Development and validation of a short version of the Assessment of Chronic Illness Care (ACIC) in Dutch Disease Manegement Progams

Background: In the Netherlands the extent to which chronically ill patients receive care congruent with the Chronic Care Model is unknown. The main objectives of this study were to (1) validate the Assessment of Chronic Illness Care (ACIC) in the Netherlands in various Disease Management Programmes (DMPs) and (2) shorten the 34-item ACIC while maintaining adequate validity, reliability, and sensitivity to change.Methods: The Dutch version of the ACIC was tested in 22 DMPs with 218 professionals. We tested the instrument by means of structural equation modelling, and examined its validity, reliability and sensitivity to change.Results: After eliminating 13 items, the confirmatory factor analyses revealed good indices of fit with the resulting 21-item ACIC (ACIC-S). Internal consistency as represented by Cronbach\'s alpha ranged from \'acceptable\' for the \'clinical information systems\' subscale to \'excellent\' for the \'organization of the healthcare delivery system\' subscale. Correlations between the ACIC and ACIC-S subscales were also good, ranging from .87 to 1.00, indicating acceptable coverage of the core areas of the CCM. The seven subscales were significantly and positively correlated, indicating that the subscales were conceptually related but also distinct. Paired t-tests results show that the ACIC scores of the original instrument all improved significantly over time in regions that were in the process of implementing DMPs (all components at p < 0.0001).Conclusion: We conclude that the psychometric properties of the ACIC and the ACIC-S are good and the ACIC-S is a promising alternate instrument to assess chronic illness care

Changes in costs and effects after the implementation of disease management programs in the Netherlands: Variability and determinants

__Abstract __ Objectives The aim of the study was to investigate the changes in costs and outcomes after the implementation of various disease management programs (DMPs), to identify their potential determinants, and to compare the costs and outcomes of different DMPs. Methods We investigated the 1-year changes in costs and effects of 1,322 patients in 16 DMPs for cardiovascular risk (CVR), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DMII) in the Netherlands. We also explored the within-DMP predictors of these changes. Finally

Value-based person-centred integrated care for frail elderly living at home: a quasi-experimental evaluation using multicriteria decision analysis

Objective To evaluate the value of the person-centred, integrated care programme Care Chain Frail Elderly (CCFE) compared with usual care, using multicriteria decision analysis (MCDA). Design In a 12-month quasi-experimental study, triple-aim outcomes were measured at 0, 6 and 12 months by trained interviewers during home-visits. Setting Primary care, community-based elderly care. Participants 384 community-dwelling frail elderly were enrolled. The 12-month completion rate was 70% in both groups. Propensity score matching was used to balance age, gender, marital status, living situation, education, smoking status and 3 month costs prior to baseline between the two groups. Intervention The CCFE is an integrated care programme with unique features like the presence of the elderly and informal caregiver at the multidisciplinary team meetings, and a bundled payment. Primary and secondary outcomes measures The MCDA results in weighted overall value scores that combines the performance on physical functioning, psychological well-being, social relationships and participation, enjoyment of life, resilience, person-centredness, continuity of care and costs, with importance weights of patients, informal caregivers, professionals, payers and policy-makers. Results At 6 months, the overall value scores of CCFE were higher in all stakeholder groups, driven by enjoyment of life (standardised performance scores 0.729 vs 0.685) and person-centredness (0.749 vs 0.663). At 12 months, the overall value scores in both groups were similar from a patient’s perspective, slightly higher for CCFE from an informal caregiver’s and professional’s perspective, and lower for CCFE from a payer’s and policy-maker’s perspective. The latter was driven by a worse performance on physical functioning (0.682 vs 0.731) and higher costs (€22 816 vs €20 680). Conclusions The MCDA indicated that the CCFE is the preferred way of delivering care to frail elderly at 6 months. However, at 12 months, MCDA results showed little difference from the perspective of patients, informal caregivers and professionals, while payers and policy-makers seemed to prefer usual care.publishedVersio

Identifying and explaining the variability in development and implementation costs of disease management programs in the Netherlands

BACKGROUND: In the Netherlands, disease management programs (DMPs) are used to treat chronic diseases. Their aim is to improve care and to control the rising expenditures related to chronic diseases. A bundled payment was introduced to facilitate the implementation of DMPs. This payment is an all-inclusive price per patient per year for a pre-specified care package. However, it is unclear to which extent the costs of developing and implementing DMPs are included in this price. Consequently, the organizations providing DMPs bear financial risk because the development and implementation (D&I) costs may be substantial. The aim of this paper is to investigate the variability in and drivers of D&I costs among 22 DMPs and highlight characteristics th

Incidence and general hospital costs of self-harm across England: Estimates based on the multicentre study of self-harm

AimsThe aim of this study was to estimate incidence of self-harm presentations to hospitals and their associated hospital costs across England.MethodsWe used individual patient data from the Multicentre Study of Self-harm in England of all self-harm presentations to the emergency departments of five general hospitals in Oxford, Manchester and Derby in 2013. We also obtained cost data for each self-harm presentation from the hospitals in Oxford and Derby, as well as population and geographical estimates from the Office for National Statistics. First, we estimated the rate of self-harm presentations by age and gender in the Multicentre Study and multiplied this with the respective populations to estimate the number of self-harm presentations by age and gender for each local Clinical Commissioning Group (CCG) area in England. Second, we performed a regression analysis on the cost data from Oxford and Derby to predict the hospital costs of self-harm in Manchester by age, gender, receipt of psychosocial assessment, hospital admission and type of self-harm. Third, the mean hospital cost per age year and gender were combined with the respective number of self-harm presentations to estimate the total hospital costs for each CCG in England. Sensitivity analysis was performed to address uncertainty in the results due to the extrapolation of self-harm incidence and cost from the Multicentre Study to England.ResultsThere were 228 075 estimated self-harm presentations (61% were female) by 159 857 patients in 2013 in England. The largest proportions of self-harm presentations were in the age group 40-49 years (30%) for men and 19-29 years (28%) for women. Associated hospital costs were approximately £128.6 (95% CI 117.8-140.9) million in 2013. The estimated incidence of self-harm and associated hospital costs were lower in the majority of English coastal areas compared to inland regions but the highest costs were in Greater London. Costs were also higher in more socio-economically deprived areas of the country compared with areas that are more affluent. The sensitivity analyses provided similar results.ConclusionsThe results of this study highlight the extent, hospital costs and distribution of self-harm presentations to hospitals in England and identify potential sub-populations that might benefit from targeted actions to help prevent self-harm and assist those who have self-harmed. They can support national as well as local health stakeholders in allocating funds and prioritising interventions in areas with the greatest need for preventing and managing self-harm

Should I stay or should I go? A retrospective propensity score-matched analysis using administrative data of hospital-at-home for older people in Scotland.

OBJECTIVES: To compare the characteristics of populations admitted to hospital-at-home services with the population admitted to hospital and assess the association of these services with healthcare costs and mortality. DESIGN: In a retrospective observational cohort study of linked patient level data, we used propensity score matching in combination with regression analysis. PARTICIPANTS: Patients aged 65 years and older admitted to hospital-at-home or hospital. INTERVENTIONS: Three geriatrician-led admission avoidance hospital-at-home services in Scotland. OUTCOME MEASURES: Healthcare costs and mortality. RESULTS: Patients in hospital-at-home were older and more socioeconomically disadvantaged, had higher rates of previous hospitalisation and there was a greater proportion of women and people with several chronic conditions compared with the population admitted to hospital. The cost of providing hospital-at-home varied between the three sites from £628 to £2928 per admission. Hospital-at-home was associated with 18% lower costs during the follow-up period in site 1 (ratio of means 0.82; 95% CI: 0.76 to 0.89). Limiting the analysis to costs during the 6 months following index discharge, patients in the hospital-at-home cohorts had 27% higher costs (ratio of means 1.27; 95% CI: 1.14 to 1.41) in site 1, 9% (ratio of means 1.09; 95% CI: 0.95 to 1.24) in site 2 and 70% in site 3 (ratio of means 1.70; 95% CI: 1.40 to 2.07) compared with patients in the control cohorts. Admission to hospital-at-home was associated with an increased risk of death during the follow-up period in all three sites (1.09, 95% CI: 1.00 to 1.19 site 1; 1.29, 95% CI: 1.15 to 1.44 site 2; 1.27, 95% CI: 1.06 to 1.54 site 3). CONCLUSIONS: Our findings indicate that in these three cohorts, the populations admitted to hospital-at-home and hospital differ. We cannot rule out the risk of residual confounding, as our analysis relied on an administrative data set and we lacked data on disease severity and type of hospitalised care received in the control cohorts

The impact of the COVID-19 pandemic on children and adolescent mental health inpatient service use in England: An interrupted time-series analysis of national patient records

Background: During the initial phases of the COVID 19 pandemic children and young people (CYP) faced significant restrictions. The virus and mitigation approaches significantly impacted how health services could function, and be safely delivered. Aims: To investigate the impact of COVID-19 lockdowns on CYP psychiatric admission trends during lockdowns 1 (started 23/032020) and 2 (started 05/11 2020) of the COVID 19 pandemic in England. Methods: Routinely collected, retrospective, English administrative data looking at psychiatric hospital admissions, length of stay and patient demographic factors were analysed using an interrupted time series analysis (ITSA) to estimate the impact of COVID 19 lockdowns 1 and 2 on service use trends. We analysed data of 6,250 CYP (up to 18 years of age) using ordinary least squares (OLS) regression analysis with Newey-West standard errors to handle autocorrelation and heteroscedasticity. Results: Psychiatric hospital admissions for CYP significantly fell during lockdown 1, and then fell further even during lockdown 2. A greater proportion of admissions during lockdown were out of area or to independent sector units. During lockdown, the average age of CYP admitted was older and a greater proportion were female. There was also a significant increase in the proportion of looked-after children and CYP from the most socioeconomically deprived areas admitted during lockdown 2. Conclusions: During both lockdowns, fewer CYP had psychiatric admissions. The subsequent rise in admissions for more socioeconomically deprived CYP and looked after children suggests these CYP may have been disproportionately affected by the pandemic, or overlooked during earlier phases

Lessons learned from the application of the HEcoPerMed guidance to three modeling case studies

Background: The HEcoPerMed consortium developed a methodological guidance for the harmonization and improvement of economic evaluations in personalized medicine. Materials &amp; methods: In three therapeutic areas, health economic models were developed to scrutinize the recommendations of the guidance. Results: Altogether, 20 of the 23 recommendations of the guidance were addressed by the models. Seven recommendations were applied in all studies, six in two of the studies and seven in one of the studies. Recommendations with an essential role on the final conclusions of the analyses were identified in each study. Conclusion: The guidance was found to be best used as a tool to identify and prioritize issues, verify solutions and justify decisions during the economic analysis of personalized interventions