Within and across country variations in treatment of patients with heart failure and diabetes.

Or, Z; Shatrov, K; Penneau, A; Wodchis, W; Abiona, O; Blankart, CR; Bowden, N; Bernal-Delgado, E; Knight, H; Lorenzoni, L; Marino, A; Papanicolas, I; Riley, K; Pellet, L; Estupiñán-Romero, F; van Gool, K; Figueroa, JF

Within and across country variations in treatment of patients with heart failure and diabetes.

Or, Z Shatrov, K Penneau, A Wodchis, W Abiona, O

Blankart, CR Bowden, N Bernal-Delgado, E Knight, H Lorenzoni, L Marino, A Papanicolas, I Riley, K Pellet, L Estupiñán-Romero, F van Gool, K Figueroa, JF

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Publisher:: WILEY
Publication Type:: Journal Article
Citation:: Health services research, 2021, 56 Suppl 3, (S3), pp. 1358-1369
Issue Date:: 2021-12

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Field	Value	Language
dc.contributor.author	Or, Z
dc.contributor.author	Shatrov, K
dc.contributor.author	Penneau, A
dc.contributor.author	Wodchis, W
dc.contributor.author	Abiona, O https://orcid.org/0000-0002-1696-4475
dc.contributor.author	Blankart, CR
dc.contributor.author	Bowden, N
dc.contributor.author	Bernal-Delgado, E
dc.contributor.author	Knight, H
dc.contributor.author	Lorenzoni, L
dc.contributor.author	Marino, A
dc.contributor.author	Papanicolas, I
dc.contributor.author	Riley, K
dc.contributor.author	Pellet, L
dc.contributor.author	Estupiñán-Romero, F
dc.contributor.author	van Gool, K
dc.contributor.author	Figueroa, JF
dc.date.accessioned	2021-12-27T06:30:18Z
dc.date.available	2021-07-20
dc.date.available	2021-12-27T06:30:18Z
dc.date.issued	2021-12
dc.identifier.citation	Health services research, 2021, 56 Suppl 3, (S3), pp. 1358-1369
dc.identifier.issn	0017-9124
dc.identifier.issn	1475-6773
dc.identifier.uri	http://hdl.handle.net/10453/152523
dc.description.abstract	<h4>Objective</h4>To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries.<h4>Data sources</h4>Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States.<h4>Data collection methods</h4>Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016.<h4>Study design</h4>We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures.<h4>Principal findings</h4>In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97).<h4>Conclusions</h4>Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	WILEY
dc.relation.ispartof	Health services research
dc.relation.isbasedon	10.1111/1475-6773.13854
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	1117 Public Health and Health Services, 1605 Policy and Administration
dc.subject.classification	Health Policy & Services
dc.subject.mesh	Aged
dc.subject.mesh	Australia
dc.subject.mesh	Chronic Disease
dc.subject.mesh	Critical Pathways
dc.subject.mesh	Cross-Cultural Comparison
dc.subject.mesh	Developed Countries
dc.subject.mesh	Diabetes Mellitus
dc.subject.mesh	Europe
dc.subject.mesh	Female
dc.subject.mesh	Heart Failure
dc.subject.mesh	Home Care Services
dc.subject.mesh	Hospitalization
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	North America
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Rehabilitation Centers
dc.title	Within and across country variations in treatment of patients with heart failure and diabetes.
dc.type	Journal Article
utslib.citation.volume	56 Suppl 3
utslib.location.activity	United States
utslib.for	1117 Public Health and Health Services
utslib.for	1605 Policy and Administration
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access	*
dc.date.updated	2021-12-27T06:30:17Z
pubs.issue	S3
pubs.publication-status	Published
pubs.volume	56 Suppl 3
utslib.citation.issue	S3

Abstract:

Objective

To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries.

Data sources

Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States.

Data collection methods

Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016.

Study design

We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures.

Principal findings

In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97).

Conclusions

Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/152523