40 results on '"Blankart, Carl Rudolf"'
Search Results
2. Within and across country variations in treatment of patients with heart failure and diabetes
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Or, Zeynep, Shatrov, Kosta, Penneau, Anne, Wodchis, Walter, Abiona, Olukorede, Blankart, Carl Rudolf, Bowden, Nicholas, Bernal-Delgado, Enrique, Knight, Hannah, Lorenzonl, Luca, Marino, Alberto, Papanicolas, Irene, Riley, Kristen, Pellet, Leila, Estupinan-Romero, Francisco, Gool, Kees van, and Figueroa, Jose F.
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Diabetes -- Care and treatment ,Medical care -- Quality management ,Heart failure -- Care and treatment ,Business ,Health care industry - Abstract
Objective: To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. Data Sources: Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States. Data Collection Methods: Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016. Study Design: We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures. Principal Findings: In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97). Conclusions: Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care. KEYWORDS care pathways, diabetes, gender, heart failure, inequalities, international comparisons, multimorbidity, What is known on this topic * Patients with similar health needs are treated very differently within countries. * Most cross-national studies examine variations in care use and resources for [...]
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- 2021
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3. Validation and application of a needs-based segmentation tool for cross-country comparisons
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Duminy, Lize, Sivapragasam, Nirmali Ruth, Matchar, David Bruce, Visaria, Abhijit, Ansah, John Pastor, Blankart, Carl Rudolf, and Schoenenberger, Lukas
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Chronic diseases -- Care and treatment ,Health care industry -- International aspects -- Comparative analysis ,Health planning -- International aspects -- Comparative analysis ,Health care industry ,Business - Abstract
Objective: To compare countries' health care needs by segmenting populations into a set of needs-based health states. Data sources: We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data. Study design: We developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1-5 global impressions (Gi) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death. Data collection/extraction methods: We segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories. Principal findings: The CCSST is a valid tool for segmenting populations into needsbased states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors. Conclusions: The CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients. KEYWORDS access/demand/utilization of services, chronic disease, comparative health systems/international health, geriatrics, health care organizations and systems, integrated delivery systems, modeling: multi-level, survey research and questionnaire design What is known on this topic * Population segmentation is a promising approach for health care resource planning and policy making. * A number of needs-based segmentation approaches exist, which either are conceptual or use utilization-based metrics. * Needs-based segmentation studies are limited to regional data sources. What this study adds * The Cross-Country Simple Segmentation Tool (CCSST) segments individuals into five ordinal medical complexity categories, called 'Global Impressions' (Gl) segments, and identifies the presence of four patient characteristics, which, if present, would increase the complexity of care, called 'Complicating Factors' (CFs). * The CCSST is applied to the SHARE panel survey dataset and allows for comparisons across countries. * Our approach helps policy makers identify country-specific areas of analysis of services and factors that may confound transition rates., 1 | INTRODUCTION Chronic conditions have been called 'the healthcare challenge of this century' by the World Health Organization. (1) The prevalence of patients with numerous and complex health care [...]
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- 2021
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4. International comparison of spending and utilization at the end of life for hip fracture patients
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Blankart, Carl Rudolf, Gool, Kees van, Papanicolas, Irene, Bernal-Delgado, Enrique, Bowden, Nicholas, Estupinan-Romero, Francisco, Gauld, Robin, Knight, Hannah, Abiona, Olukorede, Riley, Kristen, Schoenfeld, Andrew J., Shatrov, Kosta, Wodchis, Walter P., and Figueroa, Jose F.
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Medical care -- Utilization ,Medical care, Cost of -- Evaluation ,Hip joint -- Fractures ,Business ,Health care industry - Abstract
Objective: To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. Data Sources: Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). Study Design: We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death. Data Collection/Extraction Methods: We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. Principal Findings: Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. Conclusions: Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems. KEYWORDS administrative data, age inequalities, end-of-life care, gender inequalities, health care spending, health care utilization, international comparison, What is known on this topic * Countries follow different approaches to providing end-of-life care. * Health care spending and utilization increases near death. * International studies of health systems [...]
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- 2021
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5. An international comparison of long-term care trajectories and spending following hip fracture
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Wodchis, Walter P., Or, Zeynep, Blankart, Carl Rudolf, Atsma, Femke, Janlov, Nils, Bai, Yu Qing, Penneau, Anne, Arvin, Mina, Knight, Hannah, Riley, Kristen, Figueroa, Jose F., and Papanicolas, Irene
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Hip joint -- Fractures ,Long-term care of the sick -- Evaluation ,Medical care -- Quality management ,Business ,Health care industry - Abstract
Objective: The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture. Data Sources: We used administrative data from hospitals, institutional and homebased long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden. Data Extraction Methods: Data were extracted from existing administrative data systems in each participating country. Study Design: This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and communitybased care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries. Principal Findings: Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average. Conclusion: In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional care, longevity, and total expenditures. There exist opportunities to organize postacute care differently to maximize independence and mitigate costs. KEYWORDS care trajectories, hip fracture, international comparison, long-term care, What is known about this topic * International comparisons of long-term care mostly rely on global comparisons of national expenditure. * Little comparative work has examined variations in the care [...]
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- 2021
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6. Differences in health care spending and utilization among older frail adults in high-income countries: ICCONIC hip fracture persona
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Papanicolas, Irene, Figueroa, Jose F., Schoenfeld, Andrew J., Riley, Kristen, Abiona, Olukorede, Arvin, Mlna, Atsma, Femke, Bernal-Delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupinan-Romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Shatrov, Kosta, Stafford, Mai, Galien, Onno van de, Gool, Kees van, Wodchis, Walter, and Jha, Ashish K.
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Medical care -- Utilization ,Aged -- Economic aspects -- Diseases ,Medical economics -- Comparative analysis -- International aspects ,Hip joint -- Fractures ,Business ,Health care industry - Abstract
Objective: This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture. Data Sources: We used individual-level patient data from five care settings. Study Design: We compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized.. Data Collection/Extraction Methods: The data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Principal Findings: The sample ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post-acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization, $233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly concentrated in the inpatient setting. Conclusion: Across 11 high-income countries, there is substantial variation in health care spending and utilization for an older person with frailty, both before and after a hip fracture. The United States is the most expensive country due to high prices and above average utilization of post-acute rehab care. KEYWORDS health systems, hip fracture, international comparisons, What is known on this topic * Health systems spend different amounts caring for patients. * Older persons with frailty are more likely to incur high levels of spending as [...]
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- 2021
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7. A methodology for identifying high-need, high-cost patient personas for international comparisons
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Figueroa, Jose F., Horneffer, Kathryn E., Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal-Delgado, Enrique, Blankart, Carl Rudolf, Bowden, Nicholas, Deeny, Sarah, Estupinan-Romero, Francisco, Gauld, Robin, Hansen, Tonya Moen, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Pellet, Leila, Orlander, Duncan, Penneau, Anne, Schoenfeld, Andrew J., Shatrov, Kosta, Skudal, Kjersti Eeg, Stafford, Mai, Galien, Onno van de, Gool, Kees van, Wodchis, Walter P., Tanke, Marit, Jha, Ashish K., and Papanicolas, Irene
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Business ,Health care industry - Abstract
Objective: To establish a methodological approach to compare two high-need, highcost (HNHC) patient personas internationally. Data sources: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Study design: We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care-hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, homehealth care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. Data collection/extraction methods: Data collected by ICCONIC partners. Principal findings: Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. Conclusion: Although there are cross-country differences in the availability and structure of data sources, countries had the ability to effectively identify comparable HNHC personas for international study. This work serves as the methodological paper for six accompanying papers examining differences in spending, utilization, and outcomes for these personas across countries. KEYWORDS international comparison, vignettes, What is known on this topic * International comparisons of health systems mostly rely on comparisons of the inpatient setting. * Little comparative work examines patterns of spending and utilization [...]
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- 2021
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8. International comparison of health spending and utilization among people with complex multimorbidity
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Figueroa, Jose F., Papanicolas, Irene, Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bemal-Delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupinan-Romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Shatrov, Kosta, Galien, Onno van de, Gool, Kees van, Wodchis, Walter, and Jha, Ashish K.
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Medical care -- Utilization ,Medical care, Cost of -- International aspects -- Comparative analysis ,Business ,Health care industry - Abstract
Objective: The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. Data Sources: We used individual-level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States (US). Data Collection/Extraction Methods: Data collected by ICCONIC partners. Study Design: We retrospectively analyzed age-sex standardized utilization and spending of an older person (65-90 years) hospitalized with a heart failure exacerbation and a secondary diagnosis of diabetes across five domains of care: hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. Principal Findings: Sample sizes ranged from n = 1270 in Spain to n = 21,803 in the United States. Mean age (standard deviation [SD]) ranged from 76.2 (5.6) in the Netherlands to 80.3 (6.8) in Sweden. We observed substantial variation in spending and utilization across care settings. On average, England spent $10,956 per person in hospital care while the United States spent $30,877. The United States had a shorter length of stay over the year (18.9 days) compared to France (32.9) and Germany (33.4). The United States spent more days in facility-based rehabilitative care than other countries. Australia spent $421 per person in primary care, while Spain (Aragon) spent $1557. The United States and Canada had proportionately more visits to specialist providers than primary care providers. Across almost all sectors, the United States spent more than other countries, suggesting higher prices per unit. Conclusion: Across 11 countries, there is substantial variation in health care spending and utilization for a complex multimorbid persona with heart failure and diabetes. Drivers of spending vary across countries, with the United States being the most expensive country due to high prices and higher use of facility-based rehabilitative care. KEYWORDS diabetes, health care spending, heart failure, high-cost patients, high need, international comparison, What is known on this topic * Health systems are structured and financed differently. * Patients with complex multimorbidity are more susceptible to poor quality of care and incur higher [...]
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- 2021
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9. Differences in health outcomes for high-need high-cost patients across high-income countries
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Papanicolas, Irene, Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bemal-Delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupinan-Romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Schoenfeld, Andrew J., Shatrov, Kosta, Stafford, Mai, Galien, Onno van de, Gool, Kees van, Wodchis, Walter, Jha, Ashish K., and Figueroa, Jose F.
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Outcome and process assessment (Health Care) -- International aspects ,Medical care -- Quality management ,Business ,Health care industry - Abstract
Objective: This study explores variations in outcomes of care for two types of patient personas-an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes. Data Sources: We used individual-level patient data from 11 health systems. Study Design: We compared inpatient mortality, mortality, and readmission rates at 30, 90, and 365 days. For the hip fracture persona, we also calculated time to surgery. Outcomes were standardized by age and sex. Data Collection/Extraction Methods: Data was compiled by the International Collaborative on Costs, Outcomes and Needs in Care across 11 countries for the years 2016-2017 (or nearest): Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Principal Findings: The hip sample across ranged from 1859 patients in Aragon, Spain, to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia, and the majority of hip patients across countries were female. The congestive heart failure (CHF) sample ranged from 742 patients in England to 21,803 in the United States. Mean age ranged from 77.2 in the United States to 80.3 in Sweden, and the majority of CHF patients were males. Average in-hospital mortality across countries was 4.1%. for the hip persona and 6.3% for the CHF persona. At the year mark, the mean mortality across all countries was 25.3% for the hip persona and 32.7% for CHF persona. Across both patient types, England reported the highest mortality at 1 year followed by the United States. Readmission rates for all periods were higher for the CHF persona than the hip persona. At 30 days, the average readmission rate for the hip persona was 13.8% and 27.6% for the CHF persona. Conclusion: Across 11 countries, there are meaningful differences in health system outcomes for two types of patients. KEYWORDS health systems, mortality, readmissions, What is known on this topic * Patient outcomes such as mortality and readmissions are commonly used as measures of performance of heatlh systems. * There are few sources of [...]
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- 2021
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10. Genetic newborn screening and digital technologies: A project protocol based on a dual approach to shorten the rare diseases diagnostic path in Europe
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Garnier, Nicolas, primary, Berghout, Joanne, additional, Zygmunt, Aldona, additional, Singh, Deependra, additional, Huang, Kui A., additional, Kantz, Waltraud, additional, Blankart, Carl Rudolf, additional, Gillner, Sandra, additional, Zhao, Jiawei, additional, Roettger, Richard, additional, Saier, Christina, additional, Kirschner, Jan, additional, Schenk, Joern, additional, Atkins, Leon, additional, Ryan, Nuala, additional, Zarakowska, Kaja, additional, Zschüntzsch, Jana, additional, Zuccolo, Michela, additional, Müllenborn, Matthias, additional, Man, Yuen-Sum, additional, Goodman, Liz, additional, Trad, Marie, additional, Chalandon, Anne Sophie, additional, Sansen, Stefaan, additional, Martinez-Fresno, Maria, additional, Badger, Shirlene, additional, Walther van Olden, Rudolf, additional, Rothmann, Robert, additional, Lehner, Patrick, additional, Tschohl, Christof, additional, Baillon, Ludovic, additional, Gumus, Gulcin, additional, Gross, Edith, additional, Stefanov, Rumen, additional, Iskrov, Georgi, additional, Raycheva, Ralitsa, additional, Kostadinov, Kostadin, additional, Mitova, Elena, additional, Einhorn, Moshe, additional, Einhorn, Yaron, additional, Schepers, Josef, additional, Hübner, Miriam, additional, Alves, Frauke, additional, Iskandar, Rowan, additional, Mayer, Rudolf, additional, Renieri, Alessandra, additional, Piperkova, Aneta, additional, Gut, Ivo, additional, Beltran, Sergi, additional, Matthiesen, Mads Emil, additional, Poetz, Marion, additional, Hansson, Mats, additional, Trollmann, Regina, additional, Agolini, Emanuele, additional, Ottombrino, Silvia, additional, Novelli, Antonio, additional, Bertini, Enrico, additional, Selvatici, Rita, additional, Farnè, Marianna, additional, Fortunato, Fernanda, additional, and Ferlini, Alessandra, additional
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- 2023
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11. The PMA Scale: A Measure of Physicians’ Motivation to Adopt Medical Devices
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Hatz, Maximilian H.M., Sonnenschein, Tim, and Blankart, Carl Rudolf
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- 2017
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12. Health policy - the best evidence for better policies
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Quentin, Wilm, Achstetter, Katharina, Barros, Pedro Pita, Blankart, Carl Rudolf, Fattore, Giovanni, Jeurissen, Patrick, Kwon, Soonman, Laba, Tracey, Or, Zeynep, Papanicolas, Irene, Polin, Katherine, Shuftan, Nathan, Sutherland, Jason, Vogt, Verena, Vrangbaek, Karsten, Wendt, Claus, Quentin, Wilm, Achstetter, Katharina, Barros, Pedro Pita, Blankart, Carl Rudolf, Fattore, Giovanni, Jeurissen, Patrick, Kwon, Soonman, Laba, Tracey, Or, Zeynep, Papanicolas, Irene, Polin, Katherine, Shuftan, Nathan, Sutherland, Jason, Vogt, Verena, Vrangbaek, Karsten, and Wendt, Claus
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All institutes and research themes of the Radboud University Medical Center ,Health Policy ,610 Medizin und Gesundheit ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] - Abstract
Contains fulltext : 290919.pdf (Publisher’s version ) (Closed access) 01 januari 2023
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- 2023
13. The effect of political control on financial performance, structure, and outcomes of US nursing homes
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Blankart, Carl Rudolf, Foster, Andrew D., and Mor, Vincent
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United States. Centers for Medicare and Medicaid Services -- Analysis ,Public finance -- Analysis ,Nursing homes -- Analysis ,Financial management -- Analysis ,Medicaid -- Analysis ,Medicare ,Aircraft industry ,Business ,Health care industry - Abstract
Objective: To evaluate the effect of partisan political control on financial performance, structure, and outcomes of for-profit and not-for-profit US nursing homes.Data Sources/Study Setting: Nineteen-year panel (1996-2014) of state election outcomes, financial performance data from nursing home cost reports, operational and aggregate resident characteristics from OSCAR of 13 737 nursing homes.Study Design: A linear panel model was estimated to identify the effect of Democratic and Republican political control on next year's outcomes. Nursing home outcomes were defined as yearly facility revenues, expenses, and profits; the number of Medicaid, Medicare, and private-pay residents; staffing levels; and selected resident outcomes.Principal Findings: Democratic political control leads to an increase in financial flows to for-profit nursing homes, boosting profits without producing observable improvements in resident outcomes. Republican political control leads to lower revenues and profits of for-profit nursing homes. A shift from Medicaid to more profitable private-pay residents following Republican political control is observed for all nursing homes. Financial performance of not-for-profit nursing homes is not significantly affected by changes in political control.Conclusion: Political control of the two legislative chambers--but not of the governorship--shapes the structure of the nursing home industry as seen in provider behavior.KEYWORDSMedicaid, political control, public spending, 1 | INTRODUCTIONUS health care expenditures represent a substantial portion of public spending and are therefore likely to be affected by partisan political control. At the federal level, for example, [...]
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- 2019
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14. System Dynamics and Intervention Design
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von Kodolitsch, Yskert, Wick, Thomas, Pfennig, Olliver, Debus, Eike Sebastian, Schoenhagen, Paul, Blankart, Carl Rudolf, von Kodolitsch, Yskert, Wick, Thomas, Pfennig, Olliver, Debus, Eike Sebastian, Schoenhagen, Paul, and Blankart, Carl Rudolf
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In this article, we transform thoughts from classical strategy and insights from modern complexity science into a novel concept of intervention. In doing so, we pursue two goals: First, to improve the prediction of outcomes, and second, to refine the design of interventions. For the first purpose, we outline approaches to modeling the natural behavior of systems and the effect of interventions. For the second purpose, we propose an idea for the design of interventions. We call the concepts that relate to modeling system behaviors system dynamics, and those that relate to predicting outcomes of interventions intervention dynamics, and we call the concepts that relate to the design of interventions intervention design.
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- 2023
15. Genetic newborn screening and digital technologies : A project protocol based on a dual approach to shorten the rare diseases diagnostic path in Europe
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Garnier, Nicolas, Berghout, Joanne, Zygmunt, Aldona, Singh, Deependra, Huang, Kui A., Kantz, Waltraud, Blankart, Carl Rudolf, Gillner, Sandra, Zhao, Jiawei, Roettger, Richard, Saier, Christina, Kirschner, Jan, Schenk, Joern, Atkins, Leon, Ryan, Nuala, Zarakowska, Kaja, Zschuentzsch, Jana, Zuccolo, Michela, Muellenborn, Matthias, Man, Yuen-Sum, Goodman, Liz, Trad, Marie, Chalandon, Anne Sophie, Sansen, Stefaan, Martinez-Fresno, Maria, Badger, Shirlene, Walther van Olden, Rudolf, Rothmann, Robert, Lehner, Patrick, Tschohl, Christof, Baillon, Ludovic, Gumus, Gulcin, Gross, Edith, Stefanov, Rumen, Iskrov, Georgi, Raycheva, Ralitsa, Kostadinov, Kostadin, Mitova, Elena, Einhorn, Moshe, Einhorn, Yaron, Schepers, Josef, Huebner, Miriam, Alves, Frauke, Iskandar, Rowan, Mayer, Rudolf, Renieri, Alessandra, Piperkova, Aneta, Gut, Ivo, Beltran, Sergi, Matthiesen, Mads Emil, Poetz, Marion, Hansson, Mats G., Trollmann, Regina, Agolini, Emanuele, Ottombrino, Silvia, Novelli, Antonio, Bertini, Enrico, Selvatici, Rita, Farne, Marianna, Fortunato, Fernanda, Ferlini, Alessandra, Garnier, Nicolas, Berghout, Joanne, Zygmunt, Aldona, Singh, Deependra, Huang, Kui A., Kantz, Waltraud, Blankart, Carl Rudolf, Gillner, Sandra, Zhao, Jiawei, Roettger, Richard, Saier, Christina, Kirschner, Jan, Schenk, Joern, Atkins, Leon, Ryan, Nuala, Zarakowska, Kaja, Zschuentzsch, Jana, Zuccolo, Michela, Muellenborn, Matthias, Man, Yuen-Sum, Goodman, Liz, Trad, Marie, Chalandon, Anne Sophie, Sansen, Stefaan, Martinez-Fresno, Maria, Badger, Shirlene, Walther van Olden, Rudolf, Rothmann, Robert, Lehner, Patrick, Tschohl, Christof, Baillon, Ludovic, Gumus, Gulcin, Gross, Edith, Stefanov, Rumen, Iskrov, Georgi, Raycheva, Ralitsa, Kostadinov, Kostadin, Mitova, Elena, Einhorn, Moshe, Einhorn, Yaron, Schepers, Josef, Huebner, Miriam, Alves, Frauke, Iskandar, Rowan, Mayer, Rudolf, Renieri, Alessandra, Piperkova, Aneta, Gut, Ivo, Beltran, Sergi, Matthiesen, Mads Emil, Poetz, Marion, Hansson, Mats G., Trollmann, Regina, Agolini, Emanuele, Ottombrino, Silvia, Novelli, Antonio, Bertini, Enrico, Selvatici, Rita, Farne, Marianna, Fortunato, Fernanda, and Ferlini, Alessandra
- Abstract
Since 72% of rare diseases are genetic in origin and mostly paediatrics, genetic newborn screening represents a diagnostic "window of opportunity". Therefore, many gNBS initiatives started in different European countries. Screen4Care is a research project, which resulted of a joint effort between the European Union Commission and the European Federation of Pharmaceutical Industries and Associations. It focuses on genetic newborn screening and artificial intelligence-based tools which will be applied to a large European population of about 25.000 infants. The neonatal screening strategy will be based on targeted sequencing, while whole genome sequencing will be offered to all enrolled infants who may show early symptoms but have resulted negative at the targeted sequencing-based newborn screening. We will leverage artificial intelligence-based algorithms to identify patients using Electronic Health Records (EHR) and to build a repository "symptom checkers" for patients and healthcare providers. S4C will design an equitable, ethical, and sustainable framework for genetic newborn screening and new digital tools, corroborated by a large workout where legal, ethical, and social complexities will be addressed with the intent of making the framework highly and flexibly translatable into the diverse European health systems.
- Published
- 2023
- Full Text
- View/download PDF
16. Rare diseases' genetic newborn screening as the gateway to future genomic medicine: the Screen4Care EU-IMI project.
- Author
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Ferlini, Alessandra, Gross, Edith Sky, Garnier, Nicolas, Berghout, Joanne, Zygmunt, Aldona, Singh, Deependra, Huang, Kui A., Kantz, Waltraud, Blankart, Carl Rudolf, Gillner, Sandra, Zhao, Jiawei, Roettger, Richard, Saier, Christina, Kirschner, Jan, Schenk, Joern, Atkins, Leon, Ryan, Nuala, Zarakowska, Kaja, Zschüntzsch, Jana, and Zuccolo, Michela
- Subjects
GENETIC testing ,NEWBORN screening ,RARE diseases ,MEDICAL sciences ,GENETIC disorders ,REVERSE genetics ,NUCLEOTIDE sequencing - Abstract
Following the reverse genetics strategy developed in the 1980s to pioneer the identification of disease genes, genome(s) sequencing has opened the era of genomics medicine. The human genome project has led to an innumerable series of applications of omics sciences on global health, from which rare diseases (RDs) have greatly benefited. This has propelled the scientific community towards major breakthroughs in disease genes discovery, in technical innovations in bioinformatics, and in the development of patients' data registries and omics repositories where sequencing data are stored. Rare diseases were the first diseases where nucleic acid-based therapies have been applied. Gene therapy, molecular therapy using RNA constructs, and medicines modulating transcription or translation mechanisms have been developed for RD patients and started a new era of medical science breakthroughs. These achievements together with optimization of highly scalable next generation sequencing strategies now allow movement towards genetic newborn screening. Its applications in human health will be challenging, while expected to positively impact the RD diagnostic journey. Genetic newborn screening brings many complexities to be solved, technical, strategic, ethical, and legal, which the RD community is committed to address. Genetic newborn screening initiatives are therefore blossoming worldwide, and the EU-IMI framework has funded the project Screen4Care. This large Consortium will apply a dual genetic and digital strategy to design a comprehensive genetic newborn screening framework to be possibly translated into the future health care. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
17. Coverage with evidence development for medical devices in Europe:Can practice meet theory?
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Drummond, Michael, Federici, Carlo, Reckers-Droog, Vivian, Torbica, Aleksandra, Blankart, Carl Rudolf, Ciani, Oriana, Kaló, Zoltán, Kovács, Sándor, Brouwer, Werner, Drummond, Michael, Federici, Carlo, Reckers-Droog, Vivian, Torbica, Aleksandra, Blankart, Carl Rudolf, Ciani, Oriana, Kaló, Zoltán, Kovács, Sándor, and Brouwer, Werner
- Abstract
Health economists have written extensively on the design and implementation of coverage with evidence development (CED) schemes and have proposed theoretical frameworks based on cost-effectiveness modeling and value of information analysis. CED may aid decision-makers when there is uncertainty about the (cost-)effectiveness of a new health technology at the time of reimbursement. Medical devices are potential candidates for CED schemes, as regulatory regimes do not usually require the same level of efficacy and safety data normally needed for pharmaceuticals. The purpose of this research is to assess whether the actual practice of CED for medical devices in Europe meets the theoretical principles proposed by health economists and whether theory and practice can be more closely aligned. Based on decision-makers' perceptions of the challenges associated with CED schemes, plus examples from the schemes themselves, we discuss a series of proposals for assessing the desirability of schemes, their design, implementation, and evaluation. These proposals, while reflecting the practical challenges with developing CED programs, embody many of the principles suggested by economists and should support decision-makers in dealing with uncertainty about the real-world performance of devices.
- Published
- 2022
18. Improving health care from the bottom up: Factors for the successful implementation of kaizen in acute care hospitals
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Shatrov, Kosta, primary, Pessina, Camilla, additional, Huber, Kaspar, additional, Thomet, Bernhard, additional, Gutzeit, Andreas, additional, and Blankart, Carl Rudolf, additional
- Published
- 2021
- Full Text
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19. Differences in health outcomes for h igh‐need h igh‐cost patients across h igh‐income countries
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Papanicolas, Irene, primary, Riley, Kristen, additional, Abiona, Olukorede, additional, Arvin, Mina, additional, Atsma, Femke, additional, Bernal‐Delgado, Enrique, additional, Bowden, Nicholas, additional, Blankart, Carl Rudolf, additional, Deeny, Sarah, additional, Estupiñán‐Romero, Francisco, additional, Gauld, Robin, additional, Haywood, Philip, additional, Janlov, Nils, additional, Knight, Hannah, additional, Lorenzoni, Luca, additional, Marino, Alberto, additional, Or, Zeynep, additional, Penneau, Anne, additional, Schoenfeld, Andrew J., additional, Shatrov, Kosta, additional, Stafford, Mai, additional, Galien, Onno, additional, Gool, Kees, additional, Wodchis, Walter, additional, Jha, Ashish K., additional, and Figueroa, Jose F., additional
- Published
- 2021
- Full Text
- View/download PDF
20. Quo Vadis HTA for Medical Devices in Central and Eastern Europe?:Recommendations to Address Methodological Challenges
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Daubner-Bendes, Rita, Kovács, Sándor, Niewada, Maciej, Huic, Mirjana, Drummond, Michael, Ciani, Oriana, Blankart, Carl Rudolf, Mandrik, Olena, Torbica, Aleksandra, Yfantopoulos, John, Petrova, Guenka, Holownia-Voloskova, Malwina, Taylor, Rod S., Al, Maiwenn, Piniazhko, Oresta, Lorenzovici, László, Tarricone, Rosanna, Zemplényi, Antal, Kaló, Zoltán, Daubner-Bendes, Rita, Kovács, Sándor, Niewada, Maciej, Huic, Mirjana, Drummond, Michael, Ciani, Oriana, Blankart, Carl Rudolf, Mandrik, Olena, Torbica, Aleksandra, Yfantopoulos, John, Petrova, Guenka, Holownia-Voloskova, Malwina, Taylor, Rod S., Al, Maiwenn, Piniazhko, Oresta, Lorenzovici, László, Tarricone, Rosanna, Zemplényi, Antal, and Kaló, Zoltán
- Abstract
Objectives: Methodological challenges in the evaluation of medical devices (MDs) may be different for early and late technology adopter countries, as well as the potential health technology assessment (HTA) solutions to tackle them. This study aims to provide guidance to Central and Eastern European (CEE) countries on how to address key challenges of HTA for MDs with special focus on the transferability of scientific evidence. Methods:As part of the COMED Horizon 2020 project, a comprehensive list of issues related to MD HTA were identified based on a targeted literature review. Health technology assessment issues which pose a greater challenge or require different solutions in late technology adopter countries were selected. Draught recommendations to address these issues were developed and discussed in a focus group. The recommendations were then validated with a wider group of experts, including HTA and reimbursement decision makers from CEE countries in May and June 2020. Results: A consolidated list of 11 recommendations were developed in 3 major areas: (1) clinical value assessment, focusing on the use of joint EU work, relying on real-world evidence, use of coverage with evidence development schemes, transferring evidence from foreign countries and addressing the challenges of learning curve and centre effect; (2) economic value assessment, covering cost calculation of complex medical devices and transferability of economic evaluations of MDs; (3) HTA processes, related to the frequent product modifications and various indications of MDs. Conclusions: Central and Eastern European countries with limited resources for conducting HTA, can benefit from HTA methods and evidence generated in early technology adopter countries. Considering the appropriate reuse of international HTA materials, late technology adopter countries can still implement HTA, even for MDs, which have a more limit
- Published
- 2021
21. Regulatory and HTA early dialogues in medical devices
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Blankart, Carl Rudolf, Dams, Florian, Penton, Hannah, Kaló, Zoltán, Zemplényi, Antal, Shatrov, Kosta, Iskandar, Rowan, Federici, Carlo, Blankart, Carl Rudolf, Dams, Florian, Penton, Hannah, Kaló, Zoltán, Zemplényi, Antal, Shatrov, Kosta, Iskandar, Rowan, and Federici, Carlo
- Abstract
Introduction: Specific guidance and examples for health technology assessment (HTA) of medical devices are scarce in medical device development. A more intense dialogue of competent authorities, HTA agencies, and manufactures may improve evidence base on clinical and cost-effectiveness. Especially as the new Medical Device Regulation requires more clinical evidence. Methods: We explore the perceptions of manufacturers, competent authorities, and HTA agencies towards such dialogues and investigate how they should be designed to accelerate the translational process from development to patient access using semi-structured interviews. We synthesized the evidence from manufacturers, competent authorities, and HTA agencies from 14 different jurisdictions across Europe. Results: Eleven HTA agencies, four competent authorities, and eight manufacturers of high-risk devices expressed perceptions on the current situation and the expected development of three types of early dialogues. Discussion: The MDR has to be taken into account when designing the early dialogue processes. Transferring insights from medicinal product regulation is limited as the regulatory pathways differ substantially. Conclusion: Early dialogues promise to accelerate the translational process and to provide faster access to innovative medical devices. However, health policy-makers should promote and fully establish regulatory and HTA early dialogues before introducing parallel early dialogues of regulatory, HTA agencies, and manufacturers. For initiating change, the legislator must create the legal basis and set the appropriate incentives for manufacturers.
- Published
- 2021
22. Quo Vadis HTA for Medical Devices in Central and Eastern Europe? Recommendations to Address Methodological Challenges
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Daubner-Bendes, Rita, primary, Kovács, Sándor, additional, Niewada, Maciej, additional, Huic, Mirjana, additional, Drummond, Michael, additional, Ciani, Oriana, additional, Blankart, Carl Rudolf, additional, Mandrik, Olena, additional, Torbica, Aleksandra, additional, Yfantopoulos, John, additional, Petrova, Guenka, additional, Holownia-Voloskova, Malwina, additional, Taylor, Rod S., additional, Al, Maiwenn, additional, Piniazhko, Oresta, additional, Lorenzovici, László, additional, Tarricone, Rosanna, additional, Zemplényi, Antal, additional, and Kaló, Zoltán, additional
- Published
- 2021
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- View/download PDF
23. How military history can inspire medical intervention
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von Kodolitsch, Yskert, primary, Prokoph, Martin, additional, Sachweh, Arnim, additional, Kölbel, Tilo, additional, Detter, Christian, additional, Berger, Jürgen, additional, Wick, Thomas, additional, Debus, Sebastian, additional, and Blankart, Carl Rudolf, additional
- Published
- 2020
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- View/download PDF
24. The effect of political control on financial performance, structure, and outcomes of US nursing homes
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Blankart, Carl Rudolf, primary, Foster, Andrew D., additional, and Mor, Vincent, additional
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- 2018
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25. Using nonparametric conditional approach to integrate quality into efficiency analysis: Empirical evidence from cardiology departments
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Varabyova, Yauheniya, Blankart, Carl Rudolf Berchtold, and Schreyögg, Jonas
- Subjects
quality ,efficiency ,conditional approach ,data envelopment analysis (DEA) ,ddc:330 ,cardiology department - Abstract
In the past decades, hospitals have been facing pressure to increase the efficiency of resource allocation. One way to achieve higher levels of technical efficiency is to treat more patients with the same amount of personnel, which could potentially lead to a trade-off between improving efficiency and maintaining good patient service. The aim of this study is to demonstrate how the nonparametric conditional approach can be used to integrate quality into the analysis of efficiency. The conditional approach allows investigating the mechanism through which quality enters the production process. Generally, an external variable may enter the production process by affecting either the attainable frontier or the distribution of inefficiencies inside the production set. To account for the heterogeneity of hospital services, we focus on a hospital department as the unit of analysis. We use data from 178 departments of interventional cardiology and consider three different measures of quality: patient satisfaction, risk-adjusted mortality, and patient radiation exposure. Our empirical assessment shows that the impact of quality on the production process differs according to the utilized quality measure. Patient satisfaction does not affect the attainable frontier but does have an inverted U-shaped effect on the distribution of inefficiencies; risk-adjusted mortality negatively impacts the attainable frontier at high values of mortality but does not impact the distribution of inefficiencies; and patient radiation exposure is not associated with the production process. Our results refute the existence of a clear trade-off between efficiency and quality. The conditional approach can be applied to deal with the complexity of the underlying relationships between efficiency and quality.
- Published
- 2016
26. [Untitled]
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von Kodolitsch, Y., Blankart, Carl Rudolf, Vogler, M., Kallenbach, K., and Robinson, P. N.
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350 Public administration & military science ,330 Economics - Published
- 2015
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27. Cost of illness and economic burden of chronic lymphocytic leukemia
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Blankart, Carl Rudolf, primary, Koch, Taika, additional, Linder, Roland, additional, Verheyen, Frank, additional, Schreyögg, Jonas, additional, and Stargardt, Tom, additional
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- 2013
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28. The economic impact of Marfan syndrome: a nonexperimental, retrospective, population-based matched cohort study.
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Achelrod, Dmitrij, Blankart, Carl Rudolf, Linder, Roland, von Kodolitsch, Yskert, and Stargard, Tom
- Subjects
- *
MARFAN syndrome , *ECONOMIC impact analysis , *COHORT analysis , *MEDICAL care costs , *HUMAN capital , *SICK leave ,GERMAN economy, 1990- - Abstract
Background Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective. Objective To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008. Methods A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs. Results From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perpective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drives are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25-41 years) and first (0-16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, where the societal econimic impact extendes from €151.3 million to € million. Conclusions Relative to its low frequency, Marfan syndrome requires high healthcare expenditure. Not only the high costs of Marfan syndrome but also its burden on patients' lives call for more awareness from policy-makers, physicians and clinical researchers. Consequently, the diagnosis and treatment of Marfan syndrome should begin as soon as possible in order to prevent disease complications, early mortality and substantial healthcare expenditure. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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- View/download PDF
29. International comparison of hospitalizations and emergency department visits related to mental health conditions across high‐income countries before and during the COVID‐19 pandemic.
- Author
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Bowden, Nicholas, Hedquist, Aaron, Dai, Dannie, Abiona, Olukorede, Bernal‐Delgado, Enrique, Blankart, Carl Rudolf, Cartailler, Julie, Estupiñán‐Romero, Francisco, Haywood, Philip, Or, Zeynep, Papanicolas, Irene, Stafford, Mai, Wyatt, Steven, Sund, Reijo, Uwitonze, Jean Pierre, Wodchis, Walter P., Gauld, Robin, Vu, Hien, Sawaya, Tania, and Figueroa, Jose F.
- Subjects
- *
MENTAL health services , *EMERGENCY room visits , *MEDICAL care use , *INPATIENT care , *MONETARY incentives - Abstract
Objective Data Sources and Study Setting Study Design Principal Findings Conclusion What is known on this topic What this study adds To explore variation in rates of acute care utilization for mental health conditions, including hospitalizations and emergency department (ED) visits, across high‐income countries before and during the COVID‐19 pandemic.Administrative patient‐level data between 2017 and 2020 of eight high‐income countries: Canada, England, Finland, France, New Zealand, Spain, Switzerland, and the United States (US).Multi‐country retrospective observational study using a federated data approach that evaluated age‐sex standardized rates of hospitalizations and ED visits for mental health conditions.There was significant variation in rates of acute mental health care utilization across countries. Among the subset of four countries with both hospitalization and ED data, the US had the highest pre‐COVID‐19 combined average annual acute care rate of 1613 episodes/100,000 people (95% CI: 1428, 1797). Finland had the lowest rate of 776 (686, 866). When examining hospitalization rates only, France had the highest rate of inpatient hospitalizations of 988/100,000 (95% CI 858, 1118) while Spain had the lowest at 87/100,000 (95% CI 76, 99). For ED rates for mental health conditions, the US had the highest rate of 958/100,000 (95% CI 861, 1055) while France had the lowest rate with 241/100,000 (95% CI 216, 265). Notable shifts coinciding with the onset of the COVID‐19 pandemic were observed including a substitution of care setting in the US from ED to inpatient care, and overall declines in acute care utilization in Canada and France.The study underscores the importance of understanding and addressing variation in acute care utilization for mental health conditions, including the differential effect of COVID‐19, across different health care systems. Further research is needed to elucidate the extent to which factors such as workforce capacity, access barriers, financial incentives, COVID‐19 preparedness, and community‐based care may contribute to these variations. Approximately one billion people globally live with a mental health condition, with significant consequences for individuals and societies. Rates of mental health diagnoses vary across high‐income countries, with substantial differences in access to effective care. The COVID‐19 pandemic has exacerbated mental health challenges globally, with varying impacts across countries. This study provides a comprehensive international comparison of hospitalization and emergency department visit rates for mental health conditions across eight high‐income countries. It highlights significant variations in acute care utilization patterns, particularly in countries that are more likely to care for people with mental health conditions in emergency departments rather than inpatient facilities The study identifies temporal and cross‐country differences in acute care management of mental health conditions coinciding with the onset of the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
30. Quo Vadis HTA for Medical Devices in Central and Eastern Europe? Recommendations to Address Methodological Challenges
- Author
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Daubner-Bendes, Rita, Kovács, Sándor, Niewada, Maciej, Huic, Mirjana, Drummond, Michael, Ciani, Oriana, Blankart, Carl Rudolf, Mandrik, Olena, Torbica, Aleksandra, Yfantopoulos, John, Petrova, Guenka, Holownia-Voloskova, Malwina, Taylor, Rod S., Al, Maiwenn, Piniazhko, Oresta, Lorenzovici, László, Tarricone, Rosanna, Zemplényi, Antal, and Kaló, Zoltán
- Subjects
13. Climate action ,350 Public administration & military science - Abstract
Objectives: Methodological challenges in the evaluation of medical devices (MDs) may be different for early and late technology adopter countries, as well as the potential health technology assessment (HTA) solutions to tackle them. This study aims to provide guidance to Central and Eastern European (CEE) countries on how to address key challenges of HTA for MDs with special focus on the transferability of scientific evidence. Methods: As part of the COMED Horizon 2020 project, a comprehensive list of issues related to MD HTA were identified based on a targeted literature review. Health technology assessment issues which pose a greater challenge or require different solutions in late technology adopter countries were selected. Draught recommendations to address these issues were developed and discussed in a focus group. The recommendations were then validated with a wider group of experts, including HTA and reimbursement decision makers from CEE countries in May and June 2020. Results: A consolidated list of 11 recommendations were developed in 3 major areas: (1) clinical value assessment, focusing on the use of joint EU work, relying on real-world evidence, use of coverage with evidence development schemes, transferring evidence from foreign countries and addressing the challenges of learning curve and centre effect; (2) economic value assessment, covering cost calculation of complex medical devices and transferability of economic evaluations of MDs; (3) HTA processes, related to the frequent product modifications and various indications of MDs. Conclusions: Central and Eastern European countries with limited resources for conducting HTA, can benefit from HTA methods and evidence generated in early technology adopter countries. Considering the appropriate reuse of international HTA materials, late technology adopter countries can still implement HTA, even for MDs, which have a more limited evidence base compared with pharmaceuticals.
31. Validation and application of a needs���based segmentation tool for cross���country comparisons
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Duminy, Lize, Sivapragasam, Nirmali Ruth, Matchar, David Bruce, Visaria, Abhijit, Ansah, John Pastor, Blankart, Carl Rudolf, and Schoenenberger, Lukas
- Subjects
1. No poverty ,350 Public administration & military science ,3. Good health - Abstract
Objective To compare countries' health care needs by segmenting populations into a set of needs-based health states. Data sources We used seven waves of the Survey of Health, Aging and Retirement in Europe (SHARE) panel survey data. Study design We developed the Cross-Country Simple Segmentation Tool (CCSST), a validated clinician-administered instrument for categorizing older individuals by distinct, homogeneous health and related social service needs. Using clinical indicators, self-reported physician diagnosis of chronic disease, and performance-based tests conducted during the survey interview, individuals were assigned to 1���5 global impressions (GI) segments and assessed for having any of the four identifiable complicating factors (CFs). We used Cox proportional hazard models to estimate the risk of mortality by segment. First, we show the segmentation cross-sectionally to assess cross-country differences in the fraction of individuals with different levels of medical needs. Second, we compare the differences in the rate at which individuals transition between those levels and death. Data collection/extraction methods We segmented 270,208 observations (from Austria, Belgium, Czech Republic, Denmark, France, Germany, Greece, Israel, Italy, the Netherlands, Poland, Spain, Sweden, and Switzerland) from 96,396 individuals into GI and CF categories. Principal findings The CCSST is a valid tool for segmenting populations into needs-based states, showing Switzerland with the lowest fraction of individuals in high medical needs segments, followed by Denmark and Sweden, and Poland with the highest fraction, followed by Italy and Israel. Comparing hazard ratios of transitioning between health states may help identify country-specific areas for analysis of ecological and cultural risk factors. Conclusions The CCSST is an innovative tool for aggregate cross-country comparisons of both health needs and transitions between them. A cross-country comparison gives policy makers an effective means of comparing national health system performance and provides targeted guidance on how to identify strategies for curbing the rise of high-need, high-cost patients.
32. Why the US spends more treating high-need high-cost patients: a comparative study of pricing and utilization of care in six high-income countries
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Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Blankart, Carl Rudolf, Shatrov, Kosta, Wodchis, Walter, Janlov, Nils, Figueroa, Jose F., Bowden, Nicholas, Bernal-Delgado, Enrique, Papanicolas, Irene, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Blankart, Carl Rudolf, Shatrov, Kosta, Wodchis, Walter, Janlov, Nils, Figueroa, Jose F., Bowden, Nicholas, Bernal-Delgado, Enrique, and Papanicolas, Irene
- Abstract
One of the most pressing challenges facing most health care systems is rising costs. As the population ages and the demand for health care services grows, there is a growing need to understand the drivers of these costs across systems. This paper attempts to address this gap by examining utilization and spending of the course of a year for two specific high-need high-cost patient types: a frail older person with a hip fracture and an older person with congestive heart failure and diabetes. Data on utilization and expenditure is collected across five health care settings (hospital, post-acute rehabilitation, primary care, outpatient specialty and drugs), in six countries (Canada (Ontario), France, Germany, Spain (Aragon), Sweden and the United States (fee for service Medicare) and used to construct treatment episode Purchasing Power Parities (PPPs) that compare prices using baskets of goods from the different care settings. The treatment episode PPPs suggest other countries have more similar volumes of care to the US as compared to other standardization approaches, suggesting that US prices account for more of the differential in US health care expenditures. The US also differs with regards to the share of expenditures across care settings, with post-acute rehab and outpatient speciality expenditures accounting for a larger share of the total relative to comparators.
33. A methodology for identifying high-need, high-cost patient personas for international comparisons
- Author
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Figueroa, Jose F., Horneffer, Kathryn E., Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal-Delgado, Enrique, Blankart, Carl Rudolf, Bowden, Nicholas, Deeny, Sarah, Estupiñán-Romero, Francisco, Gauld, Robin, Hansen, Tonya Moen, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Pellet, Leila, Orlander, Duncan, Penneau, Anne, Schoenfeld, Andrew J., Shatrov, Kosta, Skudal, Kjersti Eeg, Stafford, Mai, van de Galien, Onno, van Gool, Kees, Wodchis, Walter P., Tanke, Marit, Jha, Ashish K., Papanicolas, Irene, Figueroa, Jose F., Horneffer, Kathryn E., Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal-Delgado, Enrique, Blankart, Carl Rudolf, Bowden, Nicholas, Deeny, Sarah, Estupiñán-Romero, Francisco, Gauld, Robin, Hansen, Tonya Moen, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Pellet, Leila, Orlander, Duncan, Penneau, Anne, Schoenfeld, Andrew J., Shatrov, Kosta, Skudal, Kjersti Eeg, Stafford, Mai, van de Galien, Onno, van Gool, Kees, Wodchis, Walter P., Tanke, Marit, Jha, Ashish K., and Papanicolas, Irene
- Abstract
Objective: To establish a methodological approach to compare two high-need, high-cost (HNHC) patient personas internationally. Data sources: Linked individual-level administrative data from the inpatient and outpatient sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Study design: We outline a methodological approach to identify HNHC patient types for international comparisons that reflect complex, priority populations defined by the National Academy of Medicine. We define two patient profiles using accessible patient-level datasets linked across different domains of care—hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, long-term care, home-health care, and outpatient drugs. The personas include a frail older adult with a hip fracture with subsequent hip replacement and an older person with complex multimorbidity, including heart failure and diabetes. We demonstrate their comparability by examining the characteristics and clinical diagnoses captured across countries. Data collection/extraction methods: Data collected by ICCONIC partners. Principal findings: Across 11 countries, the identification of HNHC patient personas was feasible to examine variations in healthcare utilization, spending, and patient outcomes. The ability of countries to examine linked, individual-level data varied, with the Netherlands, Canada, and Germany able to comprehensively examine care across all seven domains, whereas other countries such as England, Switzerland, and New Zealand were more limited. All countries were able to identify a hip fracture persona and a heart failure persona. Patient characteristics were reassuringly similar across countries. Conclusion: Although there are cross-country differences in the availability and structure of data sources
34. Differences in health outcomes for high‐need high‐cost patients across high-income countries
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Papanicolas, Irene, Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal‐delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupiñán‐romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Schoenfeld, Andrew J., Shatrov, Kosta, Stafford, Mai, Galien, Onno, Gool, Kees, Wodchis, Walter, Jha, Ashish K., Figueroa, Jose F., Papanicolas, Irene, Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal‐delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupiñán‐romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Schoenfeld, Andrew J., Shatrov, Kosta, Stafford, Mai, Galien, Onno, Gool, Kees, Wodchis, Walter, Jha, Ashish K., and Figueroa, Jose F.
- Abstract
Objective This study explores variations in outcomes of care for two types of patient personas—an older frail person recovering from a hip fracture and a multimorbid older patient with congestive heart failure (CHF) and diabetes. Data Sources We used individual-level patient data from 11 health systems. Study Design We compared inpatient mortality, mortality, and readmission rates at 30, 90, and 365 days. For the hip fracture persona, we also calculated time to surgery. Outcomes were standardized by age and sex. Data Collection/Extraction Methods Data was compiled by the International Collaborative on Costs, Outcomes and Needs in Care across 11 countries for the years 2016–2017 (or nearest): Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Principal Findings The hip sample across ranged from 1859 patients in Aragon, Spain, to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia, and the majority of hip patients across countries were female. The congestive heart failure (CHF) sample ranged from 742 patients in England to 21,803 in the United States. Mean age ranged from 77.2 in the United States to 80.3 in Sweden, and the majority of CHF patients were males. Average in-hospital mortality across countries was 4.1%. for the hip persona and 6.3% for the CHF persona. At the year mark, the mean mortality across all countries was 25.3% for the hip persona and 32.7% for CHF persona. Across both patient types, England reported the highest mortality at 1 year followed by the United States. Readmission rates for all periods were higher for the CHF persona than the hip persona. At 30 days, the average readmission rate for the hip persona was 13.8% and 27.6% for the CHF persona. Conclusion Across 11 countries, there are meaningful differences in health system outcomes for two types of patients.
35. International comparison of health spending and utilization among people with complex multimorbidity
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Figueroa, Jose F., Papanicolas, Irene, Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal‐delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupiñán‐romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Shatrov, Kosta, Galien, Onno, Gool, Kees, Wodchis, Walter, Jha, Ashish K., Figueroa, Jose F., Papanicolas, Irene, Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal‐delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupiñán‐romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Shatrov, Kosta, Galien, Onno, Gool, Kees, Wodchis, Walter, and Jha, Ashish K.
- Abstract
Objective: The objective of this study was to explore cross-country differences in spending and utilization across different domains of care for a multimorbid persona with heart failure and diabetes. Data Sources: We used individual-level administrative claims or registry data from inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States (US). Data Collection/Extraction Methods: Data collected by ICCONIC partners. Study Design: We retrospectively analyzed age–sex standardized utilization and spending of an older person (65–90 years) hospitalized with a heart failure exacerbation and a secondary diagnosis of diabetes across five domains of care: hospital care, primary care, outpatient specialty care, post–acute rehabilitative care, and outpatient drugs. Principal Findings: Sample sizes ranged from n = 1270 in Spain to n = 21,803 in the United States. Mean age (standard deviation [SD]) ranged from 76.2 (5.6) in the Netherlands to 80.3 (6.8) in Sweden. We observed substantial variation in spending and utilization across care settings. On average, England spent $10,956 per person in hospital care while the United States spent $30,877. The United States had a shorter length of stay over the year (18.9 days) compared to France (32.9) and Germany (33.4). The United States spent more days in facility-based rehabilitative care than other countries. Australia spent $421 per person in primary care, while Spain (Aragon) spent $1557. The United States and Canada had proportionately more visits to specialist providers than primary care providers. Across almost all sectors, the United States spent more than other countries, suggesting higher prices per unit. Conclusion: Across 11 countries, there is substantial variation in health care spending and utilizatio
36. International comparison of spending and utilization at the end of life for hip fracture patients
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Blankart, Carl Rudolf, Gool, Kees, Papanicolas, Irene, Bernal‐delgado, Enrique, Bowden, Nicholas, Estupiñán‐romero, Francisco, Gauld, Robin, Knight, Hannah, Abiona, Olukorede, Riley, Kristen, Schoenfeld, Andrew J., Shatrov, Kosta, Wodchis, Walter P., Figueroa, Jose F., Blankart, Carl Rudolf, Gool, Kees, Papanicolas, Irene, Bernal‐delgado, Enrique, Bowden, Nicholas, Estupiñán‐romero, Francisco, Gauld, Robin, Knight, Hannah, Abiona, Olukorede, Riley, Kristen, Schoenfeld, Andrew J., Shatrov, Kosta, Wodchis, Walter P., and Figueroa, Jose F.
- Abstract
Objective To identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries. Data Sources Individual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC). Study Design We retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death. Data Collection/Extraction Methods We identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission. Principal Findings Resource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs. Conclusions Across seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems.
37. Within and across country variations in treatment of patients with heart failure and diabetes
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Or, Zeynep, Shatrov, Kosta, Penneau, Anne, Wodchis, Walter, Abiona, Olukorede, Blankart, Carl Rudolf, Bowden, Nicholas, Bernal‐delgado, Enrique, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Papanicolas, Irene, Riley, Kristen, Pellet, Leila, Estupiñán‐romero, Francisco, Gool, Kees, Figueroa, Jose F., Or, Zeynep, Shatrov, Kosta, Penneau, Anne, Wodchis, Walter, Abiona, Olukorede, Blankart, Carl Rudolf, Bowden, Nicholas, Bernal‐delgado, Enrique, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Papanicolas, Irene, Riley, Kristen, Pellet, Leila, Estupiñán‐romero, Francisco, Gool, Kees, and Figueroa, Jose F.
- Abstract
Objective To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. Data Sources Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States. Data Collection Methods Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016. Study Design We calculated the care consumption of patients after a hospital admission over a year across the care pathway—ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female–male ratios for eight utilization and spending measures. Principal Findings In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27–0.36), while it is, 0.50 (0.45–0.56) for primary care visits, and more than 0.75 (0.81–0.92) for rehabilitation use and nurse visits at home (0.78; 0.62–0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01–1.06), have a higher number of prescriptions (+7%, 1.05–1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79–1.6, 0.99–1.64), but have fewer visits to specialists (−10%; 0.84–0.97). Conclusions Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by
38. Differences in health care spending and utilization among older frail adults in high‐income countries: ICCONIC hip fracture persona
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Papanicolas, Irene, Figueroa, Jose F., Schoenfeld, Andrew J., Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal‐delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupiñán‐romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Shatrov, Kosta, Stafford, Mai, Galien, Onno, Gool, Kees, Wodchis, Walter, Jha, Ashish K., Papanicolas, Irene, Figueroa, Jose F., Schoenfeld, Andrew J., Riley, Kristen, Abiona, Olukorede, Arvin, Mina, Atsma, Femke, Bernal‐delgado, Enrique, Bowden, Nicholas, Blankart, Carl Rudolf, Deeny, Sarah, Estupiñán‐romero, Francisco, Gauld, Robin, Haywood, Philip, Janlov, Nils, Knight, Hannah, Lorenzoni, Luca, Marino, Alberto, Or, Zeynep, Penneau, Anne, Shatrov, Kosta, Stafford, Mai, Galien, Onno, Gool, Kees, Wodchis, Walter, and Jha, Ashish K.
- Abstract
Objective This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture. Data Sources We used individual-level patient data from five care settings. Study Design We compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post–acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized.. Data Collection/Extraction Methods The data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. Principal Findings The sample ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post–acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization, $233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly concentrated in the inpatient setting. Conclusion Across 11 high-income countries, there is substantial variation in health care spending and utilization for an older person with frailty, both before and after a hip fracture. The United States is the most expensive country due to high prices and above average utilization of post–acute
39. An international comparison of long‐term care trajectories and spending following hip fracture
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Wodchis, Walter P., Or, Zeynep, Blankart, Carl Rudolf, Atsma, Femke, Janlov, Nils, Bai, Yu Qing, Penneau, Anne, Arvin, Mina, Knight, Hannah, Riley, Kristen, Figueroa, Jose F., Papanicolas, Irene, Wodchis, Walter P., Or, Zeynep, Blankart, Carl Rudolf, Atsma, Femke, Janlov, Nils, Bai, Yu Qing, Penneau, Anne, Arvin, Mina, Knight, Hannah, Riley, Kristen, Figueroa, Jose F., and Papanicolas, Irene
- Abstract
Objective The objectives of this study are to compare the relative use of different postacute care settings in different countries and to compare three important outcomes as follows: total expenditure, total days of care in different care settings, and overall longevity over a 1-year period following a hip fracture. Data Sources We used administrative data from hospitals, institutional and home-based long-term care (LTC), physician visits, and medications compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) from five countries as follows: Canada, France, Germany, the Netherlands, and Sweden. Data Extraction Methods Data were extracted from existing administrative data systems in each participating country. Study Design This is a retrospective cohort study of all individuals admitted to acute care for hip fracture. Descriptive comparisons were used to examine aggregate institutional and home-based postacute care. Care trajectories were created to track sequential care settings after acute-care discharge through institutional and community-based care in three countries where detailed information allowed. Comparisons in patient characteristics, utilization, and costs were made across these trajectories and countries. Principal Findings Across five countries with complete LTC data, we found notable variations with Germany having the highest days of home-based services with relatively low costs, while Sweden incurred the highest overall expenditures. Comparisons of trajectories found that France had the highest use of inpatient rehabilitation. Germany was most likely to discharge hip fracture patients to home. Over 365 days, France averaged the highest number of days in institution with 104, Canada followed at 94, and Germany had just 87 days of institutional care on average. Conclusion In this comparison of LTC services following a hip fracture, we found international differences in total use of institutional and noninstitutional c
40. The economic impact of Marfan syndrome: a non-experimental, retrospective, population-based matched cohort study.
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Achelrod, Dmitrij, Blankart, Carl Rudolf, Linder, Roland, von Kodolitsch, Yskert, and Stargardt, Tom
- Abstract
Background: Marfan syndrome is a rare disease of the connective tissues, affecting multiple organ systems. Elevated morbidity and mortality in these patients raises the issue of costs for sickness funds and society. To date, there has been no study analysing the costs of Marfan syndrome from a sickness fund and societal perspective.Objective: To estimate excess health resource utilisation, direct (non-)medical and indirect costs attributable to Marfan syndrome from a healthcare payer and a societal perspective in Germany in 2008.Methods: A retrospective matched cohort study design is applied, using claims data. For isolating the causal effect of Marfan syndrome on excess costs, a genetic matching algorithm was used to reduce differences in observable characteristics between Marfan syndrome patients and the control group. 892 patients diagnosed with Marfan syndrome (ICD-10 Q87.4) were matched from a pool of 26,645 control individuals. After matching, we compared health resource utilisation and costs.Results: From the sickness fund perspective, an average Marfan syndrome patient generates excess annual costs of €2496 compared with a control individual. From the societal perspective, excess annual costs amount to €15,728. For the sickness fund, the strongest cost drivers are inpatient treatment and care by non-physicians. From the sickness fund perspective, the third (25-41 years) and first (0-16 years) age quartiles reveal the greatest surplus in total costs. Marfan syndrome patients have 39% more physician contacts, a 153% longer average length of hospital stay, 119% more inpatient stays, 33% more prescriptions, 236% more medical imaging and 20% higher average prescription costs than control individuals. Depending on the prevalence, the economic impact from the sickness fund perspective ranges between €24.0 million and €61.4 million, whereas the societal economic impact extends from €151.3 million to €386.9 million.Conclusions: Relative to its low frequency, Marfan syndrome requires high healthcare expenditure. Not only the high costs of Marfan syndrome but also its burden on patients' lives call for more awareness from policy-makers, physicians and clinical researchers. Consequently, the diagnosis and treatment of Marfan syndrome should begin as soon as possible in order to prevent disease complications, early mortality and substantial healthcare expenditure. [ABSTRACT FROM AUTHOR]- Published
- 2014
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