Showing papers by "Signe Flottorp published in 2011"

Public Release of Performance Data in Changing the Behaviour of Healthcare Consumers, Professionals or Organisations

Abstract: BACKGROUND: It is becoming increasingly common to release information about the performance of hospitals, health professionals or providers, and healthcare organisations into the public domain. However, we do not know how this information is used and to what extent such reporting leads to quality improvement by changing the behaviour of healthcare consumers, providers and purchasers, or to what extent the performance of professionals and providers can be affected. OBJECTIVES: To determine the effectiveness of the public release of performance data in changing the behaviour of healthcare consumers, professionals and organisations. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, MEDLINE Ovid (from 1966), EMBASE Ovid (from 1979), CINAHL, PsycINFO Ovid (from 1806) and DARE up to 2011. SELECTION CRITERIA: We searched for randomised or quasi-randomised trials, interrupted time series and controlled before-after studies of the effects of publicly releasing data regarding any aspect of the performance of healthcare organisations or individuals. The papers had to report at least one main outcome related to selecting or changing care. Other outcome measures were awareness, attitude, views and knowledge of performance data and costs. DATA COLLECTION AND ANALYSIS: Two review authors independently screened studies for eligibility and extracted data. For each study, we extracted data about the target groups (healthcare consumers, healthcare providers and healthcare purchasers), performance data, main outcomes (choice of healthcare provider and improvement by means of changes in care) and other outcomes (awareness, attitude, views, knowledge of performance data and costs). MAIN RESULTS: We included four studies containing more than 35,000 consumers, and 1560 hospitals. Three studies were conducted in the USA and examined consumer behaviour after the public release of performance data. Two studies found no effect of Consumer Assessment of Healthcare Providers and Systems information on health plan choice in a Medicaid population. One interrupted time series study found a small positive effect of the publishing of data on patient volumes for coronary bypass surgery and low-complication outliers for lumbar discectomy, but these effects did not persist longer than two months after each public release. No effects on patient volumes for acute myocardial infarction were found.One cluster-randomised controlled trial, conducted in Canada, studied improvement changes in care after the public release of performance data for patients with acute myocardial infarction and congestive heart failure. No effects for the composite process-of-care indicators for either condition were found, but there were some improvements in the individual process-of-care indicators. There was an effect on the mortality rates for acute myocardial infarction. More quality improvement activities were initiated in response to the publicly-released report cards. No secondary outcomes were reported. AUTHORS' CONCLUSIONS: The small body of evidence available provides no consistent evidence that the public release of performance data changes consumer behaviour or improves care. Evidence that the public release of performance data may have an impact on the behaviour of healthcare professionals or organisations is lacking.

Tailored implementation for chronic diseases (TICD): A project protocol

Abstract: Background: The assumption underlying tailoring is that implementation interventions are most helpful if these effectively address the most important determinants of practice for improvement in the targeted setting. The aim of the Tailored Implementation For Chronic Diseases (TICD) project is to develop valid and efficient methods of tailoring implementation interventions to determinants of practice for knowledge implementation in chronic illness care. Methods: The TICD project has organized the planned empirical research in three work packages that follow the three main steps of tailoring: identification of determinants of healthcare practice, matching implementation interventions to identified determinants of practice, and applying and assessing the tailored implementation interventions. These three key steps of tailored implementation will be applied to targeted chronic conditions in five different healthcare systems: cardiovascular disease in the Netherlands, obesity in England, depression in Norway, chronic obstructive pulmonary disease in Poland, and multimorbidity in Germany. The design and interpretation of empirical research will be informed by systematic reviews of previous research on tailoring implementation interventions. Discussion: The TICD project will provide much needed evidence on the advantages and disadvantages of different methods of identifying important determinants of practice and selecting implementation strategies that take account of those. It will also provide five rigorous evaluations of tailored implementation interventions for five different chronic conditions.

Evidence summaries tailored to health policy-makers in low- and middle-income countries

Abstract: s in بيرع , 中文, Francais, Pусский and Espanol at the end of each article. Objective To describe how the SUPPORT collaboration developed a short summary format for presenting the results of systematic reviews to policy-makers in low- and middle-income countries (LMICs).Methods We carried out 21 user tests in six countries to explore users’ experiences with the summary format. We modified the summaries based on the results and checked our conclusions through 13 follow-up interviews. To solve the problems uncovered by the user testing, we also obtained advisory group feedback and conducted working group workshops.Findings Policy-makers liked a graded entry format (i.e. short summary with key messages up front). They particularly valued the section on the relevance of the summaries for LMICs, which compensated for the lack of locally-relevant detail in the original review. Some struggled to understand the text and numbers. Three issues made redesigning the summaries particularly challenging: (i) participants had a poor understanding of what a systematic review was; (ii) they expected information not found in the systematic reviews and (iii) they wanted shorter, clearer summaries. Solutions included adding information to help understand the nature of a systematic review, adding more references and making the content clearer and the document quicker to scan.Conclusion Presenting evidence from systematic reviews to policy-makers in LMICs in the form of short summaries can render the information easier to assimilate and more useful, but summaries must be clear and easy to read or scan quickly. They should also explain the nature of the information provided by systematic reviews and its relevance for policy decisions.

Lifestyle consultation in general practice—the doctor's toolbox: a qualitative focus group study

Abstract: BACKGROUND GPs consider individual lifestyle counselling as part of their obligation. There is a lack of knowledge about how such counselling is done. OBJECTIVE To investigate what tools GPs utilize in individual consultations concerning lifestyle change. METHODS Qualitative analysis of six focus groups with 50 GPs sharing and commenting each other's case stories. RESULTS To enhance change of lifestyle, GPs adjusted the organization of their practice and utilized visualization tools. They established doctor-patient relationships based on shared decision making and trust, and gave their patients advice and tips to accomplish change, but also used paternalistic approaches and rhetoric manipulation. CONCLUSIONS GPs use a variety of tools in consultations about lifestyle change. A patient-centred approach is shown, but GPs also deliberately use distressing communication tools.

A new model for assessment of telemedicine—MAST

Abstract: Introduction: During the last years telemedicine has been presented as a solution to health care systems facing an aging population, increase in the number of patients with chronic illnesses and limited budgets. However, the spreading and large scale implementation of telemedicine in Europe is still lacking. A frequently used argument for this is lack of evidence. Aim: On this basis the EU commission initiated a project in 2009 with the aim to provide a structured framework for assessing the effectiveness and contribution to quality of care of telemedicine applications. Methods: The development of the model is based on results from workshops with stakeholders and users of telemedicine, a systematic literature review (published in Ekeland et al., 2010) and the EUnetHTA Core Model for interventions. Results: MAST should be used if the purpose of an assessment is to describe effectiveness and contribution to quality of care of telemedicine applications and to produce basis for decision-making. In this case MAST defines the relevant assessment as a multi-disciplinary process that summarises and evaluates information about the medical, social, economic and ethical issues related to the use of telemedicine in a systematic, unbiased, robust manner. MAST includes three elements: Preceding considerations of issues that should be considered before assessment of a telemedicine application is initiated. • • Multi-disciplinary assessment of the outcomes of telemedicine within seven domains (Health problem, safety, clinical effectiveness, • • patient perspectives, economic aspects, organisational aspects and socio-cultural, ethical and legal aspects). Assessment of the transferability of the results found. • • Discussion: MAST is currently being used in evaluation of 21 telemedicine projects with a total of 5000 patients in RENEWING HEALTH (2010–2012), a project under the CIP programme of DG INFSO, European Commission.