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Lin TK, Werner K, Witter S, Alluhidan M, Alghaith T, Hamza MM, Herbst CH, Alazemi N. Individual performance-based incentives for health care workers in Organisation for Economic Co-operation and Development member countries: a systematic literature review. Health Policy 2022; 126:512-521. [DOI: 10.1016/j.healthpol.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
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Gupta B, Li D, Dong P, Acri MC. From intention to action: A systematic literature review of provider behaviour change-focused interventions in physical health and behavioural health settings. J Eval Clin Pract 2021; 27:1429-1445. [PMID: 33565177 DOI: 10.1111/jep.13547] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/31/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES It is clear there are significant delays in the uptake of best practices as part of routine care in the healthcare system, yet there is conflicting evidence on how to specifically align provider behaviour with best practices. METHOD We conducted a review of interventions utilized to change any aspect of provider behaviour. To extend prior research, studies were included in the present review if they had an active intervention targeting behaviour change of providers in health or behavioural-health settings and were published between 2001 and 2020. RESULTS Of 1547 studies, 44 met inclusion criteria. Of 44 studies identified, 28 studies utilized contextually relevant interventions (eg, tailored to a specific provider population). Twenty six interventions with a contextually relevant approach resulted in provider behaviour change. CONCLUSIONS Findings are promising for encouraging provider behaviour change when interventions are tailored to be contextually relevant, as both single-component and multifaceted interventions were successful when they were contextually relevant. It is critical to conduct additional research to ensure that providers sustain behaviour changes over a long-term beyond an intervention's implementation and evaluation period.
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Affiliation(s)
- Brinda Gupta
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Dongze Li
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Peiyu Dong
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Mary C Acri
- Social Policy Institute, Washington University in St. Louis, St. Louis, Missouri, USA
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Wilson M, Guta A, Waddell K, Lavis J, Reid R, Evans C. The impacts of accountable care organizations on patient experience, health outcomes and costs: a rapid review. J Health Serv Res Policy 2021; 25:130-138. [PMID: 32321282 DOI: 10.1177/1355819620913141] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives Accountable care organizations were implemented as a system-level approach to address quality differences and curb increasing healthcare costs in the United States of America, and have garnered the interest of policy makers in other countries to support better management of patients. The objectives of this paper are to: (1) identify the impacts of accountable care organizations on improving the quadruple aim goals of improving patient experience of care, enhancing population health outcomes, reducing the per capita cost of health care and ensuring positive provider experiences and (2) determine how and why such impacts have been achieved through accountable care organizations. Methods We used a rapid review approach, searching Health Systems Evidence (for systematic reviews) and PubMed (for reviews and studies). Results were reviewed for inclusion independently by two researchers. Data were extracted by one reviewer and checked for consistency by another. Results We identified one recent systematic review and 59 primary studies that addressed the first objective ( n = 54), the second objective ( n = 4) or both objectives ( n = 1). The reviewed studies suggest that accountable care organizations reduce costs without reducing quality. Key findings related to objective 1 include: (1) there are positive trends across the quadruple–aim outcomes for accountable care organizations as compared to Medicare fee-for-service or group physician fee-for-service models; (2) accountable care organizations produced modest cost savings, which are largely attributable to savings in outpatient expenses among the most medically complex patients and reductions in the delivery of low-value services; (3) accountable care organization models met the majority of quality measures and perform better than their fee-for-service counterparts and (4) there is relatively little evidence about the impact of accountable care organizations on provider experience. Qualitative studies related to objective 2 highlighted mechanisms that were important for enabling accountable care organizations, including supplemental staff to enhance coordination and accountable care organization-wide electronic health records. Conclusions General trends and increased adoption of models similar to accountable care organizations outside of the USA suggest that these models outperform traditional fee-for-service models across the quadruple aim goals, although with mixed evidence about health outcomes.
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Affiliation(s)
- Michael Wilson
- Assistant Director, McMaster Health Forum, McMaster University, Canada.,Associate Professor, Department of Health Evidence and Impact, McMaster University, Canada.,Member, Centre for Health Economics and Policy Analysis, McMaster University, Canada
| | - Adrian Guta
- Assistant Professor, School of Social Work, University of Windsor, Canada
| | - Kerry Waddell
- Lead, Evidence Synthesis, McMaster Health Forum, McMaster University, Canada
| | - John Lavis
- Professor, Department of Health Evidence and Impact, McMaster University, Canada.,Director, McMaster Health Forum, McMaster University, Canada.,Associate member, Department of Political Science, McMaster University, Canada
| | - Robert Reid
- Chief Scientist and Senior Vice-President Science, Trillium Health Partners, Canada.,Professor, Institute for Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Cara Evans
- PhD Student, Health Policy PhD Program, McMaster University, Canada
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Sheaff R, Brand SL, Lloyd H, Wanner A, Fornasiero M, Briscoe S, Valderas JM, Byng R, Pearson M. From programme theory to logic models for multispecialty community providers: a realist evidence synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
The NHS policy of constructing multispecialty community providers (MCPs) rests on a complex set of assumptions about how health systems can replace hospital use with enhanced primary care for people with complex, chronic or multiple health problems, while contributing savings to health-care budgets.
Objectives
To use policy-makers’ assumptions to elicit an initial programme theory (IPT) of how MCPs can achieve their outcomes and to compare this with published secondary evidence and revise the programme theory accordingly.
Design
Realist synthesis with a three-stage method: (1) for policy documents, elicit the IPT underlying the MCP policy, (2) review and synthesise secondary evidence relevant to those assumptions and (3) compare the programme theory with the secondary evidence and, when necessary, reformulate the programme theory in a more evidence-based way.
Data sources
Systematic searches and data extraction using (1) the Health Management Information Consortium (HMIC) database for policy statements and (2) topically appropriate databases, including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Applied Social Sciences Index and Abstracts (ASSIA). A total of 1319 titles and abstracts were reviewed in two rounds and 116 were selected for full-text data extraction. We extracted data using a formal data extraction tool and synthesised them using a framework reflecting the main policy assumptions.
Results
The IPT of MCPs contained 28 interconnected context–mechanism–outcome relationships. Few policy statements specified what contexts the policy mechanisms required. We found strong evidence supporting the IPT assumptions concerning organisational culture, interorganisational network management, multidisciplinary teams (MDTs), the uses and effects of health information technology (HIT) in MCP-like settings, planned referral networks, care planning for individual patients and the diversion of patients from inpatient to primary care. The evidence was weaker, or mixed (supporting some of the constituent assumptions but not others), concerning voluntary sector involvement, the effects of preventative care on hospital admissions and patient experience, planned referral networks and demand management systems. The evidence about the effects of referral reductions on costs was equivocal. We found no studies confirming that the development of preventative care would reduce demands on inpatient services. The IPT had overlooked certain mechanisms relevant to MCPs, mostly concerning MDTs and the uses of HITs.
Limitations
The studies reviewed were limited to Organisation for Economic Co-operation and Development countries and, because of the large amount of published material, the period 2014–16, assuming that later studies, especially systematic reviews, already include important earlier findings. No empirical studies of MCPs yet existed.
Conclusions
Multidisciplinary teams are a central mechanism by which MCPs (and equivalent networks and organisations) work, provided that the teams include the relevant professions (hence, organisations) and, for care planning, individual patients. Further primary research would be required to test elements of the revised logic model, in particular about (1) how MDTs and enhanced general practice compare and interact, or can be combined, in managing referral networks and (2) under what circumstances diverting patients from in-patient to primary care reduces NHS costs and improves the quality of patient experience.
Study registration
This study is registered as PROSPERO CRD42016038900.
Funding
The National Institute for Health Research (NIHR) Health Services and Delivery Research programme and supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
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Affiliation(s)
- Rod Sheaff
- School of Law, Criminology and Government, University of Plymouth, Plymouth, UK
| | - Sarah L Brand
- Y Lab Public Service Innovation Lab for Wales, School of Social Sciences, Cardiff University, Cardiff, UK
| | - Helen Lloyd
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Amanda Wanner
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Mauro Fornasiero
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Simon Briscoe
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Richard Byng
- Community and Primary Care Research Group, Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Mark Pearson
- NIHR CLAHRC for the South West Peninsula (PenCLAHRC), Institute of Health Research, University of Exeter Medical School, Exeter, UK
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Greene J, Sacks RM, Hibbard JH, Overton V. How much do clinicians support patient self-management? The development of a measure to assess clinician self-management support. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2016; 5:34-39. [PMID: 27594306 DOI: 10.1016/j.hjdsi.2016.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 02/22/2016] [Accepted: 05/12/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Primary care provider (PCP) support of patient self-management may be important mechanism to improving patient health outcomes. In this paper we develop a PCP-reported measure of clinician strategies for supporting patient self-management, and we psychometrically test and validate the measure. METHODS We developed survey items based upon effective self-management support strategies identified in a prior mixed methods study. We fielded a survey in the fall of 2014 with 139 Fairview Health Services PCPs, and conducted exploratory factor analysis and Cronbach's Alpha to test for scale reliability. To validate the measure, we examined the Self-Management Support (SMS) scale's relationship to survey items on self-management support, as well as clinicians' patient panel rates of smoking cessation and weight loss. RESULTS Nine survey items clustered reliably to create a single factor (Cronbach's Alpha=0.73). SMS scores ranged from 2.1 to 4.9. The SMS was related to each of the validation variables. PCPs who reported spending 60% percent or more of their time counseling, educating, and coaching patients had a mean SMS score of 4.0, while those who reported spending less than 30% of their time doing so had mean SMS scores 15% lower. PCPs' SMS scores exhibited significant but modest associations with their patients' smoking cessation and weight loss (among obese patients) (r=0.21 and r=0.13 respectively). CONCLUSIONS This study develops and tests a promising measure of PCPs' strategies to support patient self-management. It highlights variation across PCPs. Future work should examine whether increasing scores of PCPs low on the SMS improves chronic care quality outcomes.
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Affiliation(s)
- Jessica Greene
- George Washington University, 2030 M Street, Suite 300, Washington, DC 20036, United States.
| | - Rebecca M Sacks
- George Washington University, 2030 M Street, Suite 300, Washington, DC 20036, United States
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Tai-Seale M, Elwyn G, Wilson CJ, Stults C, Dillon EC, Li M, Chuang J, Meehan A, Frosch DL. Enhancing Shared Decision Making Through Carefully Designed Interventions That Target Patient And Provider Behavior. Health Aff (Millwood) 2016; 35:605-12. [DOI: 10.1377/hlthaff.2015.1398] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ming Tai-Seale
- Ming Tai-Seale is a senior scientist in health policy research at the Palo Alto Medical Foundation Research Institute, in Mountain View, California
| | - Glyn Elwyn
- Glyn Elwyn is a professor at the Dartmouth Center for Health Care Delivery Science, in Hanover, New Hampshire
| | - Caroline J. Wilson
- Caroline J. Wilson is a consulting quantitative research analyst at the Palo Alto Medical Foundation Research Institute
| | - Cheryl Stults
- Cheryl Stults is a research sociologist at the Palo Alto Medical Foundation Research Institute
| | - Ellis C. Dillon
- Ellis C. Dillon is a research sociologist at the Palo Alto Medical Foundation Research Institute
| | - Martina Li
- Martina Li is a project manager at the Palo Alto Medical Foundation Research Institute
| | - Judith Chuang
- Judith Chuang is a research associate at the Palo Alto Medical Foundation Research Institute
| | - Amy Meehan
- Amy Meehan is a research associate at the Palo Alto Medical Foundation Research Institute
| | - Dominick L. Frosch
- Dominick L. Frosch is a senior scientist and chief care delivery evaluation officer at the Palo Alto Medical Foundation and an associate professor in the Department of Medicine at the University of California, Los Angeles
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