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1 – 10 of over 39000Afsaneh Roshanghalb, Cristina Mazzali, Emanuele Lettieri and Anna Maria Paganoni
This study investigates the stability of the “hospital effect” on performance over time by administrative health data as a source of evidence. Using 78,907 heart failure adult…
Abstract
This study investigates the stability of the “hospital effect” on performance over time by administrative health data as a source of evidence. Using 78,907 heart failure adult records from 117 hospitals in the Lombardy Region (Northern Italy) over three years (2010–2012), we analyzed hospital performance in terms of 30-day mortality and 30-day unplanned readmissions to gather evidence about the stability of the “hospital effect.” Best/worst performers were identified through multi-level models that combine both patient and hospital covariates. Our results confirm that managerial choices affect hospital performance, and that the “hospital effect” is not, contrary to expectations, stable over the short term. Performance improvement/worsening over the three years has been also analyzed.
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Gianmaria Martini and Giorgio Vittadini
The goal of this contribution is to shed light on the benefits for research in health care coming from the use of administrative data, especially in terms of measuring hospitals’…
Abstract
The goal of this contribution is to shed light on the benefits for research in health care coming from the use of administrative data, especially in terms of measuring hospitals’ outcomes. The main approaches to health outcome evaluation are reviewed and the possible improvements deriving from the use of administrative data are highlighted. Administrative data may be an essential element in the process of gathering to the public true rankings of health care organizations, reducing the degree of asymmetric information that typically arises in health care. Patients will be more aware of the best institutions, which will induce most of them to demand to be admitted in them, taking into account the costs associated with distance and with the severity of the illness. This in turn may ask for a reorganization of the sector, closing some organizations and expanding others, having as final goal to improve the health status of the population, without income barriers. This is one of the first attempts to provide an overview of the advantages that administrative data may gather in health care.
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Liisa Jaakkimainen, Imaan Bayoumi, Richard H. Glazier, Kamila Premji, Tara Kiran, Shahriar Khan, Eliot Frymire and Michael E. Green
The authors developed and validated an algorithm using health administrative data to identify patients who are attached or uncertainly attached to a primary care provider (PCP…
Abstract
Purpose
The authors developed and validated an algorithm using health administrative data to identify patients who are attached or uncertainly attached to a primary care provider (PCP) using patient responses to a survey conducted in Ontario, Canada.
Design/methodology/approach
The authors conducted a validation study using as a reference standard respondents to a community-based survey who indicated they did or did not have a PCP. The authors developed and tested health administrative algorithms against this reference standard. The authors calculated the sensitivity, specificity positive predictive value (PPV) and negative predictive value (NPV) on the final patient attachment algorithm. The authors then applied the attachment algorithm to the 2017 Ontario population.
Findings
The patient attachment algorithm had an excellent sensitivity (90.5%) and PPV (96.8%), though modest specificity (46.1%) and a low NPV (21.3%). This means that the algorithm assigned survey respondents as being attached to a PCP and when in fact they said they had a PCP, yet a significant proportion of those found to be uncertainly attached had indicated they did have a PCP. In 2017, most people in Ontario, Canada (85.4%) were attached to a PCP but 14.6% were uncertainly attached.
Research limitations/implications
Administrative data for nurse practitioner's encounters and other interprofessional care providers are not currently available. The authors also cannot separately identify primary care visits conducted in walk in clinics using our health administrative data. Finally, the definition of hospital-based healthcare use did not include outpatient specialty care.
Practical implications
Uncertain attachment to a primary health care provider is a recurrent problem that results in inequitable access in health services delivery. Providing annual reports on uncertainly attached patients can help evaluate primary care system changes developed to improve access. This algorithm can be used by health care planners and policy makers to examine the geographic variability and time trends of the uncertainly attached population to inform the development of programs to improve primary care access.
Social implications
As primary care is an essential component of a person's medical home, identifying regions or high need populations that have higher levels of uncertainly attached patients will help target programs to support their primary care access and needs. Furthermore, this approach will be useful in future research to determine the health impacts of uncertain attachment to primary care, especially in view of a growing body of the literature highlighting the importance of primary care continuity.
Originality/value
This patient attachment algorithm is the first to use existing health administrative data validated with responses from a patient survey. Using patient surveys alone to assess attachment levels is expensive and time consuming to complete. They can also be subject to poor response rates and recall bias. Utilizing existing health administrative data provides more accurate, timely estimates of patient attachment for everyone in the population.
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The purpose of this paper is to discuss strategies for benchmarking patient safety using Lombardy region administrative archives. Patient safety indicators and statistical methods…
Abstract
Purpose
The purpose of this paper is to discuss strategies for benchmarking patient safety using Lombardy region administrative archives. Patient safety indicators and statistical methods are presented that allow risk adjustment. The analysis benchmarks regional health structures, focusing on two patient safety indicators: failure to rescue; and death in low mortality diagnostic related group.
Design/methodology/approach
Data were drawn from a research project promoted by the Italian Agency of Regional Health Services in 2002 to furnish statistical evidence regarding adverse events based on Agency for Healthcare Research and Quality indicators and methods. Hierarchical models for an equitable benchmark analyses are proposed.
Findings
Empirical analysis shows that hierarchical approaches, based on comparing health structures within homogenous specialties, disaggregates and moderates failure to rescue variabilities existing between hospitals, especially in oncology, intensive care and general medicine.
Research limitations/implications
The paper proposes using hierarchical models for properly benchmarking health structures, resolving logistic regression drawbacks and limitations.
Practical implications
The paper strengthens the theory that accurate coding supported by software and administrative databases could provide a valuable and economical source for patient safety research.
Originality/value
The paper analyses and suggests strategies for consistent benchmark analyses based on patient safety outcomes, applicable to several situations and different health structure typologies.
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Shahin Shooshtari, Brenda M. Stoesz, Leslie Udell, Leanne Fenez, Natalia Dik, Charles Burchill, Elizabeth Sachs and Verena Menec
Information on the risk of dementia in aging persons with intellectual and/or developmental disability (IDD) in Manitoba, Canada is lacking. The purpose of this paper is to…
Abstract
Purpose
Information on the risk of dementia in aging persons with intellectual and/or developmental disability (IDD) in Manitoba, Canada is lacking. The purpose of this paper is to estimate dementia prevalence in adults with IDD.
Design/methodology/approach
Anonymized population-level health and non-health administrative data (1979-2012) contained in the Population Health Research Data Repository of the Manitoba Centre for Health Policy (MCHP) were linked to identify adults with IDD, and estimate the prevalence of dementia based on the presence of ICD codes. Prevalence of dementia was estimated for persons aged 18-55 years and 55+ years, and was reported by sex, type of residence, region of residence, neighbourhood income quintiles, and IDD diagnostic category.
Findings
Of the 8,655 adults with IDD identified, 8.1 per cent had an indication of dementia in their medical records; an estimate three times greater than that found for those without IDD (2.6 per cent). More than 17 per cent of Manitobans with IDD aged 55+ years had an indication of dementia, which was nearly twice the rate reported previously. Of those with IDD and dementia, 34.7 per cent lived in long-term care facilities.
Originality/value
Health and social support services are typically available to individuals with dementia aged 65+ years; thus, younger adults with IDD and dementia may not be eligible for those supports. To promote equity in health and access to care, dementia screening and increased supports for aging individuals with IDD are recommended.
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Chiara Ardito, Roberto Leombruni, Michele Mosca, Massimiliano Giraudo and Angelo d’Errico
The purpose of this paper is to study the impact of unemployment on coronary heart diseases (CHD) in Italy on a sample of male manual workers in the private sector.
Abstract
Purpose
The purpose of this paper is to study the impact of unemployment on coronary heart diseases (CHD) in Italy on a sample of male manual workers in the private sector.
Design/methodology/approach
The authors investigate the association between CHD and different unemployment experiences (ever unemployed; short, mid and long cumulative unemployment), exploiting a large Italian administrative database on careers and health. The study design is based on the balancing of individuals' characteristics during a 12-year pre-treatment period; the measurement of unemployment occurrence during a seven-year treatment period; the observation of CHD occurrence during a five-year follow up. The workers characteristics and the probability of receiving the treatment are balanced by means of propensity score matching. Standard diagnostics on the balancing assumption are discussed and satisfied, while the robustness to violations of the unconfoundedness assumption is evaluated by a simulation-based sensitivity analysis.
Findings
The authors find a significant increase of CHD probability was found among workers who experience more than three years of unemployment (relative risks (RR)=1.91, p<0.1), and among those who exit unemployment starting a self-employment activity (RR=1.70, p<0.1). Using different selections of the study population, a clear pattern emerges: the healthier and more labour market attached are workers during pre-treatment, the greater is the negative impact of long-term unemployment on health (RR=2.79, p<0.01).
Originality/value
The very large representative sample (n=69,937) and the deep longitudinal dimension of the data (1985-2008) allowed the authors to minimize the risks of health selection and unemployment misclassification. Moreover, the adopted definition of unemployment corrected some undercoverage and misclassification issues that affect studies based on a purely administrative definition and that treat unemployment as a unique career event disregarding the duration of the experience.
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Shivinder Nijjer, Kumar Saurabh and Sahil Raj
The healthcare sector in India is witnessing phenomenal growth, such that by the year 2022, it will be a market worth trillions of INR. Increase in income levels, awareness…
Abstract
The healthcare sector in India is witnessing phenomenal growth, such that by the year 2022, it will be a market worth trillions of INR. Increase in income levels, awareness regarding personal health, the occurrence of lifestyle diseases, better insurance policies, low-cost healthcare services, and the emergence of newer technologies like telemedicine are driving this sector to new heights. Abundant quantities of healthcare data are being accumulated each day, which is difficult to analyze using traditional statistical and analytical tools, calling for the application of Big Data Analytics in the healthcare sector. Through provision of evidence-based decision-making and actions across healthcare networks, Big Data Analytics equips the sector with the ability to analyze a wide variety of data. Big Data Analytics includes both predictive and descriptive analytics. At present, about half of the healthcare organizations have adopted an analytical approach to decision-making, while a quarter of these firms are experienced in its application. This implies the lack of understanding prevalent in healthcare sector toward the value and the managerial, economic, and strategic impact of Big Data Analytics. In this context, this chapter on “Predictive Analytics in Healthcare” discusses sources, areas of application, possible future areas, advantages and limitations of the application of predictive Big Data Analytics in healthcare.
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Mushira Mohsin Khan, Karen Kobayashi, Zoua M. Vang and Sharon M. Lee
Canada’s visible minority population is increasing rapidly, yet despite the demographic significance of this population, there is a surprising dearth of nationally representative…
Abstract
Purpose
Canada’s visible minority population is increasing rapidly, yet despite the demographic significance of this population, there is a surprising dearth of nationally representative health data on visible minorities. This is a major challenge to undertaking research on the health of this group, particularly in the context of investigating racial/ethnic disparities and health disadvantages that are rooted in racialization. The purpose of this paper is to summarize: mortality and morbidity patterns for visible minorities; determinants of visible minority health; health status and determinants of the health of visible minority older adults (VMOA); and promising data sources that may be used to examine visible minority health in future research.
Design/methodology/approach
A scoping review of 99 studies or publications published between 1978 and 2014 (abstracts of 72 and full articles of 27) was conducted to summarize data and research findings on visible minority health to answer four specific questions: what is known about the morbidity and mortality patterns of visible minorities relative to white Canadians? What is known about the determinants of visible minority health? What is known about the health status of VMOA, a growing segment of Canada’s aging population, and how does this compare with white older adults? And finally, what data sources have been used to study visible minority health?
Findings
There is indeed a major gap in health data and research on visible minorities in Canada. Further, many studies failed to distinguish between immigrants and Canadian-born visible minorities, thus conflating effects of racial status with those of immigrant status on health. The VMOA population is even more invisible in health data and research. The most promising data set appears to be the Canadian Community Health Survey (CCHS).
Originality/value
This paper makes an important contribution by providing a comprehensive overview of the nature, extent, and range of data and research available on the health of visible minorities in Canada. The authors make two key recommendations: first, over-sampling visible minorities in standard health surveys such as the CCHS, or conducting targeted health surveys of visible minorities. Surveys should collect information on key socio-demographic characteristics such as nativity, ethnic origin, socioeconomic status, and age-at-arrival for immigrants. Second, researchers should consider an intersectionality approach that takes into account the multiple factors that may affect a visible minority person’s health, including the role of discrimination based on racial status, immigrant characteristics for foreign-born visible minorities, age and the role of ageism for older adults, socioeconomic status, gender (for visible minority women), and geographic place or residence in their analyses.
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Joshua Dawe, Ellie McDonald, Elisha Riggs, Josef Szwarc and Jane Yelland
Access to professional interpreter services is a critical facilitator of positive health-care experiences when health-care professionals and women accessing maternity care are not…
Abstract
Purpose
Access to professional interpreter services is a critical facilitator of positive health-care experiences when health-care professionals and women accessing maternity care are not proficient in a shared language. Understanding interpreter demand is essential for the provision of professional interpreter services. This study aims to characterise interpreter requirements among women from nonrefugee and refugee non-English-speaking migrant backgrounds in Australian maternity hospitals.
Design/methodology/approach
This study analysed administrative data from four public maternity hospitals in Victoria, Australia. The primary outcome was the proportion of women from non-English speaking migrant backgrounds who required an interpreter during their maternity care, both overall and stratified by refugee and nonrefugee background. Adjusted logistic regression was used to estimate the association between migrant background and interpreter requirements.
Findings
Among the 6,771 women from non-English speaking migrant backgrounds included in analyses, 1,344 (19.8%) required an interpreter during their maternity care. The odds of requiring an interpreter were fivefold higher among women from refugee backgrounds compared to migrant women from nonrefugee backgrounds [adjusted odds ratio (aOR): 4.83; 95% confidence interval (CI): 4.13–5.65].
Practical implications
The study highlights the diversity in cultural backgrounds and migration experiences of women accessing maternity care within metropolitan public hospitals. The high interpreter requirements, particularly among women from refugee backgrounds, underscores the need for comprehensive and woman-centred interpreter services to attenuate disparities in hospital maternity care.
Originality/value
To the best of the authors’ knowledge, this study is the first to quantify the interpreter requirements of women from non-English-speaking migrant backgrounds in maternity hospital settings and make women comparisons between women from refugee and nonrefugee backgrounds.
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Helmut Hildebrandt, Timo Schulte and Brigitte Stunder
The purpose of this article is to share emerging evidence about the qualitative and economic benefits of integrating care, based on an innovative population‐based approach across…
Abstract
Purpose
The purpose of this article is to share emerging evidence about the qualitative and economic benefits of integrating care, based on an innovative population‐based approach across a small region of Germany. The article aims to discuss the features that have similarities to the international discussion around managed care and accountable care, e.g. the use of a “gain share” model to incentivise all the main partners, and the quite unique approaches derived from a public health background. The operation of Gesundes Kinzigtal could be considered as a benchmark for the “Clinical commissioning groups” that are in development as a result of the Health and Social Care Act 2012 in the UK.
Design/methodology/approach
A regional health management company in cooperation with the physicians' network in the region and two health insurance providers has reorganized the delivery of care across all sectors towards improving the health of the population. The key features of the approach are summarised in the paper. Administrative and medical data obtained from the health insurance providers and from routine management monitoring are used to evaluate the benefits of the approach compared to control groups.
Findings
The project is beginning to demonstrate that this model of integrated care can be effective, with cost benefits and savings for the partners, and improved health outcomes for the population.
Research limitations/implications
The project started in 2006, and only early results of the first three to four years are reported here because of the use of claims data of health insurers.
Originality/value
The approach is an innovative model of integration in its combination of logistical re‐engineering of care processes, IT integration, public health and prevention measures. Its evaluation through an ambitious series of studies may have long‐term relevance for the organisation and management of care services internationally.
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