124 research outputs found
Appendix 1 -Supplemental material for Identifying positive deviants in healthcare quality and safety: a mixed methods study
No full textSupplemental material, Appendix 1 for Identifying positive deviants in healthcare quality and safety: a mixed methods study by Jane K O’Hara, Katja Grasic, Nils Gutacker, Andrew Street, Robbie Foy, Carl Thompson, John Wright and Rebecca Lawton in Journal of the Royal Society of Medicine</p
Determinants of hospital length of stay for people with serious mental illness in England and implications for payment systems: a regression analysis
No full textBackgroundSerious mental illness (SMI), which encompasses a set of chronic conditions such as schizophrenia, bipolar disorder and other psychoses, accounts for 3.4 m (7 %) total bed days in the English NHS. The introduction of prospective payment to reimburse hospitals makes an understanding of the key drivers of length of stay (LOS) imperative. Existing evidence, based on mainly small scale and cross-sectional studies, is mixed. Our study is the first to use large-scale national routine data to track English hospitals’ LOS for patients with a main diagnosis of SMI over time to examine the patient and local area factors influencing LOS and quantify the provider level effects to draw out the implications for payment systems.MethodsWe analysed variation in LOS for all SMI admissions to English hospitals from 2006 to 2010 using Hospital Episodes Statistics (HES). We considered patients with a LOS of up to 180 days and estimated Poisson regression models with hospital fixed effects, separately for admissions with one of three main diagnoses: schizophrenia; psychotic and schizoaffective disorder; and bipolar affective disorder. We analysed the independent contribution of potential determinants of LOS including clinical and socioeconomic characteristics of the patient, access to and quality of primary care, and local area characteristics. We examined the degree of unexplained variation in provider LOS.ResultsMost risk factors did not have a differential effect on LOS for different diagnostic sub-groups, however we did find some heterogeneity in the effects. Shorter LOS in the pooled model was associated with co-morbid substance or alcohol misuse (4 days), and personality disorder (8 days). Longer LOS was associated with older age (up to 19 days), black ethnicity (4 days), and formal detention (16 days). Gender was not a significant predictor. Patients who self-discharged had shorter LOS (20 days). No association was found between higher primary care quality and LOS. We found large differences between providers in unexplained variation in LOS.ConclusionsBy identifying key determinants of LOS our results contribute to a better understanding of the implications of case-mix to ensure prospective payment systems reflect accurately the resource use within sub-groups of patients with SMI
FOUR ESSAYS ON PERFORMANCE MEASURES BASED ON PATIENT-REPORTED OUTCOMES
No full textAgency relationships, and associated information symmetries, exist in many areas of economic activity including healthcare. Information on healthcare providers’
relative performance can be used to reduce information asymmetries and hold providers to account. This collection of essays focuses on the appropriate derivation and use of performance measures to incentivise healthcare providers in the English National Health Service (NHS). It gives special consideration to the role of patient self-reported health status measures to assess the differential effect of healthcare providers’ care on their patients’ health.
The thesis explores three themes: the relationship between variation in resource use and quality, the appropriate assessment and reporting of multidimensional hospital performance, and the use of performance information to motivate hospitals in a public reporting context.
Chapter 2 examines cost variation between hospitals for the four surgical procedures covered by the national patient-reported outcome measures (PROM) programme. It explores the empirical relationship between costs and patient health
outcomes to assess the claim of hospital providers that their higher costs are justified by better quality of care.
Chapter 3 sets out an empirical methodology to conduct provider performance comparisons when there are multiple dimensions of health-related quality of life affected by treatment. It discusses the advantages and disadvantages of analysing disaggregate PROM data for the purpose of informing prospective patients, clinicians and managers.
Chapter 4 extends the previous chapter by providing a methodology for assessing and summarising multidimensional provider performance using dominance criteria. This methodology is then applied to study the performance of providers of hip replacement surgery with respect to length of stay, emergency readmissions, waiting time and improvements in PROMs.
Chapter 5 estimates the demand elasticity of providers with respect to quality. It makes use of choice models to assess the usefulness of disseminating hospital PROM scores to prospective patients as a market-based incentive for providers to compete on quality
Impact of family practice continuity of care on unplanned hospital use for people with serious mental illness
No full textObjective: To investigate whether continuity of care in family practice reduces unplanned hospital use for people with serious mental illness (SMI). Data Sources Linked administrative data on family practice and hospital utilization by people with SMI in England, 2007-2014. Study Design: This observational cohort study used discrete-time survival analysis to investigate the relationship between continuity of care in family practice and unplanned hospital use: emergency department (ED) presentations, and unplanned admissions for SMI and ambulatory care-sensitive conditions (ACSC). The analysis distinguishes between relational continuity and management/ informational continuity (as captured by care plans) and accounts for unobserved confounding by examining deviation from long-term averages. Data Collection/Extraction Methods: Individual-level family practice administrative data linked to hospital administrative data. Principal Findings: Higher relational continuity was associated with 8-11 percent lower risk of ED presentation and 23-27 percent lower risk of ACSC admissions. Care plans were associated with 29 percent lower risk of ED presentation, 39 percent lower risk of SMI admissions, and 32 percent lower risk of ACSC admissions. Conclusions: Family practice continuity of care can reduce unplanned hospital use for physical and mental health of people with SMI
Multidimensional performance assessment using dominance criteria
No full textPublic sector organisations pursue multiple objectives and serve a number of stakeholders. But stakeholders are rarely explicit about the valuations they attach to different objectives, nor are these valuations likely to be identical. This complicates the assessment of their performance because no single set of weights can be legitimately chosen by regulators to aggregate outputs into unidimensional composite scores. We propose the use of dominance criteria in a multidimensional performance assessment framework to identify best practice and poor performance under relatively weak assumptions about stakeholders’ preferences. We estimate multivariate multilevel models to study providers of hip replacement surgery in the English NHS with respect to their performance in terms of length of stay, readmission rates, post-operative patient-reported health status and waiting time. We find substantial correlation between objectives and demonstrate that ignoring the correlation can lead to incorrect assessments of performance
Multidimensional performance assessment of public sector organisations using dominance criteria
No full textPublic sector organisations pursue multiple objectives and serve a number of stakeholders. But stakeholders are rarely explicit about the valuations they attach to different objectives, nor are these valuations likely to be identical. This complicates the assessment of their performance because no single set of weights can be chosen legitimately to aggregate outputs into unidimensional composite scores. We propose the use of dominance criteria in a multidimensional performance assessment framework to identify best practice and poor performance under relatively weak assumptions about stakeholders' preferences. We use as an example providers of hip replacement surgery in the English National Health Service and estimate multivariate multilevel models to study their performance in terms of length of stay, readmission rates, post-operative patient-reported health status and waiting time. We find substantial correlation between objectives and demonstrate that ignoring the correlation can lead to incorrect assessments of performance
Use of large scale HRQoL datasets to generate individualised predictions and inform patients about the likely benefit of surgery
No full textPurpose: The English NHS has mandated the routine collection of health-related quality of life (HRQoL) data before and after surgery, giving prospective patients information about the likely benefit of surgery. Yet, the information is difficult to access and interpret because it is not presented in a lay-friendly format and does not re ect patients' individual circumstances. We set out a methodology to generate personalised information to help patients make informed decisions. Methods: We used anonymised, pre- and post-operative EuroQol-5D-3L (EQ-5D) data for over 490,000 English NHS patients who underwent primary hip or knee replacement surgery or groin hernia repair between April 2009 and March 2016. We estimated linear regression models to relate changes in EQ-5D utility scores to patients' own assessment of the success of surgery, and calculated from that minimally important differences (MID) for health improvements / deteriorations. Classification tree analysis was used to develop algorithms that sort patients into homogeneous groups that best predict post-operative EQ-5D utility scores. Results: Patients were classified into between 55 (hip replacement) to 60 (hernia repair) homogeneous groups. The classifications explained between 14-27% of variation in post-operative EQ-5D utility score. Conclusions: Patients are heterogeneous in their expected benefit from surgery and decision aids should reflect this. Large administrative datasets on HRQoL can be used to generate the required individualised predictions to inform patients
Hospital and Physician Effects on Treatment Choices
No full textAbstract and slides from oral presentation at the 5th EuHEA PhD Student-Supervisor and Early Career Researcher Conference in Catania, Italy, between 5th – 7th September 2018
Hospital and Physician Effects on Treatment Choices
No full textAbstract and poster presented at the 12th EuHEA Conference 2018, which took place in Maastricht, the Netherlands, between 11 and 14 July 2018
Scale economies in the health sector:The effect of hospital volume on health gains from hip replacement surgery
No full text- …
