Patrik Vankrunkelsven

Economic Impact of Integrated Care Models for Patients with Chronic Diseases: A Systematic Review

OBJECTIVES To assess the costs and potential financial benefits of integrated care models for patients with chronic diseases, that is, type 2 diabetes mellitus, schizophrenia, and multiple sclerosis, respectively. METHODS A systematic search of the literature was performed using EMBASE, MEDLINE, and Web of Science. Studies that conducted a cost analysis, considered at least two components of the chronic care model, and compared integrated care with standard care were included. RESULTS Out of 575 articles, 26 were included. Most studies examined integrated care models for type 2 diabetes mellitus (n = 18) and to a lesser extent for schizophrenia (n = 6) and multiple sclerosis (n = 2). Across the three disease groups, the incremental cost per patient per year ranged from - €3860 to + €613.91 (x¯ = - €533.61 ± €902.96). The incremental cost for type 2 diabetes mellitus ranged from - €1507.49 to + €299.20 (x¯ = - €518.22 ± + €604.75), for schizophrenia from - €3860 to + €613.91 (x¯ = - €677.21 ± + €1624.35), and for multiple sclerosis from - €822 to + €339.43 (x¯ = - €241.29 ± + €821.26). Most of the studies (22 of 26 [84.6%]) reported a positive economic impact of integrated care models: for type 2 diabetes mellitus (16 of 18 [88.9%]), schizophrenia (4 of 6 [66.7%]), and multiple sclerosis (1 of 2 [50%]). CONCLUSIONS In this systematic literature review, predominantly positive economic impacts of integrated care models for patients with chronic diseases were found.

Development of Quality Indicators for an Integrated Approach of Knee Osteoarthritis

Objective. Osteoarthritis (OA) is a common cause of disability worldwide. Knee OA care is often suboptimal. A first necessary step in quality improvement is to gain a clear insight into usual care. We developed a set of evidence-based quality indicators for multidisciplinary high-quality knee OA care. Methods. A Rand-modified Delphi method was used to develop quality indicators for knee OA diagnosis, therapy, and followup. Recommendations were extracted from international guidelines as well as existing sets of quality indicators and scored by a multidisciplinary expert panel. Based on median score, prioritization, and agreement, recommendations were labeled as having a high, uncertain, or low potential to measure quality of care and were discussed in a consensus meeting for inclusion or exclusion. Two final validation rounds yielded a core set of recommendations, which were translated into quality indicators. Results. From a total of 86 recommendations and existing indicators, a core set of 29 recommendations was derived that allowed us to define high-quality knee OA care. From this core set, 22 recommendations were considered to be measurable in clinical practice and were transformed into a final set of 21 quality indicators regarding diagnosis, lifestyle/education/devices, therapy, and followup. Conclusion. Our study provides a robust set of 21 quality indicators for high-quality knee OA care, measurable in clinical practice. These process indicators may be used to measure usual care and evaluate quality improvement interventions across the entire spectrum of disciplines involved in knee OA care.

Designing a Patient Portal for Patient-Centered Care: Cross-Sectional Survey

Background In recent literature, patient portals are considered as important tools for the delivery of patient-centered care. To date, it is not clear how patients would conceptualize a patient portal and which health information needs they have when doing so. Objective This study aimed (1) to investigate health information needs, expectations, and attitudes toward a patient portal and (2) to assess whether determinants, such as patient characteristics, health literacy, and empowerment status, can predict two different variables, namely the importance people attribute to obtaining health information when using a patient portal and the expectations concerning personal health care when using a patient portal. Methods We conducted a cross-sectional survey of the Flemish population on what patients prefer to know about their digital health data and their expectations and attitudes toward using a patient portal to access their electronic health record. People were invited to participate in the survey through newsletters, social media, and magazines. We used a questionnaire including demographics, health characteristics, health literacy, patient empowerment, and patient portal characteristics. Results We received 433 completed surveys. The health information needs included features such as being notified when one’s health changes (371/396, 93.7%), being notified when physical parameters increase to dangerous levels (370/395, 93.7%), observing connections between one’s symptoms or diseases or biological parameters (339/398, 85.2%), viewing the evolution of one’s health in function of time (333/394, 84.5%), and viewing information about the expected effect of treatment (349/395, 88.4%). Almost 90% (369/412) of respondents were interested in using a patient portal. Determinants of patients’ attachment for obtaining health information on a patient portal were (1) age between 45 and 54 years (P=.05); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) commitment to question physicians’ decisions (P=.03, R2=0.122). Determinants of patients’ expectations on improved health care by accessing a patient portal were (1) lower education level (P=.04); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) problems in understanding health information (P=.04; R2=0.106). Conclusions The interest in using a patient portal is considerable in Flanders. People would like to receive alerts or some form of communication from a patient portal in case they need to act to manage their health. Determinants such as education, attached importance to shared decision making, difficulties in finding relevant health information, and the attached importance in questioning the decisions of physicians need to be considered in the design of a patient portal.

Knee osteoarthritis: widespread use of treatments that are not considered essential for high quality care

Background Knee OA puts a major burden on quality of life in the elderly (1). Multiple treatment modalities are available, which have demonstrated to decrease pain or improve functional impairment. However, research shows that current care doesn’t fit with recent exercise recommendations (2) and treatment modalities with poor or no research evidence are often used (3). A first step in quality improvement includes a clear insight in current care. Objectives This study aimed to measure current care in physiotherapy practice by a broad set of evidence based quality indicators and by registering the use of treatments that are not considered essential for high quality care. Methods A set of evidence based quality indicators was extracted from international guidelines and literature by a multidisciplinary expert panel. Those indicators, as well as treatments that were not considered essential for high quality knee OA care were incorporated in a digital questionnaire. Members of the Belgian professional organization of physiotherapists were addressed by a message in their electronic newsletter to complete the questionnaire. The results were analyzed using SPSS 19. Two-sided 95% confidence intervals were used to calculate the mean performance of both indicated and no essential treatments. Mutual relations between treatments that were not considered essential for high quality care were explored by calculating spearman’s rho correlations. P-values < 0.01 were considered significant. Results The questionnaire was completed by 276 physiotherapists. The average performance on quality indicators ranged between 27% and 98%. Treatments that were not considered to be essential for high quality care were used in 1% to 59% of a physiotherapist’s patients. Six of them were used in more than 20%; electrostimulation of the muscles (23%), application of cold or warmth (35% and 29%), TENS (24%), ultratones (24%), and massage (53%). Whether a physiotherapist used a treatment modality or not, turned out to be related to the use of other modalities. Electrostimulation of the quadriceps, ultratones, interferential streams, TENS and shortwave-, ultrashortwave- and radartherapy were mutually correlated with significant spearman’s correlations >0.350. Massage and the application of warmth were correlated too. Conclusions Guideline adherence on knee OA care among physiotherapists appears to be suboptimal. Indeed, treatments that are not particularly recommended seem to be widespread and may limit the time to be spent to interventions that have proved to be more effective, particularly when they are mutually correlated and more than one of those treatments is used at once. A clear insight into the barriers and facilitators for guideline adherence is needed in order to develop a well-targeted quality improvement strategy. References Guccione AA, et al. The effects of specific medical conditions on the functional limitations of elders in the Framingham Study. Am J Public Health 1994;84:351. Holden MA, et al. Physical therapists’ use of therapeutic exercise for patients with clinical knee osteoarthritis in the United kingdom: in line with current recommendations? Phys Ther 2008;88:1109-21. Walsh NE, et al. Evidence based guidelines and current practice for physiotherapy management of knee osteoarthritis. Musculoskeletal Care 2009;7:45-56. Disclosure of Interest None Declared