Designing and implementing a payment system to support cancer care coordination: A literature review

International audienceBackground: Demands for new payment systems to better coordinate services along the care continuum are emerging in oncology. Among them, bundling payments for defined episodes of care are considered as a promising payment option. The study objective was to understand how to develop an optimal payment system in order to foster coordination between hospitals and post-acute providers, and to identify potential pitfalls associated with its implementation. Methods: We conducted a literature review, exploring articles published between 2010 and 2015 in Medline. 47 papers were finally retrieved, including 18 articles focusing on cancer care. Results: The review highlighted key issues in the design and implementation of an alternative payment model in oncology. First, some studies explained that the level of integration of the different stakeholders would condition the choice of the payment design. They advised that the enrolled caregivers had a prior experience of working together so that the payment could rely on already formalized care processes. Second, most papers insisted that healthcare professionals had to be included since the design phase to agree on a standardized care pathway that would be consistent with current guidelines. To do so, focus groups and semi-structured interviews conducted with professionals from the enrolled facilities, as well as payers and patient associations, were favored. Third, the review showed that economic evaluations were necessary to have an understanding of the episode costs and determine gain-sharing arrangements between caregivers as well as their respective financial accountability. Using a micro-costing approach and adopting a societal perspective to estimate direct, indirect and intangible costs were demanded. Contingent evaluations measuring professionals’ willingness to participate in the payment scheme could serve as complementary analyses. Conclusions: The adoption of a new payment system would be strongly dependent on the design choices and implementation processes. A pilot study assessing its effectiveness in cancer care should bring important knowledge for policymakers willing to develop value-based payment systems in oncology

Evaluation of full costs of care for patients with Alzheimer's disease in France: The predominant role of informal care

International audienc

Réformer la tarification à l’activité : les nouveaux modes de paiement et leurs usages dans les établissements de santé

National audience- Introduction - Les modes de paiement alternatifs à la tarification à l’activité - Le paiement à la qualité (ou paiement à la performance, P4P) - Le paiement à la coordination - Contexte d’application dans le cas français - En pratique : l’expérimentation française de paiement à la performance - L’évaluation d’IFAQ - Conclusio

Additional file 1: of Economic evaluation of patient navigation programs in colorectal cancer care, a systematic review

Additional file of Economic evaluation of patient navigation programs in colorectal cancer care, a systematic review. (DOCX 38 kb

Impacts of a navigation program based on health information technology for patients receiving oral anticancer therapy: the CAPRI randomized controlled trial

International audienceBACKGROUND: The emergence of oral delivery in cancer therapeutics is expected to result in an increased need for better coordination between all treatment stakeholders, mainly to ensure adequate treatment delivery to the patient. There is significant interest in the nurse navigation program's potential to improve transitions of care by improving communication between treatment stakeholders and by providing personalized organizational assistance to patients. The use of health information technology is another strategy aimed at improving cancer care coordination that can be combined with the NN program to improve remote patient follow-up. However, the potential of these two strategies combined to improve oral treatment delivery is limited by a lack of rigorous evidence of actual impact. METHODS/DESIGN: We are conducting a large scale randomized controlled trial designed to assess the impact of a navigation program denoted CAPRI that is based on two Nurse Navigators and a web portal ensuring coordination between community and hospital as well as between patients and navigators, versus routine delivery of oral anticancer therapy. The primary research aim is to assess the impact of the program on treatment delivery for patients with metastatic cancer, as measured by Relative Dose Intensity. The trial involves a number of other outcomes, including tumor response, survival, toxic side effects, patient quality of life and patient experience An economic evaluation adopting a societal perspective will be conducted, in order to estimate those health. care resources' used. A parallel process evaluation will be conducted to describe implementation of the intervention. DISCUSSION: If the CAPRI program does improve treatment delivery, the evidence on its economic impact will offer important knowledge for health decision-makers, helping develop new follow-up services for patients receiving oral chemotherapy and/or targeted therapy. The process evaluation will determine the best conditions in which such a program might be implemented. TRIAL REGISTRATION: NCT 02828462 . Registered 29 June 2016

Cardiovascular risk and mortality prediction in patients suspected of sleep apnea: a model based on an artificial intelligence system

International audienceObjective. Cardiovascular disease (CVD) is one of the leading causes of death worldwide. There are many CVD risk estimators but very few take into account sleep features. Moreover, they are rarely tested on patients investigated for obstructive sleep apnea (OSA). However, numerous studies have demonstrated that OSA index or sleep features are associated with CVD and mortality. The aim of this study is to propose a new simple CVD and mortality risk estimator for use in routine sleep testing.Approach. Data from a large multicenter cohort of CVD-free patients investigated for OSA were linked to the French Health System to identify new-onset CVD. Clinical features were collected and sleep features were extracted from sleep recordings. A machine-learning model based on trees, AdaBoost, was applied to estimate the CVD and mortality risk score.Main results. After a median [inter-quartile range] follow-up of 6.0 [3.5-8.5] years, 685 of 5234 patients had received a diagnosis of CVD or had died. Following a selection of features, from the original 30 features, 9 were selected, including five clinical and four sleep oximetry features. The final model included age, gender, hypertension, diabetes, systolic blood pressure, oxygen saturation and pulse rate variability (PRV) features. An area under the receiver operating characteristic curve (AUC) of 0.78 was reached.Significance. AdaBoost, an interpretable machine-learning model, was applied to predict 6 year CVD and mortality in patients investigated for clinical suspicion of OSA. A mixed set of simple clinical features, nocturnal hypoxemia and PRV features derived from single channel pulse oximetry were used

Association of symptom subtypes and obstructive sleep apnoea-specific hypoxic burden with cardiovascular morbidity and all-cause mortality

International audienceBackground: Data from population-based cohorts suggest that symptom subtypes and obstructive sleep apnea (OSA) specific hypoxic burden (HB) could help to better identify patients with OSA at high cardiovascular (CV) risk.Aim: We aimed to evaluate whether OSA symptoms subtypes and HB derived from sleep recordings were associated with increased CV risk in clinical setting.Methods: Clinical data from a large multicenter cohort were linked to health administrative data to identify new-onset of CV events and death in patients with OSA and no overt CV disease. Latent class analysis was used to identify subtypes based on 8 clinically relevant variables. HB was defined as the total area under the respiratory event-related desaturation curve. Cox proportional hazards models were used to evaluate the association of symptom subtypes and HB with a composite outcome of incident CV events or death from any cause.Results: Four symptom subtypes were identified (minimally symptomatic [22.0%], disturbed sleep [17.5%], excessively sleepy [49.8%], and moderately sleepy [10.6%]), similar to prior studies. After a median follow-up of 78 months, 592 (11.05%) of 5358 patients experienced our composite outcome. In a fully adjusted model, increasing age and HB, male gender, the presence of diabetes, hypertension and COPD were significant predictors of the composite outcome. AHI and symptom subtypes were not associated with CV risk after adjustments.Conclusion: In clinical setting, patients with OSA who demonstrate elevated OSA specific HB are at higher risk of CV event and all cause mortality. Symptom subtypes have no predictive value after adjustment for confounders

Hypoxic burden and heart-rate variability predict stroke incidence in sleep apnoea

International audienceManuscript word count: 1,374 "take home" message: Indices of sleep apnoea-related hypoxic burden and heart rate variability derived from full-night polysomnography might be useful for identifying sleep apnoea patients at risk for stroke

Association of Nocturnal Hypoxemia and Pulse Rate Variability with Incident Atrial Fibrillation in Patients Investigated for Obstructive Sleep Apnea

International audienceRationale: Nocturnal hypoxemia and sympathetic/parasympathetic imbalance might contribute to the occurrence or atrial fibrillation (AF) in patients with obstructive sleep apnea (OSA). During sleep recordings, pulse rate variability (PRV) derived from oximetry might provide an accurate estimation of heart rate variability, which reflects the autonomic cardiovascular control. Objectives: We aimed to evaluate whether indices of oxygen desaturation and PRV derived from nocturnal oximetry were associated with AF incidence in patients investigated for OSA. Methods: Data from a large multicenter cohort of AF-free patients investigated for OSA between May 15, 2007, and December 31, 2017, were linked to health administrative data to identify hospitalized and nonhospitalized patients with new-onset AF. Cox proportional hazards models were used to evaluate the association between AF incidence and oximetry-derived indices automatically generated from sleep recordings. Results: After a median (interquartile range) follow-up of 5.34 (3.3-8.0) years, 181 of 7,205 patients developed AF (130 were hospitalized for AF). After adjusting for confounders, including anthropomorphic data, alcohol intake, cardiac, metabolic and respiratory diseases, beta blocker/calcium channel blocker medications, type of sleep study, study site, and positive airway pressure adherence, AF risk was associated with increasing nocturnal hypoxemia (P trend = 0.004 for quartiles of percentage of recording time with oxygen saturation <90%) and PRV (P trend < 0.0001 for quartiles of root mean square of the successive normal-normal beat interval differences), and decreasing sympathetic/parasympathetic tone (P trend = 0.0006 for quartiles of low-frequency power/high-frequency power ratio). The highest risk of AF was observed in patients with the highest quartiles of both the percentage of recording time with oxygen saturation <90% and the root mean square of the successive normal-normal beat interval differences compared with those with neither of these conditions (adjusted hazard ratio, 3.61; 95% confidence interval, 2.10-6.22). Similar associations were observed when the analyses were restricted to hospitalized AF. Conclusions: In patients investigated for OSA, nocturnal hypoxemia and PRV indices derived from single-channel pulse oximetry were independent predictors of AF incidence. Patients with both marked nocturnal hypoxemia and high PRV were at higher risk of AF. Oximetry may be used to identify patients with OSA at greatest risk of developing AF