International Comparative Research in Health Care A straightforward exercise? Koen Putman.
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Transcript of International Comparative Research in Health Care A straightforward exercise? Koen Putman.
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International Comparative Research in Health Care
A straightforward exercise?
Koen Putman
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How are we doing?
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(Inter)national research
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EU-Funding (CORDIS)
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Challenges
Securing comparability Accounting for national variations Finding the data
In: Burau, Curr Socio, 2012
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Health systems dynamics
In: van Olmen et al., Health Cult & Society, 2012
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Garrido et al., in:HSREPP, 2011
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UZ Pellenberg
Queen’s Medical CentreCity Hospital
RehaClinic Zurzach
Fachklinik Herzogenaurach
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Admission policies in SRU
SRU-GB1 SRU-GB2 SRU-BE1 SRU-BE2 SRU-CH SRU-DE
Factors related to the patient
physical condition ++ +
cognitive abilities + + + +
behavioural aspects + + + +
patient’s network +
Factors related to the network between facilitiesaffiliations + + +
health insurance ++
other SRUs in recruitment area
+ ++
Factors related to referring hospitalsacute stroke unit + + +
absence of bed managers +
In: Putman K et al., J Rehabil Med, 2006
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0
20
40
60
80
100
120
140
160
total therapy physio-therapy
occupationaltherapy
speechtherapy
neuro.training nursing care medical care sports autonomexercise
other therapy
tim
e (
min
.)
Pellenberg
Nottingham
Zurzach
Herzogenaurach
Absolute time in therapeutic activities between7.00am and 5.00 pm
*
* significant difference after correction for case-mixDe Wit et al., Stroke, 2005
Process of care
*
*
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BE UK CH DE
physiotherapy 3.94 7.35 10.54 4.90
occupational therapy 2.24 4.06 5.69 2.56
PT+OT 6.18 11.41 16.23 7.46
speech therapy 1.30 1.35 1.52 1.10
neuropsychology 0.57 0.49 1.71 1.70
medical care 2.33 3.31 2.28 3.07
nursing care 20.76 52.98 19.00 13.80
other therapy 0.77 0.00 2.24 3.14
TOTAL 31.91 69.54 42.98 30.27
Time available per patient per week/professional group
beds#
hrs/week x workingstaff FTE#
De Wit et al., Stroke, 2005
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use of care after discharge (6m)
Putman et al., J Rehab Med, 2007
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Challenges
Securing comparability Accounting for national variations Finding the data
In: Burau, Curr Socio, 2012
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Selection of patients
Kennedy et al., Arch Phys Med Rehabil, 2012
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Incentives
Peltola et al., Cerebrovasc Dis, 2013
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Challenges
Securing comparability Accounting for national variations Finding the data
In: Burau, Curr Socio, 2012
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Assessment traditions and ‘culture’Systematic collection useful for research
practice (Freeman et al., JNNP, 2005)
However: Heterogenity of outcome measurement in
Europe (Haigh et al., J Rehab Med, 2001)
example: FIM vs Barthel in stroke rehabilitation (Sangha et al. Int J Rehab Res, 2005)
Finding the data
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“translations”
Nyein K et al., Clin Rehab 1999
Motor FIM
Barthel Index Score
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Uniform datasets
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Questionnaires– Conceptual equivalence across cultures
– e.g.: socio-economic status– Pre-study on possible answering categories
– e.g.: discharge destination, post-discharge services
– Translations of questionnaires
Finding the data
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Ethics
Chaudhry et al., Clin Trials, 2013
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Methodological challenges
In: Horn S et al. , Arch Phys Med Rehab, 2012
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Priorities future research
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Recommendations
Inclusion of evidence in reimbursement regulations on provision of services (Weinrich et al., 2011)
“Chain of care” (Ringelstein et al, 2013)
Quality indicators/national audits (Ringelstein et al, 2013)
Comparative effectiveness research
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No stereotyping
In Hell: the cooks are English, the policemen are German, the mechanics are French, the lovers are Swiss and the bankers are Italian.
In Heaven: the cooks are French, the policemen are English, the mechanics are German, the lovers are Italian and the bankers are Swiss.
And what about the Belgians?
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International Comparative Research in Health Care
A straightforward exercise?
Koen Putman
[email protected]@uclan.ac.uk