scholarly journals Improving the Recording of Diagnoses in Primary Care with Team Incentives: A Controlled Longitudinal Follow-Up Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Tuomo Lehtovuori ◽  
Timo Kauppila ◽  
Jouko Kallio ◽  
Anna M. Heikkinen ◽  
Marko Raina ◽  
...  
Keyword(s):  
Primary Care ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Follow Up Study ◽  
Primary Care Teams ◽  
Before And After ◽  
Quasi Experimental ◽  
Clinically Significant ◽  
Made In

Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3) but not in either of the controls (−2.0 to −0.3%). The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2) and 33.7% (26.6–41.3). The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.

scholarly journals Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0146
Author(s):  
Chris Sampson ◽  
Eleanor Bell ◽  
Amanda Cole ◽  
Christopher B Miller ◽  
Tracey Marriott ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Cognitive Behavioural Therapy ◽  
Interrupted Time Series ◽  
Behavioural Therapy ◽  
Interrupted Time Series Analysis ◽  
Cognitive Behavioural ◽  
Before And After ◽  
Quasi Experimental ◽  
Care Costs

BackgroundSleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia (dCBT-I). Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed.AimWe sought to identify the effect of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England.Design & settingThe study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio.MethodWe use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.ResultsFor the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescribing.ConclusionSleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.

scholarly journals Digital cognitive behavioural therapy for insomnia and primary care costs in England: an interrupted time series analysis

2021 ◽  
Author(s):  
Chris Sampson ◽  
Eleanor Bell ◽  
Amanda Cole ◽  
Christopher B. Miller ◽  
James Rose
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Cognitive Behavioural Therapy ◽  
Interrupted Time Series ◽  
Behavioural Therapy ◽  
Interrupted Time Series Analysis ◽  
Cognitive Behavioural ◽  
Before And After ◽  
Quasi Experimental ◽  
Care Costs

AbstractBackgroundSleepio is an automated digital programme that delivers cognitive behavioural therapy for insomnia. Sleepio has been proven effective in improving sleep difficulties. However, evidence for the possible impact of Sleepio use on health care costs in the United Kingdom has not previously been developed. In this study, we assessed the effect of a population-wide rollout of Sleepio in terms of primary care costs in the National Health Service (NHS) in England.MethodsThe study was conducted in the Thames Valley region of England, where access to Sleepio was made freely available to all residents between October 2018 and January 2020. We use primary care data for people with relevant characteristics from nine general practices in Buckinghamshire. The study relies on a quasi-experimental design, using an interrupted time series to compare the trend in primary care costs before and after the rollout of Sleepio. Primary care costs include general practice contacts and prescriptions. Segmented regression analysis was used to estimate primary and secondary outcomes.ResultsFor the 10,704 patients included in our sample, the total saving over the 65-week follow-up period was £71,027. This corresponds to £6.64 per person in our sample or around £70.44 per Sleepio user. Secondary analyses suggest that savings may be driven primarily by reductions in prescriptions.ConclusionSleepio rollout reduced primary care costs. National adoption of Sleepio may reduce primary care costs by £20 million in the first year. The expected impact on primary care costs in any particular setting will depend on the uptake of Sleepio.

scholarly journals Financial team incentives improved recording of diagnoses in primary care: a quasi-experimental longitudinal follow-up study with controls

2015 ◽  
Vol 8 (1) ◽  
Author(s):  
Tuomo Lehtovuori ◽  
Timo Kauppila ◽  
Jouko Kallio ◽  
Marko Raina ◽  
Lasse Suominen ◽  
...  
Keyword(s):  
Primary Care ◽  
Follow Up Study ◽  
Quasi Experimental

scholarly journals Effect of an Alternative Newborn Naming Strategy on Wrong-Patient Errors: A Quasi-Experimental Study

2020 ◽  
Vol 11 (02) ◽  
pp. 235-241 ◽  
Author(s):  
Ethan Pfeifer ◽  
Margaret Lozovatsky ◽  
Joanna Abraham ◽  
Thomas Kannampallil
Keyword(s):  
Experimental Study ◽  
Neonatal Intensive Care ◽  
Interrupted Time Series ◽  
Neonatal Intensive Care Units ◽  
Interrupted Time Series Analysis ◽  
Entire Study ◽  
Before And After ◽  
Quasi Experimental ◽  
Small Set ◽  
Experimental Study Design

Abstract Objectives Newborns are often assigned temporary names at birth. Temporary newborn names—often a combination of the mother's last name and the newborn's gender—are vulnerable to patient misidentification due to similarities with other newborns or between a mother and her newborn. We developed and implemented an alternative distinct naming strategy, and then compared its effectiveness on reducing the number of wrong-patient orders with the standard distinct naming strategy. Methods This study was conducted over a 14-month period in the newborn nursery and neonatal intensive care units of three hospitals that were part of the same health care system. We used a quasi-experimental study design using interrupted time series analysis to compare the differences in wrong-patient orders (an indicator of patient misidentification) before and after the implementation of the alternative distinct naming strategy. Results Overall, there were 25 wrong-patient errors per 10,000 orders during entire study period (36.8 per 10,000 before and 19.6 per 10,000 after). However, there was no statistically significant change in the rate of wrong-patient ordering errors after the transition from the distinct to the alternative distinct naming strategy (β = 0.832, 95% confidence interval [CI] = −0.83 to 2.49, p = 0.326). We also found that, overall, 1.7% of the clinicians contributed to 62% of the wrong-patient errors. Conclusion Although we did not find statistically significant differences in wrong-patient errors, the alternative distinct naming approach provides pragmatic advantages over its predecessors. In addition, the localization of wrong-patient errors within a small set of clinicians highlights the potential for developing strategies for delivering training to clinicians.

scholarly journals Impact of COVID-19 on child malnutrition, obesity in women and household food insecurity in underserved urban settlements in Sri Lanka: a prospective follow up study

2021 ◽  
pp. 1-24
Author(s):  
Renuka Jayatissa ◽  
Himali Herath ◽  
Amila Gayan Perera ◽  
Thulasika Thejani Dayaratne ◽  
Nawmali Dhanuska De Alwis ◽  
...  
Keyword(s):  
Sri Lanka ◽  
Food Insecurity ◽  
Child Malnutrition ◽  
Nutrition Status ◽  
Household Food Insecurity ◽  
Follow Up Study ◽  
Household Food ◽  
Before And After ◽  
Urban Settlements

Abstract Objectives: To determine changes and factors associated with child malnutrition, obesity in women and household food insecurity before and after the first wave of COVID-19 pandemic. Design: A prospective follow up study. Setting: In 2019, the baseline Urban Health and Nutrition Study (UHNS-2019) was conducted in 603 households, which were selected randomly from 30 clusters to represent underserved urban settlements in Colombo. In the present study, 35% of households from the UHNS-2019 cohort were randomly selected for repeat interviews, one year after the baseline study and 6 months after COVID-19 pandemic in Sri Lanka. Height/length and weight of children and women were re-measured, household food insecurity was reassessed, and associated factors were gathered through interviewer administered questionnaires. Differences in measurements at baseline and follow-up studies were compared. Participants: A total of 207 households, comprising 127 women and 109 children were included. Results: The current prevalence of children with wasting and overweight was higher in the follow-up study than at baseline UHNS-2019 (18.3%vs13.7%;p=0.26 and 8.3%vs3.7%;p=0.12 respectively). There was a decrease in prevalence of child stunting (14.7%vs11.9%;p=0.37). A change was not observed in overall obesity in women, which was around 30.7%. Repeated lockdown was associated with a significant reduction in food security from 57% in UHNS-2019 to 30% in the current study (p<0.001). Conclusions: There was an increase in wasting and overweight among children while women had a persistent high prevalence of obesity. This population needs suitable interventions to improve nutrition status of children and women to minimise susceptibility to COVID-19.

scholarly journals Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Laney K. Jones ◽  
Megan McMinn ◽  
David Kann ◽  
Michael Lesko ◽  
Amy C. Sturm ◽  
...  
Keyword(s):  
Primary Care ◽  
Program Effectiveness ◽  
Primary Care Providers ◽  
Care Providers ◽  
Lipid Levels ◽  
Framework Analysis ◽  
Lipid Clinic ◽  
Adherence Counseling ◽  
Clinically Significant

Abstract Background Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods The purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post-study design, we evaluated the implementation outcomes from the MDLC using the RE-AIM framework. Results In 2019, 420 referrals were made to the MDLC (reach). Referrals were made by 19% (148) of the 796 active cardiology and primary care providers, with an average of 35 patient referrals per month in 2019 (SD 12) (adoption). The MDLC saw 83 patients in 2019 (reach). Additionally, 50% (41/82) had at least one follow-up MDLC visit, and 12% (10/82) had two or more follow-up visits in 2019 (implementation). In patients seen by the MDLC, we found an improved diagnosis of specific lipid conditions (FH (familial hypercholesterolemia), hypertriglyceridemia, and dyslipidemia), increased prescribing of evidence-based therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels by lipid condition subgroup (effectiveness). Over time, the operations team decided to transition from in-person follow-up to telehealth appointments to increase capacity and sustain the clinic (maintenance). Conclusions Despite limited reach and adoption of the MDLC, we found a large intervention effect that included improved diagnosis, increased prescribing of guideline-recommended treatments, and clinically significant reduction of lipid levels. Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the MDLC and improving outcomes for more patients throughout the system.

Sign in / Sign up

Export Citation Format

Share Document