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Patient-centeredness in Integrated healthcare delivery systems: Needs, expectations & priorities for organized healthcare systems. 13 th International Conference on Integrated Care 1.2 Patient- centred care . Christin Juhnke, M.A. Prof. Dr. Axel C. Mühlbacher

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Patient-centeredness in Integrated healthcare delivery systems: Needs, expectations & priorities for organized healthcare systems

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Patient-centeredness in Integrated healthcare delivery systems:Needs, expectations & priorities for organized healthcare systems

13th International Conference on Integrated Care 1.2 Patient-centred care

Christin Juhnke, M.A.Prof. Dr. Axel C. Mühlbacher

IGM Institute Health Economics andHealthcare Management, Hochschule Neubrandenburg, Germany


BackgroundDesigning Healthcare Delivery

  • Organized healthcare delivery systems intend to structure the care for a defined population or the care process for a defined indication.

    • Integrated care, coordinated care, disease management

  • The Institute of Medicine report “Crossing the Quality Chasm” emphasizes that healthcare should be customized based on patients’ needs and values.

  • Patient-centred 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 healthcare system.

“Healthcare systems are challenged to effectively meet the wants and needs of patients by tailoring interventions based on each person’s […] preferences as well as personal and social context”. [Sevin et al. 2009]

Hochschule Neubrandenburg


Research Question

  • Contemporary and application-oriented analysis and documentation of what patients need and expect from organized healthcare services.

  • Aim: structure the patient-relevant need dimensions of healthcare programs:

    • Identification of needs, expectations and priorities of patients in organized healthcare delivery networks.

      • Identification of characteristics of healthcare services which determine utility, motivation and quality of care from the patients’ point of view.

      • Identification of characteristics from the perspective of healthcare providers, payers and other experts within the framework of integrated and coordinated services.

Hochschule Neubrandenburg


Methods and Study DesignChronology of Methods

Project-definition

Literature research(Sept.2010; N=167)

  • Definition of research question

  • Multilevel methodological approach

  • Structuring and Analysis of data using factor analyses

    Aim:

  • Comprehensive data collection and documentation of all potentially relevant characteristics of integrated care programs

  • Analysis of needs and expectations on the psychometric structures and dimensions of the needs

Qualitative Study Phase

Interviews using Design-Thinking Method (N=22)

  • Generation of relevant characteristics

  • Designing of questionnaire

Quantitative Study Phase

Rating Experts & Patients

  • Conducting of survey in medical offices and on congresses

Data analysis/ Reporting

Explorative Data analyses: Factor analyses

  • Data Analysis

  • Development of factor model

Hochschule Neubrandenburg


Methods and Study DesignRating & Factor Analysis

  • Results of qualitative study phase were transferred to 84 care- related items

  • Five-point Likert-Scale

    • Very important

    • Important

    • So- so

    • Less important

    • Not important

  • Factor-Analysis using SPSS® 18

Hochschule Neubrandenburg


Results Sample Characteristics

  • Rating of 84 care delivery-related items

    • Paper-and pencil-based surveys

    • Patients: 12 surgeries/ medical offices in 3 German federal states

    • June - October 2010

    • N=670

    • Healthcare experts: three international health conventions

      • April - June 2010

    • N=254

Hochschule Neubrandenburg


Methods and Study DesignFactor Analysis

  • Method of multivariate data analysis

  • Aim: Descriptions of variability among observed, correlated variables in terms of a potentially lower number of unobserved variables called factors.

  • Basis:

    • Factor Theory of Spearman (1904)

    • methodological development especially Thurstone (1931; 1947)

  • Principal components analysis based on Pearson (1901) & Hotelling (1933)

Hochschule Neubrandenburg


Results Factor Analysis: Experts

  • Exploratory factor analysis:

    • 24 factors with Eigenvalue > 1

    • KMO of 0,730

    • 71,357% of total variance

  • Screeplot: 4-7 factors

  • 7-Factor solution

    • Total variance: 38,427%

    • KMO: 0,797

    • Cronbach alpha: 0,836 -0,715.

Hochschule Neubrandenburg


ResultsFactor Analysis: Patients

  • Exploratory factor analysis:

    • 20 factors with Eigenvalue > 1

    • KMO of 0,914

    • 63,462 % of total variance

  • Screeplot: 4-8 factors

  • List-wise deletion: N= 453

  • 7-Factor solution

    • Total variance: 42,963 %

    • KMO: 0,914

    • Cronbach alpha: 0,899 – 0,756

Hochschule Neubrandenburg


ResultsModel of need dimensions in organized healthcare

Hochschule Neubrandenburg


Limitations

  • Patient sample does not fulfil the criterion of representativityin terms of age

  • Study represents cross-sectional data from 670 respondents from three German regions

    • Statement on the deviation from a representative norm sample is not possible

  • Rating was based on 5-point Likertscale

    • individual items are not weighted against each other

    • items did not show a Gaussian distribution, but a left shift

Hochschule Neubrandenburg


Conclusion

  • Systematic approach of qualitative and quantitative measures as preparation of a preference study

  • Aim of structuring of needs using psychometric analyses

  • Identification and structuring of patient-relevant characteristics was successful

  • Based on the results a Discrete-Choice Experiment was conducted

     If providers and payers can incorporate patient needs and expectations into organized care programs, greater concordance regarding treatment goals, adherence and better clinical outcomes might be achieved

Hochschule Neubrandenburg


THANK YOU

  • Prof. Dr. rer. oec. Axel C. Mühlbacher

  • Christin Juhnke, M.A.

  • IGM InstitutGesundheitsökonomie und Medizinmanagement

  • Hochschule Neubrandenburg

  • BrodaerStraße2

  • 17033 Neubrandenburg

  • [email protected]

  • Phone (+49) 0395 5693 3308

Hochschule Neubrandenburg


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