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Reducing hospital admissions and transfers to long-term inpatient care: A systematic literature review. 减少住院和转移到长期住院治疗:系统的文献综述。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848211068620
Stephan Herberg, Frank Teuteberg

Individuals in need of long-term care and their relatives prefer to receive and give care in their domestic environment for as long as possible. Residential long-term care is to be avoided for as long as possible. To achieve this goal, the care setting must be optimally oriented to the needs of the person in need of care. Moreover, relatives who provide care must be professionally supported. The Regional Care Competence Center (ReKo), launched on October 1, 2019, is a quasi-experimental study (two groups and pre-post design), funded by the Innovation Fund. As part of the ReKo project, people in need of care and their relatives are assisted by a case management (CM) system. An independent CM, supported by an IT network that includes the most important service providers, is to establish a comprehensive CM for people in need of care. Based on a literature review, this paper aimed to take a conceptual approach to the ReKo project by drawing on previous research and comparing the findings with the ReKo approach. The review considered CM projects that defined avoidance of hospitalization and/or delay in the transition of care recipients to long-term inpatient care as endpoints. Using PubMed and Google Scholar, the study screened 270 articles, abstracted and quality-assessed data, and included eight randomized clinical trials, two other studies, and seven reviews in the analysis. The review results and ReKo approaches are presented along the dimensions of clinical and medical benefits, community and public health benefits, economic benefits, and political and legislative benefits. CM organizations will continue to be established internationally in aging societies. The questions of improving quality of care, avoiding service costs, and the costs of establishing a CM must be raised, even if clear evidence is difficult to provide.

需要长期护理的个人及其亲属希望尽可能长时间地在其家庭环境中接受和给予护理。应尽量避免长期住宿护理。为了实现这一目标,护理环境必须以需要护理的人的需求为最佳导向。此外,提供护理的亲属必须得到专业支持。区域护理能力中心(ReKo)于2019年10月1日启动,是一项准实验研究(两组和前后设计),由创新基金资助。作为ReKo项目的一部分,需要照顾的人及其亲属得到病例管理系统的协助。由包括最重要的服务提供者的IT网络支持的独立的CM是为需要护理的人建立一个全面的CM。在文献综述的基础上,本文旨在通过借鉴以往的研究,并将研究结果与ReKo方法进行比较,对ReKo项目采取概念性方法。本综述考虑了以避免住院和/或延迟接受护理者向长期住院治疗过渡为终点的CM项目。利用PubMed和Google Scholar,该研究筛选了270篇文章,对数据进行了摘要和质量评估,包括8个随机临床试验、2个其他研究和7个分析综述。从临床和医疗效益、社区和公共卫生效益、经济效益以及政治和立法效益等方面介绍了审查结果和ReKo方法。在老龄化社会中,CM组织将继续在国际上建立。必须提出提高护理质量、避免服务成本和建立CM成本的问题,即使很难提供明确的证据。
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引用次数: 3
Analysis of the effect of patients' health status on efficiency: Application of data envelopment analysis in healthcare. 患者健康状况对效率的影响分析:数据包络分析在医疗保健中的应用。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848211065464
Tamás Koltai, Rita V Dénes, Zoltán Dénes

The effective and efficient operation of public healthcare systems is more and more important as a consequence of the increasing amount of money spent on their operation. For this reason, accurate and science-based efficiency information is needed for managers and healthcare policy makers. The evaluation of the efficiency in this sector is particularly difficult because several measures and indicators are used. Data envelopment analysis (DEA) can provide aggregate and overall measures of efficiency. The purpose of this paper is the examination of the efficiency of in-patient rehabilitation units curing musculoskeletal disorders in Hungary. The research presented focuses on rehabilitation units which attend to patients recovering from stroke or other acquired brain injuries. Output-oriented, slack-based DEA models are applied for the evaluation of in-patient rehabilitation units using data of a national survey. The novelty of the method presented is the consideration of the change in patients' functional status when efficiency is evaluated using DEA.

由于公共医疗系统的运行花费越来越多,因此有效和高效的运行变得越来越重要。因此,管理人员和医疗保健政策制定者需要准确和基于科学的效率信息。评价这一部门的效率特别困难,因为使用了几种措施和指标。数据包络分析(DEA)可以提供总体和总体的效率度量。本文的目的是检查匈牙利的住院康复单位治疗肌肉骨骼疾病的效率。研究提出的重点是康复单位,参加病人从中风或其他获得性脑损伤恢复。采用一项全国调查数据,应用产出导向、基于松弛的DEA模型对住院康复单位进行评价。该方法的新颖之处在于在使用DEA评估效率时考虑了患者功能状态的变化。
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引用次数: 1
Effect of surgeon experience on technical efficiency. 外科医生经验对技术效率的影响。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848221080688
Yoshinori Nakata, Yuichi Watanabe, Hiroshi Otake
Surgeon experience certainly improves their technical efficiency although it also causes physiological changes with aging. The authors hypothesized that surgeons’ technical efficiency improves with increasing experience up to a point where it then decreases, which is a concave relationship. The authors collected data from all the surgical procedures performed at University Hospital from April through September in 2013–19. The dependent variable was defined as surgeons’ technical efficiency scores that were calculated using output-oriented Charnes–Cooper–Rhodes model of data envelopment analysis. Inputs were defined as (1) the number of assistants and (2) the duration of surgical operation. The output was defined as the surgical fee for each surgery. Surgeon experience was defined as the number of years since medical school graduation. Five control variables were selected: surgical volume, gender, academic rank, surgical specialty, and the year of surgery. Multiple regression analysis using pooled and random-effects Tobit models was performed for our panel data. Totally 20,375 surgical procedures performed by 264 surgeons in 42 months were analyzed. The coefficients of experience and the square of experience were not significantly different from zero. The other coefficients were also insignificant. Surgeons’ technical efficiency does not have a concave relationship with experience.
外科医生的经验当然会提高他们的技术效率,尽管它也会引起生理上的变化。作者假设,外科医生的技术效率随着经验的增加而提高,直到一定程度,然后下降,这是一个凹关系。作者收集了2013-19年4月至9月在大学医院进行的所有外科手术的数据。因变量定义为外科医生的技术效率评分,使用数据包络分析的输出导向Charnes-Cooper-Rhodes模型计算。输入定义为(1)助理人数和(2)手术时间。输出定义为每次手术的手术费用。外科医生经验定义为医学院毕业后的年数。选择5个控制变量:手术量、性别、学术等级、手术专业和手术年份。对我们的面板数据使用合并和随机效应Tobit模型进行多元回归分析。对264位外科医生在42个月内进行的20375例手术进行了分析。经验系数和经验平方均与零无显著差异。其他系数也不显著。外科医生的技术效率与经验并不成凹形关系。
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引用次数: 1
Editorial. 社论。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848231151891
Federico Lega
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引用次数: 0
Do policies affect management? Evidence from a survey of clinicians of the Italian National Health Service. 政策会影响管理吗?来自意大利国家卫生服务临床医生调查的证据。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848211073521
Giovanni Fattore, Dino Numerato, Domenico Salvatore

Since the early 1990s, New Public Management ideas have deeply influenced reforms and their implementation in the Italian NHS. We compare doctors' perceptions about management systems in two Italian regions which differ in the dominant values of the regional political environment. In total 220 doctors, orthopaedists and cardiologists, working in public hospitals in Lombardy and Emilia-Romagna, were surveyed. Doctors in Emilia-Romagna perceived their organization to be more managerially driven in comparison to their colleagues in Lombardy. Doctors from Lombardy perceived their professional freedom to be higher, regardless of their specialization. The divergence of professionals' perception between these two Italian regions, which operate within the same Beveridge model, shows that dominant values of regional politics may have tangible effects on hospital management.

自20世纪90年代初以来,新公共管理理念深刻影响了意大利NHS的改革及其实施。我们比较了意大利两个地区的医生对管理系统的看法,这两个地区在区域政治环境的主导价值上有所不同。共有220名在伦巴第和艾米利亚-罗马涅公立医院工作的医生、骨科医生和心脏病专家接受了调查。艾米利亚-罗马涅区的医生认为,与伦巴第区的同事相比,他们的组织更注重管理。伦巴第的医生认为他们的职业自由度更高,与他们的专业无关。这两个意大利地区在同一贝弗里奇模式下运作,专业人员对这两个地区的看法分歧表明,地区政治的主导价值观可能对医院管理产生切实影响。
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引用次数: 1
Why are there so many hospital beds in Germany? 为什么德国有这么多医院床位?
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848221080691
Matthias Brunn, Torsten Kratz, Michael Padget, Marie-Caroline Clément, Marc Smyrl

The place of hospitals in health systems is undergoing rapid change worldwide due to the high cost of hospital care and the changing health needs of the population. The Covid-19 pandemic has recently drawn public attention towards hospital capacity and has added new urgency to discussions on the future role of hospitals. In this context, recent experience in Germany provides valuable information for health systems seeking to manage hospital capacity. Despite reform efforts to reduce hospital capacity, Germany has the highest rates of intensive care beds among high-income countries and the highest overall hospital capacity in Europe. The capacity of the German hospital system can be explained in large part by the high number of elderly in-patients. This, in turn, is driven by (1) a fragmented ambulatory care system; (2) physicians admitting and maintaining elderly patients in hospital at a high rate; (3) a hospital market adding incentives to admit patients; and (4) a political commitment to egalitarian access and universal care. Additionally, recent policies to reduce hospital capacity have had limited impact because hospitals have not responded to financial incentives in the expected manner. Countries looking to learn from Germany's hospital capacity must therefore consider systemic features, political commitments, and unintended policy consequences.

由于医院护理费用高昂和人口不断变化的卫生需求,医院在世界各地卫生系统中的地位正在发生迅速变化。Covid-19大流行最近引起了公众对医院能力的关注,并为讨论医院未来的作用增加了新的紧迫性。在这方面,德国最近的经验为寻求管理医院容量的卫生系统提供了宝贵的信息。尽管进行了减少医院容量的改革努力,但德国的重症监护病床率在高收入国家中是最高的,在欧洲的总体医院容量也是最高的。德国医院系统的容量在很大程度上可以用大量的老年住院病人来解释。这反过来又受到以下因素的驱动:(1)分散的门诊护理系统;(2)老年患者住院率高的医师;(3)建立医院市场,鼓励病人入院;(4)对平等准入和普遍医疗的政治承诺。此外,最近减少医院容量的政策影响有限,因为医院没有以预期的方式对财政激励措施作出反应。因此,希望向德国医院能力学习的国家必须考虑到系统特征、政治承诺和意外的政策后果。
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引用次数: 2
COVID-19 management at one of the largest hospitals in Germany: Concept, evaluation and adaptation. 德国最大医院之一的COVID-19管理:概念、评估和适应。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848221100752
Ana Zhelyazkova, Philipp M Fischer, Nina Thies, Julia S Schrader-Reichling, Thorsten Kohlmann, Kristina Adorjan, René Huith, Karl-Walter Jauch, Stephan M Prückner

Context: The LMU University Hospital is among the largest healthcare facilities in Germany. The measures implemented prior to and during the first pandemic wave of COVID-19, were evaluated in preparation of a second pandemic wave. This paper presents the pandemic management concept, evaluation and adaptation of LMU University Hospital.

Methods: Between July and September 2020 the disaster management team of LMU University Hospital conducted a mixed-method evaluation of the hospital's pandemic management. A workshop series based on the After Action Review working group format was organized to examine the management structure, decision-making processes, documentation, and crisis preparedness response for a second COVID-19 wave. Further, the satisfaction of employees with the hospital's COVID-19 management was examined through an anonymous survey.

Results: The workshop series highlighted a need for structural and operational adaptation of the COVID-19 management at LMU University Hospital. The results of the employee survey (N = 2182) provided positive feedback for the measures taken during the first pandemic wave. Specific actions were derived concerning the availability of personal protective equipment and emergency childcare services. A key outcome of both evaluation activities was the identified need for further improvement in communication between stakeholders. All changes were adopted prior to the second pandemic wave.

背景:LMU大学医院是德国最大的医疗机构之一。在COVID-19第一波大流行之前和期间实施的措施在为第二波大流行做准备时进行了评估。本文介绍了LMU大学附属医院的疫情管理理念、评价和适应情况。方法:2020年7月至9月,LMU大学医院灾害管理团队对医院大流行管理进行了混合方法评估。根据行动后审查工作组的形式组织了一系列讲习班,以审查第二波COVID-19的管理结构、决策过程、文件和危机准备应对。此外,通过匿名调查,调查了员工对医院新冠肺炎管理的满意度。结果:系列研讨会强调了LMU大学医院COVID-19管理的结构和操作适应的必要性。员工调查结果(N = 2182)对第一波大流行期间采取的措施提供了积极反馈。在提供个人防护装备和紧急托儿服务方面制定了具体行动。这两项评价活动的一个关键成果是确定了进一步改善利益攸关方之间沟通的必要性。所有变化都是在第二波大流行之前通过的。
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引用次数: 0
Cost-effectiveness of future lockdown policies against the COVID-19 pandemic. 未来针对COVID-19大流行的封锁政策的成本效益。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848221080687
Afschin Gandjour

Aim: While the European Union (EU) has approved several COVID-19 vaccines, new variants of concern may be able to escape immunity. The purpose of this study is to project the cost-effectiveness of future lockdown policies in conjunction with a variant-adapted vaccine booster. The exemplary scenario foresees a 25% decline in the vaccine protection against severe disease.

Methods: A decision model was constructed using, for example, information on age-specific fatality rates, intensive care unit (ICU) costs and outcomes, and herd protection threshold. The costs and benefits of a future lockdown strategy were determined from a societal viewpoint under three future scenarios-a booster shot's efficacy of 0%, 50%, and 95%.

Results: The cost-effectiveness ratio of a lockdown policy in conjunction with a booster dose with 95% efficacy is €44,214 per life year gained. A lockdown is cost-effective when the probability of approving a booster dose with 95% efficacy is at least 48% (76% when considering uncertainty in input factors).

Conclusion: In this exemplary scenario, a future lockdown policy appears to be cost-effective if the probability of approving a variant-adapted vaccine booster with an efficacy of 95% is at least 48%.

目的:虽然欧盟(EU)已经批准了几种COVID-19疫苗,但令人担忧的新变种可能能够逃脱免疫。本研究的目的是预测未来封锁政策与变异适应疫苗增强剂结合的成本效益。在示范情景中,预防严重疾病的疫苗将下降25%。方法:利用特定年龄死亡率、重症监护病房(ICU)费用和结果、畜群保护阈值等信息构建决策模型。从社会角度出发,在三种未来情景下确定了未来封锁战略的成本和收益——强化疫苗的效力为0%、50%和95%。结果:封锁政策与95%效力的加强剂相结合的成本-效果比为每生命年增加44,214欧元。当批准效力为95%的加强剂的概率至少为48%(考虑输入因素的不确定性时为76%)时,封锁具有成本效益。结论:在这一示例情景中,如果批准效力为95%的变体适应疫苗增强剂的概率至少为48%,那么未来的封锁政策似乎具有成本效益。
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引用次数: 5
Competitive intelligence: A precursor to a learning health system. 竞争情报:学习健康系统的先兆。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848211065470
H Fred Farley, Shelly Freyn

Unlike other developed countries, the US healthcare system is largely privatized and highly competitive. This dynamic stifles effective information sharing, while the need for prompt and accurate evidence-based decision making has become crucial. Crises, like the COVID-19 pandemic, elevate the importance of quality decision making and exacerbate issues associated with the lack of a cohesive system to share information. Competitive intelligence (CI) is a discipline that encourages gathering, analyzing, and sharing information throughout a firm in order to develop and sustain competitive advantage. CI could be considered a precursor in establishing a learning organization (LO). Although CI research has focused on its process and value, little is found in the literature on how to integrate CI into an organization; this is particularly true in healthcare. A conceptual model is proposed to build and integrate a CI function and culture within a healthcare organization to encourage effective information sharing and knowledge development. In turn, this can provide a mechanism to create a learning health system (LHS). Although the model was developed specifically for US healthcare, it offers application to healthcare in other countries as well as most any industry.

与其他发达国家不同,美国的医疗保健系统基本上是私有化的,竞争激烈。这种动态阻碍了有效的信息共享,而对迅速和准确的基于证据的决策的需求变得至关重要。像COVID-19大流行这样的危机提升了高质量决策的重要性,并加剧了与缺乏凝聚力的信息共享系统相关的问题。竞争情报(CI)是一门鼓励在整个公司收集、分析和共享信息以发展和维持竞争优势的学科。CI可以被认为是建立学习型组织(LO)的先驱。尽管CI研究主要集中在其过程和价值上,但关于如何将CI整合到组织中的文献却很少;在医疗保健领域尤其如此。提出了一个概念模型,用于在医疗保健组织内构建和集成CI功能和文化,以鼓励有效的信息共享和知识开发。反过来,这可以提供一种创建学习型卫生系统(LHS)的机制。虽然该模型是专门为美国医疗保健开发的,但它可以应用于其他国家的医疗保健以及大多数任何行业。
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引用次数: 0
Association between asthma control and healthcare costs: Results from a German linked data study. 哮喘控制与医疗费用之间的关系:来自德国相关数据研究的结果。
IF 2.1 Q2 Medicine Pub Date : 2023-02-01 DOI: 10.1177/09514848221100749
Thomas Wilke, Hartmut Timmermann, Sabrina Mueller, Fraence Hardtstock, Victoria Unmuessig, Robert R Welte, Ulf Maywald

Background: This study aimed to evaluate differences in healthcare resource utilization and cost among patients with controlled and uncontrolled asthma.Methods: Claims data from a German sickness fund was linked to patient survey data. Outpatient physicians enrolled patients and assessed asthma control using the ACTTM questionnaire. All-cause and asthma-specific healthcare resource use (HCRU)/costs were compared descriptively and based on multivariable models using a continuous ACTTM score.Results: Overall, 492 asthma patients were included (mean age: 53.8, 73.8% female). The mean/median ACTTM score was 19.9/20.7, with 183 patients (37.2%) classified as having uncontrolled asthma (mean ACTTM score<20) Patients with uncontrolled asthma had significantly more hospitalizations (p = .035) and medication prescriptions (p < .001), which resulted in higher total healthcare costs for asthma-related (€1785 vs. €1615; p = .004) and all-cause care (€4695 vs. €4117; p = .009). While controlling for baseline characteristics, multivariable models confirmed a negative association between asthma control and total all-cause healthcare costs (p = .008), total asthma-related costs (p = .008), and costs of medication prescriptions (p = .001). However, no significant association was found for all-cause (p = .062) and asthma-related hospitalization costs (p = .576).Conclusion: Considering continuous patient care, improving asthma control is not only desirable from a clinical perspective, but could also be an effective approach to reduce asthma-related HCRU and cost burden.

背景:本研究旨在评估控制与非控制哮喘患者在医疗资源利用和成本方面的差异。方法:来自德国疾病基金的索赔数据与患者调查数据相关联。门诊医生登记患者并使用ACTTM问卷评估哮喘控制。采用连续ACTTM评分对全因和哮喘特异性医疗资源使用(HCRU)/成本进行描述性和基于多变量模型的比较。结果:共纳入492例哮喘患者(平均年龄:53.8岁,73.8%为女性)。平均/中位数ACTTM评分为19.9/20.7,其中183例(37.2%)患者被归类为哮喘不受控制(平均ACTTM评分= 0.035)和药物处方(p < 0.001),这导致哮喘相关的总医疗费用较高(1785欧元对1615欧元;P = 0.004)和全因护理(4695欧元对4117欧元;P = .009)。在控制基线特征的同时,多变量模型证实了哮喘控制与全因医疗保健总成本(p = 0.008)、哮喘相关总成本(p = 0.008)和药物处方成本(p = 0.001)之间的负相关。然而,全因(p = 0.062)和哮喘相关住院费用(p = 0.576)之间没有发现显著关联。结论:考虑到患者的持续护理,改善哮喘控制不仅是临床需要的,也是降低哮喘相关HCRU和费用负担的有效途径。
{"title":"Association between asthma control and healthcare costs: Results from a German linked data study.","authors":"Thomas Wilke,&nbsp;Hartmut Timmermann,&nbsp;Sabrina Mueller,&nbsp;Fraence Hardtstock,&nbsp;Victoria Unmuessig,&nbsp;Robert R Welte,&nbsp;Ulf Maywald","doi":"10.1177/09514848221100749","DOIUrl":"https://doi.org/10.1177/09514848221100749","url":null,"abstract":"<p><p><b>Background</b>: This study aimed to evaluate differences in healthcare resource utilization and cost among patients with controlled and uncontrolled asthma.<b>Methods</b>: Claims data from a German sickness fund was linked to patient survey data. Outpatient physicians enrolled patients and assessed asthma control using the ACT<sup>TM</sup> questionnaire. All-cause and asthma-specific healthcare resource use (HCRU)/costs were compared descriptively and based on multivariable models using a continuous ACT<sup>TM</sup> score.<b>Results</b>: Overall, 492 asthma patients were included (mean age: 53.8, 73.8% female). The mean/median ACT<sup>TM</sup> score was 19.9/20.7, with 183 patients (37.2%) classified as having uncontrolled asthma (mean ACT<sup>TM</sup> score<20) Patients with uncontrolled asthma had significantly more hospitalizations (<i>p</i> = .035) and medication prescriptions (<i>p</i> < .001), which resulted in higher total healthcare costs for asthma-related (€1785 vs. €1615; <i>p</i> = .004) and all-cause care (€4695 vs. €4117; <i>p</i> = .009). While controlling for baseline characteristics, multivariable models confirmed a negative association between asthma control and total all-cause healthcare costs (<i>p</i> = .008), total asthma-related costs (<i>p</i> = .008), and costs of medication prescriptions (<i>p</i> = .001). However, no significant association was found for all-cause (<i>p</i> = .062) and asthma-related hospitalization costs (<i>p</i> = .576).<b>Conclusion</b>: Considering continuous patient care, improving asthma control is not only desirable from a clinical perspective, but could also be an effective approach to reduce asthma-related HCRU and cost burden.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9135356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Health Services Management Research
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