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Gongora-Salazar P, Perera R, Rivero-Arias O, Tsiachristas A. Unravelling Elements of Value of Healthcare and Assessing their Importance Using Evidence from Two Discrete-Choice Experiments in England. PHARMACOECONOMICS 2024; 42:1145-1159. [PMID: 39085565 PMCID: PMC11405465 DOI: 10.1007/s40273-024-01416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Health systems are moving towards value-based care, implementing new care models that allegedly aim beyond patient outcomes. Therefore, a policy and academic debate is underway regarding the definition of value in healthcare, the inclusion of costs in value metrics, and the importance of each value element. This study aimed to define healthcare value elements and assess their relative importance (RI) to the public in England. METHOD Using data from 26 semi-structured interviews and a literature review, and applying decision-theory axioms, we selected a comprehensive and applicable set of value-based elements. Their RI was determined using two discrete choice experiments (DCEs) based on Bayesian D-efficient DCE designs, with one DCE incorporating healthcare costs expressed as income tax rise. Respondent preferences were analysed using mixed logit models. RESULTS Six value elements were identified: additional life-years, health-related quality of life, patient experience, target population size, equity, and cost. The DCE surveys were completed by 402 participants. All utility coefficients had the expected signs and were statistically significant (p < 0.05). Additional life-years (25.3%; 95% confidence interval [CI] 22.5-28.6%) and patient experience (25.2%; 95% CI 21.6-28.9%) received the highest RI, followed by target population size (22.4%; 95% CI 19.1-25.6%) and quality of life (17.6%; 95% CI 15.0-20.3%). Equity had the lowest RI (9.6%; 95% CI 6.4-12.1%), decreasing by 8.8 percentage points with cost inclusion. A similar reduction was observed in the RI of quality of life when cost was included. CONCLUSION The public prioritizes value elements not captured by conventional metrics, such as quality-adjusted life-years. Although cost inclusion did not alter the preference ranking, its inclusion in the value metric warrants careful consideration.
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Affiliation(s)
- Pamela Gongora-Salazar
- Social Protection and Health Division, Inter-American Development Bank, Washington, DC, USA.
- Nuffield Department of Population Health, Health Economics Research Centre (HERC), University of Oxford, Oxford, UK.
| | - Rafael Perera
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Oliver Rivero-Arias
- Nuffield Department of Population Health, Health Economics Research Centre (HERC), University of Oxford, Oxford, UK
- Nuffield Department of Population Health, National Perinatal Epidemiology Unit (NPEU), University of Oxford, Oxford, England, UK
| | - Apostolos Tsiachristas
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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Sánchez-Martínez FI, Abellán-Perpiñán JM, Martínez-Pérez JE, Gómez-Torres JL. Design of a multiple criteria decision analysis framework for prioritizing high-impact health technologies in a regional health service. Int J Technol Assess Health Care 2024; 40:e21. [PMID: 38576122 DOI: 10.1017/s0266462324000205] [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] [Indexed: 04/06/2024]
Abstract
OBJECTIVES This study aims to develop a framework for establishing priorities in the regional health service of Murcia, Spain, to facilitate the creation of a comprehensive multiple criteria decision analysis (MCDA) framework. This framework will aid in decision-making processes related to the assessment, reimbursement, and utilization of high-impact health technologies. METHOD Based on the results of a review of existing frameworks for MCDA of health technologies, a set of criteria was proposed to be used in the context of evaluating high-impact health technologies. Key stakeholders within regional healthcare services, including clinical leaders and management personnel, participated in a focus group (n = 11) to discuss the proposed criteria and select the final fifteen. To elicit the weights of the criteria, two surveys were administered, one to a small sample of healthcare professionals (n = 35) and another to a larger representative sample of the general population (n = 494). RESULTS The responses obtained from health professionals in the weighting procedure exhibited greater consistency compared to those provided by the general public. The criteria more highly weighted were "Need for intervention" and "Intervention outcomes." The weights finally assigned to each item in the multicriteria framework were derived as the equal-weighted sum of the mean weights from the two samples. CONCLUSIONS A multi-attribute function capable of generating a composite measure (multicriteria) to assess the value of high-impact health interventions has been developed. Furthermore, it is recommended to pilot this procedure in a specific decision context to evaluate the efficacy, feasibility, usefulness, and reliability of the proposed tool.
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Affiliation(s)
| | | | | | - Jorge-Luis Gómez-Torres
- International Doctorate School, PhD programme in Economics, DEcIDE, University of Murcia, Murcia, Spain
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3
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Whichello C, Smith I, Veldwijk J, de Wit GA, Rutten-van Molken MPMH, de Bekker-Grob EW. Discrete choice experiment versus swing-weighting: A head-to-head comparison of diabetic patient preferences for glucose-monitoring devices. PLoS One 2023; 18:e0283926. [PMID: 37506078 PMCID: PMC10381030 DOI: 10.1371/journal.pone.0283926] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 03/21/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Limited evidence exists for how patient preference elicitation methods compare directly. This study compares a discrete choice experiment (DCE) and swing-weighting (SW) by eliciting preferences for glucose-monitoring devices in a population of diabetes patients. METHODS A sample of Dutch adults with type 1 or 2 diabetes (n = 459) completed an online survey assessing their preferences for glucose-monitoring devices, consisting of both a DCE and a SW exercise. Half the sample completed the DCE first; the other half completed the SW first. For the DCE, the relative importance of the attributes of the devices was determined using a mixed-logit model. For the SW, the relative importance of the attributes was based on ranks and points allocated to the 'swing' from the worst to the best level of the attribute. The preference outcomes and self-reported response burden were directly compared between the two methods. RESULTS Participants reported they perceived the DCE to be easier to understand and answer compared to the SW. Both methods revealed that cost and precision of the device were the most important attributes. However, the DCE had a 14.9-fold difference between the most and least important attribute, while the SW had a 1.4-fold difference. The weights derived from the SW were almost evenly distributed between all attributes. CONCLUSIONS The DCE was better received by participants, and generated larger weight differences between each attribute level, making it the more informative method in our case study. This method comparison provides further evidence of the degree of method suitability and trustworthiness.
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Affiliation(s)
- Chiara Whichello
- Evidera, London, United Kingdom
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ian Smith
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jorien Veldwijk
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - G Ardine de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maureen P M H Rutten-van Molken
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Gongora-Salazar P, Rocks S, Fahr P, Rivero-Arias O, Tsiachristas A. The Use of Multicriteria Decision Analysis to Support Decision Making in Healthcare: An Updated Systematic Literature Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:780-790. [PMID: 36436791 DOI: 10.1016/j.jval.2022.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 11/17/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Multicriteria decision analysis (MCDA) is increasingly used for decision making in healthcare. However, its application in different decision-making contexts is still unclear. This study aimed to provide a comprehensive review of MCDA studies performed to inform decisions in healthcare and to summarize its application in different decision contexts. METHODS We updated a systematic review conducted in 2013 by searching Embase, MEDLINE, and Google Scholar for MCDA studies in healthcare, published in English between August 2013 and November 2020. We also expanded the search by reviewing grey literature found via Trip Medical Database and Google, published between January 1990 and November 2020. A comprehensive template was developed to extract information about the decision context, criteria, methods, stakeholders involved, and sensitivity analyses conducted. RESULTS From the 4295 identified studies, 473 studies were eligible for full-text review after assessing titles and abstracts. Of those, 228 studies met the inclusion criteria and underwent data extraction. The use of MCDA continues to grow in healthcare literature, with most of the studies (49%) informing priority-setting decisions. Safety, cost, and quality of care delivery are the most frequently used criteria, although there are considerable differences across decision contexts. Almost half of the MCDA studies used the linear additive model whereas scales and the analytical hierarchy process were the most used techniques for scoring and weighting, respectively. Not all studies report on each one of the MCDA steps, consider axiomatic properties, or justify the methods used. CONCLUSIONS A guide on how to conduct and report MCDA that acknowledges the particularities of the different decision contexts and methods needs to be developed.
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Affiliation(s)
- Pamela Gongora-Salazar
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK.
| | | | - Patrick Fahr
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, UK
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
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Mensah D, Karimi N, Ng KTW, Mahmud TS, Tang Y, Igoniko S. Ranking Canadian waste management system efficiencies using three waste performance indicators. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:51030-51041. [PMID: 36808539 PMCID: PMC9937868 DOI: 10.1007/s11356-023-25866-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/07/2023] [Indexed: 04/16/2023]
Abstract
Three waste management system (WMS) efficiency indicators are adopted to systematically assess WMS efficiency in Canada from 1998 to 2016. The study objectives are to examine the temporal changes in waste diversion activities and rank the performance of the jurisdictions using a qualitative analytical framework. Increasing Waste Management Output Index (WMOI) trends were identified in all jurisdictions, and more government subsidiaries and incentive packages are recommended. With the exception of Nova Scotia, statistically significant decreasing diversion gross domestic product (DGDP) ratio trends are observed. It appears that the increases in GDP from Sector 562 were not contributing to waste diversion. On average, Canada spent about $225/tonne of waste handled during the study period. Current spending per tonne handled (CuPT) trends are decreasing, with S ranging from + 5.15 to + 7.67. It appears that WMSs in Saskatchewan and Alberta are more efficient. The results suggest that the use of diversion rate alone to evaluate WMS may be misleading. The findings help the waste community to better understand the trade-offs between various waste management alternatives. The proposed qualitative framework utilizing comparative rankings is applicable elsewhere and can be a useful decision support tool for policy-makers.
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Affiliation(s)
- Derek Mensah
- Faculty of Engineering and Applied Science, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Nima Karimi
- Faculty of Engineering and Applied Science, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Kelvin Tsun Wai Ng
- Faculty of Engineering and Applied Science, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - Tanvir S Mahmud
- Faculty of Engineering and Applied Science, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Yili Tang
- Faculty of Engineering and Applied Science, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
| | - Sotonye Igoniko
- Faculty of Engineering and Applied Science, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada
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Baxter V, Speed E, Ioakimidis V, Ross M. Lessons learnt while integrating services for children: qualitative interviews with professional stakeholders. BMC Health Serv Res 2023; 23:323. [PMID: 37004032 PMCID: PMC10066018 DOI: 10.1186/s12913-023-09322-w] [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: 09/08/2022] [Accepted: 03/21/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND In the English NHS, integrated care is seen as an opportunity to deliver joined-up care for children and families. This paper examines the lessons learnt by professional stakeholders in the process of developing different examples of integrated models of care/frameworks for children's services. METHODS Initial desk research was undertaken to identify different examples of integrated care models and systems/frameworks for children's services. This identified forty-three examples in England. Of these, twelve examples were shortlisted after consultation with the senior managers within the Health and Care Partnership that had commissioned the research, and a more detailed online search for published documents was undertaken. Semi-structured qualitative interviews were then conducted with sixteen professional stakeholders in eight of these examples, ranging from one to four interviewees per example. Interviews focused on the lessons learnt from integrating and transforming services. Data were analysed using framework analysis. RESULTS The eight examples vary in their design but have several broad commonalities. A number of common themes and learning have emerged, of which two were identified within all eight examples: the first is about focusing on children and young people; the second is about focusing on partner engagement and collaboration and the importance of building trust and relationships between partners. A number of other important themes also emerged together with several challenges. CONCLUSIONS A number of common factors were identified that are essential to success in integrating health and care systems. Common across all localities were being child-centric and focusing on child outcomes plus the importance of building trust, engagement and relationships with partners. The findings can help health and care system leaders transform services to ensure efficiency, improvement in services and integration.
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Affiliation(s)
- Vanessa Baxter
- School of Health & Social Care, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK.
| | - Ewen Speed
- School of Health & Social Care, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK
| | - Vasilios Ioakimidis
- School of Health & Social Care, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK
| | - Matthew Ross
- School of Health & Social Care, University of Essex, Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK
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Struckmann V, Vogt V, Köppen J, Meier T, Hoedemakers M, Leijten F, Looman W, Karimi M, Busse R, Rutten-van Mölken M. [Patients, Partners, Professionals, Payers and Policy Makers Preferences for Integrated Care for Multimorbidity in Germany: A Discrete Choice Experiment]. DAS GESUNDHEITSWESEN 2022; 84:1145-1153. [PMID: 34670286 DOI: 10.1055/a-1547-6898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIM OF THE WORK The aim of this study was to measure and compare the relative importance that patients with multimorbidity, partners and other informal caregivers, professionals, payers and policy makers attribute to different outcome measures of integrated care (IC) programmes in Germany. METHODS A DCE was conducted, asking respondents to choose between two IC programmes for persons with multimorbidity. Each IC programme was presented by means of attributes or outcomes reflecting the Triple Aim. They were divided into the outcomes health/ wellbeing, experience with care and costs with in total eight attributes and three levels of performance. RESULTS The results of n=676 questionnaires showed that the attributes "enjoyment of life" and "continuity of care" received the highest ratings across all stakeholder groups. The lowest relative scores remained for the attribute "total costs" for all stakeholders. The preferences of professionals and informal caregivers differed most distinctly from the patients' preferences. The differences mostly concerned "physical functioning", which was rated highest by patients, and "person centeredness" and "continuity of care", which received the highest ratings from professionals. CONCLUSIONS The preference heterogeneities identified in relation to the outcomes of IC programmes between different stakeholders highlight the importance of informing professionals and policy makers about the different perspectives in order to optimise the design of IC programmes. The results also support the relevance of joint decision-making and coordination processes between professionals, informal caregivers and patients.
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Affiliation(s)
- Verena Struckmann
- Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Verena Vogt
- Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Julia Köppen
- Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Theresa Meier
- Abteilung Stationäre Versorgung/Referat Versorgungsstrukturen und Qualitätssicherung, vdek, Berlin, Deutschland
| | - Maaike Hoedemakers
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Fenna Leijten
- Dutch Ministry of Defence, Staff Defence, Healthcare Organisation, Rotterdam, Netherlands
| | - Willemijn Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,ZorgImpuls, Rotterdam, Netherlands
| | - Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Reinhard Busse
- Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Deutschland
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Erasmus School of Health Policy & Management & Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
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Pitter JG, Moizs M, Ezer ÉS, Lukács G, Szigeti A, Repa I, Csanádi M, Rutten-van Mölken MPMH, Islam K, Kaló Z, Vokó Z. Improved survival of non-small cell lung cancer patients after introducing patient navigation: A retrospective cohort study with propensity score weighted historic control. PLoS One 2022; 17:e0276719. [PMID: 36282840 PMCID: PMC9595513 DOI: 10.1371/journal.pone.0276719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
OnkoNetwork is a patient navigation program established in the Moritz Kaposi General Hospital to improve the timeliness and completeness of cancer investigations and treatment. The H2020 SELFIE consortium selected OnkoNetwork as a promising integrated care initiative in Hungary and conducted a multicriteria decision analysis based on health, patient experience, and cost outcomes. In this paper, a more detailed analysis of clinical impacts is provided in the largest subgroup, non-small cell lung cancer (NSCLC) patients. A retrospective cohort study was conducted, enrolling new cancer suspect patients with subsequently confirmed NSCLC in two annual periods, before and after OnkoNetwork implementation (control and intervention cohorts, respectively). To control for selection bias and confounding, baseline balance was improved via propensity score weighting. Overall survival was analyzed in univariate and multivariate weighted Cox regression models and the effect was further characterized in a counterfactual analysis. Our analysis included 123 intervention and 173 control NSCLC patients from early to advanced stage, with significant between-cohort baseline differences. The propensity score-based weighting resulted in good baseline balance. A large survival benefit was observed in the intervention cohort, and intervention was an independent predictor of longer survival in a multivariate analysis when all baseline characteristics were included (HR = 0.63, p = 0.039). When post-baseline variables were included in the model, belonging to the intervention cohort was not an independent predictor of survival, but the survival benefit was explained by slightly better stage distribution and ECOG status at treatment initiation, together with trends for broader use of PET-CT and higher resectability rate. In conclusion, patient navigation is a valuable tool to improve cancer outcomes by facilitating more timely and complete cancer diagnostics. Contradictory evidence in the literature may be explained by common sources of bias, including the wait-time paradox and adjustment to intermediate outcomes.
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Affiliation(s)
| | | | | | - Gábor Lukács
- Moritz Kaposi General Hospital, Kaposvár, Hungary
| | | | - Imre Repa
- Moritz Kaposi General Hospital, Kaposvár, Hungary
| | | | - Maureen P. M. H. Rutten-van Mölken
- Erasmus School of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway
- NORCE-Norwegian Research Centre, Bergen, Norway
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
- * E-mail:
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Commissioning [Integrated] Care in England: An Analysis of the Current Decision Context. Int J Integr Care 2022; 22:3. [PMID: 36304783 PMCID: PMC9541117 DOI: 10.5334/ijic.6693] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Methods: Results: Conclusion:
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Hoedemakers M, Tsiachristas A, Rutten-van Mölken M. Moving Beyond Quality-Adjusted Life-Years in Elderly Care: How Can Multicriteria Decision Analysis Complement Cost-Effectiveness Analysis in Local-Level Decision Making. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1717-1725. [PMID: 35623974 DOI: 10.1016/j.jval.2022.04.1728] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/21/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to investigate how multicriteria decision analysis (MCDA) could complement cost-effectiveness analysis (CEA) to support investment decisions in elderly care at local level. METHODS We used an integrated elderly care program in The Netherlands as a case study to demonstrate the application of both methods. In a 12-month quasi-experimental study (n = 384), data on the following outcome measures were collected: quality-adjusted life-years (CEA) and physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person centeredness, continuity of care, and costs (MCDA). We performed regression analysis on inversed probability weighted data and controlled for potential confounders to obtain a double robust estimate of the outcomes. Probabilistic sensitivity analyses determined uncertainty for both methods. RESULTS The integrated elderly care program was not likely (ie, 36%) to be cost-effective according to the CEA (incremental cost-effectiveness ratios: €88 249 from a societal perspective) using the conventional Dutch willingness-to-pay threshold (ie, €50 000). The MCDA demonstrated that informal caregivers and professionals slightly preferred the intervention over usual care, driven by enjoyment of life and person centeredness. Patients did not prefer either the intervention or usual care, whereas payers and policy makers slightly preferred usual care, mainly due to higher costs of the intervention. CONCLUSIONS MCDA could provide local-level decision makers with a broader measurement of effectiveness by including outcomes beyond health and longevity and the preferences of multiple stakeholders. This additional information could foster the acceptability and implementability of cost-effective innovations in elderly care.
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Affiliation(s)
- Maaike Hoedemakers
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, England, UK
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Stolz D, Mkorombindo T, Schumann DM, Agusti A, Ash SY, Bafadhel M, Bai C, Chalmers JD, Criner GJ, Dharmage SC, Franssen FME, Frey U, Han M, Hansel NN, Hawkins NM, Kalhan R, Konigshoff M, Ko FW, Parekh TM, Powell P, Rutten-van Mölken M, Simpson J, Sin DD, Song Y, Suki B, Troosters T, Washko GR, Welte T, Dransfield MT. Towards the elimination of chronic obstructive pulmonary disease: a Lancet Commission. Lancet 2022; 400:921-972. [PMID: 36075255 PMCID: PMC11260396 DOI: 10.1016/s0140-6736(22)01273-9] [Citation(s) in RCA: 211] [Impact Index Per Article: 105.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 05/23/2022] [Accepted: 06/28/2022] [Indexed: 10/14/2022]
Abstract
Despite substantial progress in reducing the global impact of many non-communicable diseases, including heart disease and cancer, morbidity and mortality due to chronic respiratory disease continues to increase. This increase is driven primarily by the growing burden of chronic obstructive pulmonary disease (COPD), and has occurred despite the identification of cigarette smoking as the major risk factor for the disease more than 50 years ago. Many factors have contributed to what must now be considered a public health emergency: failure to limit the sale and consumption of tobacco products, unchecked exposure to environmental pollutants across the life course, and the ageing of the global population (partly as a result of improved outcomes for other conditions). Additionally, despite the heterogeneity of COPD, diagnostic approaches have not changed in decades and rely almost exclusively on post-bronchodilator spirometry, which is insensitive for early pathological changes, underused, often misinterpreted, and not predictive of symptoms. Furthermore, guidelines recommend only simplistic disease classification strategies, resulting in the same therapeutic approach for patients with widely differing conditions that are almost certainly driven by variable pathophysiological mechanisms. And, compared with other diseases with similar or less morbidity and mortality, the investment of financial and intellectual resources from both the public and private sector to advance understanding of COPD, reduce exposure to known risks, and develop new therapeutics has been woefully inadequate.
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Affiliation(s)
- Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Takudzwa Mkorombindo
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Desiree M Schumann
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | - Alvar Agusti
- Respiratory Institute-Hospital Clinic, University of Barcelona IDIBAPS, CIBERES, Barcelona, Spain
| | - Samuel Y Ash
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mona Bafadhel
- School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK; Department of Respiratory Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - James D Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Dundee, UK
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Shyamali C Dharmage
- Centre for Epidemiology and Biostatistics, School of Population and Global health, University of Melbourne, Melbourne, VIC, Australia
| | - Frits M E Franssen
- Department of Research and Education, CIRO, Horn, Netherlands; Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Urs Frey
- University Children's Hospital Basel, Basel, Switzerland
| | - MeiLan Han
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Nadia N Hansel
- Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Nathaniel M Hawkins
- Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Kalhan
- Department of Preventive Medicine and Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melanie Konigshoff
- Division of Pulmonary, Allergy and Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fanny W Ko
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Trisha M Parekh
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Jodie Simpson
- Priority Research Centre for Healthy Lungs, Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation and Division of Respiratory Medicine, Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada
| | - Yuanlin Song
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital and National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China; Shanghai Respiratory Research Institute, Shanghai, China; Jinshan Hospital of Fudan University, Shanghai, China
| | - Bela Suki
- Department of Biomedical Engineering, Boston University, Boston, MA, USA
| | - Thierry Troosters
- Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, Leuven, Belgium
| | - George R Washko
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; Biomedical Research in Endstage and Obstructive Lung Disease, German Center for Lung Research, Hannover, Germany
| | - Mark T Dransfield
- Lung Health Center, Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
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12
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Herranz C, González-Colom R, Baltaxe E, Seijas N, Asenjo M, Hoedemakers M, Nicolas D, Coloma E, Fernandez J, Vela E, Cano I, Mölken MRV, Roca J, Hernandez C. Prospective cohort study for assessment of integrated care with a triple aim approach: hospital at home as use case. BMC Health Serv Res 2022; 22:1133. [PMID: 36071439 PMCID: PMC9454140 DOI: 10.1186/s12913-022-08496-z] [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: 04/24/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Applicability of comprehensive assessment of integrated care services in real world settings is an unmet need. To this end, a Triple Aim evaluation of Hospital at Home (HaH), as use case, was done. As ancillary aim, we explored use of the approach for monitoring the impact of adoption of integrated care at health system level in Catalonia (Spain). Methods Prospective cohort study over one year period, 2017–2018, comparing hospital avoidance (HaH-HA) with conventional hospitalization (UC) using propensity score matching. Participants were after the first episode directly admitted to HaH-HA or the corresponding control group. Triple Aim assessment using multiple criteria decision analysis (MCDA) was done. Moreover, applicability of a Triple Aim approach at health system level was explored using registry data. Results HaH-HA depicted lower: i) Emergency Room Department (ER) visits (p < .001), ii) Unplanned re-admissions (p = .012); and iii) costs (p < .001) than UC. The weighted aggregation of the standardized values of each of the eight outcomes, weighted by the opinions of the stakeholder groups considered in the MCDA: i) enjoyment of life; ii) resilience; iii) physical functioning; iv) continuity of care; v) psychological wellbeing; (vi) social relationships & participation; (vii) person-centeredness; and (viii) costs, indicated better performance of HaH-HA than UC (p < .05). Actionable factors for Triple Aim assessment of the health system with a population-health approach were identified. Conclusions We confirmed health value generation of HaH-HA. The study identified actionable factors to enhance applicability of Triple Aim assessment at health system level for monitoring the impact of adoption of integrated care. Registration ClinicalTrials.gov (26/04/2017; NCT03130283). Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08496-z.
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Affiliation(s)
- Carme Herranz
- Consorci d'Atenció Primària de Salut de L'Eixample (CAPSBE), Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Rubèn González-Colom
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Erik Baltaxe
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Institute of Pulmonary Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Nuria Seijas
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Maria Asenjo
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Maaike Hoedemakers
- Erasmus School of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam. Rotterdam, The Netherlands, Rotterdam, Netherlands
| | - David Nicolas
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Emmanuel Coloma
- Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Joaquim Fernandez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Emili Vela
- Àrea de Sistemes d'Informació. Digitalization for the Sustainability of the Healthcare System (DS3), Servei Català de La Salut, Barcelona, Spain
| | - Isaac Cano
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy and Management and Institute for Medical Technology Assessment, Erasmus University Rotterdam. Rotterdam, The Netherlands, Rotterdam, Netherlands
| | - Josep Roca
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Carme Hernandez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. .,Hospital Clínic de Barcelona, Villarroel 170, 08036, Barcelona, Spain.
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13
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Prioritization of implementation barriers related to integrated care models in Central and Eastern European countries. Health Policy 2022; 126:1173-1179. [DOI: 10.1016/j.healthpol.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/03/2022] [Accepted: 08/22/2022] [Indexed: 11/22/2022]
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14
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Ceccherini C, Daniotti S, Bearzi C, Re I. Evaluating the Efficacy of Probiotics in IBS Treatment Using a Systematic Review of Clinical Trials and Multi-Criteria Decision Analysis. Nutrients 2022; 14:2689. [PMID: 35807868 PMCID: PMC9268703 DOI: 10.3390/nu14132689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/25/2023] Open
Abstract
The evaluation of probiotics' efficacy in treating irritable bowel syndrome is supported by an increasing number of clinical studies based on a heterogeneous approach of products tested and the patient cohort involved. Although the role of gut microbiota dysbiosis in IBS pathogenesis and the beneficial contribution of probiotics were demonstrated, a tool to discriminate symptom-specific strains and a personalised medicine protocol are still lacking. Thus, this study employs, for the first time, a method that combines the preferred reporting items for systematic reviews and meta-analysis and multi-criteria decision analysis methods in a structured decision-making tool to analyze the efficacy of probiotic mix, in order to identify the most effective formulation and to discriminate which probiotics are more efficient in treating different symptoms. The PRISMA methodology resulted in a qualitative and quantitative analysis of 104 clinical studies from 2011 to 2021, revealing a prevalence of Lactobacillus rhamnosus, Lactobacillus acidophilus, and Bifidobacterium animalis subsp. lactis. MCDA analysis showed that formulations based on Lactobacillus rhamnosus and Lactobacillus acidophilus have the highest efficacy, especially on quality of life, bloating, and abdominal pain. This methodological approach could become more specific by modelling clinical studies according to the age and gender of patients and probiotic strain.
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Affiliation(s)
- Cecilia Ceccherini
- Consorzio Italbiotec, Piazza Della Trivulziana 4/A, 20126 Milano, Italy; (S.D.); (I.R.)
| | - Sara Daniotti
- Consorzio Italbiotec, Piazza Della Trivulziana 4/A, 20126 Milano, Italy; (S.D.); (I.R.)
| | - Claudia Bearzi
- Institute of Biomedical Technologies, National Research Council, Via Fratelli Cervi 93, 20054 Segrate, Italy;
| | - Ilaria Re
- Consorzio Italbiotec, Piazza Della Trivulziana 4/A, 20126 Milano, Italy; (S.D.); (I.R.)
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15
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Rodrigues M, Oliveira C, Borges A, Franco M, Silva R. What exists in academia on work stress in accounting professionals: a bibliometric analysis. CURRENT PSYCHOLOGY 2022; 42:1-18. [PMID: 35789626 PMCID: PMC9244524 DOI: 10.1007/s12144-022-03301-w] [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] [Accepted: 05/31/2022] [Indexed: 12/05/2022]
Abstract
This study aims to fill a gap in the literature by conducting the scientific and bibliometric mapping of work stress in accounting professionals, using a methodological trilogy that contributes to this topic, namely the application of the ROC curve, Prisma and R bibliometric tools. Through the analysis of a sample of 103 articles, it was found that, in order to avoid and/or overcome the levels of stress in accountants, the following factors should be taken into account: (1) a high engagement with work, (2) reduced self-efficacy perception in the decision-making process, (3) adverse consequences in the management process, and (4) high-stress levels embedded in the individual's personality. Thus, it will be necessary for the accountant to apply strategies and change the way he/she works and perceives the work, avoiding stress levels and irreversible health damage. In addition, the importance of resilience in the professional context and mindfulness may prevent high levels of stress and maybe the subject of future research.
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Affiliation(s)
- Margarida Rodrigues
- Department of Management of the Instituto de Estudos Superiores de Fafe, CEFAGE-UBI Research Center, Universidade da Beira Interior, Estrada Do Sineiro, 6200-209 Covilhã, Portugal
| | - Cidália Oliveira
- NIPE - Centre for Research in Economics and Management, University of Minho, 4704-553 Braga, Portugal
| | - Ana Borges
- CICET - FCVC & COMEGI, ISAG - European Business School, Campus de Salazares, Rua de Salazares 842, 4100-442 Porto, Portugal
| | - Mário Franco
- Department of Management and Economics, CEFAGE-UBI Research Center, Universidade da Beira Interior, Estrada Do Sineiro, 6200-209 Covilhã, Portugal
| | - Rui Silva
- CETRAD Research Center, University of Trás-os-Montes and Alto Douro –UTAD, Vila Real, Portugal
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16
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Hoedemakers M, Karimi M, Jonker M, Tsiachristas A, Rutten-van Mölken M. Heterogeneity in preferences for outcomes of integrated care for persons with multiple chronic diseases: a latent class analysis of a discrete choice experiment. Qual Life Res 2022; 31:2775-2789. [PMID: 35585287 PMCID: PMC9356934 DOI: 10.1007/s11136-022-03147-6] [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] [Accepted: 04/20/2022] [Indexed: 11/06/2022]
Abstract
Purpose For an integrated care programme to be successful, preferences of the stakeholders involved should be aligned. The aim of this study is to investigate to which extent outcomes beyond health are valued and to study the heterogeneity of preferences of those involved in integrated care. Methods A discrete choice experiment (DCE) was conducted to elicit preferences for eight Triple Aim outcomes, i.e., physical functioning, psychological well-being, social relationships & participation, enjoyment of life, resilience, person-centeredness, continuity of care and total health and social care costs. Stakeholders were recruited among Dutch persons with multi-morbidity, informal caregivers, professionals, payers, and policymakers. A Bayesian mixed-logit model was used to analyse the data. Subsequently, a latent class analysis was performed to identify stakeholders with similar preferences. Results 739 stakeholders completed the DCE. Enjoyment of life was perceived as the most important outcome (relative importance: 0.221) across stakeholders, while total health and social care costs were perceived as least important (0.063). The latent class analysis identified four classes. The first class (19.9%) put most weight on experience with care outcomes. The second class (39%) favoured enjoyment of life. The third class (18%) focused relatively more on physical health. The fourth class (24%) had the least consistent preferences. Conclusion This study has highlighted the heterogeneity in views of stakeholders in integrated care on what is important in health(care) for persons with multi-morbidity. To accurately value integrated care a variety of outcomes beyond health–e.g., enjoyment of life and experience with care–should be taken into account. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03147-6.
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Affiliation(s)
- Maaike Hoedemakers
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Marcel Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands
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17
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Litchfield I, Kingston B, Narga D, Turner A. The move towards integrated care: Lessons learnt from managing patients with multiple morbidities in the UK. Health Policy 2022; 126:777-785. [DOI: 10.1016/j.healthpol.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
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18
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Hoedemakers M, Karimi M, Leijten F, Goossens L, Islam K, Tsiachristas A, Rutten-van Molken M. Value-based person-centred integrated care for frail elderly living at home: a quasi-experimental evaluation using multicriteria decision analysis. BMJ Open 2022; 12:e054672. [PMID: 35437245 PMCID: PMC9016393 DOI: 10.1136/bmjopen-2021-054672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To evaluate the value of the person-centred, integrated care programme Care Chain Frail Elderly (CCFE) compared with usual care, using multicriteria decision analysis (MCDA). DESIGN In a 12-month quasi-experimental study, triple-aim outcomes were measured at 0, 6 and 12 months by trained interviewers during home-visits. SETTING Primary care, community-based elderly care. PARTICIPANTS 384 community-dwelling frail elderly were enrolled. The 12-month completion rate was 70% in both groups. Propensity score matching was used to balance age, gender, marital status, living situation, education, smoking status and 3 month costs prior to baseline between the two groups. INTERVENTION The CCFE is an integrated care programme with unique features like the presence of the elderly and informal caregiver at the multidisciplinary team meetings, and a bundled payment. PRIMARY AND SECONDARY OUTCOMES MEASURES The MCDA results in weighted overall value scores that combines the performance on physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and costs, with importance weights of patients, informal caregivers, professionals, payers and policy-makers. RESULTS At 6 months, the overall value scores of CCFE were higher in all stakeholder groups, driven by enjoyment of life (standardised performance scores 0.729 vs 0.685) and person-centredness (0.749 vs 0.663). At 12 months, the overall value scores in both groups were similar from a patient's perspective, slightly higher for CCFE from an informal caregiver's and professional's perspective, and lower for CCFE from a payer's and policy-maker's perspective. The latter was driven by a worse performance on physical functioning (0.682 vs 0.731) and higher costs (€22 816 vs €20 680). CONCLUSIONS The MCDA indicated that the CCFE is the preferred way of delivering care to frail elderly at 6 months. However, at 12 months, MCDA results showed little difference from the perspective of patients, informal caregivers and professionals, while payers and policy-makers seemed to prefer usual care.
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Affiliation(s)
- Maaike Hoedemakers
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- OPEN Health, Rotterdam, The Netherlands
| | - Fenna Leijten
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
- Staff Defence Healthcare Organisation, Ministry of Defence, Utrecht, The Netherlands
| | - Lucas Goossens
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway
- Social Sciences, NORCE Norwegian Research Centre AS, Bergen, Norway
| | | | - Maureen Rutten-van Molken
- Erasmus School of Health Policy & Management, Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
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19
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Application of a Mixed Methods Multi-Criteria Decision Analysis Framework in Integrated Health Care. Int J Integr Care 2022; 22:19. [PMID: 35756339 PMCID: PMC9187248 DOI: 10.5334/ijic.5997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 05/03/2022] [Indexed: 12/21/2022] Open
Abstract
Background: Evaluating integrated care programs is complex. Integration benefits may not become apparent within short evaluation timeframes, and many programs provide a wide variety of health and non-health benefits. To address these challenges, we illustrate a mixed methods approach for evaluating multiple integrated care programs using multi-criteria decision analysis. Methods: We adapted a decision support tool used by local decision makers to compare data extracted from 17 different integrated care evaluations. Criteria included impact on health services capacity, patient outcomes, integration of care, workforce development and implementation risk, weighted based on stakeholder preferences. Program benefits were compared to their implementation costs, and assessed using cost-effectiveness methods. Sensitivity analysis examined the impact of different criteria weights. Results and discussion: This method captured a diverse range of benefits provided by integrated care programs and provided an accessible heuristic to compare many projects simultaneously. However, this approach may not be sensitive to the appropriateness of each criterion to the health system, the magnitude of difference in individual criteria, equity considerations or socio-political factors. Internal and external validation, especially for subjective criteria such as implementation risk, are needed. Conclusions: This work offers a feasible, flexible and pragmatic approach for evaluating integrated care programs.
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20
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Garattini L, Badinella Martini M, Nobili A. Integrated care in Western Europe: a wise solution for the future? Expert Rev Pharmacoecon Outcomes Res 2022; 22:717-721. [PMID: 35196951 DOI: 10.1080/14737167.2022.2046465] [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: 11/04/2022]
Abstract
INTRODUCTION IC is a term commonly adopted across the world underpinning a positive attitude against fragmentation of healthcare service provision. While the principles supporting IC are simple, their implementation is more controversial. AREAS COVERED The growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by aging multi-morbid patients. A comprehensive definition of IC should now include the coordination of health and social services useful to deliver continuous care across organizational boundaries. The recent debate on IC is largely influenced by the mismatch between the increasing burden of health and social needs for chronic conditions from the demand side, and the design of health-care systems still focused on acute care from the supply side. EXPERT OPINION The major reasons of persisting IC weakness in European countries stem from arguable choices of health policy taken in the recent past. The political creed in 'market competition' is probably the most emblematic. All initiatives encouraging health-care providers to compete with each other are likely to discourage IC. Since most European GPs are still self-employed professionals working in their own cabinets, the anachronistic professional status of GPs is another historically rooted reason of IC weakness.
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Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | | | - Alessandro Nobili
- Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
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21
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Rodrigues M, Franco M. Bibliometric review about eco-cites and urban sustainable development: trend topics. ENVIRONMENT, DEVELOPMENT AND SUSTAINABILITY 2022; 24:13683-13704. [PMID: 35013668 PMCID: PMC8731202 DOI: 10.1007/s10668-021-02006-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/25/2021] [Indexed: 05/15/2023]
Abstract
The world is undergoing exponential urbanization, with consequences for society in general, both for cities and people, with serious economic, social and environmental implications. Therefore, it is crucial to reconsider urban models of cities, to ensure global, long-term sustainability. Numerous researchers have argued that one of these models involves eco-city projects, and this study aims to carry out a systematic review of the literature on this topic, through bibliometrics. To do so, the Smarter, Prisma and Vantage Point methods were used, reflecting the originality of the study. The results obtained show that China has aroused researchers' interest regarding its eco-city projects, with most studies being empirical, and so this study complements them. The main contribution of this research lies in identifying the keywords most used by authors, these being eco-cities, sustainable cities (cluster 1) and eco-cities, China, sustainable urban development and eco-cycle model (cluster 2). Finally, implications for theory and practice are presented, together with suggestions for future research.
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Affiliation(s)
- Margarida Rodrigues
- CEFAGE-UBI Research Center, Instituto de Estudos Superiores de Fafe, Universidade da Beira Interior, Estrada do Sineiro, 6200-209 Covilhã, Portugal
| | - Mário Franco
- Department of Management and Economics, CEFAGE-UBI Research Center, Universidade da Beira Interior, Estrada do Sineiro, 6200-209 Covilhã, Portugal
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22
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The Advantages and Disadvantages of Integrated Care Implementation in Central and Eastern Europe - Perspective from 9 CEE Countries. Int J Integr Care 2021; 21:14. [PMID: 34824563 PMCID: PMC8588893 DOI: 10.5334/ijic.5632] [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: 11/01/2020] [Accepted: 09/20/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction: Health and social care systems in Central and Eastern European (CEE) countries have undergone significant changes and are currently dealing with serious problems of system disintegration, coordination and a lack of control over the market environment. Description: The increased health needs related to the ageing society and epidemiological patterns in these countries also require funding needs to increase, rationing to be reformed, sectors to be integrated (the managed care approach), and an analytical information base to be developed if supervision of new technological approaches is to improve. The period of system transitions in CEE countries entailed significant changes in their health systems, including health care financing. Discussion: Large deficits in the public financing of health systems were just one of the challenges arising from the economic downturn of the 1990s, which was coupled with inflation, increasing unemployment, low salaries, a large informal sector and tax evasion in a number of CEE countries. During the communist period, there was universal access to a wide range of health services, proving it difficult to retain this coverage. As a result, many states sought to ration publicly funded health services – for example, through patient cost-sharing or decreasing the scope of basic benefits. Yet, not all of these reform plans were implemented, and in fact, some were rolled back or not implemented at all due to a lack of social or political consensus. Conclusion: CEE health systems had come to practice implicit rationing in the form of under-the-table payments from patients, quasi-formal payments to providers to compensate for lack of funding, and long waiting lists forcing patients to the private sector. All these difficulties pose a challenge to the implementation of integrated care.
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23
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Islam MK, Ruths S, Jansen K, Falck R, Mölken MRV, Askildsen JE. Evaluating an integrated care pathway for frail elderly patients in Norway using multi-criteria decision analysis. BMC Health Serv Res 2021; 21:884. [PMID: 34454494 PMCID: PMC8400755 DOI: 10.1186/s12913-021-06805-6] [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: 10/23/2020] [Accepted: 07/20/2021] [Indexed: 11/28/2022] Open
Abstract
Background To provide value-based care for patients with multi-morbidity, innovative integrated care programmes and comprehensive evaluations of such programmes are required. In Norway, a new programme called “Holistic Continuity of Patient Care” (HCPC) addresses the issue of multi-morbidity by providing integrated care within learning networks for frail elderly patients who receive municipal home care services or a short-term stay in a nursing home. This study conducts a multi-criteria decision analysis (MCDA) to evaluate whether the HCPC programme performs better on a large set of outcomes corresponding to the ‘triple aim’ compared to usual care. Methods Prospective longitudinal survey data were collected at baseline and follow-up after 6-months. The assessment of HCPC was implemented by a novel MCDA framework. The relative weights of importance of the outcomes used in the MCDA were obtained from a discrete choice experiment among five different groups of stakeholders. The performance score was estimated using a quasi-experimental design and linear mixed methods. Performance scores were standardized and multiplied by their weights of importance to obtain the overall MCDA value by stakeholder group. Results At baseline in the HCPC and usual care groups, respectively, 120 and 89 patients responded, of whom 87 and 41 responded at follow-up. The average age at baseline was 80.0 years for HCPC and 83.6 for usual care. Matching reduced the standardized differences between the groups for patient background characteristics and outcome variables. The MCDA results indicated that HCPC was preferred to usual care irrespective of stakeholders. The better performance of HCPC was mostly driven by improvements in enjoyment of life, psychological well-being, and social relationships and participation. Results were consistent with sensitivity analyses using Monte Carlo simulation. Conclusion Frail elderly with multi-morbidity represent complex health problems at large costs for society in terms of health- and social care. This study is a novel contribution to assessing and understanding HCPC programme performance respecting the multi-dimensionality of desired outcomes. Integrated care programmes like HCPC may improve well-being of patients, be cost-saving, and contribute to the pursuit of evidence based gradual reforms in the care of frail elderly. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06805-6.
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Affiliation(s)
- M Kamrul Islam
- Department of Economics, University of Bergen, Postboks 7802, 5020, Bergen, Norway. .,Department of Social Sciences, NORCE Norwegian Research Centre, Bergen, Norway.
| | - Sabine Ruths
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kristian Jansen
- Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Nursing homes, Municipality of Bergen, Bergen, Norway
| | - Runa Falck
- Department of Comparative Politics, University of Bergen, Bergen, Norway
| | | | - Jan Erik Askildsen
- Department of Economics, University of Bergen, Postboks 7802, 5020, Bergen, Norway
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Changes in Clinical Characteristics and Outcomes of Patients Admitted to Inpatient Cardiac Rehabilitation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168871. [PMID: 34444621 PMCID: PMC8394864 DOI: 10.3390/ijerph18168871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 12/04/2022]
Abstract
Aims: Cardiac rehabilitation (CR) has proven to be effective and beneficial in middle-aged and older patients. However, solid data in large cohorts of elderly individuals are yet to be explored. This retrospective study investigated the general characteristics, outcomes, and the level of response of patients referred to CR over 13 consecutive years. Methods: We reviewed the medical records of patients admitted to Villa Pineta Rehabilitation Hospital for exercise-based CR from 2006 to 2018. The patients’ baseline characteristics and changes following CR in an upper-limb weightlifting test (ULW), 30-s sit-to-stand test (30STS), and the 6-min walking test (6MWT) with associated Borg-related dyspnea (D) and fatigue (F) were collected. We also calculated the number of individuals that reached the minimal clinically relevant change (MCRC) following CR for each outcome. Results: One thousand five hundred and fifty-one patients (70.2 ± 9.7 years, 66% men) with complete datasets were included in the analysis. Coronary artery bypass graft and cardiac valve replacement surgery were the most frequent surgical procedures leading to CR referral (41.1% and 35.8%, respectively). The patients’ age (p = 0.03), number of total comorbidities (p < 0.0001), and post-surgical complications (p = 0.02) significantly increased over time. In contrast, the average absolute changes in ULW, 30STS, and 6MWT with associated D and F, and the proportion of patients that reached their respective MCRC, remained constant over the same period. Conclusion: The patients admitted to exercise-based CR were older and had more comorbidities and complications over time. The outcomes, however, were not influenced in terms of the absolute change or clinically meaningful response.
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Karimi M, van der Zwaan L, Islam K, van Genabeek J, Mölken MRV. Evaluating Complex Health and Social Care Program Using Multi-Criteria Decision Analysis: A Case Study of "Better Together in Amsterdam North". VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:966-975. [PMID: 34243840 DOI: 10.1016/j.jval.2021.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 01/04/2021] [Accepted: 02/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Multi-criteria decision analysis (MCDA) has been recommended to support policy making in healthcare. However, practical applications of MCDA are sparse. One potential use for MCDA is for the evaluation of programs for complex and vulnerable patients. These complex patients benefit from integrated care programs that span healthcare and social care and aim to improve more than just health outcomes. MCDA can evaluate programs that aim to improve broader outcomes because it allows the evaluation of multiple outcomes alongside each other. In this study, we evaluate an innovative integrated care program in the Netherlands using MCDA. METHODS We used an innovative MCDA framework with broad outcomes of health, well-being, and cost to evaluate the Better Together in Amsterdam North (BSiN) program using preferences of patients, partners, providers, payers, and policy makers in the Netherlands. BSiN provides case management support for a period of 6 months. Seven outcomes that previous research has deemed important to complex patients were measured, including physical functioning and social relationships and participation. RESULTS We find that the program improved the overall MCDA score marginally, and, thus, after 6 and after 12 months, BSiN was preferred to usual care by all stakeholders. BSiN was preferred to usual care, mostly owing to improvements in psychological well-being and social relationships and participation. CONCLUSIONS The integrated healthcare and social care program BSiN in the Netherlands was preferred to usual care according to an MCDA evaluation. MCDA seems a useful method to evaluate complex programs with benefits beyond health.
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Affiliation(s)
- Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands.
| | - Lennart van der Zwaan
- Netherlands Organization for Applied Scientific Research TNO, Unit Healthy Living, Leiden, The Netherlands
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway; NORCE Norwegian Research Centre, Bergen, Norway
| | - Joost van Genabeek
- Netherlands Organization for Applied Scientific Research TNO, Unit Healthy Living, Leiden, The Netherlands
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands; Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
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26
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van den Bogaart EHA, Kroese MEAL, Spreeuwenberg MD, Ruwaard D, Tsiachristas A. Economic Evaluation of New Models of Care: Does the Decision Change Between Cost-Utility Analysis and Multi-Criteria Decision Analysis? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:795-803. [PMID: 34119077 DOI: 10.1016/j.jval.2021.01.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To experiment with new approaches of collaboration in healthcare delivery, local authorities implement new models of care. Regarding the local decision context of these models, multi-criteria decision analysis (MCDA) may be of added value to cost-utility analysis (CUA), because it covers a wider range of outcomes. This study compares the 2 methods using a side-by-side application. METHODS A new Dutch model of care, Primary Care Plus (PC+), was used as a case study to compare the results of CUA and MCDA. Data of patients referred to PC+ or care-as-usual were retrieved by questionnaires and administrative databases with a 3-month follow-up. Propensity score matching together with generalized linear regression models was used to reduce confounding. Univariate and probabilistic sensitivity analyses were performed to explore uncertainty in the results. RESULTS Although both methods indicated PC+ as the dominant alternative, complementary differences were observed. MCDA provided additional evidence that PC+ improved access to care (standardized performance score of 0.742 vs 0.670) and that improvement in health-related quality of life was driven by the psychological well-being component (standardized performance score of 0.710 vs 0.704). Furthermore, MCDA estimated the budget required for PC+ to be affordable in addition to preferable (€521.42 per patient). Additionally, MCDA was less sensitive to the utility measures used. CONCLUSIONS MCDA may facilitate an auditable and transparent evaluation of new models of care by providing additional information on a wider range of outcomes and incorporating affordability. However, more effort is needed to increase the usability of MCDA among local decision makers.
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Affiliation(s)
- Esther H A van den Bogaart
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Mariëlle E A L Kroese
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Marieke D Spreeuwenberg
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands; Research Center for Technology in Care, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Cerezo-Espinosa de los Monteros J, Castro-Torres A, Gómez-Salgado J, Fagundo-Rivera J, Gómez-Salgado C, Coronado-Vázquez V. Administration of Strategic Agreements in Public Hospitals: Considerations to Enhance the Quality and Sustainability of Mergers and Acquisitions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4051. [PMID: 33921426 PMCID: PMC8069692 DOI: 10.3390/ijerph18084051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 11/16/2022]
Abstract
Merger processes between hospitals have high benefit potential for patients, staff and managers. This integration of health centres can improve the quality and safety in patient care. Additionally, cooperative processes enhance the sustainability of the health system, by increasing team spirit, giving innovative ideas and improving staff satisfaction. In this article, the critical factors for successful hospital mergers and acquisitions in the Public Health System were considered to develop a brief guide to help with the organisation of a merger process. Five sections were designed: Strategic administration and objectives, Staff management, New hospital complex structure, Processes and Results. This guide facilitates the communication between a variety of stakeholders, thus improving the engagement between all members of the new healthcare system. This could be particularly important for countries with large regional variance in the organisation of health care and resources.
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Affiliation(s)
| | | | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Postgraduate Program, Universidad Espíritu Santo, Guayaquil 091650, Ecuador
| | - Javier Fagundo-Rivera
- Health Sciences Doctorate School, University of Huelva, 21007 Huelva, Spain;
- Centro Universitario de Enfermería Cruz Roja, University of Seville, 41009 Seville, Spain
| | | | - Valle Coronado-Vázquez
- Illescas Health Centre, Castilla-La Mancha Health Service, 45200 Toledo, Spain;
- Health Science Institute of Aragon, 50009 Zaragoza, Spain
- Department of Health Sciences, Santa Teresa de Jesus Catholic University of Avila, 05005 Avila, Spain
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Stokes J, Shah V, Goldzahl L, Kristensen SR, Sutton M. Does prevention-focused integration lead to the triple aim? An evaluation of two new care models in England. J Health Serv Res Policy 2021; 26:125-132. [PMID: 33106038 PMCID: PMC8013794 DOI: 10.1177/1355819620963500] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine the effectiveness of two integrated care models ('vanguards') in Salford and South Somerset in England, United Kingdom, in relation to patient experience, health outcomes and costs of care (the 'triple aim'). METHODS We used difference-in-differences analysis combined with propensity score weighting to compare the two care model sites with control ('usual care') areas in the rest of England. We estimated combined and separate annual effects in the three years following introduction of the new care model, using the national General Practice Patient Survey (GPPS) to measure patient experience (inter-organisational support with chronic condition management) and generic health status (EQ-5D); and hospital episode statistics (HES) data to measure total costs of secondary care. As secondary outcomes we measured proxies for improved prevention: cost per user of secondary care (severity); avoidable emergency admissions; and primary care utilisation. RESULTS Both intervention sites showed an increase in total costs of secondary care (approximately £74 per registered patient per year in Salford, £45 in South Somerset) and cost per user of secondary care (£130-138 per person per year). There were no statistically significant effects on health status or patient experience of care. There was a more apparent short-term negative effect on measured outcomes in South Somerset, in terms of increased costs and avoidable emergency admissions, but these reduced over time. CONCLUSION New care models such as those implemented within the Vanguard programme in England might lead to unintended secondary care cost increases in the short to medium term. Cost increases appeared to be driven by average patient severity increases in hospital. Prevention-focused population health management models of integrated care, like previous more targeted models, do not immediately improve the health system's triple aim.
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Affiliation(s)
- Jonathan Stokes
- Research Fellow, Health Organisation, Policy, and Economics,
Centre for Primary Care and Health Services Research, University of Manchester,
UK
- Jonathan Stokes, Health Organisation,
Policy, and Economics, Centre for Primary Care and Health Services Research,
University of Manchester, Manchester M13 9PL, UK.
| | - Vishalie Shah
- Research Associate, Health Organisation, Policy, and Economics,
Centre for Primary Care and Health Services Research, University of Manchester,
UK
| | | | - Søren Rud Kristensen
- Senior Lecturer, Faculty of Medicine, Institute of Global Health
Innovation, Imperial College London, UK
- Associate Professor, Danish Centre for Health Economics
Research, University of Southern Denmark, Denmark
| | - Matt Sutton
- Associate Professor, Danish Centre for Health Economics
Research, University of Southern Denmark, Denmark
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Sarri G, Freitag A, Szegvari B, Mountian I, Brixner D, Bertelsen N, Kaló Z, Upadhyaya S. The Role of Patient Experience in the Value Assessment of Complex Technologies - Do HTA Bodies Need to Reconsider How Value is Assessed? Health Policy 2021; 125:593-601. [PMID: 33814201 DOI: 10.1016/j.healthpol.2021.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/29/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | | | - Neil Bertelsen
- HTAi Interest Group on Patient & Citizen Involvement; Neil Bertelsen Consulting, Germany
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary; Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Sheela Upadhyaya
- Centre for Health Technology Evaluation, National Institute for Health and Care Excellence
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30
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Looman W, Struckmann V, Köppen J, Baltaxe E, Czypionka T, Huic M, Pitter J, Ruths S, Stokes J, Bal R, Rutten-van Mölken M. Drivers of successful implementation of integrated care for multi-morbidity: Mechanisms identified in 17 case studies from 8 European countries. Soc Sci Med 2021; 277:113728. [PMID: 33878666 DOI: 10.1016/j.socscimed.2021.113728] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/26/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022]
Abstract
This paper provides a deeper understanding of the mechanisms underlying implementation strategies for integrated care. As part of the SELFIE project, 17 integrated care programmes addressing multi-morbidity from eight European countries were selected and studied. Data was extracted from 'thick descriptions' of the 17 programmes and analysed both inductively and deductively using implementation theory. The following ten mechanisms for successful implementation of integrated care were identified. With regards to service delivery, successful implementers (1) commonly adopted an incremental growth model rather than a disruptive innovation approach, and found (2) a balance between flexibility and formal structures of integration. For leadership & governance, they (3) applied collaborative governance by engaging all stakeholders, and (4) distributed leadership throughout all levels of the system. For the workforce, these implementers (5) were able to build a multidisciplinary team culture with mutual recognition of each other's roles, and (6) stimulated the development of new roles and competencies for integrated care. With respect to financing, (7) secured long-term funding and innovative payments were applied as means to overcome fragmented financing of health and social care. Implementers emphasised (8) the implementation of ICT that was specifically developed to support collaboration and communication rather than administrative procedures (technology & medical devices), and (9) created feedback loops and a continuous monitoring system (information & research). The overarching mechanism was that implementers (10) engaged in alignment work across the different components and levels of the health and social care system. These evidence-based mechanisms for implementation are applicable in different local, regional and national contexts.
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Affiliation(s)
- Willemijn Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Verena Struckmann
- Department of Health Care Management, Technische Universität Berlin, Berlin, H 80, Strasse des 17, Juni 135, D-10623, Berlin, Germany.
| | - Julia Köppen
- Department of Health Care Management, Technische Universität Berlin, Berlin, H 80, Strasse des 17, Juni 135, D-10623, Berlin, Germany.
| | - Erik Baltaxe
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Carrer del Rosselló, 149, 08036, Barcelona, Spain.
| | - Thomas Czypionka
- Institute for Advanced Studies, Vienna, Austria, Josefstädter Straße 39, 1080, Vienna, Austria.
| | - Mirjana Huic
- Ministry of Health, Zagreb, Croatia, Ksaver 200a HR, 10000, Zagreb, Croatia.
| | - Janos Pitter
- Syreon Research Institute, Budapest, Hungary, 1142, Budapest, Mexikoi str. 65/A, Budapest, Hungary.
| | - Sabine Ruths
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Research Unit for General Practice, NORCE Norwegian Research Centre, P.O. Box 7804, 5020 Bergen, Norway.
| | - Jonathan Stokes
- Centre for Primary Care and Health Services Research, University of Manchester, 7th Floor, Williamson Building, Oxford Road, M13 9PL, Manchester, United Kingdom.
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, The Netherlands, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands, P.O. Box 1738, 3000 DR, Rotterdam, the Netherlands.
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Czypionka T, Kraus M, Reiss M, Baltaxe E, Roca J, Ruths S, Stokes J, Struckmann V, Haček RT, Zemplényi A, Hoedemakers M, Rutten-van Mölken M. The patient at the centre: evidence from 17 European integrated care programmes for persons with complex needs. BMC Health Serv Res 2020; 20:1102. [PMID: 33256723 PMCID: PMC7706259 DOI: 10.1186/s12913-020-05917-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 11/12/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND As the prevalence of multi-morbidity increases in ageing societies, health and social care systems face the challenge of providing adequate care to persons with complex needs. Approaches that integrate care across sectors and disciplines have been increasingly developed and implemented in European countries in order to tackle this challenge. The aim of the article is to identify success factors and crucial elements in the process of integrated care delivery for persons with complex needs as seen from the practical perspective of the involved stakeholders (patients, professionals, informal caregivers, managers, initiators, payers). METHODS Seventeen integrated care programmes for persons with complex needs in 8 European countries were investigated using a qualitative approach, namely thick description, based on semi-structured interviews and document analysis. In total, 233 face-to-face interviews were conducted with stakeholders of the programmes between March and September 2016. Meta-analysis of the individual thick description reports was performed with a focus on the process of care delivery. RESULTS Four categories that emerged from the overarching analysis are discussed in the article: (1) a holistic view of the patient, considering both mental health and the social situation in addition to physical health, (2) continuity of care in the form of single contact points, alignment of services and good relationships between patients and professionals, (3) relationships between professionals built on trust and facilitated by continuous communication, and (4) patient involvement in goal-setting and decision-making, allowing patients to adapt to reorganised service delivery. CONCLUSIONS We were able to identify several key aspects for a well-functioning integrated care process for complex patients and how these are put into actual practice. The article sets itself apart from the existing literature by specifically focussing on the growing share of the population with complex care needs and by providing an analysis of actual processes and interpersonal relationships that shape integrated care in practice, incorporating evidence from a variety of programmes in several countries.
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Affiliation(s)
- Thomas Czypionka
- Institute for Advanced Studies, Josefstädter Straße 39, 1080, Vienna, Austria.,London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Markus Kraus
- Institute for Advanced Studies, Josefstädter Straße 39, 1080, Vienna, Austria.
| | - Miriam Reiss
- Institute for Advanced Studies, Josefstädter Straße 39, 1080, Vienna, Austria
| | - Erik Baltaxe
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Villarroel 170, Barcelona,, 08036,, Catalonia, Spain
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Villarroel 170, Barcelona,, 08036,, Catalonia, Spain
| | - Sabine Ruths
- University of Bergen, Postboks 7804, 5020, Bergen, Norway
| | - Jonathan Stokes
- University of Manchester, 7th Floor, Williamson Building, Oxford Road, Manchester, M13 9P, UK
| | - Verena Struckmann
- Berlin University of Technology, Strasse des 17. Juni 135 (H80), 10623, Berlin, Germany
| | | | - Antal Zemplényi
- Syreon Research Institute, Mexikoi str. 65/A, 1142, Budapest, Hungary
| | - Maaike Hoedemakers
- Erasmus University Rotterdam, P.O.Box 1738, 3000, DR, Rotterdam, The Netherlands
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Philip J, Collins A, Phillips J, Luckett T, Morgan DD, Lobb EA, DiGiacomo M, Kochovska S, Brown L, Currow DC. The Development of the Australian National Palliative Care Clinical Studies Collaborative "Integrating Qualitative Research into Clinical Trials Framework". J Palliat Med 2020; 24:331-337. [PMID: 33085551 DOI: 10.1089/jpm.2020.0480] [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] [Indexed: 11/13/2022] Open
Abstract
Qualitative methodologies have multiple contributions to health research, including improving baseline understanding in new areas of enquiry; questioning existing assumptions; understanding viewpoints of specific subgroups; and offering complex, contextual information. While the role of qualitative research within mixed methods approaches is well documented, the contribution to clinical trial design and conduct is less well recognized. The Australian Palliative Care Clinical Studies Collaborative and Cancer Symptom Trials have developed a framework to detail how qualitative research might contribute to each key aspect of clinical trials. This practical framework provides real-world examples, including sample qualitative questions, to consider at each phase of controlled clinical trial development. As the number of randomized clinical trials in palliative care increases, a readily accessible approach to integrating qualitative research into clinical trial design and conduct is needed so that its full potential for improving study recruitment, conduct, outcomes, interpretation, and implementation may be realized.
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Affiliation(s)
- Jennifer Philip
- Faculty of Medicine, Dentistry and Health Sciences, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Anna Collins
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Tim Luckett
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Deidre D Morgan
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah, Kogarah, New South Wales, Australia.,School of Medicine, University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Michelle DiGiacomo
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Linda Brown
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia.,Hull York Medical School, University of Hull, Hull, United Kingdom
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Rutten-van Mölken M, Karimi M, Leijten F, Hoedemakers M, Looman W, Islam K, Askildsen JE, Kraus M, Ercevic D, Struckmann V, Gyorgy Pitter J, Cano I, Stokes J, Jonker M. Comparing patients' and other stakeholders' preferences for outcomes of integrated care for multimorbidity: a discrete choice experiment in eight European countries. BMJ Open 2020; 10:e037547. [PMID: 33039997 PMCID: PMC7552858 DOI: 10.1136/bmjopen-2020-037547] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES To measure relative preferences for outcomes of integrated care of patients with multimorbidity from eight European countries and compare them to the preferences of other stakeholders within these countries. DESIGN A discrete choice experiment (DCE) was conducted in each country, asking respondents to choose between two integrated care programmes for persons with multimorbidity. SETTING Preference data collected in Austria (AT), Croatia (HR), Germany (DE), Hungary (HU), the Netherlands (NL), Norway (NO), Spain (ES), and UK. PARTICIPANTS Patients with multimorbidity, partners and other informal caregivers, professionals, payers and policymakers. MAIN OUTCOME MEASURES Preferences of participants regarding outcomes of integrated care described as health/well-being, experience with care and cost outcomes, that is, physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and total costs. Each outcome had three levels of performance. RESULTS 5122 respondents completed the DCE. In all countries, patients with multimorbidity, as well as most other stakeholder groups, assigned the (second) highest preference to enjoyment of life. The patients top-three most frequently included physical functioning, psychological well-being and continuity of care. Continuity of care also entered the top-three of professionals, payers and policymakers in four countries (AT, DE, HR and HU). Of the five stakeholder groups, preferences of professionals differed most often from preferences of patients. Professionals assigned lower weights to physical functioning in AT, DE, ES, NL and NO and higher weights to person-centredness in AT, DE, ES and HU. Payers and policymakers assigned higher weights than patients to costs, but these weights were relatively low. CONCLUSION The well-being outcome enjoyment of life is the most important outcome of integrated care in multimorbidity. This calls for a greater involvement of social and mental care providers. The difference in opinion between patients and professionals calls for shared decision-making, whereby efforts to improve well-being and person-centredness should not divert attention from improving physical functioning.
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Affiliation(s)
- Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Fenna Leijten
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Staff Defence Healthcare Organisation, Ministry of defence, Utrecht, The Netherlands
| | - Maaike Hoedemakers
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Willemijn Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Hordaland, Norway
| | - Jan E Askildsen
- Department of Economics, University of Bergen, Bergen, Hordaland, Norway
| | | | - Darija Ercevic
- Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
| | - Verena Struckmann
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | | | - Isaac Cano
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Catalunya, Spain
| | - Jonathan Stokes
- Centre for Health Economics, University of Manchester Institute of Population Health, Manchester, UK
| | - Marcel Jonker
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Kaló Z, Zemplényi A, Rutten-van Mölken M, Looman W, Huić M, Tandara Haček R, Petrova G, Piniazhko O, Tesar T, Csanádi M, Pitter JG. Development of transferability guidance for integrated care models with special focus on Central and Eastern European countries. Croat Med J 2020; 61:252-259. [PMID: 32643342 PMCID: PMC7358690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 06/10/2020] [Indexed: 03/30/2024] Open
Abstract
AIM To develop pragmatic recommendations for Central and Eastern European (CEE) policymakers about transferability assessment of integrated care models established in higher income European Union (EU) countries. METHODS Draft recommendations were developed based on Horizon 2020-funded SELFIE project deliverables related to 17 promising integrated care models for multimorbid patients throughout Europe, as well as on an online survey among CEE stakeholders on the relevance of implementation barriers. Draft recommendations were discussed at the SELFIE transferability workshop and finalized together with 22 experts from 12 CEE countries. RESULTS Thirteen transferability recommendations are provided in three areas. Feasibility of local implementation covers the identification and prioritization of implementation barriers and proposals for potential solutions. Performance measurement of potentially transferable models focuses on the selection of models with proven benefits and assurance of performance monitoring. Transferability of financing methods for integrated care explores the relevance of financing methodologies and planning of adequate initial and long-term financing. CONCLUSIONS Implementation of international integrated care models cannot be recommended without evidence on its local feasibility or scientifically sound and locally relevant performance assessment in the country of origin. However, if the original financing method is not transferable to the target region, development of a locally relevant alternative financing method can be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marcell Csanádi
- Marcell Csanádi, Syreon Research Institute, Mexikói Str. 65/a., Budapest, Hungary,
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DiStefano MJ, Krubiner CB. Beyond the numbers: a critique of quantitative multi-criteria decision analysis. Int J Technol Assess Health Care 2020; 36:1-5. [PMID: 32605684 DOI: 10.1017/s0266462320000410] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
When setting priorities for health, there is broad agreement that a range of social values and ethical principles beyond clinical and cost-effectiveness matter, but exactly how health technology assessment (HTA) should account for a broader set of criteria remains an area of ongoing debate. In light of this, we welcome a recent review paper by Baltussen et al. evaluating the potential of different multi-criteria decision analysis (MCDA) approaches to enable HTA agencies to incorporate a broader set of values in their appraisals. The authors describe three approaches to MCDA-qualitative MCDA, quantitative MCDA, and MCDA with decision rules-laying out their relative advantages and disadvantages and providing recommendations for how they can best be implemented. While we endorse many of the authors' assessments and conclusions, including the critical role of deliberation in any MCDA approach and the undertaking of qualitative MCDA at a minimum, we take a stronger position regarding the flaws of quantitative MCDA and strongly caution against it. We find quantitative MCDA antithetical to at least two of the ways MCDA is intended to improve HTA recommendations: (i) enhancing quality and (ii) promoting transparency. Quantitative MCDA may mask the complex tradeoffs that exist within and between decision criteria and remain generally inaccessible to those who are not well-versed in its technical methods of appraisal. We advocate for a predominantly qualitative approach to MCDA appraisal centered around deliberation and supplemented with decision aids to help account for health opportunity costs.
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Affiliation(s)
- Michael J DiStefano
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Berman Institute of Bioethics, Johns Hopkins University, BaltimoreMD, USA
| | - Carleigh B Krubiner
- Berman Institute of Bioethics, Johns Hopkins University, BaltimoreMD, USA
- Center for Global Development, Washington, DC, USA
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Crocker H, Kelly L, Harlock J, Fitzpatrick R, Peters M. Measuring the benefits of the integration of health and social care: qualitative interviews with professional stakeholders and patient representatives. BMC Health Serv Res 2020; 20:515. [PMID: 32505181 PMCID: PMC7275591 DOI: 10.1186/s12913-020-05374-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 05/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Integrated care has the potential to ease the increasing pressures faced by health and social care systems, however, challenges around measuring the benefits for providers, patients, and service users remain. This paper explores stakeholders' views on the benefits of integrated care and approaches to measuring the integration of health and social care. METHODS Twenty-five semi-structured qualitative interviews were conducted with professional stakeholders (n = 19) and patient representatives (n = 6). Interviews focused on the benefits of integrated care and how it should be evaluated. Data was analysed using framework analysis. RESULTS Three overarching themes emerged from the data: (1) integrated care and its benefits, with stakeholders defining it primarily from the patient's perspective; (2) potential measures for assessing the benefits of integration in terms of system effects, patient experiences, and patient outcomes; and (3) broader considerations around the assessment of integrated care, including the use of qualitative methods. CONCLUSIONS There was consensus among stakeholders that patient experiences and outcomes are the best measures of integration, and that the main measures currently used to assess integration do not directly assess patient benefits. Validated health status measures are readily available, however, a substantial shift in practices is required before their use becomes commonplace.
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Affiliation(s)
- Helen Crocker
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
| | - Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.,Harris Manchester College, Oxford, OX1 3TD, UK
| | - Jenny Harlock
- Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Kelly L, Harlock J, Peters M, Fitzpatrick R, Crocker H. Measures for the integration of health and social care services for long-term health conditions: a systematic review of reviews. BMC Health Serv Res 2020; 20:358. [PMID: 32336288 PMCID: PMC7183623 DOI: 10.1186/s12913-020-05206-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 04/12/2020] [Indexed: 01/09/2023] Open
Abstract
Background As people are living longer with higher incidences of long-term health conditions, there is a move towards greater integration of care, including integration of health and social care services. Integrated care needs to be comprehensively and systematically evaluated if it is to be implemented widely. We performed a systematic review of reviews to identify measures which have been used to assess integrated care across health and social care services for people living with long-term health conditions. Methods Four electronic databases (PUBMED; MEDLINE; EMBASE; Cochrane library of systematic reviews) were searched in August 2018 for relevant reviews evaluating the integration of health and social care between 1998 and 2018. Articles were assessed according to apriori eligibility criteria. A data extraction form was utilised to collate the identified measures into five categories. Results Of the 18 articles included, system outcomes and process measures were most frequently identified (15 articles each). Patient or carer reported outcomes were identified in 13 articles while health outcomes were reported in 12 articles. Structural measures were reported in nine articles. Challenges to measuring integration included the identification of a wide range of potential impacts of integration, difficulties in comparing findings due to differences in study design and heterogeneity of types of outcomes, and a need for appropriate, robust measurement tools. Conclusions Our review revealed no shortage of measures for assessing the structures, processes and outcomes of integrated care. The very large number of available measures and infrequent use of any common set make comparisons between schemes more difficult. The promotion of core measurement sets and stakeholder consultation would advance measurement in this area.
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Affiliation(s)
- Laura Kelly
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.,Harris Manchester College, Oxford, OX1 3TD, UK
| | - Jenny Harlock
- Health Sciences, University of Warwick, Coventry, CV4 7AL, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Helen Crocker
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, UK.
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38
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Marques ICP, Franco M. Cooperation networks in the area of health: systematic literature review. Scientometrics 2020. [DOI: 10.1007/s11192-019-03341-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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39
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Digital transformation in the area of health: systematic review of 45 years of evolution. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00402-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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From protocolized to person-centered chronic care in general practice: study protocol of an action-based research project (COPILOT). Prim Health Care Res Dev 2019; 20:e134. [PMID: 31547898 PMCID: PMC6764186 DOI: 10.1017/s1463423619000550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM To develop a proactive person-centered care approach for persons with (multiple) chronic diseases in general practice, and to explore the impact on 'Quadruple aims': experiences of patients and professionals, patient outcomes and costs of resources use. BACKGROUND The management of people with multiple chronic diseases challenges health care systems designed around single disease. Patients with multimorbidity often receive highly fragmented care that may lead to inefficient, ineffective and potentially harmful treatments and neglect of essential health needs. A more comprehensive, person-centered approach is advocated for persons with multiple morbidities. However, examples on how to provide more person-centered care and evidence of its impact are scarce. A group of Dutch general practitioners (GPs) took the initiative to develop such a care approach. METHODS/DESIGN Mixed methods with a development and pilot-testing phase. The proactive person-centered approach will be developed using an action-based research design consisting of multiple plan-act-observe-reflect-adjust cycles. In each cycle, experiences of patients and primary care professionals from 13 practices will be collected via interviews, observations and focus groups. Starting point for the first cycle is a 'person-centered consultation' of up to 1 h in which the GP discusses the health status and health care needs of the patient. Furthermore, shared decisions between GP and patient are made on treatment goals and follow-up. In the pilot-test phase, a nested case cohort study allows to explore the impact of the new approach on 'Quadruple aim' outcomes comparing persons with and without exposure to the new care approach. DISCUSSION This study will provide a proactive person-centered approach for persons with multimorbidity in primary care and estimate its potential impact on quadruple outcomes.
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Kadu M, Ehrenberg N, Stein V, Tsiachristas A. Methodological Quality of Economic Evaluations in Integrated Care: Evidence from a Systematic Review. Int J Integr Care 2019; 19:17. [PMID: 31565040 PMCID: PMC6743034 DOI: 10.5334/ijic.4675] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/20/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The aim of this review is to systematically assess the methodological quality of economic evaluations in integrated care and to identify challenges with conducting such studies. THEORY AND METHODS Searches of grey-literature and scientific papers were performed, from January 2000 to December 2018. A checklist was developed to assess the quality of economic evaluations. Authors' statements of challenges encountered during their evaluations were qualitatively coded. RESULTS Forty-four articles were eligible for inclusion. The review found that study design, measurement of cost and outcomes, statistical analysis and presentation of data were the areas with most quality variation. Authors identified challenges mostly related to time horizon of the evaluation, inadequate or lack of comparator group, contamination bias, and a post-hoc evaluation culture. DISCUSSION Our review found significant differences in quality, with some studies showing poor methodological rigor; challenging conclusions on the cost-effectiveness of integrated care. CONCLUSION It is essential for evaluators to use best-practice standards when planning and conducting economic evaluations, in order to build a reliable evidence base for decision-making in integrated care.
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Affiliation(s)
- Mudathira Kadu
- International Foundation for Integrated Care, Oxford, UK
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, CA
| | | | - Viktoria Stein
- International Foundation for Integrated Care, Oxford, UK
| | - Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Hoedemakers M, Marie Leijten FR, Looman W, Czypionka T, Kraus M, Donkers H, van den Hende-Wijnands E, van den Broek NM, Rutten-van Mölken M. Integrated Care for Frail Elderly: A Qualitative Study of a Promising Approach in The Netherlands. Int J Integr Care 2019; 19:16. [PMID: 31534444 PMCID: PMC6729107 DOI: 10.5334/ijic.4626] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/14/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Increasingly, frail elderly need to live at home for longer, relying on support from informal caregivers and community-based health- and social care professionals. To align care and avoid fragmentation, integrated care programmes are arising. A promising example of such a programme is the Care Chain Frail Elderly (CCFE) in the Netherlands, which supports elderly with case and care complexity living at home with the best possible health and quality of life. The goal of the current study was to gain a deeper understanding of this programme and how it was successfully put into practice in order to contribute to the evidence-base surrounding complex integrated care programmes for persons with multi-morbidity. METHODS Document analyses and semi-structured interviews with stakeholders were used to create a 'thick description' that provides insights into the programme. RESULTS Through case finding, the CCFE-programme targets the frailest primary care population. The person-centred care approach is reflected by the presence of frail elderly at multidisciplinary team meetings. The innovative way of financing by bundling payments of multiple providers is one of the main facilitators for the success of this programme. Other critical success factors are the holistic assessment of unmet health and social care needs, strong leadership by the care groups, close collaboration with the healthcare insurer, a shared ICT-system and continuous improvements. CONCLUSION The CCFE is an exemplary initiative to integrate care for the frailest elderly living at home. Its innovative components and critical success factors are likely to be transferable to other settings when providers can take on similar roles and work closely with payers who provide integrated funding.
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Affiliation(s)
- Maaike Hoedemakers
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, NL
| | | | - Willemijn Looman
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, NL
| | | | | | | | | | | | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, NL
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, NL
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43
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Juhaeri J. Benefit-risk evaluation: the past, present and future. Ther Adv Drug Saf 2019; 10:2042098619871180. [PMID: 31489173 PMCID: PMC6712756 DOI: 10.1177/2042098619871180] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/27/2019] [Indexed: 12/31/2022] Open
Abstract
In the last two decades there has been a shift in the approach to evaluating the benefit-risk (BR) profiles of medicinal products from an unstructured, subjective, and inconsistent, to a more structured and objective, process. This article describes that shift from a historical perspective; the past, the present, and the future, and highlights key events that played critical roles in changing the field.
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Affiliation(s)
- Juhaeri Juhaeri
- Sanofi, Bridgewater, 55 Corporate Drive, Bridgewater, NJ 08807, USA
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Baltaxe E, Cano I, Herranz C, Barberan-Garcia A, Hernandez C, Alonso A, Arguis MJ, Bescos C, Burgos F, Cleries M, Contel JC, de Batlle J, Islam K, Kaye R, Lahr M, Martinez-Palli G, Miralles F, Moharra M, Monterde D, Piera J, Ríos J, Rodriguez N, Ron R, Rutten-van Mölken M, Salas T, Santaeugenia S, Schonenberg H, Solans O, Torres G, Vargiu E, Vela E, Roca J. Evaluation of integrated care services in Catalonia: population-based and service-based real-life deployment protocols. BMC Health Serv Res 2019; 19:370. [PMID: 31185997 PMCID: PMC6560864 DOI: 10.1186/s12913-019-4174-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/20/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Comprehensive assessment of integrated care deployment constitutes a major challenge to ensure quality, sustainability and transferability of both healthcare policies and services in the transition toward a coordinated service delivery scenario. To this end, the manuscript articulates four different protocols aiming at assessing large-scale implementation of integrated care, which are being developed within the umbrella of the regional project Nextcare (2016-2019), undertaken to foster innovation in technologically-supported services for chronic multimorbid patients in Catalonia (ES) (7.5 M inhabitants). Whereas one of the assessment protocols is designed to evaluate population-based deployment of care coordination at regional level during the period 2011-2017, the other three are service-based protocols addressing: i) Home hospitalization; ii) Prehabilitation for major surgery; and, iii) Community-based interventions for frail elderly chronic patients. All three services have demonstrated efficacy and potential for health value generation. They reflect different implementation maturity levels. While full coverage of the entire urban health district of Barcelona-Esquerra (520 k inhabitants) is the main aim of home hospitalization, demonstration of sustainability at Hospital Clinic of Barcelona constitutes the core goal of the prehabilitation service. Likewise, full coverage of integrated care services addressed to frail chronic patients is aimed at the city of Badalona (216 k inhabitants). METHODS The population-based analysis, as well as the three service-based protocols, follow observational and experimental study designs using a non-randomized intervention group (integrated care) compared with a control group (usual care) with a propensity score matching method. Evaluation of cost-effectiveness of the interventions using a Quadruple aim approach is a central outcome in all protocols. Moreover, multi-criteria decision analysis is explored as an innovative method for health delivery assessment. The following additional dimensions will also be addressed: i) Determinants of sustainability and scalability of the services; ii) Assessment of the technological support; iii) Enhanced health risk assessment; and, iv) Factors modulating service transferability. DISCUSSION The current study offers a unique opportunity to undertake a comprehensive assessment of integrated care fostering deployment of services at regional level. The study outcomes will contribute refining service workflows, improving health risk assessment and generating recommendations for service selection. TRIALS REGISTRATION NCT03130283 (date released 04/06/2018), NCT03768050 (date released 12/05/2018), NCT03767387 (date released 12/05/2018).
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Affiliation(s)
- Erik Baltaxe
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. .,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.
| | - Isaac Cano
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Carmen Herranz
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,CAPSBE. Consorci d'Atenció Primaria de Salut. Barcelona Esquerra, Barcelona, Spain
| | - Anael Barberan-Garcia
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Carme Hernandez
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Albert Alonso
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - María José Arguis
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Cristina Bescos
- Royal Philips Netherlands BV acting through Philips Homecare, Boeblingen, Germany
| | - Felip Burgos
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Montserrat Cleries
- Area d'Atenció Sanitària, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Joan Carles Contel
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Jordi de Batlle
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.,Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain
| | - Kamrul Islam
- Department of Economics, University of Bergen, Bergen, Norway
| | | | - Maarten Lahr
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Graciela Martinez-Palli
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain
| | - Felip Miralles
- Eurecat. Technological Center of Catalonia, Barcelona, Catalunya, Spain
| | - Montserrat Moharra
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - David Monterde
- Institut Català de la Salut, Serveis Centrals, Barcelona, Catalonia, Spain
| | - Jordi Piera
- Badalona Serveis Assistencials (BSA), Badalona, Catalonia, Spain
| | - José Ríos
- Medical Statistics Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and Hospital Clinic, Barcelona, Spain.,Biostatistics Unit, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Rodriguez
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - Reut Ron
- Assuta Medical Centers, Tel Aviv-Yafo, Israel
| | - Maureen Rutten-van Mölken
- School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.,Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Tomas Salas
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Catalonia, Spain
| | - Sebastià Santaeugenia
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain.,Central Catalonia Chronicity Research Group (C3RG), University of Vic - Central University of Catalonia, 08500, Vic, Spain
| | - Helen Schonenberg
- Royal Philips Netherlands BV acting through Philips Homecare, Boeblingen, Germany
| | - Oscar Solans
- Chronic Care Program. Ministry of Health, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - Gerard Torres
- Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.,Respiratory Department, Institut de Recerca Biomedica (IRBLeida), Lleida, Spain
| | - Eloisa Vargiu
- Eurecat. Technological Center of Catalonia, Barcelona, Catalunya, Spain
| | - Emili Vela
- Area d'Atenció Sanitària, Servei Català de la Salut, Barcelona, Catalonia, Spain
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain. .,Center for Biomedical Network Research in Respiratory Diseases (CIBERES), Madrid, Spain.
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