The effect of patient, provider and financing regulations on the intensity of ambulatory physical therapy episodes: a multilevel analysis based on routinely available data.

BACKGROUND: Many studies have found considerable variations in the resource intensity of physical therapy episodes. Although they have identified several patient- and provider-related factors, few studies have examined their relative explanatory power. We sought to quantify the contribution of patients and providers to these differences and examine how effective Swiss regulations are (nine-session ceiling per prescription and bonus for first treatments). METHODS: Our sample consisted of 87,866 first physical therapy episodes performed by 3,365 physiotherapists based on referrals by 6,131 physicians. We modeled the number of visits per episode using a multilevel log linear regression with crossed random effects for physiotherapists and physicians and with fixed effects for cantons. The three-level explanatory variables were patient, physiotherapist and physician characteristics. RESULTS: The median number of sessions was nine (interquartile range 6-13). Physical therapy use increased with age, women, higher health care costs, lower deductibles, surgery and specific conditions. Use rose with the share of nine-session episodes among physiotherapists or physicians, but fell with the share of new treatments. Geographical area had no influence. Most of the variance was explained at the patient level, but the available factors explained only 4% thereof. Physiotherapists and physicians explained only 6% and 5% respectively of the variance, although the available factors explained most of this variance. Regulations were the most powerful factors. CONCLUSION: Against the backdrop of abundant physical therapy supply, Swiss financial regulations did not restrict utilization. Given that patient-related factors explained most of the variance, this group should be subject to closer scrutiny. Moreover, further research is needed on the determinants of patient demand

Comparing potentially avoidable hospitalization rates related to ambulatory care sensitive conditions in Switzerland: the need to refine the definition of health conditions and to adjust for population health status.

BACKGROUND: Regional rates of hospitalization for ambulatory care sensitive conditions (ACSC) are used to compare the availability and quality of ambulatory care but the risk adjustment for population health status is often minimal. The objectives of the study was to examine the impact of more extensive risk adjustment on regional comparisons and to investigate the relationship between various area-level factors and the properly adjusted rates. METHODS: Our study is an observational study based on routine data of 2 million anonymous insured in 26 Swiss cantons followed over one or two years. A binomial negative regression was modeled with increasingly detailed information on health status (age and gender only, inpatient diagnoses, outpatient conditions inferred from dispensed drugs and frequency of physician visits). Hospitalizations for ACSC were identified from principal diagnoses detecting 19 conditions, with an updated list of ICD-10 diagnostic codes. Co-morbidities and surgical procedures were used as exclusion criteria to improve the specificity of the detection of potentially avoidable hospitalizations. The impact of the adjustment approaches was measured by changes in the standardized ratios calculated with and without other data besides age and gender. RESULTS: 25% of cases identified by inpatient main diagnoses were removed by applying exclusion criteria. Cantonal ACSC hospitalizations rates varied from to 1.4 to 8.9 per 1,000 insured, per year. Morbidity inferred from diagnoses and drugs dramatically increased the predictive performance, the greatest effect found for conditions linked to an ACSC. More visits were associated with fewer PAH although very high users were at greater risk and subjects who had not consulted at negligible risk. By maximizing health status adjustment, two thirds of the cantons changed their adjusted ratio by more than 10 percent. Cantonal variations remained substantial but unexplained by supply or demand. CONCLUSION: Additional adjustment for health status is required when using ACSC to monitor ambulatory care. Drug-inferred morbidities are a promising approach

Adolescent drug use escalation and de-escalation: a 3-year follow-up study [Abstract]

This study aims to assess adolescents drug use with a longitudinal perspective in order to identify factors interacting with drug use onset and course. Supported by the Swiss Federal Office of Public Health, the study was initiated in 1999 with a follow-up in 2001 and 2002. The first objective was to measure risk factors for substance use initiation. The second objective was to analyse the co-variation of substance use with environmental, social, relational, medical and psychological factors. A total of 102 adolescents, aged 14-19 years, were recruited for the study in the French-speaking part of Switzerland. Results clearly show that substance use is not a disorder per se in adolescence, but that it is part of a multidimensional complex of problems that some adolescents may encounter: increase and decrease in substance use is paralleled with an increase or decrease in the other areas. This implies that prevention of substance use should not be focused mainly on substances but should consider the adolescent's environment and significant life area

Incidence of glomerulonephritis in the western part of Switzerland over the last decade.

Glomerulonephritis is a rare yet serious group of diseases with a high risk of progression to end-stage renal disease. For optimal healthcare planning, detailed epidemiological and demographic data are essential. Despite their clinical relevance, these data are largely lacking in Switzerland. The objective of this study was to assess the incidence of the different forms of glomerulonephritis in the western part of Switzerland and its changes over the last 10 years, compared with international data. We listed all renal biopsy reports analysed between 2007 and 2016 at the University hospital of Lausanne, the renal pathology reference centre of all hospitals in the cantons of Vaud, Fribourg, Valais and Neuchâtel. Biopsies with a first diagnosis of primary glomerulonephritis were included in the analysis. The incidence was calculated as the number of patients newly diagnosed with glomerulonephritis divided by the number of inhabitants of all the above-mentioned cantons during the year under review, as retrieved from the federal statistical office of Switzerland. We collected biopsy reports from 864 patients between 2007 and 2016; 168 biopsies met the inclusion criteria. The most common primary glomerulonephritis was IgA nephropathy at 32.7% of cases, followed by lupus nephritis (29.8%) and pauci-immune glomerulonephritis (11.9%). Overall, the mean incidence of glomerulonephritis was 1.3/100,000/year. Between 2007 and 2016, the incidence of all glomerulonephritis taken together remained stable. The same was true for the incidence of IgA nephropathy, lupus nephritis and pauci-immune glomerulonephritis. In contrast, we observed a trend towards higher creatinine levels, proteinuria and degree of interstitial fibrosis at diagnosis. The incidence of glomerulonephritis in the western part of Switzerland was low and remained stable over time, in line with European data

Hospital discharge data is not accurate enough to monitor the incidence of postpartum hemorrhage.

Postpartum hemorrhage remains a leading cause of maternal morbidity and mortality worldwide. Therefore, cumulative incidence of postpartum hemorrhage and severe postpartum hemorrhage are commonly monitored within and compared across maternity hospitals or countries for obstetrical safety improvement. These indicators are usually based on hospital discharge data though their accuracy is seldom assessed. We aimed to measure postpartum hemorrhage and severe postpartum hemorrhage using electronic health records and hospital discharge data separately and compare the detection accuracy of these methods to manual chart review, and to examine the temporal trends in cumulative incidence of these potentially avoidable adverse outcomes. We analyzed routinely collected data of 7904 singleton deliveries from a large Swiss university hospital for a three year period (2014-2016). We identified postpartum hemorrhage and severe postpartum hemorrhage in electronic health records by text mining discharge letters and operative reports and calculating drop in hemoglobin from laboratory tests. Diagnostic and procedure codes were used to identify cases in hospital discharge data. A sample of 334 charts was reviewed manually to provide a reference-standard and evaluate the accuracy of the other detection methods. Sensitivities of detection algorithms based on electronic health records and hospital discharge data were 95.2% (95% CI: 92.6% 97.8%) and 38.2% (33.3% to 43.0%), respectively for postpartum hemorrhage, and 87.5% (85.2% to 89.8%) and 36.2% (26.3% to 46.1%) for severe postpartum hemorrhage. Postpartum hemorrhage cumulative incidence based on electronic health records decreased from 15.6% (13.1% to 18.2%) to 8.5% (6.7% to 10.5%) from the beginning of 2014 to the end of 2016, with an average of 12.5% (11.8% to 13.3%). The cumulative incidence of severe postpartum hemorrhage remained at approximately 4% (3.5% to 4.4%). Hospital discharge data-based algorithms provided significantly underestimated incidences. Hospital discharge data is not accurate enough to assess the incidence of postpartum hemorrhage at hospital or national level. Instead, automated algorithms based on structured and textual data from electronic health records should be considered, as they provide accurate and timely estimates for monitoring and improvement in obstetrical safety. Furthermore, they have the potential to better code for postpartum hemorrhage thus improving hospital reimbursement

Évolution des comportements et des représentations sociales liés à la consommation de cannabis chez les adolescents. Résumé

La recherche, dont les résultats principaux sont décrits dans ce résumé, visait trois objectifs différents: a) mieux comprendre l'évolution de la consommation de substances durant l'adolescence; b) mesurer les représentations sociales, par rapport à la consommation, dans une population de consommateurs comparée à une population «tout-venant»; c) valider un instrument de dépistage de la consommation. L'échantillon, sur lequel porte l'observation du suivi, est représentatif d'une population de consommateurs de substances. Le suivi a été réalisé sur une période de quatre ans, l'âge des sujets variant entre 15 et 20 ans au moment du premier entretien. Pour l'évaluation des représentations sociales, une population «tout-venant» a été recrutée, afin de pouvoir comparer les attitudes et opinions des adolescents en relation avec la consommation. Enfin, pour la validation de l'instrument de screening, les deux populations, suivi et «tout-venant», ont été réunies

Qualités psychométriques du Consumer satisfaction questionnaire (CSQ-8) et du Helping alliance questionnaire (HAQ) [Psychometric properties of the Consumer Satisfaction Questionnaire (CSQ-8) and the Helping Alliance Questionnaire (HAQ)].

BACKGROUND: This study was based on data from a quality of care assessment survey conducted in 2011 in outpatient polyclinics of the Vaud Canton in Switzerland, comprising questionnaires completed by 568 children over the age often and 672 parents of children of all ages. The objective of this study was to evaluate the psychometric qualities of the eight-item French versions for children of the Helping Alliance Questionnaire (HAQ) and the Consumer Satisfaction Questionnaire (CSQ-8) to allow formal validation and clinical application of these tools in the context of French-speaking child psychiatry. METHODOLOGY: Responses from children over the age often to the HAQ and CSQ-8 questionnaires were submitted to confirmatory factorial analysis (CFA) for ordinal data to verify their good fit with the original long versions. Construct validity (correspondence between scores on the scales and other external criteria considered to evaluate similar concepts) of the child questionnaires was tested by Spearman's correlation with the parents' responses and their feeling of being reassured or in agreement with respect to the first visit, and with the perception of the help provided by individual and family interviews. RESULTS: CFA showed an acceptable fit with the one-dimensional model of the original scales, both for the HAQ and the CSQ-8. Significant positive correlations of the scales with the parents' responses and with other convergent external criteria confirmed the good construct validity. CONCLUSIONS: These psychometric analyses provide a basis for the validation and clinical application of the abridged French versions of the HAQ and CSQ-8 in quality of care assessment in child psychiatry

Early identification of children with developmental delay and behavioural problems according to parents concerns in the Republic of Serbia

The main goal of this research was to describe the type and level of parents' concerns about child development and behaviour according to the PEDS test (Parents' Evaluation of Developmental Status). The sample included 289 parents of children from three to seven years of age, from two preschool institutions in Serbia. A significantly high correlation was determined between parents' general concerns and expressed concerns with regard to behaviour ((2)=17.86, df=2, p lt .001) and getting along with others ((2)=22.57, df=2, p lt .000). A marginally significant correlation was determined between parents' general concerns and manifested concerns with regard to fine motor skills ((2)=5.90, df=2, p=.052), as well as expressive language ((2)=5.858, df=2, p=.053). According to the criteria of PEDS test, this research identified 56.4% of children whose development needed to be monitored, 27.7% of children who needed to be referred for detailed diagnostic procedures, and 1.7% who needed to be included in treatment or special education support.This is the peer‐reviewed version of the article: Ilić, S. B.; Nikolić, S. J.; Ilić-Stošović, D. D.; Golubović, Š. S. Early Identification of Children with Developmental Delay and Behavioural Problems According to Parents Concerns in the Republic of Serbia. Early Child Development and Care 2020, 190 (16), 2605–2611. [https://doi.org/10.1080/03004430.2019.1595610