Value of Healthcare Supply

Einleitung / Introduction

One important lever to counter rising healthcare costs is the de-implementation of Low Value Care (LVC). LVC are services, that, (a) provide little or no benefit to patients, (b) potentially cause iatrogenic harm, (c) incur unnecessary costs, and/or (d) waste scarce health care resources compared to the use of alternative services or its use in an alternative patient group. The management of chronic diseases, such as chronic-obstructive pulmonary disease (COPD), inherits the potential to avoid LVC. The literature highlights the importance of medication adherence for COPD patients to decrease symptoms and to prevent rapid health deterioration. However, LVC in medication adherence for COPD patients has not yet been identified and quantified systematically for large patient samples. Therefore, we developed an approach to identify and quantify implications of inadequate medication adherence with respect to exacerbation likelihood and health care spending based on health insurance data to develop de-implementation strategies for LVC.

Methode / Method

Patient level data was anonymously retrieved from a Swiss sickness fund containing – among others - personal data, contract information, and billing data from 2015 to 2020. The medication part of the COPD treatment path was retraced using billing data to track individual medication adherence of patients two years pre- and one year post-hospitalized exacerbations. Medication adherence is approximated by patients’ daily medication reserve. Once patients run short in their medication re-serve, we assumed they are not taking their prescribed medication. The calculations on hospitalization costs were conducted with a linear multivariate regression.

Ergebnisse / Results

13,557 COPD patients are included in the analysis. Almost half of the patient sample takes their medication less than 40% of the recommended prescription schedule. Our results show that patients with high medication adherence are up to 50% less likely to experience an exacerbation compared to patients with low medication adherence. Additionally, healthcare expenditures pre- and post-exacerbation are up to 27% lower compared to patients who do not adhere to medication regimens.

Zusammenfassung / Conclusion

We present a new approach to identify and quantify LVC using health insurance data. Regarding LVC in medication adherence of COPD patients, structured treatment programs where health literacy is promoted should be developed and used in Switzerland to increase the patients’ awareness on taking the medications according to prescription. Digital health interventions training patients to adhere to their medication plan can also help to save costs and scarce resources and prevent unnecessary harm. Further research needs to be conducted to uncover additional use cases of LVC and feasible de-implementation strategies.

AutorInnen

Anja Bischof, Lehrstuhl für Management im Gesundheitswesen, Universität St. Gallen

Johannes Cordier, Lehrstuhl für Management im Gesundheitswesen, Universität St. Gallen

Justus Vogel, Lehrstuhl für Management im Gesundheitswesen, Universität St. Gallen

Alexander Geissler, Lehrstuhl für Management im Gesundheitswesen, Universität St. Gallen

Einleitung / Introduction

In a first response to the COVID-19 pandemic, government officials urged patients to carefully consider visits to ambulatory care practices. Patients therefore missed appointments and physicians’ practices were temporarily closed during lockdown measures. However, even after the lockdown ended chronically ill patients and also patients with new symptoms kept avoiding or postponing visits to general practitioners or ambulatory care specialists. This raised concerns regarding the health consequences of the pandemic and the corresponding lockdown measures especially since continuity of care plays a vital role in patient care. The objective of this paper is to assess the continuity of care according to medical guidelines in patients with type 2 diabetes and coronary heart disease during the pandemic including lockdown in Germany.

Methode / Method

This study uses routine data of 11 million people from the Bavarian Association of Statutory Health Insurance Physicians (KVB). We compare the continuity of care of chronically ill patients in the first months of the pandemic including lockdown to a reference period before the pandemic. Continuity of care is measured by process indicators extracted from clinical practice guidelines such as quarterly GP or specialist consultations for diabetes patients. In addition, continuity of care indices are calculated and compared for the time before and during lockdown.

Ergebnisse / Results

First results of the ongoing project include differences in continuity of care before and during the pandemic, disease-specific differences in continuity of care as well as associations between socioeconomic variables and continuity of care.

Zusammenfassung / Conclusion

The COVID-19 pandemic likely affected the continuous care of chronically ill patients. The identified deficits can inform policy-makers to better prepare for future pandemics and assure continuous care to at-risk patients.

AutorInnen

Adriana König, Technische Universität München

Leonie Sundmacher, Technische Universität München

Einleitung / Introduction

Pertussis, also known as whopping cough, is an acute respiratory disease that is caused by the bacterial pathogen Bordetella pertussis. According to ECDC data in 2018, Germany, the Netherlands, Norway, Spain, and the United Kingdom (UK) accounted for 72% of all notified pertussis cases, of which 47% are over 30 years old. In addition to mortality and mobility, pertussis has an impact on healthcare expenses, resources used, and costs. We aim to summarize the available evidence regarding incidence and HCRU of pertussis in patients with compared to patients without underlying conditions.

Methode / Method

The electronic databases used for the review were: PubMed and EMBASE. The PICO standard framework was used to develop the research questions. Specific inclusion and exclusion criteria were selected. The search was performed on the 20th of June 2022 and another updated search undertaken later did not uncover any further studies. Furthermore, to be able to evaluate the included studies in this review, a methodological quality assessment was implemented following specialized evaluation tools of the NHLBI.

Ergebnisse / Results

689 studies were identified through the search of both databases. An additional three studies were discovered through a manual search. Exclusion criteria resulted in eleven studies in total. Four were retrospective studies, two retrospective cohort studies, one prospective study, two systematic literature reviews, and two case-control studies. We additionally reviewed eight conference abstracts to assess also current evidence on this emerging topic. Overall, asthma and COPD were the most common underlying conditions considered in the included studies. Some studies examined the associated risk of pertussis incidence following from underlying heart disease, physical disabilities, or obesity; with a single study evaluating multiple UC at the same time. Most studies were covering small sample sizes, ranging between 33 and 524 pertussis cases in patients with underlying conditions. Concerning asthma and COPD, associated adjusted relative risk between underlying condition and pertussis incidence ranges between 1.64 and 4.06. Additionally, evidence is indication significant excess costs in the index quarter and up to 5 months after pertussis incidence in patients with compared to those without underlying condition.

Zusammenfassung / Conclusion

Despite the different underlying conditions considered in our search only a few have been studied so far in the literature. Most of the studies are from the US, UK, and Australia, and no data are available from the German health care setting. Although the availability of some economic studies, data on incremental HCRU and costs following pertussis incidence in patients with underlying conditions is scarce.

AutorInnen

Davide Lovera, VANDAGE

Julian Witte, VANDAGE

Daniel Gensorowsky, VANDAGE

Einleitung / Introduction

In the last two decades the number of patients undergoing prolonged weaning (defined as having failed at least 3 weaning attempts or requiring more than 7 days of weaning after the first spontaneous breathing trial) has increased dramatically in Germany. Prolonged weaning is associated with an increased risk for poor health outcomes due to bacterial infections, weakened respiratory muscles or tissue damage of the respiratory tract. Prolonged weaning is also associated with a high psychological burden for ventilated individuals as well as their family members. Thus, developing effective weaning approaches tailored to the needs of patients experiencing prolonged mechanical ventilation is of high importance. As multidisciplinary weaning approaches, which comprise the expertise of different health care professions like respiratory physicians, nurses, physiotherapists, dietitians, occupational therapists and psychologists, become more widespread, this systematic literature review seeks to analyze the effect of implementing multidisciplinary weaning approaches on overall weaning success and patients’ health outcomes.

Methode / Method

In order to run a structured search in PUBMED, we implemented the standard PICO search framework. We defined population as adults older than 18 years and undergoing prolonged mechanical ventilation in an inpatient and non-intensive care unit setting. Multidisciplinary therapy approaches constituted our intervention of interest. As central outcomes we defined weaning success, mortality and health care costs. We did not explicitly specify a comparison group. Finally, our systematic literature review only considers studies conducted in OECD-countries. We only included studies written in English or German and published after 2000/01/01.

Ergebnisse / Results

The conducted PUBMED search yielded 867 hits. In a first step, two reviewers independently screened titles and abstracts. Any disagreements were resolved by a third reviewer. This first screening step led to the elimination of 745 articles. We conducted a full text screening for the remaining 122 articles. Removing another 92 articles, 30 articles have been included in the review. To compare the selected studies, we analyzed the implemented methodological approaches, outcome definitions and outcome measurements. The majority of intervention studies are single-armed studies without control groups. Furthermore, outcome definitions and outcome measurements differ significantly between studies.

Zusammenfassung / Conclusion

So far, no consistent definition of weaning success has been established in evaluation studies making inferences with regard to effectiveness of different multidisciplinary weaning approaches difficult. To ensure comparability, future research should focus on developing a consistent definition of weaning success.

AutorInnen

Melanie Martin, Vandage GmbH