Return to sender:Unraveling the role of structural and social network ties in patient sharing networks

Healthcare is increasingly delivered through networks of organizations. Well-structured patient sharing networks are known to have positive associations with the quality of delivered services. However, the drivers of patient sharing relations are rarely studied explicitly. In line with recent developments in network and integration theorizing, we hypothesize that structural and social network ties between organizations are uniquely associated with a higher number of shared patients. We test these hypotheses using a Bayesian zero-dispersed Poisson regression model within the Additive and Multiplicative Effects Framework based on administrative claims data from 732,122 dermatological patients from the Netherlands in 2017. Our results indicate that 2.6% of all dermatological patients are shared and that the amount of shared patients is significantly associated with structural (i.e. emergency contracts) and social (i.e. shared physicians) ties between organizations, confirming our hypotheses. We also find some evidence that patients are shared with more capable organizations. Our findings highlight the role of relational ties in the way health services are delivered. At the same time, they also raise some potential anti-trust concerns.</p

Return to sender:Unraveling the role of structural and social network ties in patient sharing networks

Healthcare is increasingly delivered through networks of organizations. Well-structured patient sharing networks are known to have positive associations with the quality of delivered services. However, the drivers of patient sharing relations are rarely studied explicitly. In line with recent developments in network and integration theorizing, we hypothesize that structural and social network ties between organizations are uniquely associated with a higher number of shared patients. We test these hypotheses using a Bayesian zero-dispersed Poisson regression model within the Additive and Multiplicative Effects Framework based on administrative claims data from 732,122 dermatological patients from the Netherlands in 2017. Our results indicate that 2.6% of all dermatological patients are shared and that the amount of shared patients is significantly associated with structural (i.e. emergency contracts) and social (i.e. shared physicians) ties between organizations, confirming our hypotheses. We also find some evidence that patients are shared with more capable organizations. Our findings highlight the role of relational ties in the way health services are delivered. At the same time, they also raise some potential anti-trust concerns.</p

Moving Beyond the QALY: Economic Evaluation in Health and Social Care for Elderly Populations

__Abstract__ The growing number of elderly consumes an increasing amount of health and social care services, straining public budgets. Economic evaluations have traditionally focused on curative care using health-related quality of life as outcomes, and gave answers which interventions to fund or not to fund. However in order to evaluate long-term care as well, broader outcomes are necessary. The aim of this thesis is to address a number of issues related to outcome measurement in economic evaluations in elderly populations consuming health and social care. After performing a traditional economic evaluation in long-term care and identifying the limitations, a systematic review was performed in order to search for more appropriate outcomes. The review identified the ICECAP-O instrument, and this has been validated in Dutch and German Nursing homes, as well as in a population of post-hospitalized older people. Finally, we have performed an economic evaluation using the ICECAP-O. The ICECAP-O in general measures broader than health outcomes. It was related to measures of health-related and dementia-specific quality of life, physical, mental and social health, and to wellbeing instruments. It also differentiates between elderly below and above 75 years, multimorbidity, dementia severity, living alone or together and elderly with nursing homes with or without physical restraints. In

Cost-effectiveness of a pressure ulcer quality collaborative

ABSTRACT. BACKGROUND: A quality improvement collaborative (QIC) in the Dutch long-term care sector (nursing homes, assisted living facilities, home care) used evidence-based prevention methods to reduce the incidence and prevalence of pressure ulcers (PUs). The collaborative consisted of a core team of experts and 25 organizational project teams. Our aim was to determine its cost-effectiveness from a healthcare perspective. METHODS: We used a non-controlled pre-post design to establish the change in incidence and prevalence of PUs in 88 patients over the course of a year. Staff indexed data and prevention methods (activities, materials). Quality of life (Qol) weights were assigned to the PU states. We assessed the costs of activities and materials in the project. A Markov model was built based on effectiveness and cost data, complemented with a probabilistic sensitivity analysis. To illustrate the results of longer term, three scenarios were created in which change in incidence and prevalence measures were (1) not sust

Quality of life of nursing home residents with dementia: Validation of the German version of the ICECAP-O

Objectives: To validate the ICECAP-O capability wellbeing measure's German translation in older people with dementia living in a nursing home, and to investigate the influence of proxy characteristics on responses. Method: Cross-sectional study. For 95 residents living in a German nursing home, questionnaires were completed by nursing professionals serving as proxy respondents. We investigated the convergent validity of the ICECAP-O with other Quality of Life (Qol) measures, the EQ-5D extended with a cognitive dimension (EQ-5D+C), the Alzheimer's Disease Related Quality of Life (ADRQL) measures, and the Barthel-index measure of Activities of Daily Living (ADL). Discriminant validity was investigated using bivaria

INDCOR white paper 3: Interactive Digital Narratives and Interaction

The nature of interaction within Interactive Digital Narrative (IDN) is inherently complex. This is due, in part, to the wide range of potential interaction modes through which IDNs can be conceptualised, produced and deployed and the complex dynamics this might entail. The purpose of this whitepaper is to provide IDN practitioners with the essential knowledge on the nature of interaction in IDNs and allow them to make informed design decisions that lead to the incorporation of complexity thinking throughout the design pipeline, the implementation of the work, and the ways its audience perceives it. This white paper is concerned with the complexities of authoring, delivering and processing dynamic interactive contents from the perspectives of both creators and audiences. This white paper is part of a series of publications by the INDCOR COST Action 18230 (Interactive Narrative Design for Complexity Representations), which all clarify how IDNs representing complexity can be understood and applied (INDCOR WP 0 - 5, 2023).Comment: 17 pages, 1 figur

Analyzing sub-optimal rural microgrids and methods for improving the system capacity and demand factors : filibaba microgrid case study examined

Solar energy kiosks in developing countries are commonly designed with battery storage as daytime energy production does not coincide with an evening peak consumption. Curtailment of excess solar energy production can occur when current load and battery storage charging is not high enough during peak solar generation hours. Valuation of the options for coping with this phenomena, after a system is already built, is important for kiosk operators to continue to improve technical and economic performance. Furthermore, little real-world data is available to analyze the extent and impact of this issue, much less the available decisions for the manager of such systems when it occurs. This paper analyzes some of these phenomena and the decisions that kiosk operators can make to improve such performance. Furthermore it analyzes data-sets from a 1.8 kW solar-battery energy kiosk in rural Filibaba, Zambia to determine the level of lost energy production/curtailing that occurred in that system. Finally, potential strategies, including demand response strategies are proposed to both increase as well as shift consumption to daytime hours and ultimately increase the capacity factor of the system. Such strategies could potentially help reduce the lost production of almost 1.7MWh that was witnessed in 11 months of system usage. These strategies could also increase the revenue of the system by approx. US$810 annually. Such strategies include pricing incentives, manual demand response, and system re-design options. In the general context of operations of rural solar kiosks, this work advocates for the need to continuously improve operational as well as hardware strategy based on field-evidence

Establishing a composite endpoint for measuring the effectiveness of geriatric interventions based on older persons' and informal caregivers' preference weights:a vignette study

Background: The Older Persons and Informal Caregivers Survey Minimal Dataset's (TOPICS-MDS) questionnaire which measures relevant outcomes for elderly people was successfully incorporated into over 60 research projects of the Dutch National Care for the Elderly Programme. A composite endpoint (CEP) for this instrument would be helpful to compare effectiveness of the various intervention projects. Therefore, our aim is to establish a CEP for the TOPICS-MDS questionnaire, based on the preferences of elderly persons and informal caregivers. Methods: A vignette study was conducted with 200 persons (124 elderly and 76 informal caregivers) as raters. The vignettes described eight TOPICS-MDS outcomes of older persons (morbidity, functional limitations, emotional wellbeing, pain experience, cognitive functioning, social functioning, self-perceived health and self-perceived quality of life) and the raters assessed the general well-being (GWB) of these vignette cases on a numeric rating scale (0-10). Mixed linear regression analyses were used to derive the preference weights of the TOPICS-MDS outcomes (dependent variable: GWB scores; fixed factors: the eight outcomes; unstandardized coefficients: preference weights). Results: The mixed regression model that combined the eight outcomes showed that the weights varied from 0.01 for social functioning to 0.16 for self-perceived health. A model that included "informal caregiver" showed that the interactions between this variable and each of the eight outcomes were not significant (p > 0.05). Conclusion: A preference-weighted CEP for TOPICS-MDS questionnaire was established based on the preferences of older persons and informal caregivers. With this CEP optimal comparing the effectiveness of interventions in older persons can be realized

Examining the construct and known-group validity of a composite endpoint for the Older Persons and Informal Caregivers Survey Minimum Data Set (TOPICS-MDS); A largescale data sharing initiative

Background Preference-weighted multi-faceted endpoints have the potential to facilitate comparative effectiveness research that incorporates patient preferences. The Older Persons and Informal Caregivers Survey Composite endpoint (TOPICS-CEP) is potentially a valuable outcome measure for evaluating interventions in geriatric care as it combines multiple outcomes relevant to older persons in a single metric. The objective of this study was to validate TOPICS-CEP across different study settings (general population, primary care and hospital). Methods Data were extracted from TOPICS Minimum Dataset (MDS), a pooled public-access national database with information on older persons throughout the Netherlands. Data of

Capabilities and quality of life in Dutch psycho-geriatric nursing homes: an exploratory study using a proxy version of the ICECAP-O

Contains fulltext : 110478.pdf (publisher's version ) (Open Access)PURPOSE: To validate the ICECAP-O capability measure in psycho-geriatric elderly in nursing homes, we compared the capability scores of restrained and unrestrained clients. Both nursing staff and family were used as proxies for assessing clients' capabilities. METHOD: For 122 psycho-geriatric elderly, a total of 96 nursing professionals and 68 family members completed a proxy questionnaire. We investigated the convergent and discriminant validity of the ICECAP-O and measures of care dependency, health-related quality of life, and overall quality of life. We also directly compared ICECAP-O scores of the 56 clients for whom both nursing staff and family members had completed the questionnaire. RESULTS: Convergent validity between ICECAP-O and care dependency, health-related, and overall quality of life measures could be established, as well as discriminant validity for the restrained and unrestrained groups. Nursing and family proxy ICECAP-O tariffs were not significantly correlated. DISCUSSION: ICECAP-O measures a more general concept than health-related quality of life and can differentiate between restrained and non-restrained psycho-geriatric clients. Since nurses seem to be able to assess the current quality of life of clients using the ICECAP-O more precisely than the family proxies, for now the use of nursing proxies is recommended in a nursing home setting