Susanne Bethge

A Review on Methods of Risk Adjustment and their Use in Integrated Healthcare Systems

Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The objective of this review was to obtain an overview of existing models of risk adjustment as well as on crucial weights in risk adjustment. Moreover, the predictive performance of selected methods in international healthcare systems should be analysed. Theory and methods: A comprehensive, systematic literature review on methods of risk adjustment was conducted in terms of an encompassing, interdisciplinary examination of the related disciplines. Results: In general, several distinctions can be made: in terms of risk horizons, in terms of risk factors or in terms of the combination of indicators included. Within these, another differentiation by three levels seems reasonable: methods based on mortality risks, methods based on morbidity risks as well as those based on information on (self-reported) health status. Conclusions and discussion: After the final examination of different methods of risk adjustment it was shown that the methodology used to adjust risks varies. The models differ greatly in terms of their included morbidity indicators. The findings of this review can be used in the evaluation of integrated healthcare delivery systems and can be integrated into quality- and patient-oriented reimbursement of care providers in the design of healthcare contracts.

PMC44 EXPERTS' JUDGEMENT ON PATIENT-CENTRED COORDINATED CARE

PMC44 EXPERTS’ JUDGEMENT ON PATIENT-CENTRED COORDINATED CARE Mühlbacher AC, Juhnke C, Bethge S Hochschule Neubrandenburg, Neubrandenburg, Germany OBJECTIVES: Delivering care coordination services is often described as the key to effectively meet patients’ needs and expectations. Patient empowerment and patient participation is highly discussed and postulated, but there is a lack of knowledge of how to design patient-centered coordinated care. This study intends to provide health policy and decision-makers with a comprehensive assessment on experts’ priorities in the relative value of different dimensions of coordinated care. METHODS: A questionnaire with 88 items was conducted with N = 251 health care experts. Exploratory and confi rmatory factor analysis was performed using SPSS18. The number of factors to be retained was controlled by Kaiser’s criterion (eigenvalues above 1), validation of the scree plot, and the interpretability of the items. Cronbach’s alpha was used to assess the internal consistency of the subscales identifi ed. RESULTS: The exploratory factor analysis leaded to 25 factors. After analyzing the screeplots and qualitative results confi rmatory factor analysis was computed for an 8 factor solution accounting for 42,828 % of the total variance and with KMO of 0.723. Cronbach alpha reliability coeffi cients were computed for each of the sub-scales and ranged between 0.849 and 0.745. Based on the existing literature and the analysis conducted, coordinated care could be differentiated into eight dimensions: access, knowledge transfer, technical care, interpersonal care, patient-centeredness, continuity, infrastructure and participation in social life. CONCLUSIONS: The aim of the study was to structure the key attributes for future stated preference research. Differences in experts’ judgment and patients’ perspective will be analyzed in upcoming research. If expectations of stakeholders are taken into account adequately, it can be assumed that this will increase the motivation to participate in and the satisfaction with coordinated care programs.

Incentives for Blood Donation: A Discrete Choice Experiment to Analyze Extrinsic Motivation

Background: Demographic trends affect size and age structure of populations. One of the consequences will be an increasing need for blood products to treat age-related diseases. Donation services rely on voluntariness and charitable motivation. It might be questioned whether there will be sufficient blood supply with voluntary donation. The present study focused on elicitation of preferences for incentives and aimed to contribute to the discussion on how to increase donation rates. Methods: A self-administered discrete choice experiment (DCE) was applied. Respondents were repeatedly asked to choose between hypothetical blood donation centers. In case of reluctance to receiving incentives a none-option was included. Random parameter logit (RPL) and latent class models (LCM) were used for analysis. Results: The study sample included 416 college students from the US and Germany. Choice decisions were significantly influenced by the characteristics of the donation center in the DCE. Incentives most preferred were monetary compensation, paid leave, and blood screening test. LCM identified subgroups with preference heterogeneity. Small subgroups indicated moderate to strong aversion to incentives. Conclusion: The majority of the sample positively responded to incentives and indicated a willingness to accept incentives. In face of future challenges, the judicious use and appropriate utilization of incentives might be an option to motivate potential donors and should be open to discussion.

Patient-centered health care delivery systems in the US: a Discrete-Choice Experiment

Objectives: Patient-centered care, in which health services are customized on the basis of patients’ needs and values, is seen as a critical factor in a high-performance health care system. This project seeks to characterize patients’ needs and values for specific features of health care delivery systems. Methods: Quantitative data were obtained by means of a discrete choice experiment (DCE) using a logit model. Alternatives were described by 21 specific attributes that described certain features of a health care delivery system. Each set included six attributes with three specific levels. The DCE was divided into four blocks based on thematic mapping (DCE 1, patient involvement; DCE 2, point of care; DCE 3, personnel; DCE 4, organization). Each DCE included six attributes with three specific levels. Respondents were randomly assigned to an DCE. Results: N=3900 respondents (patients) have completed the survey at Duke HealthView. The feature “out-of-pocket costs” was of high importance across all 4 DCEs (DCE-1coefficient: 0.7050; DCE-2coefficient: 0.9057; DCE-3coefficient, 0.7330; DCE-4coefficient: 0.8384). In DCE 1 regarding patient involvement, “trust and respect” (0.6538) and “attention to personal situation” (0.4732) were of greatest importance. In DCE 2 addressing preferences at the point of care, “shared decision making” (0.7441) and “access to patient record” (0.4576) were nearly equally valuable to patients but of highest relevance. In DCE 3 focusing on personnel in health care delivery systems, “multidisciplinary care” (0.7308) was ranked highest. Lastly, in DCE 4 analyzing features of the organization of health care delivery systems, “medical devices and furnishings” (0.4082) and “treatment guidelines” (0.4702) were of almost equal value to patients.

People needing overweight and obesity therapy want care co-ordination: Results of a Discrete-Choice Experiment

Background: Obesity is associated with increased risk of morbidity, mortality and appears to adversely affect health-related quality of life. Preference-based therapies may lead to higher patient compliance and adherence. The aim of the study was to identify key attributes of weight loss programs and to elicit patients’ preferences for overweight and obesity therapy. Method: Based on a subsequent qualitative study a self-administered survey, measuring attitudes and preferences, was conducted in Germany in 2009. Discrete-choice-experiment scenarios including 8 binary attributes were developed using a fractional factorial design and results analysed using random-effects-logit-model. Results: N=110 patients answered the questionnaire (51,82% male, mean age 53,05 years, mean BMI 33,54 kg/m2 (SD 7,73). From highest relevance for the respondents’ selection were care coordination (Coefficient 1.473; SE 0.185, OR 4,365) and individual therapy (Coefficient 1.446; SE 0.188, OR 4,2499). The aspect of infrastructure of care was less relevant. Conclusion: Patients value coordination of care and individual therapy as most important. Weight reduction therapy should enable patients to receive a structured, coordinated and interpersonal therapy that is individualized on their personal needs, behaviour and circumstances. Patients are willing to abandon infrastructural quality for getting better coordination and structure in their therapy.

Identification of needs and attitudes of overweight and obese patients for weight loss therapy: a mix-method analysis in German rehabilitation facilities

There is urgent need for effective treatment and coordinated care programmes for the obesity epidemic. Treatment success can only be achieved by a long-term change of behaviour and consideration of patient priorities. This study analysed, treatment needs and expectations of overweight and obese patients in rehabilitation facilities to identify patient-relevant characteristics with regard to long-term weight loss programmes. This was done using a combination of qualitative-procedures [literature analysis, expert-interviews (N = 5), focus-groups (N = 44)] and quantitative-assessment (survey N = 201, explorative factor analyses). The factor analysis (Cronbach’s alpha 0.87–0.55; variance 55.41%) revealed eight patient-relevant factors: ‘knowledge’, ‘varied range of therapy options’, ‘interpersonal care’, ‘individualised therapy planning’, ‘infrastructure quality’, ‘coordinated care’, ‘social interaction’ and ‘technical competence’. Only if the needs and preferences of patients are known, the creation of patie...