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Gibbs JF, Guarnieri E, Chu QD, Murdoch K, Asif A. Value-based chronic care model approach for vulnerable older patients with multiple chronic conditions. J Gastrointest Oncol 2021; 12:S324-S338. [PMID: 34422397 PMCID: PMC8343083 DOI: 10.21037/jgo-20-317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022] Open
Abstract
"Old age, itself, is not a disease" (Suborne 2007). The rising rate of the global aging population is predicted to create a health care crisis within the next three decades. Vulnerable older adults suffer from multiple chronic conditions (MCCs) in addition to cognitive and physical decline during the process of aging resulting in an inability to optimally achieve self-management. In terms of resource utilization, complex inpatient, and outpatient care results in higher physician visits, polypharmacy, and higher prescription costs. Health literacy has become known as an important social determinant of health affecting the older population. Both reductions in health literacy and self-management are associated with poorer health outcomes. The patient activation measure (PAM) has been coined "a vital sign" to ascertain a patient activation level throughout the continuum of care with the introduction of an intervention's progress. In this review, we conceptualize a systematic approach of the development of a "tailored" integrated community and care team to develop a partnership in assisting senior adults with MCCs. Through this intervention the value-based chronic care model (CCM) and PAM allows for an adaptable integration between the activated patient, their caregivers, and the community. The Model for Improvement (MFI) serves as a well-recognized technique for developing and executing quality improvement strategies in this "tailored" engaged and activated individual and community care team approach in achieving health outcomes and quality of life among the vulnerable older adult population worldwide.
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Affiliation(s)
- John F. Gibbs
- Department of Surgery, Hackensack Meridian Health School of Medicine at Seton Hall University, Nutley, NJ, USA
| | - Ellen Guarnieri
- Department of Healthcare Quality and Safety, Thomas Jefferson University College of Population Health, Philadelphia, PA, USA
| | - Quyen D. Chu
- Department of Surgery, LSU-Shreveport School of Medicine, Shreveport, LA, USA
| | - Kenneth Murdoch
- Department of Nursing, Jersey Shore University Medical Center, Neptune, NJ, USA
| | - Arif Asif
- Department of Medicine, Hackensack Meridian School of Medicine at Seton Hall University, Nutley, NJ, USA
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Khoo J, Hasan H, Eagar K. Emerging role of the Australian private health insurance sector in providing chronic disease management programs: current activities, challenges and constraints. AUST HEALTH REV 2019; 43:572-577. [PMID: 30857589 DOI: 10.1071/ah18164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/07/2018] [Indexed: 11/23/2022]
Abstract
Objective This study explored the current activities of a sample of Australian private health insurance (PHI) funds to support the care of people living with chronic conditions, following changes to PHI legislation in 2007 permitting funds to cover a broader range of chronic disease management (CDM) services. Methods A qualitative research design was used to gather perspectives from PHI sector representatives via semistructured interviews with eight participants. The interview data were analysed systematically using the framework analysis method. Results Three main types of activities were most commonly identified: (1) healthcare navigation; (2) structured disease management and health coaching programs; and (3) care coordination services. These activities were primarily conducted via telephone by a combination of in-house and third-party health professionals. PHI funds seem to be taking a pragmatic approach to the type of CDM activities currently offered, guided by available data and identified member need. Activities are focused on people with diagnosed chronic conditions exiting hospital, rather than the broader population at-risk of developing a chronic condition. Conclusions Despite legislation permitting PHI funds to pay benefits for CDM services being in place for more than 10 years, insurers are still in an early stage of implementation and evaluation of CDM activities. Primarily due to the regulated scope of PHI coverage in Australia, participants reported several challenges in providing CDM services, including identifying target groups, evaluating service outcomes and collaborating with other healthcare providers. The effectiveness of the approach of PHI funds to CDM in terms of the groups targeted and outcomes of services provided still needs to be established because evidence suggests that population-level interventions that target a larger number of people with lower levels of risks are likely to have greater benefit than targeting a small number of high-risk cases. What is known about the topic? Since 2007, PHI funds in Australia have been able to pay benefits for a range of out-of-hospital services, focused on CDM. Although a small number of program evaluations has been published, there is little information on the scope of activities and the factors influencing the design and implementation of CDM programs. What does this paper add? This paper presents the findings of a qualitative study reporting on the CDM activities offered by a sample of PHI funds, their approach to delivery and the challenges and constraints in designing and implementing CDM activities, given the PHI sector's role as a supplementary health insurer in the Australian health system. What are the implications for practitioners? Current CDM activities offered by insurers focus on health navigation advice, structured, time-limited CDM programs and care coordination services for people following a hospital admission. There is currently little integration of these programs with the care provided by other health professionals for a person accessing these services. Although the role of insurers is currently small, the movement of insurers into service provision raises considerations for managing potential conflicts in having a dual role as an insurer and provider, including the effectiveness and value of services offered, and how these programs complement other types of health care being received.
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Affiliation(s)
- Joanna Khoo
- Australian Health Services Research Institute, Building 234 (iC Enterprise 1), Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. ; ; and Capital Markets Cooperative Research Centre (CMCRC) Health Market Quality Research Program, Capital Markets CRC Ltd, Level 3, 55 Harrington Street, Sydney, NSW 2000, Australia; and Corresponding author.
| | - Helen Hasan
- Australian Health Services Research Institute, Building 234 (iC Enterprise 1), Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. ;
| | - Kathy Eagar
- Australian Health Services Research Institute, Building 234 (iC Enterprise 1), Innovation Campus, University of Wollongong, Wollongong, NSW 2522, Australia. ;
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Couderc AL, Nouguerède E, Baumstarck K, Loubière S, Le Caer H, Guillem O, Rousseau F, Greillier L, Norguet-Monnereau E, Cecile M, Boulahssass R, Le Caer F, Tournier S, Butaud C, Guillet P, Nahon S, Kirscher S, Diaz N, Morando C, Villani P, Auquier P, Daumas A. PREDOMOS study, impact of a social intervention program for socially isolated elderly cancer patients: update to the study protocol for a randomized controlled trial. Trials 2019; 20:54. [PMID: 30646923 PMCID: PMC6334455 DOI: 10.1186/s13063-018-3127-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 12/11/2018] [Indexed: 11/10/2022] Open
Abstract
Background Social isolation potentiates the risk of death by cancer in the older cancer patient population. The PREDOMOS study investigates the impact of establishing a Program of Social intervention associated with techniques of Domotic and Remote assistance on the improvement of quality of life of older isolated patients, treated for locally advanced or metastatic cancer. This paper updates the pilot trial protocol. Methods/design The original protocol was published in Trials, accessible at https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-017-1894-7. This update reports on the eligibility criteria expansion and on the adjunction of a cost-utility analysis. We widened the eligible population to patients with locally advanced or metastatic cancer including malignant hemopathies (except acute myeloid leukemia) and to patients in the first and second lines of oncologic treatment. We restricted the inclusion to patients with a Mini Mental State Examination score strictly over 24. In addition to the secondary outcomes outlined in the protocol, a medico-economic analysis has been added to evaluate both the health benefits and costs of the two strategies and calculate the incremental cost-utility ratio of the innovative program assessed, compared to the standard practice. Trial registration ClinicalTrials.gov, NCT02829762. Registered on 29 June 2016.
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Affiliation(s)
- Anne-Laure Couderc
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France.,Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France
| | - Emilie Nouguerède
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France. .,Service d'Oncologie Digestive, CHU Timone, AP-HM, 264 Rue Saint Pierre, 13385, Marseille, cedex 05, France.
| | - Karine Baumstarck
- EA3279, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, cedex 05, France
| | - Sandrine Loubière
- EA3279, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, cedex 05, France
| | - Hervé Le Caer
- Service de Pneumologie, CH Yves le Foll, 10 rue Marcel Proust, Saint-Brieuc, France
| | - Olivier Guillem
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Onco-Gériatrie, CH Intercommunal des Alpes du Sud Site de Gap (CHICAS), 1 Place Auguste Muret, 05000, Gap, France
| | - Frédérique Rousseau
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Oncologie Médicale, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite Dromel, 13009, Marseille, France
| | - Laurent Greillier
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Oncologie Multidisciplinaire et Innovation Thérapeutique, CHU NORD, AP-HM, Chemin des Bourrely, 13915, Marseille, cedex 20, France
| | - Emmanuelle Norguet-Monnereau
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Oncologie Digestive, CHU Timone, AP-HM, 264 Rue Saint Pierre, 13385, Marseille, cedex 05, France
| | - Maud Cecile
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Oncologie Médicale, Institut Paoli Calmettes, 232 Boulevard de Sainte Marguerite Dromel, 13009, Marseille, France
| | - Rabia Boulahssass
- Service de Gérontologie, Hôpital de Cimiez, 4 Avenue Reine Victoria, CS 91179, 06003, Nice, France
| | - Françoise Le Caer
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service de Gériatrie, CH Yves le Foll, 10 rue Marcel Proust, Saint-Brieuc, France
| | - Sandrine Tournier
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service de Gériatrie, Hôpital Saint Joseph, 26 Boulevard Louvain, 13285, Marseille, cedex 08, France
| | - Chantal Butaud
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Unité Mobile de Gériatrie, Hôpital Saint Musse, CH Intercommunal Toulon-La Seyne sur Mer (CHITS), 54 Rue Henri Claire Deville, 83000, Toulon, France
| | - Pierre Guillet
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Unité Mobile de Gériatrie, Hôpital Saint Musse, CH Intercommunal Toulon-La Seyne sur Mer (CHITS), 54 Rue Henri Claire Deville, 83000, Toulon, France
| | - Sophie Nahon
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Hémato-Oncologie, CH du Pays d'Aix, Avenue les Tamaris, 13616, Aix-en-Provence, France
| | - Sylvie Kirscher
- Unit of Coordination in Onco-Geriatry (UCOG), PACA-west, France.,Service d'Oncologie Médicale, Institut Sainte Catherine (ISC), 250 Chemin de Baigne Pieds, 84918, Avignon, cedex 09, France
| | - Nadine Diaz
- Service Social, Hôpital Sainte Marguerite, AP-HM, 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France
| | - Claire Morando
- Direction de la Recherche Clinique et de l'Innovation (DRCI), AP-HM, 80 Rue Brochier, 13354, Marseille, cedex 05, France
| | - Patrick Villani
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France
| | - Pascal Auquier
- EA3279, Self-perceived Health Assessment Research Unit, Aix-Marseille University, 27 Boulevard Jean Moulin, 13385, Marseille, cedex 05, France
| | - Aurélie Daumas
- Service de Médecine Interne Gériatrie et Thérapeutique, CHU Sainte Marguerite, Assistance Publique des Hôpitaux de Marseille (AP-HM), 270 Boulevard de Sainte Marguerite Dromel, 13274, Marseille, cedex 09, France
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Nuckols TK, Keeler E, Morton S, Anderson L, Doyle BJ, Pevnick J, Booth M, Shanman R, Arifkhanova A, Shekelle P. Economic Evaluation of Quality Improvement Interventions Designed to Prevent Hospital Readmission: A Systematic Review and Meta-analysis. JAMA Intern Med 2017; 177:975-985. [PMID: 28558095 PMCID: PMC5710454 DOI: 10.1001/jamainternmed.2017.1136] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/02/2017] [Indexed: 01/11/2023]
Abstract
Importance Quality improvement (QI) interventions can reduce hospital readmission, but little is known about their economic value. Objective To systematically review economic evaluations of QI interventions designed to reduce readmissions. Data Sources Databases searched included PubMed, Econlit, the Centre for Reviews & Dissemination Economic Evaluations, New York Academy of Medicine's Grey Literature Report, and Worldcat (January 2004 to July 2016). Study Selection Dual reviewers selected English-language studies from high-income countries that evaluated organizational or structural changes to reduce hospital readmission, and that reported program and readmission-related costs. Data Extraction and Synthesis Dual reviewers extracted intervention characteristics, study design, clinical effectiveness, study quality, economic perspective, and costs. We calculated the risk difference and net costs to the health system in 2015 US dollars. Weighted least-squares regression analyses tested predictors of the risk difference and net costs. Main Outcomes and Measures Main outcomes measures included the risk difference in readmission rates and incremental net cost. This systematic review and data analysis is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Results Of 5205 articles, 50 unique studies were eligible, including 25 studies in populations limited to heart failure (HF) that included 5768 patients, 21 in general populations that included 10 445 patients, and 4 in unique populations. Fifteen studies lasted up to 30 days while most others lasted 6 to 24 months. Based on regression analyses, readmissions declined by an average of 12.1% among patients with HF (95% CI, 8.3%-15.9%; P < .001; based on 22 studies with complete data) and by 6.3% among general populations (95% CI, 4.0%-8.7%; P < .001; 18 studies). The mean net savings to the health system per patient was $972 among patients with HF (95% CI, -$642 to $2586; P = .23; 24 studies), and the mean net loss was $169 among general populations (95% CI, -$2610 to $2949; P = .90; 21 studies), reflecting nonsignificant differences. Among general populations, interventions that engaged patients and caregivers were associated with greater net savings ($1714 vs -$6568; P = .006). Conclusions and Relevance Multicomponent QI interventions can be effective at reducing readmissions relative to the status quo, but net costs vary. Interventions that engage general populations of patients and their caregivers may offer greater value to the health system, but the implications for patients and caregivers are unknown.
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Affiliation(s)
- Teryl K. Nuckols
- Cedars-Sinai Medical Center, Los Angeles, California
- RAND Corporation, Santa Monica, California
| | | | - Sally Morton
- College of Science, Virginia Polytechnic Institute and State University, Blacksburg
| | - Laura Anderson
- Cedars-Sinai Medical Center, Los Angeles, California
- Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles
| | - Brian J. Doyle
- Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | | | | | | | | | - Paul Shekelle
- RAND Corporation, Santa Monica, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
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5
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Anderson L, Sharp GA, Norton RJ, Dalal H, Dean SG, Jolly K, Cowie A, Zawada A, Taylor RS. Home-based versus centre-based cardiac rehabilitation. Cochrane Database Syst Rev 2017; 6:CD007130. [PMID: 28665511 PMCID: PMC6481471 DOI: 10.1002/14651858.cd007130.pub4] [Citation(s) in RCA: 178] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of death globally. Traditionally, centre-based cardiac rehabilitation programmes are offered to individuals after cardiac events to aid recovery and prevent further cardiac illness. Home-based cardiac rehabilitation programmes have been introduced in an attempt to widen access and participation. This is an update of a review previously published in 2009 and 2015. OBJECTIVES To compare the effect of home-based and supervised centre-based cardiac rehabilitation on mortality and morbidity, exercise-capacity, health-related quality of life, and modifiable cardiac risk factors in patients with heart disease. SEARCH METHODS We updated searches from the previous Cochrane Review by searching the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) on 21 September 2016. We also searched two clinical trials registers as well as previous systematic reviews and reference lists of included studies. No language restrictions were applied. SELECTION CRITERIA We included randomised controlled trials, including parallel group, cross-over or quasi-randomised designs) that compared centre-based cardiac rehabilitation (e.g. hospital, gymnasium, sports centre) with home-based programmes in adults with myocardial infarction, angina, heart failure or who had undergone revascularisation. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on pre-defined inclusion criteria. Disagreements were resolved through discussion or by involving a third review author. Two authors independently extracted outcome data and study characteristics and assessed risk of bias. Quality of evidence was assessed using GRADE principles and a Summary of findings table was created. MAIN RESULTS We included six new studies (624 participants) for this update, which now includes a total of 23 trials that randomised a total of 2890 participants undergoing cardiac rehabilitation. Participants had an acute myocardial infarction, revascularisation or heart failure. A number of studies provided insufficient detail to enable assessment of potential risk of bias, in particular, details of generation and concealment of random allocation sequencing and blinding of outcome assessment were poorly reported.No evidence of a difference was seen between home- and centre-based cardiac rehabilitation in clinical primary outcomes up to 12 months of follow up: total mortality (relative risk (RR) = 1.19, 95% CI 0.65 to 2.16; participants = 1505; studies = 11/comparisons = 13; very low quality evidence), exercise capacity (standardised mean difference (SMD) = -0.13, 95% CI -0.28 to 0.02; participants = 2255; studies = 22/comparisons = 26; low quality evidence), or health-related quality of life up to 24 months (not estimable). Trials were generally of short duration, with only three studies reporting outcomes beyond 12 months (exercise capacity: SMD 0.11, 95% CI -0.01 to 0.23; participants = 1074; studies = 3; moderate quality evidence). However, there was evidence of marginally higher levels of programme completion (RR 1.04, 95% CI 1.00 to 1.08; participants = 2615; studies = 22/comparisons = 26; low quality evidence) by home-based participants. AUTHORS' CONCLUSIONS This update supports previous conclusions that home- and centre-based forms of cardiac rehabilitation seem to be similarly effective in improving clinical and health-related quality of life outcomes in patients after myocardial infarction or revascularisation, or with heart failure. This finding supports the continued expansion of evidence-based, home-based cardiac rehabilitation programmes. The choice of participating in a more traditional and supervised centre-based programme or a home-based programme may reflect local availability and consider the preference of the individual patient. Further data are needed to determine whether the effects of home- and centre-based cardiac rehabilitation reported in the included short-term trials can be confirmed in the longer term and need to consider adequately powered non-inferiority or equivalence study designs.
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Affiliation(s)
- Lindsey Anderson
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
| | - Georgina A Sharp
- Peninsula Postgraduate Medical EducationRaleigh Building, 22A Davy Road, Plymouth Science ParkPlymouthUKPL6 8BY
| | - Rebecca J Norton
- University of Exeter Medical School, University of Exeterc/o Institute of Health ResearchSt Lukes CampusHeavitree RoadExeterExeterUKEX1 2LU
| | - Hasnain Dalal
- University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospitals TrustDepartment of Primary CareTruroUKTR1 3HD
| | - Sarah G Dean
- University of ExeterUniversity of Exeter Medical SchoolVeysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
| | - Kate Jolly
- University of BirminghamInstitute of Applied Health ResearchBirminghamUK
| | | | - Anna Zawada
- Agency for Health Technology Assessment and Tariff SystemI. Krasickiego St. 26WarsawPoland02‐611
| | - Rod S Taylor
- University of Exeter Medical SchoolInstitute of Health ResearchVeysey Building, Salmon Pool LaneExeterUKEX2 4SG
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