Health Services Research and Managerial Epidemiology最新文献

We consider the nontrivial problem of estimating the health cost repartition among different diseases in the common case where the patients may have multiple diseases. To tackle this problem, we propose to use an iterative proportional repartition (IPR) algorithm, a nonparametric method which is simple to understand and to implement, allowing (among other) to avoid negative cost estimates and to retrieve the total health cost by summing up the estimated costs of the different diseases. This method is illustrated with health costs data from Switzerland and is compared in a simulation study with other methods such as linear regression and general linear models. In the case of an additive model without interactions between disease costs, a situation where the truth is clearly defined such that the methods can be compared on an objective basis, the IPR algorithm clearly outperformed the other methods with respect to efficiency of estimation in all the settings considered. In the presence of interactions, the situation is more complex and will deserve further investigation.

Background: Inaccessible, unaffordable, and poor quality care are the key underlying reasons for the high burden of maternal and child morbidity and mortality in low- and middle-income countries.

Objective: To assess the availability of lifesaving maternal and child health (MCH) commodities and associated factors in public and private health facilities of Addis Ababa, Ethiopia, 2016.

Methods: Institutional-based, descriptive cross-sectional study was carried out in the selected health facilities (29 publics and 6 private) in Addis Ababa. The data were collected through pretested, structured questionnaire, and in-depth interviews. For the quantitative analysis, data were analyzed using SPSS version 20 statistical software, SPSS Inc. Descriptive statistics were used to summarize the variables, and the Spearman correlation test was run to determine the predictors of the outcome variables. For the qualitative data, the data were handled manually and transformed into categories related to the topics and coded on paper individually in order to identify themes and patterns for thematic analysis.

Result: The overall availability of the lifesaving MCH commodities in the health facilities was 74.3%. There is a moderate, positive association between the availability of lifesaving MCH commodities with the adequacy of budget (r_s = 0.485, P < .001), use of more than 1 selection criteria during selection (r_s = 0.407, P = .015), and training given to health facilities on logistics management (r_s = 0.490, P = .003).

Conclusion: The availability of the lifesaving MCH commodities in the health facilities was within the range of fairly high to high. Adequacy of budget, use of more than 1 selection criteria during selection, and training given on logistics management were the predictors of the availability of the commodities.

Objective: This study explores the price implications of hospital systems by analyzing the association of system characteristics with selected cardiac surgery pricing.

Data source: Using a large private insurance claim database, the authors identified 11 282 coronary artery bypass graft (CABG) cases and 49 866 percutaneous coronary intervention (PCI) cases from 2002 to 2007.

Study design: We conducted a retrospective observational study using generalized linear models.

Principal findings: We found that the CABG and PCI prices in centralized health and physician insurance systems were significantly lower than the prices in stand-alone hospitals by 4.4% and 6.4%, respectively. In addition, the CABG and PCI prices in independent health systems were significantly lower than in stand-alone hospitals, by 15.4% and 14.5%, respectively.

Conclusion: The current antitrust guidelines tend to focus on the market share of merging parties and pay less attention to the characteristics of merging parties. The results of this study suggest that antitrust analysis could be more effective by considering characteristics of hospital systems.

Introduction: The incidence of chronic disease and treatment costs have been steadily increasing in the United States over the past few decades. Primary prevention and healthy lifestyle counseling have been identified as important strategies for reducing health-care costs and chronic disease prevalence. This article seeks to examine decision-makers' experiences and self-perceived roles in guideline and lifestyle counseling implementation in a primary care setting in the United States.

Methods: Qualitative interviews were conducted with administrators at a health-care network in Upstate New York and with state-level administrators, such as insurers. Decision-makers were asked to discuss prevention guidelines and healthy lifestyle counseling, as well as how they support implementation of these initiatives. Interviews were analyzed using a thematic analysis framework and relevant sections of text were sorted using a priori codes.

Results: Interviews identified numerous barriers to guideline implementation. These included the complexity and profusion of guidelines, the highly politicized nature of health-care provision, and resistance from providers who sometimes prefer to make decisions autonomously. Barriers to supporting prevention counseling included relatively time-limited patient encounters, the lack of reimbursement mechanisms for counseling, lack of patient resources, and regulatory complexities.

Conclusions: Our research indicates that administrators and administrative structures face barriers to supporting prevention activities such as guideline implementation and healthy lifestyle counseling in primary care settings. They also identified several solutions for addressing existing primary prevention barriers, such as relying on nurses to provide healthy lifestyle support to patients. This article provides an important assessment of institutional readiness to support primary prevention efforts.

Background and aims: Perceived stress and mindfulness can impact medical decision-making in both patients and clinicians. The aim of this study was to conduct a cross-sectional evaluation of the relationships between stress, mindfulness, self-regulation, perceptions of treatment conversations, and decision-making preferences among clinicians. Also, perceptions of treatment conversations and decision-making preferences among patients with cancer were evaluated.

Methodology: Survey instruments were developed for clinicians and patients incorporating previously published questions and validated instruments. Institutional review board approval was obtained. Patients, physicians, and advanced practice providers from a tertiary referral center were asked to complete surveys. Continuous variables were evaluated for normality and then bivariate relationships between variables were evaluated using χ², Fisher's exact test, Cochran-Mantel-Haenszel (CMH) row mean scores differ statistic, or Kruskal-Wallis tests, where appropriate. Significance was defined at P < .05. All tests were conducted using SAS v.9.4.

Results: 77 patients and 86 clinicians (60.1% and 43% response rates, respectively) participated in the surveys. More clinicians who reported feeling "great/good" said they always/sometimes had enough time to spend with patients (66.1%) compared to those that hardly ever/never had enough time (26.3%), χ²(1, N = 75) = 6.62, P = .0101; CMH row mean scores differ statistic). Interestingly, 40.3% of patients preferred a paternalistic style of decision-making compared to 6.3% of clinicians, χ²(2, N = 146) = 27.46, P < .0001; χ² test. Higher levels of dispositional mindfulness (Mindful Attention Awareness Scale) were found among clinicians who reported they felt "great/good" (median = 4.5) as compared to those who reported that they were "definitely stressed/stressed out" (3.3), χ²(2, N = 80) = 10.32, P = .0057; Kruskal-Wallis test. Higher levels of emotional self-regulation (Emotional Regulation Questionnaire-Cognitive Reappraisal facet) were found among clinicians who reported they felt "great/good" (median = 31.0) compared to those who reported that they were "definitely stressed/stressed out" (20.0), χ²(2, N = 79) = 8.88, P = .0118; Kruskal-Wallis test.

Conclusion: In order to have meaningful conversations about treatment planning, an understanding of mental well-being and its relationship to decision-making preferences is crucial for both oncology patients and clinicians. Our results show that for clinicians, lower perceived stress was associated with higher levels of mindfulness (experiencing the present moment), emotional self-regulation, and spending more time with patients. Larger prospective studies are needed to validate these findings.