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Hayes H, Meacock R, Stokes J, Sutton M. The effect of local hospital waiting times on GP referrals for suspected cancer. PLoS One 2024; 19:e0294061. [PMID: 38718085 PMCID: PMC11078401 DOI: 10.1371/journal.pone.0294061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 10/24/2023] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Reducing waiting times is a major policy objective in publicly-funded healthcare systems. However, reductions in waiting times can produce a demand response, which may offset increases in capacity. Early detection and diagnosis of cancer is a policy focus in many OECD countries, but prolonged waiting periods for specialist confirmation of diagnosis could impede this goal. We examine whether urgent GP referrals for suspected cancer patients are responsive to local hospital waiting times. METHOD We used annual counts of referrals from all 6,667 general practices to all 185 hospital Trusts in England between April 2012 and March 2018. Using a practice-level measure of local hospital waiting times based on breaches of the two-week maximum waiting time target, we examined the relationship between waiting times and urgent GP referrals for suspected cancer. To identify whether the relationship is driven by differences between practices or changes over time, we estimated three regression models: pooled linear regression, a between-practice estimator, and a within-practice estimator. RESULTS Ten percent higher rates of patients breaching the two-week wait target in local hospitals were associated with higher volumes of referrals in the pooled linear model (4.4%; CI 2.4% to 6.4%) and the between-practice estimator (12.0%; CI 5.5% to 18.5%). The relationship was not statistically significant using the within-practice estimator (1.0%; CI -0.4% to 2.5%). CONCLUSION The positive association between local hospital waiting times and GP demand for specialist diagnosis was caused by practices with higher levels of referrals facing longer local waiting times. Temporal changes in waiting times faced by individual practices were not related to changes in their referral volumes. GP referrals for diagnostic cancer services were not found to respond to waiting times in the short-term. In this setting, it may therefore be possible to reduce waiting times by increasing supply without consequently increasing demand.
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Affiliation(s)
- Helen Hayes
- Office of Health Economics (OHE), London, United Kingdom
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Rachel Meacock
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- MRC/CSO Social & Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, United Kingdom
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
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Hayes H, Stokes J, Sutton M, Meacock R. How do hospitals respond to payment unbundling for diagnostic imaging of suspected cancer patients? Health Econ 2024; 33:823-843. [PMID: 38233916 DOI: 10.1002/hec.4804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
Payments for some diagnostic scans undertaken in outpatient settings were unbundled from Diagnosis Related Group based payments in England in April 2013 to address under-provision. Unbundled scans attracted additional payments of between £45 and £748 directly following the reform. We examined the effect on utilization of these scans for patients with suspected cancer. We also explored whether any detected effects represented real increases in use of scans or better coding of activity. We applied difference-in-differences regression to patient-level data from Hospital Episodes Statistics for 180 NHS hospital Trusts in England, between April 2010 and March 2018. We also explored heterogeneity in recorded use of scans before and after the unbundling at hospital Trust-level. Use of scans increased by 0.137 scans per patient following unbundling, a 134% relative increase. This increased annual national provider payments by £79.2 million. Over 15% of scans recorded after the unbundling were at providers that previously recorded no scans, suggesting some of the observed increase in activity reflected previous under-coding. Hospitals recorded substantial increases in diagnostic imaging for suspected cancer in response to payment unbundling. Results suggest that the reform also encouraged improvements in recording, so the real increase in testing is likely lower than detected.
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Affiliation(s)
- Helen Hayes
- Office of Health Economics (OHE), London, UK
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
- MRC/CSO Social & Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
- Centre for Health Economics, Monash University, Melbourne, Victoria, Australia
| | - Rachel Meacock
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
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Stokes J, Bower P, Smith SM, Guthrie B, Blakeman T, Valderas JM, Salisbury C. A primary care research agenda for multiple long-term conditions: a Delphi study. Br J Gen Pract 2024:BJGP.2023.0163. [PMID: 38164536 PMCID: PMC10947355 DOI: 10.3399/bjgp.2023.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/02/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Multiple long-term conditions (MLTC), also known as multimorbidity, has been identified as a priority research topic globally. Research priorities from the perspectives of patients and research funders have been described. Although most care for MLTC is delivered in primary care, the priorities of academic primary care have not been identified. AIM To identify and prioritise the academic primary care research agenda for MLTC. DESIGN AND SETTING This was a three-phase study with primary care MLTC researchers from the UK and other high-income countries. METHOD The study consisted of: an open-ended survey question, a face-to-face workshop to elaborate questions with researchers from the UK and Ireland, and a two-round Delphi consensus survey with international multimorbidity researchers. RESULTS Twenty-five primary care researchers responded to the initial open-ended survey and generated 84 potential research questions. In the subsequent workshop discussion (n = 18 participants), this list was reduced to 31 questions. The longlist of 31 research questions was included in round 1 of the Delphi; 27 of the 50 (54%) round 1 invitees and 24 of the 27 (89%) round 2 invitees took part in the Delphi. Ten questions reached final consensus. These questions focused broadly on addressing the complexity of the patient group with development of new models of care for multimorbidity, and methods and data development. CONCLUSION These high-priority research questions offer funders and researchers a basis on which to build future grant calls and research plans. Addressing complexity in this research is needed to inform improvements in systems of care and for disease prevention.
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Affiliation(s)
- Jonathan Stokes
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK; NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Susan M Smith
- Department of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Thomas Blakeman
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Jose M Valderas
- Department of Family Medicine, National University Health System, Singapore; Centre for Research in Health System Performance, National University of Singapore, Singapore
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, Population Health Sciences, University of Bristol, Bristol, UK
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Booth A, Stokes J, Meaney S, Leitao S, Geisler M, McMenamin M. Knowledge on impact of lifestyle and demographic factors on fertility. Ir Med J 2024; 117:896. [PMID: 38259263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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5
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McCann E, Chehade M, Spergel JM, Yaworsky A, Symonds T, Stokes J, Tilton ST, Sun X, Kamat S. Validation of the novel Eosinophilic Esophagitis Impact Questionnaire. J Patient Rep Outcomes 2023; 7:120. [PMID: 38010430 PMCID: PMC10682344 DOI: 10.1186/s41687-023-00654-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) has a detrimental effect on health-related quality of life (HRQOL). The Eosinophilic Esophagitis Impact Questionnaire (EoE-IQ) is a novel patient-reported outcome (PRO) measure assessing the impact of EoE on HRQOL. To assess suitability of the EoE-IQ, its measurement properties were evaluated. METHODS Using baseline and week 24 data from the pivotal, randomized, placebo-controlled, multinational phase 3 R668-EE-1774 trial (NCT03633617) of dupilumab, we evaluated EoE-IQ's measurement properties (including reliability, construct and known-groups validity, and ability to detect change) and established the threshold for change in scores that can be considered clinically meaningful. RESULTS The analysis population comprised 239 adults and adolescents with EoE. Mean age was 28.1 (standard deviation, 13.14) years; 63.6% were male, and 90.4% were White. Reliability estimates for the EoE-IQ average score exceeded acceptable thresholds for patients who were stable as indicated by ratings of Patient Global Impression of Severity (PGIS) and Change (PGIC) (intraclass correlation coefficients, 0.75 and 0.81). Construct validity correlations with other EoE-specific PRO scores were moderate at baseline (|r|= 0.44-0.60) and moderate to strong at week 24 (|r|= 0.61-0.72). In known-groups analysis, EoE-IQ average score discriminated among groups of patients at varying EoE severity levels defined by PGIS scores. A ≥ 0.6-point reduction in EoE-IQ average score (where scores range from 1 to 5, with higher scores indicating worse HRQOL) from baseline to week 24 can be considered clinically meaningful. CONCLUSIONS The EoE-IQ's measurement properties are acceptable, making it a valid, reliable measure of the HRQOL impacts of EoE among adults and adolescents. TRIAL REGISTRATION ClinicalTrials.gov, NCT03633617. Registered August 14, 2018, https://clinicaltrials.gov/study/NCT03633617 .
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Affiliation(s)
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | | | - Tara Symonds
- Clinical Outcomes Solutions, Folkestone, Kent, CT19 4RH, UK
| | | | | | - Xian Sun
- Regeneron Pharmaceuticals, Tarrytown, NY, USA
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Moss C, Anselmi L, Morciano M, Munford L, Stokes J, Sutton M. Analysing changes to the flow of public funding within local health and care systems: An adaptation of the System of Health Accounts framework to a local health system in England. Health Policy 2023; 137:104904. [PMID: 37717554 DOI: 10.1016/j.healthpol.2023.104904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Abstract
Financial flows relating to health care are routinely analysed at national and international level. They have rarely been systematically analysed at local level, despite sub-national variation due to population needs and decisions enacted by local organisations. We illustrate an adaptation of the System of Health Accounts framework to map the flow of public health and care funding within local systems, with an application for Greater Manchester (GM), an area in England which agreed a health and social care devolution deal with the central government in 2016. We analyse how financial flows changed in GM during the four years post-devolution, and whether spending was aligned with local ambitions to move towards prevention of ill-health and integration of health and social care. We find that GM decreased spending on public health by 15%, and increased spending on general practice by 0.1% in real terms. The share of total local expenditure paid to NHS Trusts for general and acute services increased from 70.3% to 71.6%, while that for community services decreased from 11.7% to 10.3%. Results suggest that GM may have experienced challenges in redirecting resources towards their goals. Mapping financial flows at a local level is a useful exercise to examine whether spending is aligned with system goals and highlight areas for further investigation.
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Affiliation(s)
- Charlie Moss
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.
| | - Laura Anselmi
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Marcello Morciano
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK; "Marco Biagi" Department of Economics and Research Centre for the Analysis of Public Policies (CAPP), University of Modena and Reggio Emilia, IT
| | - Luke Munford
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK; MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
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Hayes H, Meacock R, Stokes J, Sutton M. How do family doctors respond to reduced waiting times for cancer diagnosis in secondary care? Eur J Health Econ 2023:10.1007/s10198-023-01626-2. [PMID: 37787842 DOI: 10.1007/s10198-023-01626-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 08/09/2023] [Indexed: 10/04/2023]
Abstract
Reducing waiting times is a priority in public health systems. Efforts of healthcare providers to shorten waiting times could be negated if they simultaneously induce substantial increases in demand. However, separating out the effects of changes in supply and demand on waiting times requires an exogenous change in one element. We examine the impact of a pilot programme in some English hospitals to shorten waiting times for urgent diagnosis of suspected cancer on family doctors' referrals. We examine referrals from 6,666 family doctor partnerships to 145 hospitals between 1st April 2012 and 31st March 2019. Five hospitals piloted shorter waiting times initiatives in 2017. Using continuous difference-in-differences regression, we exploit the pilot as a 'supply shifter' to estimate the effect of waiting times on referral volumes for two suspected cancer types: bowel and lung. The proportion of referred patients breaching two-week waiting times targets for suspected bowel cancer fell by 3.9 percentage points in pilot hospitals in response to the policy, from a baseline of 4.8%. Family doctors exposed to the pilot increased their referrals (demand) by 10.8%. However, the pilot was not successful for lung cancer, with some evidence that waiting times increased, and a corresponding reduction in referrals of -10.5%. Family doctor referrals for suspected cancer are responsive at the margin to waiting times. Healthcare providers may struggle to achieve long-term reductions in waiting times if supply-side improvements are offset by increases in demand.
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Affiliation(s)
- Helen Hayes
- Office of Health Economics (OHE), London, UK.
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK.
| | - Rachel Meacock
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
- MRC/CSO Social & Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care & Health Services Research, School of Health Sciences, The University of Manchester, Manchester, UK
- Melbourne Institute of Applied Economic and Social Research, Faculty of Business and Economics, The University of Melbourne, Parkville, VIC, Australia
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Stokes J, Petch S, Leitao S, McMenamin M, Geisler M. Investigation of fertility awareness amongst Obstetrics and Gynaecology and General Practice trainees. Ir Med J 2023; 116:833. [PMID: 37791668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
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Höhn A, Stokes J, Pollack R, Boyd J, Chueca Del Cerro C, Elsenbroich C, Heppenstall A, Hjelmskog A, Inyang E, Kopasker D, Sonthalia S, Thomson RM, Zia K, Katikireddi SV, Meier P. Systems science methods in public health: what can they contribute to our understanding of and response to the cost-of-living crisis? J Epidemiol Community Health 2023; 77:610-616. [PMID: 37328262 PMCID: PMC10423532 DOI: 10.1136/jech-2023-220435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/01/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Many complex public health evidence gaps cannot be fully resolved using only conventional public health methods. We aim to familiarise public health researchers with selected systems science methods that may contribute to a better understanding of complex phenomena and lead to more impactful interventions. As a case study, we choose the current cost-of-living crisis, which affects disposable income as a key structural determinant of health. METHODS We first outline the potential role of systems science methods for public health research more generally, then provide an overview of the complexity of the cost-of-living crisis as a specific case study. We propose how four systems science methods (soft systems, microsimulation, agent-based and system dynamics models) could be applied to provide more in-depth understanding. For each method, we illustrate its unique knowledge contributions, and set out one or more options for studies that could help inform policy and practice responses. RESULTS Due to its fundamental impact on the determinants of health, while limiting resources for population-level interventions, the cost-of-living crisis presents a complex public health challenge. When confronted with complexity, non-linearity, feedback loops and adaptation processes, systems methods allow a deeper understanding and forecasting of the interactions and spill-over effects common with real-world interventions and policies. CONCLUSIONS Systems science methods provide a rich methodological toolbox that complements our traditional public health methods. This toolbox may be particularly useful in early stages of the current cost-of-living crisis: for understanding the situation, developing solutions and sandboxing potential responses to improve population health.
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Affiliation(s)
- Andreas Höhn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jonathan Stokes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Roxana Pollack
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jennifer Boyd
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Corinna Elsenbroich
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Alison Heppenstall
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Annika Hjelmskog
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Elizabeth Inyang
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Daniel Kopasker
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Shreya Sonthalia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Rachel M Thomson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Kashif Zia
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Petra Meier
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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10
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Lipton RB, Halker Singh RB, Mechtler L, McVige J, Ma J, Yu SY, Stokes J, Dabruzzo B, Gandhi P, Ashina M. Patient-reported migraine-specific quality of life, activity impairment and headache impact with once-daily atogepant for preventive treatment of migraine in a randomized, 52-week trial. Cephalalgia 2023; 51:3331024231190296. [PMID: 37638400 DOI: 10.1177/03331024231190296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Atogepant is an oral, small-molecule, calcitonin gene-related peptide receptor antagonist for the preventive treatment of episodic migraine. METHODS In this 52-week, multicenter, randomized, open-label trial, adults with 4-14 monthly migraine days received atogepant 60 mg once-daily or standard care. Health outcome endpoints collected from participants randomized to atogepant included change from baseline in Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQ v2.1) Role Function-Restrictive (RFR), Role Function-Preventive (RFP) and Emotional Function (EF) domain scores, change in Activity Impairment in Migraine-Diary (AIM-D) Performance of Daily Activities (PDA) and Physical Impairment (PI) domain scores, and change in Headache Impact Test-6 (HIT-6) total score. RESULTS Of 744 randomized participants, 521 received atogepant 60 mg in the modified intent-to-treat population. Least-squares mean changes from baseline in MSQ-RFR score were 30.02 (95% confidence interval = 28.16-31.87) at week 12 and 34.70 (95% confidence interval = 32.74-36.66) at week 52. Improvements were also observed in other MSQ domains, AIM-D PDA, PI and HIT-6 total scores. A ≥5-point improvement from baseline in HIT-6 score was observed in 59.9% of participants at week 4 and 80.8% of participants at week 52. CONCLUSION Over 52 weeks, atogepant 60 mg once-daily was associated with sustained improvements in quality of life and reductions in activity impairment and headache impact.Trial Registration: NCT03700320.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Messoud Ashina
- Danish Headache Center, Rigshospitalet Glostrup, University of Copenhagen, Denmark
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Stokes J, Booth A, Meaney S, McMenamin M, Geisler M. An Investigation into Fertility Awareness amongst the child-bearing population. Ir Med J 2023; 116:774. [PMID: 37555524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
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Simpson G, Stokes J, Farmer A, Dambha-Miller H. Social care need in multimorbidity. J R Soc Med 2023; 116:124-127. [PMID: 37078268 PMCID: PMC10164274 DOI: 10.1177/01410768231168382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Affiliation(s)
- Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, SO16 5ST, United Kingdom
| | - Jonathan Stokes
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8TB, United Kingdom
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, United Kingdom
| | - Hajira Dambha-Miller
- Primary Care Research Centre, University of Southampton, Southampton, SO16 5ST, United Kingdom
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Simpson G, Stuart B, Hijryana M, Akyea RK, Stokes J, Gibson J, Jones K, Morrison L, Santer M, Boniface M, Zlatev Z, Farmer A, Dambha-Miller H. Eliciting and prioritising determinants of improved care in multimorbidity: A modified online Delphi study. J Multimorb Comorb 2023; 13:26335565231194552. [PMID: 37692105 PMCID: PMC10483969 DOI: 10.1177/26335565231194552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Multimorbidity is a major challenge to health and social care systems around the world. There is limited research exploring the wider contextual determinants that are important to improving care for this cohort. In this study, we aimed to elicit and prioritise determinants of improved care in people with multiple conditions. Methods A three-round online Delphi study was conducted in England with health and social care professionals, data scientists, researchers, people living with multimorbidity and their carers. Results Our findings suggest a care system which is still predominantly single condition focused. 'Person-centred and holistic care' and 'coordinated and joined up care', were highly rated determinants in relation to improved care for multimorbidity. We further identified a range of non-medical determinants that are important to providing holistic care for this cohort. Conclusions Further progress towards a holistic and patient-centred model is needed to ensure that care more effectively addresses the complex range of medical and non-medical needs of people living with multimorbidity. This requires a move from a single condition focused biomedical model to a person-based biopsychosocial approach, which has yet to be achieved.
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Affiliation(s)
- Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Marisza Hijryana
- Institute of Epidemiology and Health Care, University College London (UCL), London, UK
| | - Ralph Kwame Akyea
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Jonathan Stokes
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jon Gibson
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Karen Jones
- Personal Social Services Research Unit, University of Kent, Canterbury, UK
| | - Leanne Morrison
- Primary Care Research Centre, University of Southampton, Southampton, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Michael Boniface
- Digital Health and Biomedical Engineering, School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Zlatko Zlatev
- Digital Health and Biomedical Engineering, School of Electronics and Computer Science, University of Southampton, Southampton, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Simpson G, Entwistle C, Short AD, Morciano M, Stokes J. A typology of integrated care policies in the care home sector: A policy document analysis. Front Public Health 2023; 11:943351. [PMID: 36895695 PMCID: PMC9989008 DOI: 10.3389/fpubh.2023.943351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
Background Health and social care systems in many countries have begun to trial and adopt "integrated" approaches. Yet, the significant role care homes play within the health and social care system is often understated. A key first step to identifying the care home integration interventions that are most (cost-)effective is the ability to precisely identify and record what has been implemented, where, and when-a "policy map." Methods To address gaps relating to the identification and recording of (cost-)effective integrated care home interventions, we developed a new typology tool. We conducted a policy mapping exercise in a devolved region of England-Greater Manchester (GM). Specifically, we carried out systematic policy documentary searches and extracted a range of qualitative data relating to integrated health and social care initiatives in the GM region for care homes. The data were then classified according to existing national ambitions for England as well as a generic health systems framework to illustrate gaps in existing recording tools and to iteratively develop a novel approach. Results A combined total of 124 policy documents were identified and screened, in which 131 specific care home integration initiatives were identified. Current initiatives emphasized monitoring quality in care homes, workforce training, and service delivery changes (such as multi-disciplinary teams). There was comparatively little emphasis on financing or other incentive changes to stimulate provider behavior for the care home setting. We present a novel typology for capturing and comparing care home integration policy initiatives, largely conceptualizing which part of the system or specific transition point the care home integration is targeting, or whether there is a broader cross-cutting system intervention being enacted, such as digital or financial interventions. Conclusions Our typology builds on the gaps in current frameworks, including previous lack of specificity to care homes and lack of adaptability to new and evolving initiatives internationally. It could provide a useful tool for policymakers to identify gaps in the implementation of initiatives within their own areas, while also allowing researchers to evaluate what works most effectively and efficiently in future research based on a comprehensive policy map.
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Affiliation(s)
- Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, United Kingdom
| | | | - Andrea D Short
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Marcello Morciano
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom.,Marco Biagi Department of Economics, University of Modena and Reggio Emilia, Modena, Italy.,Research Centre for the Analysis of Public Policies, University of Modena and Reggio Emilia, Modena, Italy
| | - Jonathan Stokes
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, United Kingdom
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Gwaltney C, Stokes J, Aiudi A, Mazar I, Ollis S, Love E, Karaa A, Houts CR, Wirth RJ, Shields AL. Psychometric performance of the Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) in a randomized, double-blind, placebo-controlled crossover study in subjects with mitochondrial disease. J Patient Rep Outcomes 2022; 6:129. [PMID: 36562873 PMCID: PMC9789285 DOI: 10.1186/s41687-022-00534-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) is a 10-item patient-reported outcome (PRO) measure designed to assess the severity of mitochondrial disease symptoms. Analyses of data from a clinical trial with PMM patients were conducted to evaluate the psychometric properties of the PMMSA and to provide score interpretation guidelines for the measure. METHODS The PMMSA was completed as a daily diary for approximately 14 weeks by individuals in a Phase 2 randomized, placebo-controlled crossover trial evaluating the safety, tolerability, and efficacy of subcutaneous injections of elamipretide in patents with mitochondrial disease. In addition to the PMMSA, performance-based assessments, clinician ratings, and other PRO measures were also completed. Descriptive statistics, psychometric analyses, and score interpretation guidelines were evaluated for the PMMSA. RESULTS Participants (N = 30) had a mean age of 45.3 years, with the majority of the sample being female (n = 25, 83.3%) and non-Hispanic white (n = 29, 96.6%). The 10 PMMSA items assessing a diverse symptomology were not found to form a single underlying construct. However, four items assessing tiredness and muscle weakness were grouped into a "general fatigue" domain score. The PMMSA Fatigue 4 summary score (4FS) demonstrated stable test-retest scores, internal consistency, correlations with the scores produced by reference measures, and the ability to differentiate between different global health levels. Changes on the PMMSA 4FS were also related to change scores produced by the reference measures. PMMSA severity scores were higher for the symptom rated as "most bothersome" by each subject relative to the remaining nine PMMSA items (most bothersome symptom mean = 2.88 vs. 2.18 for other items). Distribution- and anchor-based evaluations suggested that reduction in weekly scores between 0.79 and 2.14 (scale range: 4-16) may represent a meaningful change on the PMMSA 4FS and reduction in weekly scores between 0.03 and 0.61 may represent a responder for each of the remaining six non-fatigue items, scored independently. CONCLUSIONS Upon evaluation of its psychometric properties, the PMMSA, specifically the 4FS domain, demonstrated strong reliability and construct-related validity. The PMMSA can be used to evaluate treatment benefit in clinical trials with individuals with PMM. Trial registration ClinicalTrials.gov identifier, NCT02805790; registered June 20, 2016; https://clinicaltrials.gov/ct2/show/NCT02805790 .
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Affiliation(s)
- Chad Gwaltney
- Gwaltney Consulting Group, 1 Bucks Trail, Westerly, RI USA
| | - Jonathan Stokes
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
| | - Anthony Aiudi
- grid.476731.00000 0004 0414 8723Stealth BioTherapeutics Inc., Newton, MA USA
| | - Iyar Mazar
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
| | - Sarah Ollis
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
| | - Emily Love
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
| | - Amel Karaa
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | | | - R. J. Wirth
- Vector Psychometric Group LLC, Chapel Hill, NC USA
| | - Alan L. Shields
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
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Oikonomidi T, Norman G, McGarrigle L, Stokes J, van der Veer SN, Dowding D. Predictive model-based interventions to reduce outpatient no-shows: a rapid systematic review. J Am Med Inform Assoc 2022; 30:559-569. [PMID: 36508503 PMCID: PMC9933067 DOI: 10.1093/jamia/ocac242] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Outpatient no-shows have important implications for costs and the quality of care. Predictive models of no-shows could be used to target intervention delivery to reduce no-shows. We reviewed the effectiveness of predictive model-based interventions on outpatient no-shows, intervention costs, acceptability, and equity. MATERIALS AND METHODS Rapid systematic review of randomized controlled trials (RCTs) and non-RCTs. We searched Medline, Cochrane CENTRAL, Embase, IEEE Xplore, and Clinical Trial Registries on March 30, 2022 (updated on July 8, 2022). Two reviewers extracted outcome data and assessed the risk of bias using ROB 2, ROBINS-I, and confidence in the evidence using GRADE. We calculated risk ratios (RRs) for the relationship between the intervention and no-show rates (primary outcome), compared with usual appointment scheduling. Meta-analysis was not possible due to heterogeneity. RESULTS We included 7 RCTs and 1 non-RCT, in dermatology (n = 2), outpatient primary care (n = 2), endoscopy, oncology, mental health, pneumology, and an magnetic resonance imaging clinic. There was high certainty evidence that predictive model-based text message reminders reduced no-shows (1 RCT, median RR 0.91, interquartile range [IQR] 0.90, 0.92). There was moderate certainty evidence that predictive model-based phone call reminders (3 RCTs, median RR 0.61, IQR 0.49, 0.68) and patient navigators reduced no-shows (1 RCT, RR 0.55, 95% confidence interval 0.46, 0.67). The effect of predictive model-based overbooking was uncertain. Limited information was reported on cost-effectiveness, acceptability, and equity. DISCUSSION AND CONCLUSIONS Predictive modeling plus text message reminders, phone call reminders, and patient navigator calls are probably effective at reducing no-shows. Further research is needed on the comparative effectiveness of predictive model-based interventions addressed to patients at high risk of no-shows versus nontargeted interventions addressed to all patients.
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Affiliation(s)
- Theodora Oikonomidi
- Corresponding Author: Theodora Oikonomidi, PhD, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK;
| | - Gill Norman
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK,Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Laura McGarrigle
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK,Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jonathan Stokes
- Centre for Primary Care & Health Services Research, The University of Manchester, Manchester, UK,MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Sabine N van der Veer
- Centre for Health Informatics, Division of Informatics, Imaging and Data Science, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK,National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK
| | - Dawn Dowding
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester, Manchester, UK,Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Almorox EG, Stokes J, Morciano M. Has COVID-19 changed carer's views of health and care integration in care homes? A sentiment difference-in-difference analysis of on-line service reviews. Health Policy 2022; 126:1117-1123. [PMID: 36064471 PMCID: PMC9396455 DOI: 10.1016/j.healthpol.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 06/16/2022] [Accepted: 08/18/2022] [Indexed: 11/23/2022]
Abstract
Closer integration of health and social care is a policy priority in many countries. The COVID-19 pandemic has reinforced the necessity of joining up health and social care systems, especially in care home settings. However, the meaning and perceived importance of integration for residents' and carers' experience is unclear and we do not know whether it has changed during the pandemic. Using unique data from on-line care home service reviews, we combined multiple methods. We used Natural Language Processing with supervised machine learning to construct a measure of sentiment for care home residents' and their relatives' (measured by AFINN score). Difference-in-difference analysis was used to examine whether experiencing integrated care altered these sentiments by comparing changes in sentiment in reviews related to integration (containing specific terms) to those which were not. Finally, we used network analysis on post-estimation results to assess which specific attributes stakeholders focus on most when detailing their most/least positive experiences of health and care integration in care homes, and whether these attributes changed over the pandemic. Reviews containing integration words were more positive than reviews unrelated to integration in the pre-pandemic period (about 2.3 points on the AFINN score) and remained so during the first year of the pandemic. Overall positive sentiment increased during the COVID-19 period (average by +1.1 points), mainly in reviews mentioning integration terms at the beginning of the first (+2.17, p-value 0.175) and second waves (+3.678, p-value 0.027). The role of care home staff was pivotal in both positive and negative reviews, with a shift from aspects related to care in pre-pandemic to information services during the pandemic, signalling their importance in translating integrated needs-based paradigms into policy and practice.
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Affiliation(s)
- Eduardo Gonzalo Almorox
- Health Organisation, Policy and Economics (HOPE) Research Group, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Floor 7, Suite 10, Room 7.06 Williamson Building, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE) Research Group, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Floor 7, Suite 10, Room 7.06 Williamson Building, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, The University of Manchester, Floor 7, Suite 10, Room 7.06 Williamson Building, Oxford Road, Manchester M13 9PL, United Kingdom; Dipartimento di Economia "Marco Biagi", Universita' di Modena e Reggio Emilia, Viale Berengario 51, Modena 41121 , Italy.
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Goldzahl L, Stokes J, Sutton M. The effects of multi-disciplinary integrated care on healthcare utilization: Evidence from a natural experiment in the UK. Health Econ 2022; 31:2142-2169. [PMID: 35932257 DOI: 10.1002/hec.4561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 06/01/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
Better integration is a priority for most international health systems. However, multiple interventions are often implemented simultaneously, making evaluation difficult and providing limited evidence for policy makers about specific interventions. We evaluate a common integrated care intervention, multi-disciplinary group (MDG) meetings for discussion of high-risk patients, introduced in one socio-economically deprived area in the UK in spring 2015. Using data from multiple waves of the national GP Patient Survey and Hospital Episode Statistics, we estimate its effects on primary and secondary care utilization and costs, health status and patient experience. We use triple differences, exploiting the targeting at people aged 65 years and over, parsing effects from other population-level interventions implemented simultaneously. The intervention reduced the probability of visiting a primary care nurse by three percentage points and decreased length of stay by 1 day following emergency care admission. However, since planned care use increased, overall costs were unaffected. MDG meetings are presumably fulfilling public health objectives by decreasing length of stay and detecting previously unmet needs. However, the effect of MDGs on health system cost is uncertain and health remains unchanged. Evaluations of specific integrated care interventions may be more useful to public decision makers facing budget constraints.
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Affiliation(s)
- Léontine Goldzahl
- IESEG School of Management, Lille, France
- Université de Lille, CNRS, UMR 9221 - LEM - Lille Economie Management, Lille, France
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Stokes J, Bower P, Guthrie B, Mercer SW, Rice N, Ryan AM, Sutton M. Cuts to local government spending, multimorbidity and health-related quality of life: A longitudinal ecological study in England. Lancet Reg Health Eur 2022; 19:100436. [PMID: 36039277 PMCID: PMC9417904 DOI: 10.1016/j.lanepe.2022.100436] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Population health has stagnated or is declining in many high-income countries. We analysed whether nationally administered austerity cuts in England were associated with prevalence of multimorbidity (individuals with two or more long-term conditions) and health-related quality of life. METHODS We conducted an observational, longitudinal study on 147 local authorities in England. We examined associations of changes in spending over time (2009/10-2017/18), in total and by budget line, with (i) prevalence of multimorbidity, 2+ conditions (2011/12-2017/18), and (ii) health-related quality of life (EQ-5D-5L) score (2012/13-2016/17). We estimated linear, log-log regression models, incorporating local authority fixed-effects, time-varying demographic and socio-economic confounders, and time trends. FINDINGS All local authorities experienced real spending cuts, varying from 42% (Barking and Dagenham) to 0·3% (Sefton). A 1% cut in per capita total service expenditure was associated with a 0·10% (95% CI 0·03 to 0·16) increase in prevalence of multimorbidity. We found no association (0·003%; 95% CI -0·01 to 0·01) with health-related quality of life. By budget line, after controlling for other spending, a 1% cut in public health expenditure was associated with a 0·15% (95% CI 0·11 to 0·20) increase in prevalence of multimorbidity, and a 1% cut in adult social care expenditure was associated with a 0·01% (95% CI 0·002 to 0·02) decrease in average health-related quality of life. INTERPRETATION Fiscal austerity is associated with worse multimorbidity and health-related quality of life. Policymakers should consider the potential health consequences of local government expenditure cuts and knock-on effects for health systems. FUNDING Medical Research Council.
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Affiliation(s)
- Jonathan Stokes
- Centre for Primary Care & Health Services Research, University of Manchester, Oxford Road, Manchester M13 9PL, England
| | - Peter Bower
- Centre for Primary Care & Health Services Research, University of Manchester, Oxford Road, Manchester M13 9PL, England
| | - Bruce Guthrie
- Usher Institute of Population Health Sciences and Informatics, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, Scotland
| | - Stewart W. Mercer
- Usher Institute of Population Health Sciences and Informatics, Old Medical School, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, Scotland
| | - Nigel Rice
- Department of Economics and Related Studies and Centre for Health Economics, University of York, Heslington, York YO10 5DD, England
| | - Andrew M. Ryan
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Matt Sutton
- Centre for Primary Care & Health Services Research, University of Manchester, Oxford Road, Manchester M13 9PL, England
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22
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Affiliation(s)
- Jonathan Stokes
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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23
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Stokes J, Turner AJ, Anselmi L, Morciano M, Hone T. The relative effects of non-pharmaceutical interventions on wave one Covid-19 mortality: natural experiment in 130 countries. BMC Public Health 2022; 22:1113. [PMID: 35659646 PMCID: PMC9165709 DOI: 10.1186/s12889-022-13546-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/27/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-pharmaceutical interventions have been implemented around the world to control Covid-19 transmission. Their general effect on reducing virus transmission is proven, but they can also be negative to mental health and economies, and transmission behaviours can also change voluntarily, without mandated interventions. Their relative impact on Covid-19 attributed mortality, enabling policy selection for maximal benefit with minimal disruption, is not well established due to a lack of definitive methods. METHODS We examined variations in timing and strictness of nine non-pharmaceutical interventions implemented in 130 countries and recorded by the Oxford COVID-19 Government Response Tracker (OxCGRT): 1) School closing; 2) Workplace closing; 3) Cancelled public events; 4) Restrictions on gatherings; 5) Closing public transport; 6) Stay at home requirements ('Lockdown'); 7) Restrictions on internal movement; 8) International travel controls; 9) Public information campaigns. We used two time periods in the first wave of Covid-19, chosen to limit reverse causality, and fixed country policies to those implemented: i) prior to first Covid-19 death (when policymakers could not possibly be reacting to deaths in their own country); and, ii) 14-days-post first Covid-19 death (when deaths were still low, so reactive policymaking still likely to be minimal). We then examined associations with daily deaths per million in each subsequent 24-day period, which could only be affected by the intervention period, using linear and non-linear multivariable regression models. This method, therefore, exploited the known biological lag between virus transmission (which is what the policies can affect) and mortality for statistical inference. RESULTS After adjusting, earlier and stricter school (- 1.23 daily deaths per million, 95% CI - 2.20 to - 0.27) and workplace closures (- 0.26, 95% CI - 0.46 to - 0.05) were associated with lower Covid-19 mortality rates. Other interventions were not significantly associated with differences in mortality rates across countries. Findings were robust across multiple statistical approaches. CONCLUSIONS Focusing on 'compulsory', particularly school closing, not 'voluntary' reduction of social interactions with mandated interventions appears to have been the most effective strategy to mitigate early, wave one, Covid-19 mortality. Within 'compulsory' settings, such as schools and workplaces, less damaging interventions than closing might also be considered in future waves/epidemics.
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Affiliation(s)
- Jonathan Stokes
- Health Organisation, Policy & Economics (HOPE), Centre for Primary Care & Health Services Research, University of Manchester, Manchester, England.
| | - Alex James Turner
- Health Organisation, Policy & Economics (HOPE), Centre for Primary Care & Health Services Research, University of Manchester, Manchester, England
| | - Laura Anselmi
- Health Organisation, Policy & Economics (HOPE), Centre for Primary Care & Health Services Research, University of Manchester, Manchester, England
| | - Marcello Morciano
- Health Organisation, Policy & Economics (HOPE), Centre for Primary Care & Health Services Research, University of Manchester, Manchester, England
- Research Centre for the Analysis of Public Policies (CAPP), University of Modena and Reggio Emilia, Modena, Italy
| | - Thomas Hone
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, England
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Ukita R, Stokes J, Wu W, Patel Y, Talackine J, Cardwell N, Benson C, Lefevre R, Eagle S, Demarest C, Simonds E, Tipograf Y, Skoog D, Cook K, Rosenzweig E, Bacchetta M. Large Animal Investigation of Cardiopulmonary Support for Acute-on-Chronic Right Ventricular Failure: Physiologic and Hemodynamic Consequences of Circuit Configuration. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Lipton RB, Gandhi P, Stokes J, Cala ML, Evans CJ, Knoble N, Gelhorn HL, Revicki D, Viswanathan HN, Dodick DW. Development and validation of a novel patient-reported outcome measure in people with episodic migraine and chronic migraine: The Activity Impairment in Migraine Diary. Headache 2021; 62:89-105. [PMID: 34962305 PMCID: PMC9306594 DOI: 10.1111/head.14229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/04/2021] [Accepted: 09/13/2021] [Indexed: 12/14/2022]
Abstract
Objective To evaluate the content validity and psychometric properties of the Activity Impairment in Migraine Diary (AIM‐D). Background Measuring treatment effects on migraine impairment requires a psychometrically sound patient‐reported outcome (PRO) measure developed consistent with U.S. Food and Drug Administration guidance. Methods The AIM‐D was created from concepts that emerged during qualitative interviews with five clinicians experienced in treating migraine and concept elicitation (CE) interviews with 40 adults with episodic migraine (EM) or chronic migraine (CM). The initial version was refined based on three waves of cognitive interviews with 38 adults with EM or CM and input from a panel of clinical and measurement experts. The AIM‐D was psychometrically evaluated using data from 316 adults with EM or CM who participated in a 13‐week prospective observational study. Study participants completed PRO assessments including the AIM‐D and a daily headache diary. Exploratory and confirmatory factor analysis were used to determine the factor structure. The reliability, validity, and responsiveness of the AIM‐D were assessed. Additional PRO measures including the Patient Global Impression – Severity (PGI‐S), Migraine Specific Quality of Life Questionnaire, Version 2.1 Role Function‐Restrictive domain, and Headache Impact Test were used for psychometric evaluation of the AIM‐D. Results Based on CE interviews with adults with migraine and input from an expert panel, activity impairment was identified as the target in the preliminary conceptual framework, which had two domains: performance of daily activities (PDAs) and physical impairment (PI). Revision of the draft AIM‐D through multiple rounds of cognitive interviews and expert panel meetings resulted in a content valid 11‐item version. Exploratory factor analysis supported both one‐ and two‐domain structures for the AIM‐D, which were further supported by confirmatory factor analysis (factor loadings all >0.90). The AIM‐D domains (PDA and PI) and total score showed high internal consistency reliability (Cronbach's alpha 0.95–0.97), acceptable test–retest reliability for weekly average scores (intraclass correlation coefficient >0.60 for participants with no change in PGI‐S between baseline and week 2), and good convergent and known‐groups validity. There was evidence of responsiveness based on changes in PGI‐S score and monthly migraine days. Conclusion The AIM‐D is a content valid and psychometrically sound measure designed to evaluate activity impairment and is suitable for use in clinical trials of preventive treatments for EM or CM.
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Affiliation(s)
- Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | | | | | | | | | | | - Dennis Revicki
- Evidera, Bethesda, Maryland, USA.,Outcomes Research Consulting, Sarasota, Florida, USA
| | | | - David W Dodick
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
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Jenkins P, MacCormick A, Stokes J, Lyall F, Rogers A, Gafoor N. Learning from mistakes when reporting urgent and emergency vascular studies. Clin Radiol 2021; 77:159-166. [PMID: 34903386 DOI: 10.1016/j.crad.2021.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023]
Abstract
The majority of out-of-hours cases relate to neurological, chest, and gastrointestinal pathologies with acute vascular cases being encountered less commonly. Trainees and exposure of non-vascular/interventional radiology (IR) consultants to angiographic imaging is often limited in working hours and this may lead to reporting on-call cases outside of normal daytime practice. In a recent local review, a number on-call vascular studies were found to contain a number of vascular-related discrepancies. Vascular reporting is a complex subspecialty, which comprises many clear diagnoses (large vessel occlusions, large vessel aneurysms, or dissections); however, also several subtle and complex abnormalities. These more subtle abnormalities, at times, require dedicated vascular specialist review to ensure subtle findings are communicated appropriately to the clinical team. The recent increased complexity of endovascular treatments and their complications has also provided further challenge for the non-specialist reporter. Similarly, improved imaging techniques have allowed for non-obvious but significant findings that may require urgent management, such as small aneurysms and dissection flaps. We will review a range of key vascular findings that demonstrate learning opportunities, particularly within the acute and on-call settings. These will include gastrointestinal haemorrhage, subtle aortic pathologies, head and neck vascular emergencies, small to mid-sized vessel injuries and imaging of post-procedural complications. Educational hints and tips will be provided to enable learning from mistakes encountered by trainees and non-vascular specialist radiologists in the on-call or urgent reporting settings, and these will be reviewed with reference to the literature.
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Affiliation(s)
- P Jenkins
- Peninsula Radiology Academy, Plymouth, UK.
| | | | - J Stokes
- Department of Neuroradiology, University of Plymouth Hospitals NHS Trust, Plymouth, UK
| | - F Lyall
- Peninsula Radiology Academy, Plymouth, UK
| | - A Rogers
- Department of Radiology, Royal Cornwall NHS Trust, Cornwall, UK
| | - N Gafoor
- Department of Interventional Radiology, University of Plymouth Hospitals NHS Trust, Plymouth, UK
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Shirneshan E, Coon CD, Johnson N, Stokes J, Wells T, Lundy JJ, Andrae DA, Evans CJ, Campbell J. Development of the Near Vision Presbyopia Task-based Questionnaire for use in evaluating the impact of presbyopia. J Patient Rep Outcomes 2021; 5:125. [PMID: 34855038 PMCID: PMC8639892 DOI: 10.1186/s41687-021-00378-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Presbyopia is a progressive condition that reduces the eye’s ability to focus on near objects with increasing age. After a systematic literature review identified no existing presbyopia-specific patient-reported outcome (PRO) instruments meeting regulatory guidance, a new PRO instrument, the Near Vision Presbyopia Task-based Questionnaire (NVPTQ), was developed. Results To explore the patient experience with presbyopia, concept elicitation interviews were conducted with 20 presbyopic participants. The most frequently reported impacts were difficulty with reading menus/books/newspapers/magazines, reading on a cell phone/caller ID, and reading small print. Based on these results, a task-based PRO instrument (the NVPTQ) was developed instructing participants to complete four near-vision, paper-based reading tasks (book, newspaper, nutrition label, menu) under standardized settings, and subsequently assess their vision-related reading ability and associated satisfaction. The draft NVPTQ was cognitively debriefed with a sample of 20 presbyopes, which demonstrated that most participants interpreted the items as intended and endorsed the relevance of the concepts being assessed. After the qualitative research, the draft instrument was psychometrically tested using data from a Phase 2 study. Based on item-level analyses, all items in the NVPTQ demonstrated expected response option patterns and lacked substantial floor or ceiling effects. The reliability, validity, and responsiveness of the NVPTQ Performance and Satisfaction domain scores were assessed. All domains scores had large Cronbach’s coefficient α values and good test–retest statistics, indicating that the scores are internally consistent and produce stable values over time. The pattern of correlations with a concurrent measure of visual functioning (National Eye Institute Visual Function Questionnaire 25) demonstrated that the NVPTQ domain scores were related to an alternative assessment of near-vision activities. The NVPTQ domain scores were able to distinguish between groups that were known to differ on the clinical outcome of uncorrected near visual acuity, supporting the construct validity of these scores. The NVPTQ domain scores showed evidence of responsiveness to change by being able to distinguish between groups defined as improved and not improved based on patient-reported and clinical outcomes. Conclusions This research has resulted in a content-valid and psychometrically sound instrument designed to evaluate vision-related reading ability and satisfaction with vision-related reading ability. Trial registration: ClinicalTrials.gov NCT02780115. Registered 23 May 2016, https://www.clinicaltrials.gov/ct2/show/NCT02780115?term=NCT02780115&draw=2&rank=1.
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Affiliation(s)
- Elaheh Shirneshan
- Allergan, an AbbVie company, 2525 Dupont Drive, T2-2P, Irvine, CA, 92629, USA.
| | | | | | | | | | | | | | | | - Joanna Campbell
- Allergan, an AbbVie company, 2525 Dupont Drive, T2-2P, Irvine, CA, 92629, USA
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Dambha-Miller H, Simpson G, Akyea RK, Hounkpatin H, Morrison L, Gibson J, Stokes J, Islam N, Chapman A, Stuart B, Zaccardi F, Zlatev Z, Jones K, Roderick P, Boniface M, Santer M, Farmer A. The development and validation of population clusters for integrating health and social care: A protocol for a mixed-methods study in Multiple Long-Term Conditions (Cluster-AIM) (Preprint). JMIR Res Protoc 2021; 11:e34405. [PMID: 35708751 PMCID: PMC9247810 DOI: 10.2196/34405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/18/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Multiple long-term health conditions (multimorbidity) (MLTC-M) are increasingly prevalent and associated with high rates of morbidity, mortality, and health care expenditure. Strategies to address this have primarily focused on the biological aspects of disease, but MLTC-M also result from and are associated with additional psychosocial, economic, and environmental barriers. A shift toward more personalized, holistic, and integrated care could be effective. This could be made more efficient by identifying groups of populations based on their health and social needs. In turn, these will contribute to evidence-based solutions supporting delivery of interventions tailored to address the needs pertinent to each cluster. Evidence is needed on how to generate clusters based on health and social needs and quantify the impact of clusters on long-term health and costs. Objective We intend to develop and validate population clusters that consider determinants of health and social care needs for people with MLTC-M using data-driven machine learning (ML) methods compared to expert-driven approaches within primary care national databases, followed by evaluation of cluster trajectories and their association with health outcomes and costs. Methods The mixed methods program of work with parallel work streams include the following: (1) qualitative semistructured interview studies exploring patient, caregiver, and professional views on clinical and socioeconomic factors influencing experiences of living with or seeking care in MLTC-M; (2) modified Delphi with relevant stakeholders to generate variables on health and social (wider) determinants and to examine the feasibility of including these variables within existing primary care databases; and (3) cohort study with expert-driven segmentation, alongside data-driven algorithms. Outputs will be compared, clusters characterized, and trajectories over time examined to quantify associations with mortality, additional long-term conditions, worsening frailty, disease severity, and 10-year health and social care costs. Results The study will commence in October 2021 and is expected to be completed by October 2023. Conclusions By studying MLTC-M clusters, we will assess how more personalized care can be developed, how accurate costs can be provided, and how to better understand the personal and medical profiles and environment of individuals within each cluster. Integrated care that considers “whole persons” and their environment is essential in addressing the complex, diverse, and individual needs of people living with MLTC-M. International Registered Report Identifier (IRRID) PRR1-10.2196/34405
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Affiliation(s)
| | - Glenn Simpson
- Primary Care Research Centre, Southampton, United Kingdom
| | - Ralph K Akyea
- University of Nottingham, Nottingham, United Kingdom
| | | | | | - Jon Gibson
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Jonathan Stokes
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | | | - Adriane Chapman
- Electronic and Computer Science Centre for Health Technologies, University of Southampton, Southampton, United Kingdom
| | - Beth Stuart
- Primary Care Research Centre, Southampton, United Kingdom
| | - Francesco Zaccardi
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Zlatko Zlatev
- Electronic and Computer Science Centre for Health Technologies, University of Southampton, Southampton, United Kingdom
| | - Karen Jones
- Centre for the Study of Health, Science and Environment, University of Kent, Kent, United Kingdom
| | - Paul Roderick
- Public Health, University of Southampton, Southampton, United Kingdom
| | - Michael Boniface
- Electronic and Computer Science Centre for Health Technologies, University of Southampton, Southampton, United Kingdom
| | - Miriam Santer
- Primary Care Research Centre, Southampton, United Kingdom
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Johnson N, Shirneshan E, Coon CD, Stokes J, Wells T, Lundy JJ, Andrae DA, Evans CJ, Campbell J. Development of the Presbyopia Impact and Coping Questionnaire. Ophthalmol Ther 2021; 10:1057-1075. [PMID: 34643894 PMCID: PMC8589917 DOI: 10.1007/s40123-021-00391-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Presbyopia is a progressive, age-related visual condition that is characterized by reduced ability to focus on near/close objects, causing impacts on individuals' daily function and health-related quality of life. The Presbyopia Impact and Coping Questionnaire (PICQ) is a new patient-reported outcome (PRO) instrument that assesses presbyopia impact and use of coping behaviors among presbyopic individuals. METHODS To document the impacts of presbyopia and associated coping behaviors, concept elicitation (CE) interviews were conducted with 20 presbyopic participants. Results from the CE interviews were used to develop draft items for additional testing. Following item generation, the draft PICQ was cognitively debriefed with 20 participants. Data from a phase 2 controlled clinical trial were used for psychometric analyses of the PICQ. The PICQ was administered at site visits throughout a 28-day treatment period. Confirmatory factor analysis (CFA) methods were used to guide the development of the scoring algorithm. The reliability (internal consistency, test-retest), construct validity (convergent and discriminant validity, known-groups methods), and responsiveness (Guyatt's responsiveness statistic [GRS]) of the PICQ scores were evaluated. Finally, anchor-based and distribution-based methods were used to inform thresholds for interpreting meaningful within-patient change. RESULTS CE interviews identified the important and relevant presbyopia-related impacts and coping behaviors and 22 items were drafted and cognitively debriefed. Following minor revisions and item addition/deletion, a version of the PICQ including 23 items was subjected to psychometric testing. The analysis sample included 151 participants. The CFA established two PICQ domain scores, Coping and Impact, on 0-to-4 scales that demonstrate good model fit (root mean square error of approximation = 0.06, comparative fit index = 0.98, Tucker-Lewis index = 0.98, standardized root mean square = 0.07). Cronbach's alphas for the Coping and Impact scores were 0.89 and 0.84, respectively. Test-retest intraclass correlation coefficients were 0.77 for Coping and 0.67 for Impact. The pattern of results assessing construct validity was acceptable for the PICQ Coping and Impact scores, with the magnitude of correlations and effect sizes generally meeting a priori expectations. The corresponding GRS effect sizes for the PICQ Coping scores were -1.23 (i.e., large) for Patient Global Impression of Change (PGIC) and -0.72 (i.e., medium) for uncorrected near visual acuity (UNVA). The GRS effect sizes for the PICQ Impact scores were -0.60 (i.e., medium) for PGIC and -0.35 (i.e., small) for UNVA. Across three sets of anchor-based analyses for interpreting individual-level change, a responder threshold of -1.00 was identified for both PICQ Coping and PICQ Impact scores. CONCLUSIONS The totality of evidence from the qualitative and quantitative research establishes that the PICQ scores produced are valid and reliable measures of presbyopia impacts and coping behaviors that are important and relevant for assessing presbyopia treatment outcomes. CLINICALTRIALS. GOV IDENTIFIER NCT02780115; date of registration May 19, 2016.
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Affiliation(s)
| | - Elaheh Shirneshan
- Allergan, an AbbVie company, 2525 Dupont Drive, T2-2P, Irvine, CA, 92629, USA.
| | | | | | | | | | | | | | - Joanna Campbell
- Allergan, an AbbVie company, 2525 Dupont Drive, T2-2P, Irvine, CA, 92629, USA
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Hone T, Stokes J, Trajman A, Saraceni V, Coeli CM, Rasella D, Durovni B, Millett C. Racial and socioeconomic disparities in multimorbidity and associated healthcare utilisation and outcomes in Brazil: a cross-sectional analysis of three million individuals. BMC Public Health 2021; 21:1287. [PMID: 34210313 PMCID: PMC8252284 DOI: 10.1186/s12889-021-11328-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence is limited on racial/ethnic group disparities in multimorbidity and associated health outcomes in low- and middle-income countries hampering effective policies and clinical interventions to address health inequalities. METHODS This study assessed race/ethnic and socioeconomic disparities in the prevalence of multimorbidity and associated healthcare utilisation, costs and death in Rio de Janeiro, Brazil. A cross-sectional analysis was carried out of 3,027,335 individuals registered with primary healthcare (PHC) services. Records included linked data to hospitalisation, mortality, and welfare-claimant (Bolsa Família) records between 1 Jan 2012 and 31 Dec 2016. Logistic and Poisson regression models were carried out to assess the likelihood of multimorbidity (two or more diagnoses out of 53 chronic conditions), PHC use, hospital admissions and mortality from any cause. Interactions were used to assess disparities. RESULTS In total 13,509,633 healthcare visits were analysed identifying 389,829 multimorbid individuals (13%). In adjusted regression models, multimorbidity was associated with lower education (Adjusted Odds Ratio (AOR): 1.26; 95%CI: 1.23,1.29; compared to higher education), Bolsa Família receipt (AOR: 1.14; 95%CI: 1.13,1.15; compared to non-recipients); and black race/ethnicity (AOR: 1.05; 95%CI: 1.03,1.06; compared to white). Multimorbidity was associated with more hospitalisations (Adjusted Rate Ratio (ARR): 2.75; 95%CI: 2.69,2.81), more PHC visits (ARR: 3.46; 95%CI: 3.44,3.47), and higher likelihood of death (AOR: 1.33; 95%CI: 1.29,1.36). These associations were greater for multimorbid individuals with lower educational attainment (five year probability of death 1.67% (95%CI: 1.61,1.74%) compared to 1.13% (95%CI: 1.02,1.23%) for higher education), individuals of black race/ethnicity (1.48% (95%CI: 1.41,1.55%) compared to 1.35% (95%CI: 1.31,1.40%) for white) and individuals in receipt of welfare (1.89% (95%CI: 1.77,2.00%) compared to 1.35% (95%CI: 1.31,1.38%) for non-recipients). CONCLUSIONS The prevalence of multimorbidity and associated hospital admissions and mortality are greater in individuals with black race/ethnicity and other deprived socioeconomic groups in Rio de Janeiro. Interventions to better prevent and manage multimorbidity and underlying disparities in low- and middle-income country settings are needed.
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Affiliation(s)
- Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8R, UK.
| | - Jonathan Stokes
- Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Anete Trajman
- Programa de Pós-graduação em Clínica Médica and Mestrado Profissional em Atenção Primária à Saúde, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Valeria Saraceni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia Medina Coeli
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Davide Rasella
- Public Health Policy Evaluation Unit, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8R, UK
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Betina Durovni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, Charing Cross Hospital, St Dunstan's Road, London, W6 8R, UK
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Oswaldo Cruz, Salvador, Brazil
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Gwaltney C, Stokes J, Aiudi A, Mazar I, Ollis S, Love E, Shields A. Development and content validity of the Barth Syndrome Symptom Assessment (BTHS-SA) for adolescents and adults. Orphanet J Rare Dis 2021; 16:264. [PMID: 34108006 PMCID: PMC8190857 DOI: 10.1186/s13023-021-01897-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 05/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Barth Syndrome (BTHS) is a rare genetic disorder that presents as a complex of debilitating symptoms and reduced life expectancy. Well-developed, BTHS-specific assessments measuring primary signs and symptoms of BTHS are not currently available, making it difficult to evaluate treatment effects in BTHS clinical studies. The objective of this research was to develop symptom-focused patient-reported outcome (PRO) measures for use in clinical studies with adolescents and adults with BTHS. Methods Concept elicitation interviews (CEIs) with pediatric (n = 18, age < 16 years) and adult (n = 15, age ≥ 16 years) individuals with BTHS and/or their caregivers were conducted to identify signs and symptoms relevant to BTHS and important to individuals with the condition. Based on CEI results, questionnaire construction activities were conducted to create unique adolescent and adult versions of the Barth Syndrome-Symptom Assessment (BTHS-SA). The questionnaires were evaluated in cognitive debriefing interviews (CDIs) with adolescents (n = 12; age 12- < 16 years) and adults (n = 12; age ≥ 16 years) with BTHS to assess relevance and readability of the tools. Results During the CEIs, a total of 48 and 40 signs and symptoms were reported by the pediatric and adult groups, respectively; 31 were reported by both age groups. Fatigue/tiredness and muscle weakness were the symptoms most frequently reported by both pediatric and adult patients with BTHS as important to improve with an effective treatment. The CEI results informed construction of a nine-item version of the BTHS-SA for adolescents and an eight-item version for adults. Developed for daily administration, each version asks respondents to rate symptom severity “at its worst” over the 24 h prior to administration. CDIs with both adolescents and adults with BTHS demonstrated that each BTHS-SA version was reflective of the disease experience and that respondents could interpret the questionnaire as intended and provide responses that accurately reflected their symptom experience. Conclusions The BTHS-SA adolescent and adult versions are content-valid PRO measures that can be used to evaluate severity of disease-specific symptoms in future clinical trials. Given the lack of available and well-developed assessments in this underserved therapeutic area, these tools fulfill a need for clinical researchers developing treatments for individuals with BTHS.
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Affiliation(s)
- Chad Gwaltney
- Gwaltney Consulting, 1 Bucks Trail, Westerly, RI, USA.
| | | | - Anthony Aiudi
- Stealth BioTherapeutics, 275 Grove Street, Suite 3-107, Newton, MA, USA
| | - Iyar Mazar
- Adelphi Values, 290 Congress St, 6th Floor, Boston, MA, USA
| | - Sarah Ollis
- Adelphi Values, 290 Congress St, 6th Floor, Boston, MA, USA
| | - Emily Love
- Adelphi Values, 290 Congress St, 6th Floor, Boston, MA, USA
| | - Alan Shields
- Adelphi Values, 290 Congress St, 6th Floor, Boston, MA, USA
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Hayes H, Stokes J, Kristensen SR, Sutton M. The effect of payment method and multimorbidity on health and healthcare utilisation. J Health Organ Manag 2021. [DOI: 10.1108/jhom-05-2020-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThree types of payment methods have been introduced across European countries in attempts to encourage better, more integrated care of persons with multimorbidity: pay-for-performance; pay-for-coordination; and an all-inclusive payment method. We examine whether there are differences in the way these payment methods affect health and healthcare use in persons with multimorbidity.Design/methodology/approachUsing individual-level survey data from twenty European countries, we examine unadjusted differences in average outcomes for the years 2011–2015 by whether countries adopted new payment methods for integrated care. We then test for a differential effect for multimorbid persons using linear, individual random effects regressions, including country and time fixed effects and clustering standard errors at the country level.FindingsWe find little effect of varying payment methods on key outcomes for multimorbid individuals despite the theoretical predictions and the rhetoric in many policy documents.Research limitations/implicationsPolicymakers should bear in mind that the success of the payment method relies on the specific design of the incentives and their implementation. New effective models of care and how to incentivise these for multimorbid patients is an ongoing research priority.Originality/valueThis paper is the first to study the effects of payments for integration on the dimensions and populations these schemes intend to affect; health and healthcare use at the individual level for multimorbid individuals.
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Karimi M, Tsiachristas A, Looman W, Stokes J, Galen MV, Rutten-van Mölken M. Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients. Health Policy 2021; 125:751-759. [PMID: 33947604 DOI: 10.1016/j.healthpol.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/29/2022]
Abstract
Bundled payments aim to stimulate the integration of healthcare services and ultimately reduce healthcare expenditure growth through improved quality of care. The Netherlands introduced bundled payments for chronic diseases in 2010 by reimbursing providers annually for a bundle of primary care services related to COPD, Diabetes, or Vascular Risk Management. We aimed to assess the long-term effects of these bundled payments on healthcare expenditure. We used health insurance claims data from 2008 to 2015 to compare the healthcare expenditure between everyone who was included in bundled payments and a control group. We performed a difference-in-difference analysis in combination with propensity score matching and found that bundled payments consistently increased health care expenditure over seven years. The average half-year increase was €233 (95%CI: 204-262) for DM2, €609 (95%CI: 533-686) for COPD, and €231 (95%CI: 208-254) for VRM, representing 13%, 52%, and 20% of 2008 half-year cost. The increase was higher for those with multimorbidity compared to those without multimorbidity. This suggests that the expectations of the bundled payments are yet to be fulfilled.
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Affiliation(s)
- Milad Karimi
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Apostolos Tsiachristas
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK
| | - Willemijn Looman
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands
| | - Jonathan Stokes
- Health Organisation, Policy and Economics, Primary Care and Health Services Research Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Mirte van Galen
- Vektis C.V., Sparrenheuvel 18, Building B, 3708 JE Zeist, the Netherlands
| | - Maureen Rutten-van Mölken
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands, PO Box 1738, 3000 DR Rotterdam.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Morciano M, Stokes J, Kontopantelis E, Hall I, Turner AJ. Excess mortality for care home residents during the first 23 weeks of the COVID-19 pandemic in England: a national cohort study. BMC Med 2021; 19:71. [PMID: 33663498 PMCID: PMC7932761 DOI: 10.1186/s12916-021-01945-2] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 02/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To estimate excess mortality for care home residents during the COVID-19 pandemic in England, exploring associations with care home characteristics. METHODS Daily number of deaths in all residential and nursing homes in England notified to the Care Quality Commission (CQC) from 1 January 2017 to 7 August 2020. Care home-level data linked with CQC care home register to identify home characteristics: client type (over 65s/children and adults), ownership status (for-profit/not-for-profit; branded/independent) and size (small/medium/large). Excess deaths computed as the difference between observed and predicted deaths using local authority fixed-effect Poisson regressions on pre-pandemic data. Fixed-effect logistic regressions were used to model odds of experiencing COVID-19 suspected/confirmed deaths. RESULTS Up to 7 August 2020, there were 29,542 (95% CI 25,176 to 33,908) excess deaths in all care homes. Excess deaths represented 6.5% (95% CI 5.5 to 7.4%) of all care home beds, higher in nursing (8.4%) than residential (4.6%) homes. 64.7% (95% CI 56.4 to 76.0%) of the excess deaths were confirmed/suspected COVID-19. Almost all excess deaths were recorded in the quarter (27.4%) of homes with any COVID-19 fatalities. The odds of experiencing COVID-19 attributable deaths were higher in homes providing nursing services (OR 1.8, 95% CI 1.6 to 2.0), to older people and/or with dementia (OR 5.5, 95% CI 4.4 to 6.8), amongst larger (vs. small) homes (OR 13.3, 95% CI 11.5 to 15.4) and belonging to a large provider/brand (OR 1.2, 95% CI 1.1 to 1.3). There was no significant association with for-profit status of providers. CONCLUSIONS To limit excess mortality, policy should be targeted at care homes to minimise the risk of ingress of disease and limit subsequent transmission. Our findings provide specific characteristic targets for further research on mechanisms and policy priority.
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Affiliation(s)
- Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK.
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK.
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Ian Hall
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, M13 9PL, UK
- Department of Mathematics, University of Manchester, Manchester, M13 9PL, UK
| | - Alex J Turner
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, M13 9PL, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Stokes J, Guthrie B, Mercer SW, Rice N, Sutton M. Multimorbidity combinations, costs of hospital care and potentially preventable emergency admissions in England: A cohort study. PLoS Med 2021; 18:e1003514. [PMID: 33439870 PMCID: PMC7815339 DOI: 10.1371/journal.pmed.1003514] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/19/2021] [Accepted: 01/05/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with multimorbidities have the greatest healthcare needs and generate the highest expenditure in the health system. There is an increasing focus on identifying specific disease combinations for addressing poor outcomes. Existing research has identified a small number of prevalent "clusters" in the general population, but the limited number examined might oversimplify the problem and these may not be the ones associated with important outcomes. Combinations with the highest (potentially preventable) secondary care costs may reveal priority targets for intervention or prevention. We aimed to examine the potential of defining multimorbidity clusters for impacting secondary care costs. METHODS AND FINDINGS We used national, Hospital Episode Statistics, data from all hospital admissions in England from 2017/2018 (cohort of over 8 million patients) and defined multimorbidity based on ICD-10 codes for 28 chronic conditions (we backfilled conditions from 2009/2010 to address potential undercoding). We identified the combinations of multimorbidity which contributed to the highest total current and previous 5-year costs of secondary care and costs of potentially preventable emergency hospital admissions in aggregate and per patient. We examined the distribution of costs across unique disease combinations to test the potential of the cluster approach for targeting interventions at high costs. We then estimated the overlap between the unique combinations to test potential of the cluster approach for targeting prevention of accumulated disease. We examined variability in the ranks and distributions across age (over/under 65) and deprivation (area level, deciles) subgroups and sensitivity to considering a smaller number of diseases. There were 8,440,133 unique patients in our sample, over 4 million (53.1%) were female, and over 3 million (37.7%) were aged over 65 years. No clear "high cost" combinations of multimorbidity emerged as possible targets for intervention. Over 2 million (31.6%) patients had 63,124 unique combinations of multimorbidity, each contributing a small fraction (maximum 3.2%) to current-year or 5-year secondary care costs. Highest total cost combinations tended to have fewer conditions (dyads/triads, most including hypertension) affecting a relatively large population. This contrasted with the combinations that generated the highest cost for individual patients, which were complex sets of many (6+) conditions affecting fewer persons. However, all combinations containing chronic kidney disease and hypertension, or diabetes and hypertension, made up a significant proportion of total secondary care costs, and all combinations containing chronic heart failure, chronic kidney disease, and hypertension had the highest proportion of preventable emergency admission costs, which might offer priority targets for prevention of disease accumulation. The results varied little between age and deprivation subgroups and sensitivity analyses. Key limitations include availability of data only from hospitals and reliance on hospital coding of health conditions. CONCLUSIONS Our findings indicate that there are no clear multimorbidity combinations for a cluster-targeted intervention approach to reduce secondary care costs. The role of risk-stratification and focus on individual high-cost patients with interventions is particularly questionable for this aim. However, if aetiology is favourable for preventing further disease, the cluster approach might be useful for targeting disease prevention efforts with potential for cost-savings in secondary care.
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Affiliation(s)
- Jonathan Stokes
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Bruce Guthrie
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Stewart W. Mercer
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Nigel Rice
- Department of Economics and Related Studies and Centre for Health Economics, University of York, York, United Kingdom
| | - Matt Sutton
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
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Catandi G, Stokes J, Maclellan L, Broeckling C, Carnevale E. 141 Diet supplementation alters oocyte lipid content and developmental competence in mares. Reprod Fertil Dev 2021. [DOI: 10.1071/rdv33n2ab141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The equine oocyte is dense in lipids, which may serve as an energy source for oocyte maturation and later embryonic development. However, the association between lipid content and fertility remains to be determined, as does the extent that diet can modify oocyte lipids. We hypothesised that diet supplementation can alter the oocyte lipid profile and subsequent developmental potential. In Study 1, we examined if oocyte triglyceride (TG) relative abundance was affected by dietary supplementation. Mares (16–22 years, n=9) were fed grass/alfalfa hay and supplemented daily with a combination of commercially available feed additives designed to promote equine wellness and fertility [Equine GI™ (147g daily), Potency® (28g daily), Motility Plus® (23g daily), Healthy Weight Oil (60mL daily), Platinum Performance Inc.]. Oocytes were collected from the mares before (PRE) and after ≥8 weeks (POST) of supplementation during the natural breeding season. In Study 2, we compared oocyte developmental potential after injection of sperm into oocytes obtained from mares supplemented for ≥8 weeks with the same additives (ADD, 18–24 yr, n=5) or from a similar group of mares supplemented with a grain control diet (450g of grain mix and 60ml of corn oil daily, GRN, 19–23 years, n=5). Oocytes were collected from dominant follicles (≥35mm) during oestrus and at 20±2 h after induction of follicular maturation. In Study 1, oocytes were denuded of cumulus cells after collection, snap frozen, and assessed for TG composition by nontargeted liquid chromatography-mass spectrometry using an Acquity UPLC system (Waters). In Study 2, recovered oocytes were placed in maturation medium for 22±2h before being injected with sperm from one stallion, and blastocyst formation was assessed in 7 or 8 days. A total of 100 annotated TG species were identified. Normalized peak areas for PRE and POST oocyte TG were compared using two-tailed, paired t-tests. Blastocyst development rates were compared by Fisher’s exact test. Relative abundance of 71 TG species differed (P ≤ 0.05) between PRE and POST; all TG species as well as total relative abundance of TG were higher in oocytes from PRE compared with POST. Blastocyst rates per sperm-injected oocyte were greater (P=0.03) for ADD (40%, 6/15) than for GRN (5%, 1/19). Dietary supplementation of the complex mix of nutrients to middle-aged and older mares resulted in reduced relative abundance of TG in oocytes and improved developmental potential. We determined that oocyte lipid content can be modified through diet. The extent that diet supplementation improved oocyte competence by altering the lipid profile is still to be determined.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Morciano M, Checkland K, Billings J, Coleman A, Stokes J, Tallack C, Sutton M. New integrated care models in England associated with small reduction in hospital admissions in longer-term: A difference-in-differences analysis. Health Policy 2020; 124:826-833. [PMID: 32595094 PMCID: PMC7386936 DOI: 10.1016/j.healthpol.2020.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/28/2020] [Accepted: 06/03/2020] [Indexed: 12/30/2022]
Abstract
Closer integration of health and social care services has become a cornerstone policy in many developed countries, but there is still debate over what population and service level is best to target. In England, the 2019 Long Term Plan for the National Health Service included a commitment to spread the integration prototypes piloted under the Vanguard `New Care Models' programme. The programme, running from 2015 to 2018, was one of the largest pilots in English history, covering around 9 % of the population. It was largely intended to design prototypes aimed at reducing hospital utilisation by moving specialist care out of hospital into the community and by fostering coordination of health, care and rehabilitation services for (i) the whole population ('population-based sites'), or (ii) care home residents ('care home sites'). We evaluate and compare the efficacy of the population-based and care home site integrated care models in reducing hospital utilisation. We use area-level monthly counts of emergency admissions and bed-days obtained from administrative data using a quasi-experimental difference-in-differences design. We found that Vanguard sites had higher hospital utilisation than non-participants in the pre-intervention period. In the post-intervention period, there is clear evidence of a substantial increase in emergency admissions among non-Vanguard sites. The Vanguard integrated care programme slowed the rise in emergency admissions, especially in care home sites and in the third and final year. There was no significant reduction in bed-days. In conclusion, integrated care policies should not be relied upon to make large reductions in hospital activity in the short-run, especially for population-based models.
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Affiliation(s)
- Marcello Morciano
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom.
| | - Katherine Checkland
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Jenny Billings
- Centre for Health Service Studies, University of Kent, Canterbury, CT2 7NF, United Kingdom
| | - Anna Coleman
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Jonathan Stokes
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Charles Tallack
- Research and Economic Analysis for the Long Term (REAL) Centre, The Health Foundation, London, EC4Y 8AP, United Kingdom
| | - Matt Sutton
- Health Organisation, Policy and Economics (HOPE) Research Group, University of Manchester, Manchester, M13 9PL, United Kingdom
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Catandi G, Obeidat Y, Stokes J, Chicco A, Chen T, Carnevale E. Maternal diet can alter oocyte mitochondrial number and function. J Equine Vet Sci 2020. [DOI: 10.1016/j.jevs.2020.103030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Catandi G, Obeidat Y, Stokes J, Chicco A, Chen T, Carnevale E. 98 Effects of maternal age on oxygen consumption of oocytes and invitro-produced equine embryos. Reprod Fertil Dev 2020. [DOI: 10.1071/rdv32n2ab98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mitochondrial replication is arrested during early cleavage stages, leaving the embryo dependent on maternally derived mitochondria for oxidative phosphorylation. Numbers of mitochondrial DNA (mtDNA) are used as indicators of functional mitochondria; however, direct comparisons for mtDNA and oxygen consumption rate (OCR) have not been performed for horses. The objectives of this study were to compare equine oocyte mtDNA copy numbers with a measure of mitochondrial function (OCR) and to determine whether maternal age of the oocyte donor impacts OCR of early-stage embryos. We hypothesised that (1) OCR in oocytes is not directly associated with mitochondrial numbers and (2) aerobic metabolism (OCR) is lower in early embryos from old than from young mares. Mares ages 6-13 years (Young, n=7) and=20 years (Old, n=8) were used as oocyte donors. Oocytes were collected from dominant follicles (=35mm) during oestrus and at 16±2h after induction of follicular maturation. Recovered oocytes were incubated in tissue culture medium 199 with 10% fetal calf serum, 25mgmL−1 of gentamicin, and 0.2mM pyruvate for 26±2h. Metaphase II oocytes (Young, n=14; Old, n=15) were fertilized by intracytoplasmic sperm injection (ICSI) using frozen-thawed sperm from one stallion. Presumptive zygotes were cultured in global medium (LifeGlobal Group). Other oocytes and early embryos were used for OCR. A microchamber containing an electrochemical sensor was used to measure OCR from individual oocytes (Young, n=9; Old, n=14) and early embryos (Young, n=8; Old, n=10). After analyses, oocytes were snap frozen, and mtDNA was later quantified by qPCR. Metabolic assays of embryos that cleaved were performed at Day 2 after ICSI. After the assay, embryos were placed back to culture until blastocyst formation at Day 7 or 8. Two-tailed Student's t-tests were used for OCR and mtDNA comparisons, and Fisher's exact tests were used to compare development rates. We found that OCR was higher (P=0.007) for oocytes from Young (mean±s.e.m.: 1.8±0.2) than from Old (1.3±0.1 fmol s−1). However, mtDNA numbers were not different (P=0.3) for Young (5.6±0.4×105) and Old (6.2±0.4×105). Cleavage rates were similar (P=0.6) between Young (11 out of 14, 79%) and Old (13 of 15, 87%). Day 2 embryos from Young had higher basal OCR compared with Old (3.8±0.1 and 3.2±0.2 fmol s−1, respectively; P=0.05). Blastocyst rates per cleaved oocytes were similar for Young (5 of 11, 45%) and Old (4 of 13, 31%; P=0.7). Lower OCR was observed in oocytes and early embryos from Old, which indicates that mitochondrial metabolic function is reduced for mitochondria originating in the oocytes of Old compared with Young. Use of mtDNA was not indicative of mitochondrial metabolic function. Although sample numbers were limited, cleavage and blastocyst development were not significantly different between Young and Old. Further developmental competence was not determined, although the compromised metabolic capacity of oocytes and embryos from old mares could ultimately contribute to lower fertility outcomes.
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Stokes J, Gellatly J, Bower P, Meacock R, Cotterill S, Sutton M, Wilson P. Implementing a national diabetes prevention programme in England: lessons learned. BMC Health Serv Res 2019; 19:991. [PMID: 31870371 PMCID: PMC6929377 DOI: 10.1186/s12913-019-4809-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/04/2019] [Indexed: 11/23/2022] Open
Abstract
Background Type 2 diabetes mellitus is preventable through lifestyle intervention. Diabetes prevention programmes (DPPs) aim to deliver prevention-based behaviour change interventions to reduce incidence. Such programmes vary from usual primary care in terms of where, how, and by whom they are delivered. Implementation is therefore likely to face new commissioning, incentive and delivery challenges. We report on the implementation of a national DPP in NHS England, and identify lessons learned in addressing the implementation challenges. Methods In 2017/18, we conducted 20 semi-structured telephone interviews covering 16 sampled case sites with the designated lead(s) responsible for local implementation of the programme. Interviews explored the process of implementation, including organisation of the programme, expectations and attitudes to the programme, funding, target populations and referral and clinical pathways. We drew on constant comparative methods to analyse the data and generate over-arching themes. We complemented our qualitative data with a survey focused on variation in the financial incentives used across sites to ensure usual primary care services recruited patients to new providers. Results We identified five over-arching areas of learning for implementing this large-scale programme: 1) managing new providers; 2) promoting awareness of services; 3) recruiting patients; 4) incentive payments; and 5) mechanisms for sharing learning. In general, tensions appeared to be caused by a lack of clear roles/responsibilities between hierarchical actors, and lack of communication. Both local sites and the national NHS coordination team gained experience through learning by doing. Initial tensions with roles and expectations have been worked out during implementation. Conclusions Implementing a national disease prevention programme is a major task, and one that will be increasingly faced by health systems globally as they aim to adjust to demand pressures. We provide practical learning opportunities for the wider uptake and sustainability of prevention programmes. Future implementers might wish to define clear responsibilities for each actor prior to implementation, ensure early engagement with new providers, offer mechanisms/forums for sharing learning, generate evidence and provide advice on incentive payments, and prioritise public and professional awareness of the programme.
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Affiliation(s)
- Jonathan Stokes
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
| | - Judith Gellatly
- Division of Nursing, University of Manchester, Manchester, UK
| | - Peter Bower
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Sarah Cotterill
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Matt Sutton
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Paul Wilson
- Alliance Manchester Business School, University of Manchester, Manchester, UK
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Baltaxe E, Czypionka T, Kraus M, Reiss M, Askildsen JE, Grenkovic R, Lindén TS, Pitter JG, Rutten-van Molken M, Solans O, Stokes J, Struckmann V, Roca J, Cano I. Digital Health Transformation of Integrated Care in Europe: Overarching Analysis of 17 Integrated Care Programs. J Med Internet Res 2019; 21:e14956. [PMID: 31573914 PMCID: PMC6794072 DOI: 10.2196/14956] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 12/31/2022] Open
Abstract
Background Digital health tools comprise a wide range of technologies to support health processes. The potential of these technologies to effectively support health care transformation is widely accepted. However, wide scale implementation is uneven among countries and regions. Identification of common factors facilitating and hampering the implementation process may be useful for future policy recommendations. Objective The aim of this study was to analyze the implementation of digital health tools to support health care and social care services, as well as to facilitate the longitudinal assessment of these services, in 17 selected integrated chronic care (ICC) programs from 8 European countries. Methods A program analysis based on thick descriptions—including document examinations and semistructured interviews with relevant stakeholders—of ICC programs in Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain, and the United Kingdom was performed. A total of 233 stakeholders (ie, professionals, providers, patients, carers, and policymakers) were interviewed from November 2014 to September 2016. The overarching analysis focused on the use of digital health tools and program assessment strategies. Results Supporting digital health tools are implemented in all countries, but different levels of maturity were observed among the programs. Only few ICC programs have well-established strategies for a comprehensive longitudinal assessment. There is a strong relationship between maturity of digital health and proper evaluation strategies of integrated care. Conclusions Notwithstanding the heterogeneity of the results across countries, most programs aim to evolve toward a digital transformation of integrated care, including implementation of comprehensive assessment strategies. It is widely accepted that the evolution of digital health tools alongside clear policies toward their adoption will facilitate regional uptake and scale-up of services with embedded digital health tools.
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Affiliation(s)
- Erik Baltaxe
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases, Madrid, Spain
| | | | | | | | | | - Renata Grenkovic
- Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia
| | | | | | - Maureen Rutten-van Molken
- School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Oscar Solans
- Oficina eSalut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Jonathan Stokes
- Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Verena Struckmann
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Josep Roca
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases, Madrid, Spain
| | - Isaac Cano
- Hospital Clinic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Center for Biomedical Network Research in Respiratory Diseases, Madrid, Spain
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Shah V, Stokes J, Sutton M. Effects of non-medical health coaching on multimorbid patients in primary care: a difference-in-differences analysis. BMC Health Serv Res 2019; 19:593. [PMID: 31438937 PMCID: PMC6704561 DOI: 10.1186/s12913-019-4367-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Health systems, globally, are attempting to strengthen primary care to promote a population-health management approach to care provision, incentivising prevention and self-management. This paper evaluates the "Enhanced Primary Care" model implemented in a geographical region in England. Enhanced Primary Care introduces a new non-medical role, health coaches, to the traditional primary care team to provide additional support for patients with chronic conditions. We evaluate effects of health coaching on patient outcomes using a quasi-experiment. Methods We estimate the programme’s effects on health status (EQ-5D-5L, physical functioning, psychological wellbeing, and resilience), health behaviour (smoking habit), experience of care (person-centeredness and continuity of care), and health care (primary care) utilisation using data from 3.5 million respondents to the national GP Patient Surveys between 2013 and 2017. We use a weighted difference-in-differences design to compare changes in outcomes over time between intervention practices and comparable control practices in the rest of England. We conduct our main analysis on multimorbid patients and additional analysis on all patients to assess population-level effects. Results For multimorbid patients, we find reductions in psychological wellbeing (short and medium term) of −0.0174 (95% confidence interval −0.0283 to −0.0065), relative difference −2% from the pre-intervention mean; and person-centeredness (short term) of −0.0356 (−0.0530 to −0.0183), −4%. We find no significant effects on other outcome measures. For population-level effects, in the short term we find reductions in primary care utilisation of −0.0331 (−0.0448 to −0.0214), −5%. All other outcomes are not consistently statistically significant. Conclusions Our results show that there is very little effect of health coaching on patient experience and outcomes in the short-to-medium term (up to 14 months). Introduction of Enhanced Primary Care was associated with slightly lower psychological wellbeing and person-centeredness amongst multimorbid patients (it might be initially difficult for patients to adjust to the model). However, it was also associated with a decline in primary care visits at the population-level (potentially freeing up practitioner time for more complex patients). The results raise important questions regarding primary care workforce changes advocated in the NHS Long Term Plan, and the time horizon of any benefits of prevention strategies. Electronic supplementary material The online version of this article (10.1186/s12913-019-4367-8) contains supplementary material, which is available to authorized users.
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Stokes J, Lau YS, Kristensen SR, Sutton M. Corrigendum to "Does pooling health & social care budgets reduce hospital use and lower costs?" [Soc. Sci. Med. 232 (2019) 382-388]. Soc Sci Med 2019; 235:112380. [PMID: 31257074 DOI: 10.1016/j.socscimed.2019.112380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jonathan Stokes
- Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
| | - Yiu-Shing Lau
- Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
| | - Søren Rud Kristensen
- Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK; Faculty of Medicine, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Matt Sutton
- Health Organisation, Policy, and Economics, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Stokes J, Lau YS, Kristensen SR, Sutton M. Does pooling health & social care budgets reduce hospital use and lower costs? Soc Sci Med 2019; 232:382-388. [DOI: 10.1016/j.socscimed.2019.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 05/02/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
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Hudgens S, Schüler R, Stokes J, Eremenco S, Hunsche E, Leist TP. Development and Validation of the FSIQ-RMS: A New Patient-Reported Questionnaire to Assess Symptoms and Impacts of Fatigue in Relapsing Multiple Sclerosis. Value Health 2019; 22:453-466. [PMID: 30975397 DOI: 10.1016/j.jval.2018.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/05/2018] [Accepted: 11/11/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES A new patient-reported outcome (PRO) instrument to measure fatigue symptoms and impacts in relapsing multiple sclerosis (RMS) was developed in a qualitative stage, followed by psychometric validation and migration from paper to an electronic format. METHODS Adult patients with relapsing-remitting multiple sclerosis (RRMS) were interviewed to elicit fatigue-related symptoms and impacts. A draft questionnaire was debriefed in cognitive interviews with further RRMS patients, and revised. Content confirmation interviews were conducted with patients with progressive-relapsing multiple sclerosis (PRMS) and relapsing secondary-progressive multiple sclerosis (RSPMS). Psychometric analyses used data from adult patients with different RMS subtypes and matched non-RMS controls in a multicenter, observational study. After item reduction, the final instrument was migrated to a smartphone (eDiary) and usability was confirmed in interviews with additional adult RMS patients. RESULTS The qualitative stage included 37 RRMS, 5 PRMS, and 5 RSPMS patients. Saturation of concepts was reached during concept elicitation. Cognitive interviews confirmed that participants understood the instructions, items, and response options of the instrument-named FSIQ-RMS-as intended. Psychometric validation included 164 RMS and 74 control patients. Internal consistency and test-retest reliability were demonstrated. The symptoms domain discriminated along the RMS symptom-severity continuum and between patients and controls. Patients were able to attribute fatigue-related symptoms to RMS. Usability and conceptual equivalence of the eDiary were confirmed (n = 10 participants). CONCLUSIONS With 7 symptom items and 13 impact items (in 3 impacts subdomains: physical, cognitive and emotional, and coping) after item reduction, the FSIQ-RMS is a comprehensive, valid, and reliable measure of fatigue-related symptoms and impacts in RMS patients.
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Affiliation(s)
| | - René Schüler
- Global Market Access & Pricing, Actelion, Singapore
| | | | | | - Elke Hunsche
- Global Market Access & Pricing, Actelion, Allschwil, Switzerland
| | - Thomas P Leist
- Comprehensive Multiple Sclerosis Center, Thomas Jefferson University, Philadelphia, PA, USA
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