9.2%; states: 7.0-9.7%, one outlier of 13.3%). CONCLUSIONS The results especially revealed varying performance patterns in access to and quality of acute stroke care between the federal states, indicating different areas for improvement which might be addressed by more targeted policy measures in the future.
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Affiliation(s)
- P Hengel
- Department of Health Care Management, Technische Universität Berlin, Str. des 17. Juni 135, Berlin, 10623, Germany.
| | - U Nimptsch
- Department of Health Care Management, Technische Universität Berlin, Str. des 17. Juni 135, Berlin, 10623, Germany
| | - M Blümel
- Department of Health Care Management, Technische Universität Berlin, Str. des 17. Juni 135, Berlin, 10623, Germany
| | - K Achstetter
- Department of Health Care Management, Technische Universität Berlin, Str. des 17. Juni 135, Berlin, 10623, Germany
| | - R Busse
- Department of Health Care Management, Technische Universität Berlin, Str. des 17. Juni 135, Berlin, 10623, Germany
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2
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Beks H, Wood SM, Clark RA, Vincent VL. Spatial methods for measuring access to health care. Eur J Cardiovasc Nurs 2023; 22:832-840. [PMID: 37590972 DOI: 10.1093/eurjcn/zvad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
Access to health care is a universal human right and key indicator of health system performance. Spatial access encompasses geographic factors mediating with the accessibility and availability of health services. Equity of health service access is a global issue, which includes access to the specialized nursing workforce. Nursing research applying spatial methods is in its infancy. Given the use of spatial methods in health research is a rapidly developing field, it is timely to provide guidance to inspire greater application in cardiovascular research. Therefore, the objective of this methods paper is to provide an overview of spatial analysis methods to measure the accessibility and availability of health services, when to consider applying spatial methods, and steps to consider for application in cardiovascular nursing research.
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Affiliation(s)
- Hannah Beks
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
| | - Sarah M Wood
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Versace L Vincent
- Deakin Rural Health, Deakin University, PO Box 423, Princes Highway, Warrnambool, Victoria 3280, Australia
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3
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Wood SM, Alston L, Beks H, Mc Namara K, Coffee NT, Clark RA, Wong Shee A, Versace VL. The application of spatial measures to analyse health service accessibility in Australia: a systematic review and recommendations for future practice. BMC Health Serv Res 2023; 23:330. [PMID: 37005659 PMCID: PMC10066971 DOI: 10.1186/s12913-023-09342-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND Australia's inequitable distribution of health services is well documented. Spatial access relates to the geographic limitations affecting the availability and accessibility of healthcare practitioners and services. Issues associated with spatial access are often influenced by Australia's vast landmass, challenging environments, uneven population concentration, and sparsely distributed populations in rural and remote areas. Measuring access contributes to a broader understanding of the performance of health systems, particularly in rural/remote areas. This systematic review synthesises the evidence identifying what spatial measures and geographic classifications are used and how they are applied in the Australian peer-reviewed literature. METHODS A systematic search of peer-reviewed literature published between 2002 and 2022 was undertaken using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Search terms were derived from three major topics, including: [1] Australian population; [2] spatial analysis of health service accessibility; and [3] objective physical access measures. RESULTS Database searches retrieved 1,381 unique records. Records were screened for eligibility, resulting in 82 articles for inclusion. Most articles analysed access to primary health services (n = 50; 61%), followed by specialist care (n = 17; 21%), hospital services (n = 12; 15%), and health promotion and prevention (n = 3; 4%). The geographic scope of the 82 articles included national (n = 33; 40%), state (n = 27; 33%), metropolitan (n = 18; 22%), and specified regional / rural /remote area (n = 4; 5%). Most articles used distance-based physical access measures, including travel time (n = 30; 37%) and travel distance along a road network (n = 21; 26%), and Euclidean distance (n = 24; 29%). CONCLUSION This review is the first comprehensive systematic review to synthesise the evidence on how spatial measures have been applied to measure health service accessibility in the Australian context over the past two decades. Objective and transparent access measures that are fit for purpose are imperative to address persistent health inequities and inform equitable resource distribution and evidence-based policymaking.
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Affiliation(s)
- Sarah M Wood
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia.
| | - Laura Alston
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Research Unit, Colac Area Health, Colac, Vic, Australia
| | - Hannah Beks
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
| | - Kevin Mc Namara
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
| | - Neil T Coffee
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- University of Canberra, Canberra, ACT, Australia
| | - Robyn A Clark
- Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Anna Wong Shee
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
| | - Vincent L Versace
- School of Medicine, Faculty of Health, Deakin Rural Health, Deakin University, Warrnambool Campus, PO Box 423, Warrnambool, VIC, 3280, Australia
- Grampians Health, Ballarat, Vic, Australia
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4
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Barragán-Prieto A, Pérez-Sánchez S, Moniche F, Moyano RV, Delgado F, Martínez-Sánchez P, Moya M, Oropesa JM, Mínguez-Castellanos A, Villegas I, Álvarez Soria MJ, Tamayo Toledo JA, de la Cruz Cosme C, Canto Neguillo R, Herrerías Esteban JM, Montero Cobos DJ, Moreno Muñoz JA, González A, Montaner J. Express improvement of acute stroke care accessibility in large regions using a centralized telestroke network. Eur Stroke J 2022; 7:259-266. [PMID: 36082245 PMCID: PMC9446331 DOI: 10.1177/23969873221101282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/29/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Acute ischemic stroke therapy has improved in recent decades, decreasing the rates of disability and death among stroke patients. Unfortunately, all health care systems have geographical disparities in infrastructure for stroke patients. A centralized telestroke network might be a low-cost strategy to reduce differences in terms of geographical barriers, equitable access, and quality monitoring across different hospitals. Aims: We aimed to quantify changes in stroke patients’ geographic access to specialized evaluation by neurologists and to intravenous acute stroke reperfusion treatments following the rapid implementation of a centralized telestroke network in the large region of Andalusia (8.5 million inhabitants). Methods: We conducted an observational study using spatial and analytical methods to examine how a centralized telestroke network influences the quality and accessibility of stroke care for a large region. Results: In the pre-implementation period, 5,005,477 (59.72% of the Andalusian population) had access to specialized stroke care in less than 30 min. After the 5-month process of implementing the telestroke network, 7,832,988 (93.5%) inhabitants had an access time of less than 30 min, bridging the gap in acute stroke care in rural hospitals. Conclusions: A centralized telestroke network may be an efficient tool to reduce the differences in stroke care access and quality monitoring across different hospitals, especially in large regions with low population density.
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Affiliation(s)
- Ana Barragán-Prieto
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Soledad Pérez-Sánchez
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Francisco Moniche
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Department of Neurology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Fernando Delgado
- Department of Interventional Neurorradiology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | - Miguel Moya
- Department of Neurology, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Juan M Oropesa
- Department of Neurology, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | | | | | | | | | - Rafael Canto Neguillo
- Department of Emergency Medicine, Hospital de Alta Resolución Sierra Norte, Sevilla, Spain
| | | | | | | | - Alejandro González
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
- Department of Interventional Neurorradiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Joan Montaner
- Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Neurovascular Research Laboratory, Instituto de Biomedicina de Sevilla, Sevilla, Spain
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Bladin CF, Kim J, Bagot KL, Vu M, Moloczij N, Denisenko S, Price C, Pompeani N, Arthurson L, Hair C, Rabl J, O'Shea M, Groot P, Bolitho L, Campbell BCV, Dewey HM, Donnan GA, Cadilhac DA. Improving acute stroke care in regional hospitals: clinical evaluation of the Victorian Stroke Telemedicine program. Med J Aust 2020; 212:371-377. [DOI: 10.5694/mja2.50570] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/18/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Chris F Bladin
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
- Ambulance Victoria Melbourne VIC
| | - Joosup Kim
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
- Monash Health, Monash University Melbourne VIC
| | - Kathleen L Bagot
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
- Monash Health, Monash University Melbourne VIC
| | | | | | | | | | - Nancy Pompeani
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
| | | | | | | | | | | | | | - Bruce CV Campbell
- Melbourne Health Melbourne VIC
- Melbourne Brain Centre at the Royal Melbourne HospitalUniversity of Melbourne Melbourne VIC
| | | | - Geoffrey A Donnan
- Melbourne Brain Centre at the Royal Melbourne HospitalUniversity of Melbourne Melbourne VIC
| | - Dominique A Cadilhac
- Florey Institute of Neuroscience and Mental Health Melbourne VIC
- Monash Health, Monash University Melbourne VIC
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6
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Scott I, McGavigan A, Ferson M, Woolley I, Burt MG, Russell A, Bridgman P, Ting J, Blacker D, Bonomo Y, Martin J, Szer J. Selected state of the art research in internal medicine, 2017. Intern Med J 2018; 48:619-623. [PMID: 29898274 DOI: 10.1111/imj.13820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Ian Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Andrew McGavigan
- Cardiology, Flinders Medical Centre, Adelaide, South Australia, Australia.,School of Medicine, Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Mark Ferson
- Public Health Unit, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Ian Woolley
- Infectious Diseases, Monash Medical Centre, Melbourne, Victoria, Australia.,Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Morton G Burt
- Southern Adelaide Diabetes and Endocrine Services, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Anthony Russell
- Diabetes and Endocrinology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Paul Bridgman
- Cardiology, Christchurch Hospital, Christchurch, New Zealand
| | - Joseph Ting
- Department of Emergency Medicine, Mater Hospital, Brisbane, Queensland, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Blacker
- Neurology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Yvonne Bonomo
- Addiction Medicine, St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Jennifer Martin
- Clinical Pharmacology, Newcastle University, Newcastle, New South Wales, Australia
| | - Jeff Szer
- Bone Marrow Transplant Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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