Quality Assurance Indicators of Long-Term Care in European Countries

This study reports on the quality indicators that were collected by the ANCIEN project partners in each country considered in Work Package 5 (Quality in Long-Term Care). The main contribution of this report is a classification of the quality assurance indicators in different European countries according to three dimensions: organisation type (indicators applied to formal institutional care \u2013 FIC, formal home-based care \u2013 FHBC, formal home nursing care - FHNC, and informal home care - IHC); quality dimensions (indicators about effectiveness, safety, patient value responsiveness, or coordination) and system dimensions (input, process, or outcome indicators). The countries that provided quality indicators, which are used at a national level or are recommended to be used at a local level by a national authority, are: Estonia, Finland, France, Germany, Hungary, Italy, Latvia, the Netherlands, Spain, Sweden and the United Kingdom. In total, we collected 390 quality indicators. Each quality indicator has been assigned to one or more options in each dimension

eVisits in the digital era of Swedish primary care

Objective: To evaluate asynchronous digital visits (eVisits) with regard to digital communication, clinical decisionmaking,and subsequent care utilization in the digital era of primary care in Sweden.Methods: A mixed-methods approach was adopted across the various papers in the thesis, with all studiesevaluating the eVisit platform Flow in various clinical contexts.- Paper I was a comparative study of digital triage decisions when presented with automated patienthistory reports generated by the platform. Inter-rater reliability of triage decisions by majority vote in apanel of five physicians was compared to triage decisions by a machine learning model trained usingdata labelled by an expert primary care physician.- Paper II was a qualitative focus group study of nurse and physician experiences of digitalcommunication at three primary health care centers using the platform. Themes were generated usingqualitative content analysis as described by Graneheim and Lundman.- Papers III and IV were observational studies comparing office visits in the Skåne Region from Capio,a large private health care provider, to eVisit patients from Capio Go, a national eVisit service. Adultpatients with a chief complaint of sore throat, dysuria, or cough/common cold/influenza were recruited.eVisit patients were recruited prospectively digitally prior to their eVisit, while the office visit controlgroup was recruited retrospectively using letters. Paper III primarily compared antibiotic prescriptionrates per sore throat visit, while paper IV primarily compared subsequent physical health careutilization within two weeks for patients in the Skåne Region.Results: Interrater reliability was low (Cohen κ 0.17) between the panel majority vote and the machine learningmodel. Physicians and nurses experienced digitally filtered primary care, adjusting to a novel medium ofcommunication highlighting challenges in interpreting symptoms through text as well as alterations in practiceworkflow using asynchronous communication. Antibiotics prescription rate within three days was not higher aftereVisits compared to office visits (169/798 (21.2%) vs. 124/312 (39.7%) for sore throat, respectively; P<.001). Nosignificant differences in subsequent physical visits within two weeks (excluding the first 48 h of expected “digi-physical”care) were noted following eVisits compared to office visits (179 (18.0%) vs. 102 (17.6%); P = .854).Conclusions: eVisits do not seem to be associated with over-prescription of antibiotics, or over-utilization ofphysical health care when assessing common infectious symptoms. Given staff experiencing uncertainties ininterpretation of symptoms and triage decisions being inconsistent, eVisits may be best used as one of manymodalities to access primary care, with focus placed on facilitating patient-centered professional judgement bystaff, rather than automation of complex decisions

Cost-utility analysis of case management for frail older people: effects of a randomised controlled trial

Background To evaluate the effects of a case management intervention for frail older people (aged 65+ years) by cost and utility. Materials and methods One hundred and fifty-three frail older people living at home were randomly assigned to either an intervention (n = 80) or a control group (n = 73). The 1-year intervention was carried out by nurses and physiotherapists working as case managers, who undertook home visits at least once a month. Differences in costs and quality-adjusted life years (QALYs) based on the health-related quality-of-life instruments EQ-5D and EQ-VAS, and also the incremental cost-effectiveness ratio were investigated. All analyses used the intention-to-treat principle. Results There were no significant differences between the intervention group and control group for total cost, EQ-5D-based QALY or EQ-VAS-based QALY for the 1-year study. Incremental cost-effectiveness ratio was not conducted because no significant differences were found for either EQ-5D- or EQ-VAS-based QALY, or costs. However, the intervention group had significantly lower levels of informal care and help with instrumental activities of daily living both as costs (€3,927 vs. €6,550, p = 0.037) and provided hours (200 vs. 333 hours per year, p = 0.037). Conclusions The intervention was cost neutral and does not seem to have affected health-related quality of life for the 1-year study, which may be because the follow-up period was too short. The intervention seems to have reduced hours and cost of informal care and help required with instrumental activities of daily living. This suggests that the intervention provides relief to informal caregivers

Availability of specialized healthcare facilities for deaf and hard of hearing individuals.

Context: To allow a medical consultation to proceed successfully, it is essential that physicians are aware of the linguistic and cultural backgrounds of deaf and hard of hearing individuals (DHH) and related communication aspects. Some specialised healthcare facilities have emerged to respond to the specific needs of people who are DHH. Objective: This study aims to provide insight into the various types of general healthcare facilities available for DHH individuals. By sharing and comparing experiences and results improvements can be made. Design, Data Sources and Study selection: A systematic review of the literature on specialised healthcare for DHH people was performed. The following databases were searched: PubMed, Web of Science, PsycINFO, Academic Search Premier, CINAHL and Embase. After independent extraction per article by two readers, fifteen articles were included in the systematic review. As it appeared that not all existing locations of facilities of which we were aware were described in the literature, we expanded the data collection with internet searches, specific literature searches and unstructured interviews. Results: Some countries have developed facilities to meet the needs DHH people Experts and patients’ groups report that the perceived quality of healthcare and health education in specialised healthcare settings is higher compared to regular healthcare settings. Two projects undertaken to improve the health related knowledge level of DHH people, proved to be effective. Conclusion: Some facilities or combinations of facilities are used in different countries to attempt to meet the needs of DHH patients. These facilities are rarely described in the scientific literature. Further development of specialised healthcare facilities for DHH patients, which should include high quality studies on their effectiveness, is imperative to comply with medical ethical standards and respect the human rights of DHH people