Use Of Health Outcomes Research Articles

Estimating the health value added by nursing homes

Measuring performance in healthcare remains a challenge. The use of health outcomes rather than structure and process indicators is considered as the way forward, but outcome-based results risk being biased by selection. Accounting for such selection bias is more difficult in settings with small-sized providers and low chances of resident health improvement, like in the case of nursing homes. In this paper we (i) measure the health outcomes of Dutch nursing homes in terms of mortality and avoidable hospitalizations among residents, (ii) we adopt a novel approach to test for selection bias and (iii) we examine the relationship between outcomes and other nursing home quality indicators and characteristics. Using administrative data from more than 110,000 residents, we estimate the performance of the 849 largest nursing homes in the Netherlands in the period 2015–2019. Controlling for an extensive set of observable case-mix variables, we first test for the presence of selection bias using a distance-based instrumental variable. We do not find any evidence for such a structural bias. While the wide confidence intervals of the estimates display considerable imprecision, our results do reveal substantial differences between top and bottom performing nursing homes. Because the outcome-based estimates turn out to be only weakly correlated with other quality indicators, we conclude that our mortality and avoidable hospitalization-based indicators provide important complementary information. When small sample issues and case-mix differences are adequately accounted for, outcome-based indicators can provide useful policy guidance for quality improvement in nursing homes.

Civil-military coordination of public health response to urban disasters in Malaysia

Introduction. Direct and indirect impacts of disasters and emergencies on public health and health care systems, and the use of health outcomes as indicators of the effectiveness of disaster management activities highlight the importance of the role health sector plays in all phases of disaster management cycle. In Malaysia, several gaps have been identified with regards to humanitarian assistance and disaster relief (HADR) operations, including lack of coordination between agencies, and most of the agencies focusing on the preparedness and response phases. 
 The purpouse of this narrative review was to obtain a broad appreciation of the extent of the research literature on the role of civil-military coordination during the disaster events in urban settings, particularly in the context of public health response to disasters and emergencies, and a broad understanding of any clear evidence which may have policy implications for KL, Malaysia.
 Materials and methods. This study is a narrative review of literature on civil-military coordination of public health response to urban disasters in Malaysia. The databases that were individually searched included PubMed, PsychINFO and Pre-CINAHL. Google Scholar was also searched.
 Results. The results of this study highlighted the importance of developing proactive approaches to public health and disasters as opposed to a general reactive approach. Ultimately, by establishing efficient partnership with the military as one of the key stakeholders, through civil-military coordination, an enhanced response to public health implications of disasters and emergencies can be achieved. 
 Conclusions. Optimizing multi-sectoral approach, interoperability and coordination of civil-military capabilities to address health-related impacts of disasters is especially important in the dense and complex urban setting of Kuala Lumpur (KL) metropolitan area.

PSYCHOLOGICAL AND HEALTH CONSEQUENCES OF HELPING OTHERS: INNOVATIVE METHODS TO UNDERSTAND STRAINS AND GAINS

Older adults are often involved in prosocial behaviors including volunteering, informal assistance to family members, or extensive caregiving for family with chronic disease or disability. Many studies find that volunteering and providing informal support can enhance health and well-being, but family caregiving has generally been characterized as being highly stressful and harmful to health and well-being. Recent research has suggested that involvement in prosocial activities, including caregiving, can actually build resilience and buffer the impacts of stress, and that the commonalities across different types of prosocial behaviors in older adults deserve greater attention. This symposium brings together researchers who are using innovative methods to study prosocial behaviors, including measuring daily experiences and their linkages with affect, epidemiological methods, and use of health outcomes including serum biomarkers of inflammation and immunity, activity tracking, and mortality. Results across the presentations show that the effects of helping others can be considered as mixed blessings, with potentially harmful and helpful effects depending on contextual factors. Factors including a history of adverse childhood experiences, and dementia caregiving, can create particular challenges. The Discussant, Dr. Karl Pillemer, will discuss implications for future research on volunteering, informal assistance to family, and family caregiving. He will also address ways that gerontological researchers can present a more balanced public narrative about how stressful experiences such as caregiving can produce not only negative affect, but also potentially positive health benefits, resilience to stress, and personal growth.

Prevention of postpartum haemorrhage: cost consequences analysis of misoprostol in low-resource settings.

BackgroundWhile inferior to oxytocin injection in both efficacy and safety, orally administered misoprostol has been included in the World Health Organization Model List of Essential Medicines for use in the prevention of postpartum haemorrhage (PPH) in low-resource settings. This study evaluates the costs and health outcomes of use of oral misoprostol to prevent PPH in settings where injectable uterotonics are not available.MethodsA cost-consequences analysis was conducted from the international health system perspective, using data from a recent Cochrane systematic review and WHO’s Mother-Baby Package Costing Spreadsheet in a hypothetical cohort of 1000 births in a mixed hospital (40 % births)/community setting (60 % births). Costs were estimated based on 2012 US dollars.ResultsUsing oxytocin in the hospital setting and misoprostol in the community setting in a cohort of 1000 births, instead of oxytocin (hospital setting) and no treatment (community setting), 22 cases of PPH could be prevented. Six fewer women would require additional uterotonics and four fewer women a blood transfusion. An additional 130 women would experience shivering and an extra 42 women fever. Oxytocin/misoprostol was found to be cost saving (US$320) compared to oxytocin/no treatment.If misoprostol is used in both the hospital and community setting compared with no treatment (i.e. oxytocin not available in the hospital setting), 37 cases of PPH could be prevented; ten fewer women would require additional uterotonics; and six fewer women a blood transfusion. An additional 217 women would experience shivering and 70 fever. The cost savings would be US$533.Sensitivity analyses indicate that the results are sensitive to the incidence of PPH-related outcomes, drug costs and the proportion of hospital births.ConclusionsOur findings confirm that, even though misoprostol is not the optimum choice in the prevention of PPH, misoprostol could be an effective and cost-saving choice where oxytocin is not or cannot be used due to a lack of skilled birth attendants, inadequate transport and storage facilities or where a quality assured oxytocin product is not available. These benefits need to be weighed against the large number of additional side effects such as shivering and fever, which have been described as tolerable and of short duration.

Analysis of Four Recruitment Methods for Obtaining Normative Data through a Web-Based Questionnaire: A Pilot Study

Quality normative data requires a diverse sample of participants and plays an important role in the appropriate use of health outcomes. Using social media and other online resources for survey recruitment is a tempting prospect, but the effectiveness of these methods in collecting a diverse sample is unknown. The purpose of this study is to pilot test four methods of recruitment to determine their ability to produce a sample representative of the general US population. This project is part of a larger study to gather normative data for the Michigan Hand Outcomes Questionnaire (MHQ). We used flyers, e-mail, Facebook, and an institution-specific clinical research recruitment Web site to direct participants to complete an online version of the MHQ. Participants also provided comorbidity and demographic information. The institution-specific recruitment Web site yielded the greatest number of respondents in an age distribution that mirrored the US population. Facebook was effective for recruiting young adults, and e-mail was successful for recruiting the older adults. None of the methods was successful in reaching an ethnically diverse sample. Obtaining normative data that is truly representative of the US population is a difficult task. The use of any one recruitment method is unlikely to result in a representative sample, but a greater understanding of these methods will empower researchers to use them to target specific populations. This pilot analysis provides support for the use of Facebook and clinical research sites in addition to traditional methods of e-mail and paper flyers.

Governing healthcare through performance measurement in Massachusetts and the Netherlands

Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of public agencies to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care.In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives.

Health outcomes and infectious disease control

With the development of improved health systems, antibiotics and vaccines throughout the 20th century, the prospects for control of infectious diseases improved. During the same time-frame, an approach to disease control was developed which used the health outcomes resulting from various interventions to choose, guide and modify those interventions. Despite these major advances in the control of diseases, infectious diseases have (with occasional exceptions) not only continued to occur but in many instances the situation has deteriorated with the emergence and re-emergence in recent years of a range of infectious diseases. In this paper we consider why infectious disease control has not benefited from the move towards a health outcomes approach, why infectious disease control might benefit from such a move, and the differences between infectious and non-infectious diseases when considering health outcomes. We follow-up with some practical approaches to the use of health outcomes. We argue that appropriate use of health outcomes when planning and evaluating infectious disease control programs will improve human health.

Assessment of Medical Outcomes: New Opportunities for Achieving a Long Sought-After Objective

Health outcome assessment may be used for a variety of purposes: to evaluate the effectiveness of medical practices; to assess the quality of services provided; to educate providers, purchasers, and users of health services about the sequelae of treated and untreated disease; to guide reimbursement and regulatory policy; and to characterize the health status of a population. This article focuses on the use of health outcomes to evaluate the effectiveness of medical practices and to assess the quality of services provided.