Defining a patient-centered approach to cancer survivorship care: development of the patient centered survivorship care index (PC-SCI)

Purpose This study presents the validation of an index that defines and measures a patient-centered approach to quality survivorship care. Methods We conducted a national survey of 1,278 survivors of breast, prostate, and colorectal cancers to identify their priorities for cancer survivorship care. We identified 42 items that were “very important or absolutely essential” to study participants. We then conducted exploratory and confirmatory factor analyses (EFA/CFA) to develop and validate the Patient-Centered Survivorship Care Index (PC-SCI). Results A seven-factor structure was identified based on EFA on a randomly split half sample and then validated by CFA based on the other half sample. The seven factors include: (1) information and support in survivorship (7 items), (2) having a medical home (10 items) (3) patient engagement in care (3 items), (4) care coordination (5 items), (5) insurance navigation (3 items), (6) care transitions from oncologist to primary care (3 items), and (7) prevention and wellness services (5 items). All factors have excellent composite reliabilities (Cronbach’s alpha 0.84-0.94, Coefficient of Omega: 0.81-0.94). Conclusions Providing quality post-treatment care is critical for the long-term health and well-being of survivors. The PC-SCI defines a patient-centered approach to survivorship care to complement clinical practice guidelines. The PC-SCI has acceptable composite reliability, providing the field with a valid instrument of patient-centered survivorship care. The PC-SCI provides cancer centers with a means to guide, measure and monitor the development of their survivorship care to align with patient priorities of care. Trial registration ClinicalTrials.gov ID: NCT02362750, 13 February 2015

Construction and Performance of the Hospice Care Index Claims-Based Quality Measure

As part of the Medicare Hospice Benefit (MHB), hospices submit claims containing information that allows policy makers to assess hospice quality, help policy makers improve the MHB, and increase patients’ experiences of care. We examine ten different hospice quality indicators related to the provision of services and patterns of live discharge. We calculated indicators using 100% Medicare fee-for-service (FFS) claims from October 1, 2018 through September 30, 2019. A hospice’s total score among all ten indicators is referred to as their Hospice Care Index (HCI), with a possible high score of 10. We examined all hospices with at least 20 discharges. After exclusion, we examined 4,155 hospices representing 1,562,003 beneficiaries. Most hospices earn a high HCI score: over 85% of hospices had scores of eight or more. At the same time, there were some lower scoring hospices: one in ten hospices scored seven on the index, and the remaining 4.9% scored six or lower. We find that on average hospices with higher HCI scores have better Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice ratings. Among hospices with a score of ten, 85.1% of caregivers reported they would definitely recommend the hospice vs. 82.9% of caregivers of patients receiving treatment from hospices with a score of seven or less. Using the HCI, the Centers for Medicare and Medicaid Services and hospice patient caregivers can assess hospices across a broad set of indicators. Policymakers and hospices should monitor these ten indicators to understand their performance relative to peers.

Assessment of the effects of methodological choice in continuity of care research: a real-world example with dyslipidaemia cohort

ObjectiveTo determine if the choice of methodological elements affects the results in continuity of care studies.DesignThis is a retrospective cohort study. The association between continuity of care and clinical outcome was investigated using the Continuity of Care Index. The association was explored in 12 scenarios based on four definitions of the relative timing of continuity and outcome measurements in three populations (three Ps × four Ts).SettingNational Health Insurance claims from all primary and secondary care facilities in South Korea between 2007 and 2015.ParticipantsParticipants were patients diagnosed with dyslipidaemia, made ≥2 ambulatory visits and were newly prescribed with ≥1 antihyperlipidaemic agent at an ambulatory setting in 2008. Three study populations were defined based on the number of ambulatory visits: 10 084 patients in population 1 (P1), 8454 in population 2 (P2) and 4754 in population 3 (P3).Main outcome measureHospitalisation related to one of the four atherosclerotic cardiovascular diseases, including myocardial infarction, stable or unstable angina, ischaemic stroke and transient ischaemic attack.ResultsConcurrent measure of continuity and outcome (T1) showed a significantly higher risk of hospitalisation (adjusted HRs: 2.73–3.07, p<0.0001) in the low continuity of care group, whereas T2, which measured continuity until the outcome occurred, showed no risk difference between the continuity of care groups. T3, which measured continuity as a time-varying variable, had adjusted HRs of 1.31–1.55 (p<0.05), and T4, measuring continuity for a predefined period and measuring outcomes in the remaining period, had adjusted HRs of 1.34–1.46 (p<0.05) in the low continuity of care. Within each temporal relationship, the effect estimates became more substantial as the inclusion criteria became stricter.ConclusionsThe study design in continuity of care studies should be planned carefully because the results are sensitive to the temporal relationship between continuity and outcome and the population selection criteria.

Early Childhood Caries in 4- to 5-Year-Old Children in Erzurum, Turkey

Introduction: Early childhood caries is tooth decay seen in children under 72 months old. It is associated with multiple predisposing factors and has a negative impact on quality of life. In this study, our aim was to assess the oral health conditions and prevalence of early childhood caries (ECC) in children in the city of Erzurum, Turkey.Materials and Methods: This cross-sectional epidemiological study was conducted in Atatürk University, Faculty of Dentistry, Pediatric Dentistry Department/Erzurum-Turkey, in the 2015–2016 academic year. A total of 1,156 children (588 girls and 568 boys), with mean age of 4.9 ± 0.3 years (min 4, max 5) were included in the study. Restorative index (RI), deft, significant caries index (SiC), SiC10, treatment needs, number of lost primary teeth per 100 children, care index, and prevalence of carious primary teeth were evaluated. Data were analyzed by Chi-square test and Mann–Whitney U test (p &lt; 0.05).Results: A total of 73.3% prevalence of ECC was observed in preschool children with a mean deft score of 3.9±4 and an increase in ECC with age. RI was 2.2%, SiC was 8.5, SiC10 was 12.3, caries treatment needs was 93.5%, care index was 2.1%, and number of lost primary teeth per 100 children was 0.9 tooth.Conclusion: High level of ECC indicates the necessity of starting an oral health education program for mothers and dental screening of children, and the demand for improving oral and dental services.

Global, regional, and national burden and quality of care index (QCI) of lip and oral cavity cancer: a systematic analysis of the Global Burden of Disease Study 1990–2017

Background To measure the quality of care for lip and oral cavity cancer worldwide using the data from the Global Burden of Disease (GBD) Study 2017. Methods After devising four main indices of quality of care for lip and oral cavity cancer using GBD 2017 study’s measures, including prevalence, incidence, years of life lost, years lived with disability, and disability-adjusted life years, we utilised principal component analysis (PCA) to determine a component that bears the most proportion of info among the others. This component of the PCA was considered as the Quality-of-Care Index (QCI) for lip and oral cavity cancer. The QCI score was then reported in both men and women worldwide and different countries based on the socio-demographic index (SDI) and World Bank classifications. Results Between 1990 and 2017, care quality continuously increased globally (from 53.7 to 59.6). In 1990, QCI was higher for men (53.5 for men compared with 50.8 for women), and in 2017 QCI increased for both men and women, albeit a slightly higher rise for women (57.2 for men compared with 59.9 for women). During the same period, age-standardised QCI for lip and oral cavity cancer increased in all regions (classified by SDI and World Bank). Globally, the highest QCI scores were observed in the elderly age group, whereas the least were in the adult age group. Five countries with the least amount of QCIs were all African. In contrast, North American countries, West European countries and Australia had the highest indices. Conclusion The quality of care for lip and oral cavity cancer showed a rise from 1990 to 2017, a promising outcome that supports patient-oriented and preventive treatment policies previously advised in the literature. However, not all countries enjoyed such an increase in the QCI to the same extent. This alarming finding could imply a necessary need for better access to high-quality treatments for lip and oral cavity cancer, especially in central African countries and Afghanistan. More policies with a preventive approach and paying more heed to the early diagnosis, broad insurance coverage, and effective screening programs are recommended worldwide. More focus should also be given to the adulthood age group as they had the least QCI scores globally.

An assessment of the quality of care provided at primary health care centres in camps for internally displaced persons in Iraq in 2018

Introduction The humanitarian crisis in Iraq remains one of the largest and most unstable in the world. In 2014, over 2.5 million civilians were displaced in Iraq; between 2015 and 2017 more than 3 million people continued to be displaced. While health-related research concerning internally displaced persons (IDPs) population has been conducted in many settings, very few have looked at the quality of care delivered in primary health care centres (PHCC) inside camps. The objective of this operational research is to assess the quality of health care services at PHCC in operational IDP camps supported by local and international NGOs (humanitarian partners) as well as the Directorate of Health (DoH) in Iraq at baseline and after 6 months. Method A framework based on five components was used to assess quality of care by assigning a quality-of-care index score. Using a longitudinal design; data were collected through observations of facilities and of patient consultations, as well as health worker and patient exit interviews, in static PHCC in operational IDP camps of Iraq during two different phases: in June (n = 55), and December 2018 (n = 47). These facilities supported more than 500,000 IDPs. Descriptive and statistical analyses were conducted, and the results compared. Result For all camps (n = 47), the average overall quality of care index score increased between the two phases. No specific type of organisation consistently provided a better quality of care. The camp size was unrelated to the quality of care provided at the respective facility. The domain indicators “Client Care” and “Environment and Safety” mostly related to the variation in the general assessment of quality. Patient satisfaction was unrelated to any other domain score. Compared at 0 and after 6-months, the quality of care index score between the type of organisation and governorate showed that feedback positively impacted service delivery after the first assessment. Positive differences in scores also appeared, with notable improvements in Client care and Technical competence. Conclusion Humanitarian partners and the DoH are able to provide quality care, independent of camp size or the number of camps managed, and their cooperation can lead to quick improvements. This research also shows that quality of care assessment in emergency settings can be carried out in formal IDP camps using non-emergency standards.

Predicting healthcare-associated infections, length of stay, and mortality with the nursing intensity of care index

Objectives: The objectives of this study were (1) to develop and validate a simulation model to estimate daily probabilities of healthcare-associated infections (HAIs), length of stay (LOS), and mortality using time varying patient- and unit-level factors including staffing adequacy and (2) to examine whether HAI incidence varies with staffing adequacy. Setting: The study was conducted at 2 tertiary- and quaternary-care hospitals, a pediatric acute care hospital, and a community hospital within a single New York City healthcare network. Patients: All patients discharged from 2012 through 2016 (N = 562,435). Methods: We developed a non-Markovian simulation to estimate daily conditional probabilities of bloodstream, urinary tract, surgical site, and Clostridioides difficile infection, pneumonia, length of stay, and mortality. Staffing adequacy was modeled based on total nurse staffing (care supply) and the Nursing Intensity of Care Index (care demand). We compared model performance with logistic regression, and we generated case studies to illustrate daily changes in infection risk. We also described infection incidence by unit-level staffing and patient care demand on the day of infection. Results: Most model estimates fell within 95% confidence intervals of actual outcomes. The predictive power of the simulation model exceeded that of logistic regression (area under the curve [AUC], 0.852 and 0.816, respectively). HAI incidence was greatest when staffing was lowest and nursing care intensity was highest. Conclusions: This model has potential clinical utility for identifying modifiable conditions in real time, such as low staffing coupled with high care demand.

Influence of organization and demographic characteristics of primary care practices on continuity of care: analysis of a retrospective cohort from 287 primary care practices covering about 6 million people in Catalonia

Background There is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. The main objective of this study is to describe the continuity of care in primary healthcare in Catalonia (Spain) and to analyze whether the organization of primary care practices (PCP) or their patients’ sociodemographic characteristics play a role in its continuity of care. Methods Four indices were used to measure continuity of care: Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity Index (SECON). The study was conducted on 287 PCP of the Catalan Institute of Health (Institut Català de la Salut—ICS). Each continuity of care index was calculated at the patient level (3.2 million patients and 35.5 million visits) and then aggregated at the PCP level. We adjusted linear regression models for each continuity index studied, considering the result of the index as an independent variable and demographic and organizational characteristics of the PCP as explanatory variables. Pearson correlation tests were used to compare the four continuity of care indices. Results Indices’ results were: UPC: 70,5%; MMCI: 73%; COC: 53,7%; SECON: 60,5%. The continuity of care indices had the highest bivariate correlation with the percentage of appointments booked with an assigned health provider (VISUBA variable: the lower the value, the higher the visits without an assigned health provider, and thus an organization favoring immediate consultation). Its R2 ranged between 56 and 63%, depending on the index. The multivariate model which explained better the variability of continuity of care indices (from 49 to 56%) included the variables VISUBA and rurality with a direct relationship; while the variables primary care physician leave days and training practices showed an inverse relationship. Conclusion Study results suggest that an organization of primary care favoring immediate consultation is related to a lower continuity of patient care.