Within and across country variations in treatment of patients with heart failure and diabetes
| Autor: | Leila Pellet, Jose F. Figueroa, Kristen Riley, Carl Rudolf Blankart, Enrique Bernal-Delgado, Hannah Knight, Nicholas Bowden, Alberto Marino, Luca Lorenzoni, Kees van Gool, Irene Papanicolas, Walter P. Wodchis, Olukorede Abiona, Zeynep Or, Anne Penneau, Kosta Shatrov, Francisco Estupiñán-Romero |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Cross-Cultural Comparison
Male medicine.medical_specialty medicine.medical_treatment Home health nursing Rehabilitation Centers Decile Health care medicine Diabetes Mellitus 1117 Public Health and Health Services 1605 Policy and Administration Humans Medical prescription Research Articles Aged Heart Failure Rehabilitation Gini coefficient Primary Health Care business.industry Health Policy Developed Countries International comparisons Australia 350 Public administration & military science Home Care Services Confidence interval Europe Hospitalization Family medicine Chronic Disease North America Health Policy & Services Critical Pathways RA Public aspects of medicine Female business |
| Zdroj: | Health Serv Res |
| Popis: | ObjectiveTo compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries.Data sourcesPatient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States.Data collection methodsPatients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016.Study designWe calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures.Principal findingsIn all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97).ConclusionsDistribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care. |
| Databáze: | OpenAIRE |
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