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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

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

background designing healthcare delivery
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
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


Literature research(Sept.2010; N=167)

  • Definition of research question
  • Multilevel methodological approach
  • Structuring and Analysis of data using factor analyses


  • 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 design rating factor analysis
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
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 design factor analysis
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
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

results factor analysis patients
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

  • 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

  • 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