Hoitoresurssikäytön vaikutukset asiakastuloksiin tyypin 2 diabeteksen hoidossa

The purpose of this thesis is to research the connections between resource utilization factors and customer effects in type 2 diabetes care. Research problem was approached with a literature review of service and health management research related to chronic care and an empirical study. The aim was to build a theoretical model between concepts, and to test this model with empirical data. Three relevant resource utilization factors in diabetes care were found: (1) main care provider asset specificity, or specialization, (2) visit frequency to main care provider, and (3) professional resource variety, or multidisciplinarity. The relevant customer effects were identified as customer satisfaction, patient adherence to care, health outcomes, and patient perception of own health. A patient survey to diabetes care customers was performed in six European regions to gather empirical data (N = 1418). Multiple linear regression method was used to examine the hypothetical connections between the variables. The study found that main care provider asset specificity and professional resource variety have an positive impact on customer satisfaction. Health outcomes and professional resource variety were negatively connected to patient's perception of own health. Weak connection of main care provider asset specificity and professional resource variety with patient adherence was observed. Four of the eleven hypotheses received statistical support (p = 0.05), two remained slightly over the threshold and rest did not receive support. The suitability of the overall model was assessed low. The found relations were supported by existing literature and add to the body of knowledge. Some implications for managers are drawn and future research topics are put forward.Tämän diplomityön tarkoitus oli tutkia valittujen resurssikäyttötekijöiden vaikutuksia asiakkaaseen tyypin 2 diabeteksen jatkuvassa hoidossa. Tutkimusongelmaa lähestyttiin tutkimalla terveydenhuolto- ja palvelukirjallisuutta, ja rakentamalla kirjallisuuden pohjalta teoreettinen malli resurssi- käyttötekijöiden ja asiakasvaikutusten yhteyksistä. Mallia testattiin empiirisesti. Kirjallisuudesta löytyi kolme tärkeää resurssikäyttötekijää diabeteksen hoidossa (1) päähoitohenkilön erikoistuneisuus diabetespotilaisiin, (2) käyntitiheys päähoitohenkilöllä, ja (3) eri hoitoammattilaisten valikoima eli hoidon moniammatillisuus. Merkityksellisiksi asiakasvaikutuksiksi määriteltiin asiakastyytyväisyys, potilaan sitoutuminen omahoitoon, kliiniset tulokset ja potilaan kokemus omasta terveydestä. Tutkimuksen empiirinen aineisto kerättiin kuudella tutkimusalueella kuudessa eri EU-maassa potilaille suunnatulla asiakaskyselylomakkeella (N=1418). Hypoteeseja testattiin käyttäen lineaarista monimuuttujaregressiota. Tutkimuksessa havaittiin, että päähoitohenkilön erikoistuneisuus potilasryhmään ja hoitoammattilaisten valikoima vaikuttivat positiivisesti asiakastyytyväisyyteen. Kliiniset tulokset ja hoitoammattilaisten valikoima olivat negatiivisesti yhteydessä potilaan kokemukseen terveydestä. Päähoito- henkilön erikoistuneisuus potilasryhmään ja hoitoammattilaisten valikoima vaikuttivat olevan heikosti yhteydessä potilaan sitoutumiseen itsehoitoon. Rakennettu teoreettinen malli sopi kokonaisuudessaan heikosti empiiriseen aineistoon. Löydetyt yhteydet saavat tukea olemassa olevasta kirjallisuudesta, ja löydös vahvistaa niiden paikkansapitävyyttä. Tuloksien perusteella tutkimus tarjoaa joitakin käytännön neuvoja päätöksentekijöille sekä ehdotuksia jatkotutkimusaiheiksi

Assessing the structures and domains of wellness models: A systematic review

Objective: This study systematically identifies different wellness domains, explores whether we are reaching any consensus, and presents an archetype of a wellness model. Methods: Studies were selected for review if they proposed a model for assessing individuals’ wellness, the model was generic (i.e., non-context or disease-specific), designed for adults and included at least physical, psychological and social domains. Furthermore, the study needed to be peer-reviewed with a full-text available in English. Based on this, 44 models were identified and their domains were extracted and grouped using thematic analysis, and placed under themes that were created using quantitative methods. Publication year and formed groupings were used to examine the evolution of models. Median, mode, and percentages were used to form the archetype. Results: The investigated models included 379 unique domains that could be clustered into 70 groups and under 14 themes. While the numbers of published wellness models increased, no consensus on the domains was reached. The majority of the models were presented at one level with five domains. Conclusions: Incorporating wellness into everyday practice requires comparable measures to evaluate and benchmark outcomes. Hence, we need to reach a mutual understanding on the structure and domains of wellness

Classifying outcomes in secondary and tertiary care clinical quality registries—an organizational case study with the COMET taxonomy

The choice of what patient outcomes are included in clinical quality registries is crucial for comparable and relevant data collection. Ideally, a uniform outcome framework could be used to classify the outcomes included in registries, steer the development of outcome measurement, and ultimately enable better patient care through benchmarking and registry research. The aim of this study was to compare clinical quality registry outcomes against the COMET taxonomy to assess its suitability in the registry context.Peer reviewe

Terveydenhuollon palveluvalikoiman priorisointi

Selvityksen tavoitteena on terveydenhuollon priorisoinnin kansallinen kehittäminen. Priorisoinnilla tarkoitetaan tässä yhteydessä kaikkia niitä toimintoja, jotka pyrkivät terveydenhuollon resurssien kohdentamiseen. Selvityksessä on kuvattu terveydenhuollon priorisoinnin oikeudellisia reunaehtoja sekä haettu tietoa eri maiden priorisoinnin kehittämisestä ja niiden vaikutuksista. Hankkeessa tehtiin myös kyselyjä ja työpajoja eri sidosryhmille. Suomessa toivotaan kansallisia avoimia ja läpinäkyviä periaatteita priorisoinnin tueksi. Tällä hetkellä kansalaiset ja ammattilaiset eivät hahmota terveyspalvelujen kokonaisuutta ja todellisia kustannuksia. Jotta priorisoinnista tulisi hyväksyttyä, on 1) alettava toteuttaa systemaattista viestintästrategiaa osallistamisen mahdollistamiseksi ja 2) osallistettava eri sidosryhmiä priorisoinnin periaatteiden kehittämiseen. Tämä vaatii myös 3) kansallisten rakenteiden ja prosessien luomista periaatteiden muodostamiseen sekä niiden jalostamiseksi kriteereiksi ja menetelmiksi sekä 4) lainsäädännön kehittämistä. Perustuslain tulkinnassa on painotettu yksilön oikeuksia. Perustuslaki jättää kuitenkin liikkumavaraa kehittää priorisoinnin oikeudellista ohjausta myös väestöterveyden ja yhteiskunnan taloudelliset voimavarat nykyistä selvemmin huomioon ottavaan suuntaan.Sivua 18 on päivitetty 29.8.2022 ja aineisto korvaa aikaisemmin, 24.8.2022 julkaistun version. Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa (tietokayttoon.fi). Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Kliinisen tutkimuksen hoitotulosten taksonomia soveltui laaturekistereiden hoitotulosten mittaamisen arviointiin

Tausta: Hoitotulosmittareiden valinta kliinisissä laaturekistereissä on kriittistä olennaisen ja vertailtavan tiedon keräämiseksi. Hoitotulosmittareiden arviointiin tulisi käyttää yhtenäistä hoitotulosten viitekehystä. Tutkimuksen tavoitteena oli tunnistaa sopiva viitekehys ja validoida sitä rekisteriympäristössä. Menetelmät: Kirjallisuudesta etsittiin järjestelmällisesti hoitotulosten viitekehystä, joka on potilaskeskeinen, helppokäyttöinen, yhteinen kliinisen tutkimuksen viitekehysten kanssa ja mahdollistaa rekistereiden arvioinnin. Valittu viitekehys validoitiin HUS Yliopistollisen sairaalan 63 laaturekisteristä kerätyillä hoitotulosmittareilla, jotka poimittiin ja luokiteltiin viitekehyksen avulla. Tulokset: Kirjallisuudesta löytyneistä 23 hoitotulosviitekehyksestä valittiin COMET-taksonomia. HUS:ssa oli suuria eroja laaturekistereiden välillä hoitotulososa-alueissa ja mittareiden määrässä. Fysiologisia mittareita löytyi 98%, resurssikäytön kaikissa ja toimintakyvyn mittareita 62% rekistereistä. Potilaan raportoimia mittareita esiintyi 48% rekistereistä. Pohdinta: COMET-taksonomia oli soveltuva viitekehys laaturekistereiden hoitotulosten mittaamisen arvioimiseksi muutamilla parannusehdotuksilla. HUS:n laaturekisterit ovat erilaisilla kypsyystasoilla, ja kehitettävää löytyi erityisesti potilaan elämään liittyvien vaikutusten mittaamisessa ja hoitotulosmittareiden priorisoinnissa. Tutkimus tarjoaa muille rekistereiden arvioijille vertailukohdan.Objective: The choice of patient outcomes in clinical quality registries is crucial for comparable and relevant data collection. Ideally, a uniform outcome framework would guide the assessment of outcomes. We set out to find a suitable published framework and validate it in clinical quality registries. Study design and Setting: A literature review was conducted to find an outcome framework that is patient-centric, easy-to-use, shared with clinical research, and allows registry evaluation. Chosen outcome framework was validated by extracting and classifying outcomes from 63 clinical quality registries at HUS Helsinki University Hospital, Finland. Results: COMET taxonomy was chosen from 23 published frameworks. HUS Clinical quality registries showed great variation in outcome domains and in number of measures. Physiological outcomes were present in 98%, resource use in all, and functioning domains in 62% of the registries. Patient-reported outcome measures were found in 48% of the registries. Conclusions: The COMET taxonomy was suitable for evaluating the choice of outcomes in clinical quality registries while some improvements are suggested. HUS Helsinki University Hospital clinical quality registries exist at different maturity levels showing room for improvement in life impact outcomes and in outcome prioritization. This article offers a comparison point for other registry evaluators

The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe

Background While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Methods Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011–2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. Results The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. Conclusions While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning.Peer reviewe

Correction: The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe.

[This corrects the article DOI: 10.1371/journal.pone.0192599.]

The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe

Background While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Methods Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011-2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. Results The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. Conclusions While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning

Regression analysis of satisfaction with services ^a.

<p>Regression analysis of satisfaction with services <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0192599#t002fn001" target="_blank">^a</a>.</p