Use of the EQ-5D Instrument and Value Scale in Comparing Health States of Patients in Four Health Care Programs among Health Care Providers

AbstractObjectivesThe main objective of this article was to explore the use of the patient evaluation of health states in determining the quality of health care program provision among health care providers. The other objectives were to explore the effect of size and status of health care providers on patient-reported outcomes.MethodsThe EuroQol five-dimensional questionnaire was used in four health care programs (hip replacement, hernia surgery, carpal tunnel release, and veins surgery) to evaluate patients’ health states before and after the procedure, following carefully prepared instructions. Data were collected for a single year, 2011. The number of questionnaires filled by patients was 165 for hip replacement, 551 for hernia surgery, 437 for vein surgery, and 158 for carpal tunnel release. The data were analyzed using linear regression model and the EuroQol five-dimensional questionnaire value set for Slovenia. Differences between providers were determined using the Tukey test. Potential quality-adjusted life-years (QALYs) gained for all four programs were calculated for the optimal allocation of patients among providers.ResultsThere are significant differences among health care providers in the share of patients who reported positive changes in health care status as well as in average improvement in patient-reported outcomes in all four programs. In the case of optimal allocation, each patient undergoing hip replacement would gain 2.25 QALYs, each patient undergoing hernia surgery would gain 0.83 QALY, each patient undergoing veins surgery would gain 0.36 QALY, and each patient undergoing carpal tunnel release would gain 0.78 QALY.ConclusionsThe analysis exposed differences in average health state valuations across four health care programs among providers. Further data on patient-reported outcomes for more than a single year should be collected. On the basis of trend data, further analysis to determine the possible causes for differences should be conducted and the possibility to use this approach for measuring health care providers’ performance and its use in contracting should be explored

Meddržavne selitve prebivalcev Slovenije ter obseg emigrantov in tujcev v Sloveniji - devetdeseta leta

Članek, ki temelji na raziskavi »Migracije v Sloveniji z luči vključitve v EU«, prikazuje najprej nekatere glavne metodološke utemeljitve, nato sledi prikaz »zaloge« slovenskih emigrantov v tujini in tujcev v Sloveniji ter meddržavnih selitvenih tokov v zadnjih dveh desetletjih. Na koncu so prikazane glavne sklepne ugotovitve. Jedro prispevka predstavlja prikaz meddržavnih selitvenih tokov, v okviru katerega prikazujemo tako legalne kot nelegalne tokove. Statistično evidentirani legalni tokovi vključujejo do srede devetdesetih let selitve državljanov, po tem letu pa tudi selitve tujcev. Selitve državljanov predstavljajo majhen delež vseh statistično evidentiranih meddržavnih selitvenih tokov Slovenije. Ne glede na pokritje legalnih meddržavnih selitev je imela Slovenija v zadnjih dveh desetletjihv teh selitvah neto selitveni prirast. Nelegalno priseljevanje je precej obsežnejše od legalnega; v drugi polovici devetdesetih let je slednjega presegalo za 60%

Meddržavne selitve prebivalcev Slovenije ter obseg emigrantov in tujcev v Sloveniji - devetdeseta leta

The article, which is based on a research project titled »Migration in Slovenia within the context of EU accession«, starts with some basic methodological explanation and continues with the presentation of the »stock« of Slovene emigrants abroad and of immigrants/foreigners in Slovenia, and finally, of external migration flows for the last two decades. At the end some main conclusions are presented. The core of the article is the presentation of external migration flows (legal and illegal). Statistically registered legal flows include- for the period till the mid 1990s - the flows of citizens of Slovenia, and after that also the flows of foreigners. Migration of citizens presents only a small part of total statistically registered flows. Regardless of the coverage of legal external flows net migration was positive during the last two decades. Illegal immigration is much higher than legal; during the second half of the 1990s it was 60% higher than the latter.Članek, ki temelji na raziskavi »Migracije v Sloveniji z luči vključitve v EU«, prikazuje najprej nekatere glavne metodološke utemeljitve, nato sledi prikaz »zaloge« slovenskih emigrantov v tujini in tujcev v Sloveniji ter meddržavnih selitvenih tokov v zadnjih dveh desetletjih. Na koncu so prikazane glavne sklepne ugotovitve. Jedro prispevka predstavlja prikaz meddržavnih selitvenih tokov, v okviru katerega prikazujemo tako legalne kot nelegalne tokove. Statistično evidentirani legalni tokovi vključujejo do srede devetdesetih let selitve državljanov, po tem letu pa tudi selitve tujcev. Selitve državljanov predstavljajo majhen delež vseh statistično evidentiranih meddržavnih selitvenih tokov Slovenije. Ne glede na pokritje legalnih meddržavnih selitev je imela Slovenija v zadnjih dveh desetletjihv teh selitvah neto selitveni prirast. Nelegalno priseljevanje je precej obsežnejše od legalnega; v drugi polovici devetdesetih let je slednjega presegalo za 60%

Structure, Processes and Results in Healthcare System in Slovenia

Achieving high quality in the provision of healthcare services represents a basic factor in meeting the healthcare needs of the individuals. Accessibility to health services in Slovenia over the last two decades has been presented according to some of the core values of quality and safety: performance, quality and patient-centeredness. The focus of the chapter is on three pillars of health system quality: structure, processes, and outcomes. In each part, we presented the standard practice and state of the art, but also the main achievements in the last decade. In the structural part, we highlight the investment in equipment and human resources and in the process part, the role of the primary level as a gatekeeper with the secondary and tertiary level. The results section concentrates on the measurement of the results in healthcare; the use of quality indicators and PROMs is discussed, the role of quality strategy and health technology assessment in the Slovenian healthcare system is presented

MEDICAL DEVICES DISTINCTIVE FEATURES

Medical devices (MDs) have distinctive features, such as incremental innovation, dynamic pricing, the learning curve and organisational impact, that need to be considered when they are evaluated. This paper investigates how MDs have been assessed in practice, in order to identify methodological gaps that need to be addressed to improve the decision-making process for their adoption. We used the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist supplemented by some additional categories to assess the quality of reporting and consideration of the distinctive features of MDs. Two case studies were considered: transcatheter aortic valve implantation (TAVI) representing an emerging technology and implantable cardioverter defibrillators (ICDs) representing a mature technology. Economic evaluation studies published as journal articles or within Health Technology Assessment reports were identified through a systematic literature review. A total of 19 studies on TAVI and 41 studies on ICDs were analysed. Learning curve was considered in only 16% of studies on TAVI. Incremental innovation was more frequently mentioned in the studies of ICDs, but its impact was considered in only 34% of the cases. Dynamic pricing was the most recognised feature but was empirically tested in less than half of studies of TAVI and only 32% of studies on ICDs. Finally, organisational impact was considered in only one study of ICDs and in almost all studies on TAVI, but none of them estimated its impact. By their very nature, most of the distinctive features of MDs cannot be fully assessed at market entry. However, their potential impact could be modelled, based on the experience with previous MDs, in order to make a preliminary recommendation. Then, well-designed post-market studies could help in reducing uncertainties and make policymakers more confident to achieve conclusive recommendations. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd

An Audit of Diabetes-Dependent Quality of Life (ADDQOL) in Older Patients with Diabetes Mellitus Type 2 in Slovenia

AbstractObjectiveThis article reports a study to measure diabetes-dependent quality of life (QOL) in older Slovenian patients with diabetes mellitus type 2 (DMT2).MethodsA cross-sectional study of older (age ≥ 65 years) patients with DMT2 at outpatient diabetic centers was conducted in all regions in Slovenia. The Audit of Diabetes-Dependent Quality of Life questionnaire was carried out between January and May 2012. Statistical analysis was performed by using IBM SPSS Statistics software, version 18.0.ResultsAfter exclusion of noneligible respondents, a total of 285 respondents were included in the analysis, which represented a 57% response rate. Lower QOL was significantly connected to a heart attack episode (odds ratio 2.42; 95% confidence interval 1.06–5.20) and to the perception of not having diabetes under control (odds ratio 0.36; 95% confidence interval 0.18–0.69). Eleven (3.9%) patients reported no impact of DMT2 on their QOL at all, while in the remaining respondents, particular reference was put to the effects on freedom to eat, dependency on others, and family life. There was no significant difference between the older people living in urban and rural areas.ConclusionsThe findings of the present study highlight the impact of DMT2 on QOL. DMT2 imposes a personal burden on individuals. Information on the QOL of older patients with diabetes is important to Slovenian policymakers and family physicians to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the QOL of patients with diabetes

Towards a Central‑Eastern European EQ‑5D‑3L population norm: comparing data from Hungarian, Polish and Slovenian population studies

Abstract Background EQ-5D-3L population data are available only from Hungary, Poland and Slovenia in Central and Eastern Europe (CEE). We aimed to compare the accessible studies and estimate a regional EQ-5D-3L population norm for CEE. Methods A combined dataset using patient-level data of 8850 respondents was created. Based on the European Census of 2011, regional population norm estimates were calibrated by gender, age and education for the joint citizenry of 11 CEE countries. Results EQ-5D-3L health states were available for 6926 and EQ VAS scores for 6569 respondents. Demographic characteristics of the samples refected the recruitment methods (Hungary: online; Slovenia: postal survey, Poland: personal interviews). Occurrence of problems difered signifcantly by educational level in all the fve dimensions (p<0.001). The inter-country diferences persisted after controlling for demographic variables. The estimated EQ-5D-3L index CEE norms with UK tarifs for age groups 18–24, 25–34, 35–44, 45–54, 55–64, 65–74 and 75+were 0.911, 0.912, 0.871, 0.817, 0.762, 0.743 and 0.636 for males and 0.908, 0.888, 0.867, 0.788, 0.752, 0.68 and 0.584 for females, respectively. Estimates were provided also using Polish, European and Slovenian value sets. Conclusions Besides gender and age, education should be considered during the design and interpretation of quality-of-life studies in CEE. The estimated regional EQ-5D-3L population norm may be used as a benchmark by CEE countries with lack of local dataset. However, the substantial inter-country diferences in health status and scarcity of data over age 65 call for harmonized country-specifc EQ-5D-3L population norm studies in the CEE region

The burden of informal caregiving in Hungary, Poland and Slovenia: results from national representative surveys

Background We aimed to investigate the burden of informal care in Hungary (HU), Poland (PL) and Slovenia (SI). Methods A cross-sectional online survey was performed involving representative samples of 1000 respondents per country. Caregiving situations were explored; health status of informal caregivers/care recipients and care-related quality of life were assessed using the EQ-5D-5L and CarerQol-7D. Results The proportion of caregivers was (HU/PL/SI) 14.9, 15.0 and 9.6%, respectively. Their mean age was 56.1, 45.6 and 48.0, and the average time spent on informal care was 27.6, 35.5 and 28.8 h/week. Chronic care was dominant (> 1 year: 78.5%, 72.0%, 74.0%) and care recipients were mainly (own/in-law) parents. Average EQ-5D-5L scores of care recipients were 0.53, 0.49 and 0.52. For Poland and Slovenia, EQ-5D-5L scores of informal care providers were signifcantly lower than of other respondents. Average CarerQol-7D scores were (HU/PL/SI) 76.0, 69.6 and 70.9, and CarerQol-VAS was 6.8, 6.4 and 6.6, respectively. Overall, 89, 87, and 84% of caregivers felt some or a lot fulflment related to caring. Problems with combining tasks with daily activities were most important in Hungary and Slovenia. Women had a higher probability of being a caregiver in Hungary. CarerQol-7D scores were signifcantly associated with caregivers’ EQ-5D-5L scores. In Hungary and Poland, living in a larger household was positively, while caring for patients with mental health problems was negatively associated with CarerQol-7D scores. Conclusions These frst results from the Central and Eastern European region using preference-based measures for the evaluation of informal care can serve as a valuable input for health economic analyses

A comparison of European, Polish, Slovenian and British EQ-5D-3L value sets using a Hungarian sample of 18 chronic diseases

Background In the Central and Eastern European region, the British EQ-5D-3L value set is used commonly in quality of life (QoL) studies. Only Poland and Slovenia have country-specifc weights. Our study aimed to investigate the impact of value set choice on the evaluation of 18 chronic conditions in Hungary. Methods Patients’ EQ-5D-3L index scores were calculated using the VAS-based Slovenian and European and the time-tradeof-based Polish and British value sets. We performed pairwise comparisons of mean index values by dimensions, diagnoses and age groups. We evaluated disease burden by comparing index values matched by age and gender in each condition with those of the general population of the CEE region in all four value sets. Results Altogether, 2421 patients (55% female) were included in our sample with the average age of 55.87 years (SD=17.75). The average Slovenian, European, Polish and British EQ-5D-3L scores were 0.598 (SD=0.279), 0.661 (SD=0.257), 0.770 (SD=0.261) and 0.644 (SD=0.279), respectively. We found highly signifcant diferences in most diagnoses, with the greatest diference between the Polish and Slovenian index values in Parkinson’s disease (0.265). Systematic pairwise comparison across all conditions and value sets revealed greatest diferences between the time-trade-of (TTO) and VAS-based value sets as well as varying sensitivity of the disease burden evaluations of chronic disease conditions to the choice of value sets. Conclusions Our results suggest that the choice of value set largely infuences the health state utility results in chronic diseases, and might have a signifcant impact on health policy decisions