Patient engagement has become a major focus of health reform. However, there is limited evidence showing that increases in patient engagement are associated with improved health outcomes or lower ...costs. We examined the extent to which a single assessment of engagement, the Patient Activation Measure, was associated with health outcomes and costs over time, and whether changes in assessed activation were related to expected changes in outcomes and costs. We used data on adult primary care patients from a single large health care system where the Patient Activation Measure is routinely used. We found that results indicating higher activation in 2010 were associated with nine out of thirteen better health outcomes-including better clinical indicators, more healthy behaviors, and greater use of women's preventive screening tests-as well as with lower costs two years later. Changes in activation level were associated with changes in over half of the health outcomes examined, as well as costs, in the expected directions. These findings suggest that efforts to increase patient activation may help achieve key goals of health reform and that further research is warranted to examine whether the observed associations are causal.
The Internet of things (IoT) has emerged as a topic of intense interest among the research and industrial community as it has had a revolutionary impact on human life. The rapid growth of IoT ...technology has revolutionized human life by inaugurating the concept of smart devices, smart healthcare, smart industry, smart city, smart grid, among others. IoT devices' security has become a serious concern nowadays, especially for the healthcare domain, where recent attacks exposed damaging IoT security vulnerabilities. Traditional network security solutions are well established. However, due to the resource constraint property of IoT devices and the distinct behavior of IoT protocols, the existing security mechanisms cannot be deployed directly for securing the IoT devices and network from the cyber-attacks. To enhance the level of security for IoT, researchers need IoT-specific tools, methods, and datasets. To address the mentioned problem, we provide a framework for developing IoT context-aware security solutions to detect malicious traffic in IoT use cases. The proposed framework consists of a newly created, open-source IoT data generator tool named IoT-Flock. The IoT-Flock tool allows researchers to develop an IoT use-case comprised of both normal and malicious IoT devices and generate traffic. Additionally, the proposed framework provides an open-source utility for converting the captured traffic generated by IoT-Flock into an IoT dataset. Using the proposed framework in this research, we first generated an IoT healthcare dataset which comprises both normal and IoT attack traffic. Afterwards, we applied different machine learning techniques to the generated dataset to detect the cyber-attacks and protect the healthcare system from cyber-attacks. The proposed framework will help in developing the context-aware IoT security solutions, especially for a sensitive use case like IoT healthcare environment.
Abstract Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly ...constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic.
Expanding public health insurance seeks to attain several desirable objectives, including increasing access to healthcare services, reducing the risk of catastrophic healthcare expenditures, and ...improving health outcomes. The extent to which these objectives are met in a real-world policy context remains an empirical question of increasing research and policy interest in recent years.
We reviewed systematically empirical studies published from July 2010 to September 2016 using Medline, Embase, Econlit, CINAHL Plus via EBSCO, and Web of Science and grey literature databases. No language restrictions were applied. Our focus was on both randomised and observational studies, particularly those including explicitly attempts to tackle selection bias in estimating the treatment effect of health insurance. The main outcomes are: (1) utilisation of health services, (2) financial protection for the target population, and (3) changes in health status.
8755 abstracts and 118 full-text articles were assessed. Sixty-eight studies met the inclusion criteria including six randomised studies, reflecting a substantial increase in the quantity and quality of research output compared to the time period before 2010. Overall, health insurance schemes in low- and middle-income countries (LMICs) have been found to improve access to health care as measured by increased utilisation of health care facilities (32 out of 40 studies). There also appeared to be a favourable effect on financial protection (26 out of 46 studies), although several studies indicated otherwise. There is moderate evidence that health insurance schemes improve the health of the insured (9 out of 12 studies).
Increased health insurance coverage generally appears to increase access to health care facilities, improve financial protection and improve health status, although findings are not totally consistent. Understanding the drivers of differences in the outcomes of insurance reforms is critical to inform future implementations of publicly funded health insurance to achieve the broader goal of universal health coverage.
Organization and Performance of US Health Systems Beaulieu, Nancy D; Chernew, Michael E; McWilliams, J Michael ...
JAMA : the journal of the American Medical Association,
01/2023, Letnik:
329, Številka:
4
Journal Article
Recenzirano
Health systems play a central role in the delivery of health care, but relatively little is known about these organizations and their performance.
To (1) identify and describe health systems in the ...United States; (2) assess differences between physicians and hospitals in and outside of health systems; and (3) compare quality and cost of care delivered by physicians and hospitals in and outside of health systems.
Health systems were defined as groups of commonly owned or managed entities that included at least 1 general acute care hospital, 10 primary care physicians, and 50 total physicians located within a single hospital referral region. They were identified using Centers for Medicare & Medicaid Services administrative data, Internal Revenue Service filings, Medicare and commercial claims, and other data. Health systems were categorized as academic, public, large for-profit, large nonprofit, or other private systems. Quality of preventive care, chronic disease management, patient experience, low-value care, mortality, hospital readmissions, and spending were assessed for Medicare beneficiaries attributed to system and nonsystem physicians. Prices for physician and hospital services and total spending were assessed in 2018 commercial claims data. Outcomes were adjusted for patient characteristics and geographic area.
A total of 580 health systems were identified and varied greatly in size. Systems accounted for 40% of physicians and 84% of general acute care hospital beds and delivered primary care to 41% of traditional Medicare beneficiaries. Academic and large nonprofit systems accounted for a majority of system physicians (80%) and system hospital beds (64%). System hospitals were larger than nonsystem hospitals (67% vs 23% with >100 beds), as were system physician practices (74% vs 12% with >100 physicians). Performance on measures of preventive care, clinical quality, and patient experience was modestly higher for health system physicians and hospitals than for nonsystem physicians and hospitals. Prices paid to health system physicians and hospitals were significantly higher than prices paid to nonsystem physicians and hospitals (12%-26% higher for physician services, 31% for hospital services). Adjusting for practice size attenuated health systems differences on quality measures, but price differences for small and medium practices remained large.
In 2018, health system physicians and hospitals delivered a large portion of medical services. Performance on clinical quality and patient experience measures was marginally better in systems but spending and prices were substantially higher. This was especially true for small practices. Small quality differentials combined with large price differentials suggests that health systems have not, on average, realized their potential for better care at equal or lower cost.
The use of nurse practitioners (NPs) in primary care is one way to address growing patient demand and improve care delivery. However, little is known about trends in NP presence in primary care ...practices, or about how state policies such as scope-of-practice laws and expansion of eligibility for Medicaid may encourage or inhibit the use of NPs. We found increasing NP presence in both rural and nonrural primary care practices in the period 2008-16. At the end of the period, NPs constituted 25.2 percent of providers in rural and 23.0 percent in nonrural practices, compared to 17.6 percent and 15.9 percent, respectively, in 2008. States with full scope-of-practice laws had the highest NP presence, but the fastest growth occurred in states with reduced and restricted scopes of practice. State Medicaid expansion status was not associated with greater NP presence. Overall, primary care practices are embracing interdisciplinary provider configurations, and including NPs as providers can strengthen health care delivery.
Drivers of poor medical care Saini, Vikas, Dr; Garcia-Armesto, Sandra, MD; Klemperer, David, MD ...
The Lancet (British edition),
07/2017, Letnik:
390, Številka:
10090
Journal Article
Recenzirano
Summary The global ubiquity of overuse and underuse of health-care resources and the gravity of resulting harms necessitate an investigation of drivers to inform potential solutions. We describe the ...network of influences that contribute to poor care and suggest that it is driven by factors that fall into three domains: money and finance; knowledge, bias, and uncertainty; and power and human relationships. In each domain the drivers operate at the global, national, regional, and individual level, and are modulated by the specific contexts within which they act. We discuss in detail drivers of poor care in each domain.
Objective
To assess racial and ethnic disparities in care for Medicare fee‐for‐service (FFS) beneficiaries and whether disparities differ between health system‐affiliated physician organizations ...(POs) and nonaffiliated POs.
Data Sources
We used Medicare Data on Provider Practice and Specialty (MD‐PPAS), Medicare Provider Enrollment, Chain, and Ownership System (PECOS), IRS Form 990, 100% Medicare FFS claims, and race/ethnicity estimated using the Medicare Bayesian Improved Surname Geocoding 2.0 algorithm.
Study Design
Using a sample of 16 007 POs providing primary care in 2015, we assessed racial/ethnic disparities on 12 measures derived from claims (2 cancer screenings; diabetic eye examinations; continuity of care; two medication adherence measures; three measures of follow‐up visits after acute care; all‐cause emergency department (ED) visits, all‐cause readmissions, and ambulatory care‐sensitive admissions). We decomposed these “total” disparities into within‐PO and between‐PO components using models with PO random effects. We then pair‐matched 1853 of these POs that were affiliated with health systems to similar nonaffiliated POs. We examined differences in within‐PO disparities by affiliation status by interacting each nonwhite race/ethnicity with an affiliation indicator.
Data Collection/Extraction methods
Medicare Data on Provider Practice and Specialty identified POs billing Medicare; PECOS and IRS Form 990 identified health system affiliations. Beneficiaries age 18 and older were attributed to POs using a plurality visit rule.
Principal Findings
We observed total disparities in 12 of 36 comparisons between white and nonwhite beneficiaries; nonwhites received worse care in 10. Within‐PO disparities exceeded between‐PO disparities and were substantively important (>=5 percentage points or>=0.2 standardized differences) in nine of the 12 comparisons. Among these 12, nonaffiliated POs had smaller disparities than affiliated POs in two comparisons (P < .05): 1.6 percentage points smaller black‐white disparities in follow‐up after ED visits and 0.6 percentage points smaller Hispanic‐white disparities in breast cancer screening.
Conclusions
We find no evidence that system‐affiliated POs have smaller racial and ethnic disparities than nonaffiliated POs. Where differences existed, disparities were slightly larger in affiliated POs.
Coproduction of healthcare service Batalden, Maren; Batalden, Paul; Margolis, Peter ...
BMJ quality & safety,
07/2016, Letnik:
25, Številka:
7
Journal Article
Recenzirano
Odprti dostop
Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often ...resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.
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