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Medical Care Jul 2023Patients are increasingly interested in data on the economic burdens and impacts of health care choices; caregivers, employers, and payers are also interested in these...
BACKGROUND
Patients are increasingly interested in data on the economic burdens and impacts of health care choices; caregivers, employers, and payers are also interested in these costs. Although there have been various federal investments into patient-centered outcomes research (PCOR), an assessment of the coverage and gaps in federally funded data for PCOR economic evaluations has not been produced to date.
OBJECTIVES
To classify relevant categories of PCOR economic costs, to assess current federally funded data for coverage of these categories, and to identify gaps for future research and collection.
RESEARCH DESIGN
A targeted internet search was conducted to identify a list of relevant outcomes and data sources. The study team assessed data sources for coverage of economic outcomes. A technical panel and key informant interviews were used for evaluation and feedback.
RESULTS
Four types of formal health care sector costs, 3 types of informal health care sector costs, and 10 types of non-health care sector costs were identified as relevant for PCOR economic evaluations. Twenty-nine federally funded data sources were identified. Most contained elements on formal costs. Data on informal costs (eg, transportation) were less common, and non-health care sector costs (eg, productivity) were the least common. Most data sources were annual, cross-sectional, nationally representative individual-level surveys.
CONCLUSIONS
The existing federal data infrastructure captures many areas of the economic burden of health and health care, but gaps remain. Research from multiple data sources and potential future integrations may offset gaps in individual data sources. Linkages are promising strategies for future research on patient-centered economic outcomes.
Topics: Humans; Cross-Sectional Studies; Patient Outcome Assessment; Delivery of Health Care; Caregivers; Outcome Assessment, Health Care
PubMed: 37219065
DOI: 10.1097/MLR.0000000000001862 -
Current Problems in Pediatric and... Dec 2021Healthcare and outcomes for children with medical complexity (CMC) and their families can be improved by conducting well-conceived, designed, implemented, and analyzed...
Healthcare and outcomes for children with medical complexity (CMC) and their families can be improved by conducting well-conceived, designed, implemented, and analyzed research studies of clinical interventions. This article presents a framework for how to approach the study of clinical interventions for CMC, including 7 key questions and example answers to each: (1) What intervention questions should be our focus? (2) What barriers to intervention research exist? (3) How do we design and optimize interventions? (4) How do we characterize and select patients to enroll? (5) How can we enhance data collection and integration? (6) How can we improve enrollment and participation? And (7) which intervention experimental designs should we choose? By exploring each of these key aspects of intervention-based research, we hope to expand thinking about and spark ideas for specific research projects focused on clinical interventions for CMC.
Topics: Child; Humans; Outcome Assessment, Health Care; Pediatrics
PubMed: 34996708
DOI: 10.1016/j.cppeds.2021.101126 -
Heart (British Cardiac Society) May 2022The UK is one of the few countries in the world with national registries that record key statistics across a broad range of cardiovascular disorders. The British... (Review)
Review
The UK is one of the few countries in the world with national registries that record key statistics across a broad range of cardiovascular disorders. The British Cardiovascular Society and its affiliated groups have played a central role in the development of these registries and continue to provide clinical oversight to the present day. Seven of the UK's national registries are now integrated under the management of the National Institute for Cardiovascular Outcomes Research (NICOR) that currently holds records on nearly 6.5 million episodes of care since 1990. This represents a substantial data resource for national audit that has driven up standards of cardiovascular care in the UK with a palpable impact on patient outcomes. The registries have also spawned an impressive programme of research providing novel insights into the epidemiology of cardiovascular disease. Linkage with other datasets and international collaborations create the environment for new outputs, new opportunities for 'big data' research and new ways of performing clinical trials. As the centenary of the British Cardiac Society (now British Cardiovascular Society) approaches, its role in the development of the UK's cardiovascular audits can be counted as one of its outstanding achievements.
Topics: Academies and Institutes; Cardiovascular Diseases; Heart; Humans; Outcome Assessment, Health Care; Registries
PubMed: 35131894
DOI: 10.1136/heartjnl-2021-320151 -
International Journal of Technology... Jun 2023The Patient-Centered Outcomes Research Institute (PCORI) is a nonprofit, nongovernmental organization established by the U.S. Congress to fund comparative clinical... (Review)
Review
The Patient-Centered Outcomes Research Institute (PCORI) is a nonprofit, nongovernmental organization established by the U.S. Congress to fund comparative clinical effectiveness research focusing on patient-centered outcomes through the engagement of stakeholders. Evaluation of emerging healthcare innovations is one of PCORI's five National Priorities for Health. One such initiative is PCORI's Emerging Technologies and Therapeutics Reports program, established to provide timely overviews of evidence on new drugs and other healthcare technologies. This article provides an overview of completed and ongoing Emerging Technologies and Therapeutics Reports including lessons learned to date. In addition to systematic searches, systematic selection of studies, and transparent reporting of the available evidence, informed by a select number of stakeholders (i.e., key informants), these reports focus on contextual factors shaping the diffusion of emerging technologies that are often not reported in the medical literature. This article also compares processes and methodologies of health technology assessments (HTAs) from a selected number of national and international publicly funded agencies with a goal toward potential future enhancement of PCORI's Emerging Technologies and Therapeutics Reports program. HTAs vary considerably in terms of funding, types of assessments, the role of manufacturers, stakeholder engagement, timeline to complete from the start to the finish of a draft report publication, and communication of uncertainty for informed decision making. Future Emerging Technologies and Therapeutics Reports may focus on rapid reports to support a more expedient development of evidence. Future research could explore the role of contextual factors identified in these reports on targeted evidence generation.
Topics: Humans; Patient Outcome Assessment; Outcome Assessment, Health Care; Health Facilities; Delivery of Health Care; Academies and Institutes
PubMed: 37336780
DOI: 10.1017/S0266462323000284 -
Journal of Medical Economics Nov 2021
Topics: Asia; Developing Countries; Economics, Medical; Humans; Outcome Assessment, Health Care
PubMed: 34859736
DOI: 10.1080/13696998.2021.2014164 -
Archives of Clinical Neuropsychology :... Aug 2022In the current healthcare climate, reimbursement for services is increasingly linked to the ability to demonstrate beneficial patient outcomes. Neuropsychology faces... (Review)
Review
In the current healthcare climate, reimbursement for services is increasingly linked to the ability to demonstrate beneficial patient outcomes. Neuropsychology faces some unique challenges in outcomes research, namely, that neuropsychologists often do not follow patients over time and the effect of neuropsychological services on patient outcomes may not be fully realized until under another provider's care. Yet there is an urgent need for empirical evidence linking neuropsychological practice to positive patient outcomes. To provide a framework for this research, we define a core set of patient-centered outcomes and neuropsychological processes that apply across practice settings and patient populations. Within each area, we review the available existing literature on neuropsychological outcomes, identifying substantial gaps in the literature for future research. This work will be critical for the field to demonstrate the benefit of neuropsychological services, to continue to advocate effectively for reimbursement, and to ensure high-quality patient care.
Topics: Delivery of Health Care; Humans; Neuropsychological Tests; Neuropsychology; Outcome Assessment, Health Care; Patient-Centered Care
PubMed: 35366309
DOI: 10.1093/arclin/acac015 -
Investigacion Y Educacion En Enfermeria Nov 2023The aim of this review was to identify reported nursing-sensitive outcomes in the Emergency Department to date. (Review)
Review
OBJECTIVE
The aim of this review was to identify reported nursing-sensitive outcomes in the Emergency Department to date.
METHODS
An Umbrella review was conducted. Four databases, CINAHL, Pubmed, Web of Science and Scopus, were searched from inception until October 2022. MeSH terms were: "nursing", "sensitivity and specificity", "emergency service, hospital", "nursing care". Two reviewers independently screened studies against the inclusion criteria for eligibility, extracted data and assessed study quality with the SIGN tool. Results of the included studies were summarized and described in themes for narrative analysis. The study was enrolled in the PROSPERO registry (CRD42022376941) and PRISMA guidelines were followed.
RESULTS
The search strategy yielded 2289 records. After duplicate removal, title, abstract and full-text eligibility screening, nine systematic reviews were included in the review. A total of 35 nursing-sensitive outcomes were reported. The most described outcomes were waiting times, patient satisfaction and time to treatment. The less measured were mortality, left without being seen and physical function. Synthesizing nursing-sensitive outcomes in themes for reporting, the most measured outcomes were within the safety domain (n=20), followed by the clinical (n=9), perceptual (n=5) and the least explored functional domain (n=1).
CONCLUSION
Nursing sensitive outcomes research in emergency nursing practice is a conceptual challenge still in its early stage. Several nursing-sensitive outcomes were identified in this review that can evaluate the contribution of emergency department nursing care to patient outcomes. Further research is required to explore patient outcomes sensitive to emergency nursing care.
Topics: Humans; Emergency Service, Hospital; Emergency Medical Services; Outcome Assessment, Health Care; Hospitals; Patient Satisfaction
PubMed: 38589303
DOI: 10.17533/udea.iee.v41n3e03 -
Expert Review of Pharmacoeconomics &... 2023Strong primary care has positive impact on patients' and population health, and high continuity of care is one of its hallmarks. Insight into the underlying mechanisms... (Review)
Review
INTRODUCTION
Strong primary care has positive impact on patients' and population health, and high continuity of care is one of its hallmarks. Insight into the underlying mechanisms is limited and research on this topic requires measures of primary care outputs, which are states that mediate between processes and outcomes of primary care.
AREAS COVERED
Nine potential outputs of high continuity of care were specified to examine 45 validated patient questionnaires, which were identified in a systematic review. Eighteen questionnaires covered one or more primary care outputs, yet at variable and mostly limited extent.
EXPERT OPINION
Measures of primary care outputs can strengthen clinical and health services research, but such measures have yet to be developed and validated for most primary care outputs. The use of these measures in outcome evaluations of interventions in healthcare would enhance the interpretation of intervention effects. Validated measures are also needed to tap the full potential of advanced methods of data-analysis in clinical and health services research. Better understanding of the primary care outputs may also help to mitigate broader challenges in healthcare systems.
Topics: Humans; Delivery of Health Care; Health Services Research; Outcome Assessment, Health Care; Primary Health Care; Surveys and Questionnaires
PubMed: 37306502
DOI: 10.1080/14737167.2023.2224566 -
JAMA Pediatrics Jan 2022Children who are placed in out-of-home care may have poorer outcomes in adulthood, on average, compared with their peers, but the direction and magnitude of these...
IMPORTANCE
Children who are placed in out-of-home care may have poorer outcomes in adulthood, on average, compared with their peers, but the direction and magnitude of these associations need clarification.
OBJECTIVE
To estimate associations between being placed in out-of-home care in childhood and adolescence and subsequent risks of experiencing a wide range of social and health outcomes in adulthood following comprehensive adjustments for preplacement factors.
DESIGN, SETTING, AND PARTICIPANTS
This cohort and cosibling study of all children born in Finland between 1986 and 2000 (N = 855 622) monitored each person from their 15th birthday either until the end of the study period (December 2018) or until they migrated, died, or experienced the outcome of interest. Cox and Poisson regression models were used to estimate associations with adjustment for measured confounders (from linked population registers) and unmeasured familial confounders (using sibling comparisons). Data were analyzed from October 2020 to August 2021.
EXPOSURES
Placement in out-of-home care up to age 15 years.
MAIN OUTCOMES AND MEASURES
Through national population, patient, prescription drug, cause of death, and crime registers, 16 specific outcomes were identified across the following categories: psychiatric disorders; low socioeconomic status; injuries and experiencing violence; and antisocial behaviors, suicidality, and premature mortality.
RESULTS
A total of 30 127 individuals (3.4%) were identified who had been placed in out-of-home care for a median (interquartile range) period of 1.3 (0.2-5.1) years and 2 (1-3) placement episodes before age 15 years. Compared with their siblings, individuals who had been placed in out-of-home care were 1.4 to 5 times more likely to experience adverse outcomes in adulthood (adjusted hazard ratio [aHR] for those with a fall-related injury, 1.40; 95% CI, 1.25-1.57 and aHR for those with an unintentional poisoning injury, 4.79; 95% CI, 3.56-6.43, respectively). The highest relative risks were observed for those with violent crime arrests (aHR, 4.16; 95% CI, 3.74-4.62; cumulative incidence, 24.6% in individuals who had been placed in out-of-home care vs 5.1% in those who had not), substance misuse (aHR, 4.75; 95% CI, 4.25-5.30; cumulative incidence, 23.2% vs 4.6%), and unintentional poisoning injury (aHR 4.79; 95% CI, 3.56-6.43; cumulative incidence, 3.1% vs 0.6%). Additional adjustments for perinatal factors, childhood behavioral problems, and traumatic injuries, including experiencing violence, did not materially change the findings.
CONCLUSIONS AND RELEVANCE
Out-of-home care placement was associated with a wide range of adverse outcomes in adulthood, which persisted following adjustments for measured preplacement factors and unmeasured familial factors.
Topics: Adolescent; Ambulatory Care; Child; Child, Preschool; Cohort Studies; Female; Humans; Male; Outcome Assessment, Health Care; Pediatrics; Time
PubMed: 34694331
DOI: 10.1001/jamapediatrics.2021.4324 -
Pain Mar 2022
Topics: Humans; Outcome Assessment, Health Care; Pain; Pain Management
PubMed: 35148287
DOI: 10.1097/j.pain.0000000000002373