Dataset Information

Regional health care planning: a methodology to cluster facilities using community utilization patterns.

ABSTRACT:

Background

Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed demand in the state's Bed Need Methodology. The scientific, practical, and political concerns that were considered throughout the formulation and development of the methodology are detailed.

Methods

The clustering methodology employs a 2-step K-means + Ward's clustering algorithm to group hospitals. The final number of clusters is selected using a heuristic that integrates both a statistical-based measure of cluster fit and characteristics of the resulting Hospital Groups.

Results

Using recent hospital utilization data, the clustering methodology identified 33 Hospital Groups in Michigan.

Conclusions

Despite being developed within the politically charged climate of Certificate of Need regulation, we have provided an objective, replicable, and sustainable methodology to create Hospital Groups. Because the methodology is built upon theoretically sound principles of clustering analysis and health care service utilization, it is highly transferable across applications and suitable for grouping facilities or areal units.

SUBMITTER: Delamater PL

PROVIDER: S-EPMC3766152 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Publications

Regional health care planning: a methodology to cluster facilities using community utilization patterns.

Delamater Paul L PL Shortridge Ashton M AM Messina Joseph P JP

BMC health services research 20130822

<h4>Background</h4>Community-based health care planning and regulation necessitates grouping facilities and areal units into regions of similar health care use. Limited research has explored the methodologies used in creating these regions. We offer a new methodology that clusters facilities based on similarities in patient utilization patterns and geographic location. Our case study focused on Hospital Groups in Michigan, the allocation units used for predicting future inpatient hospital bed de ...[more]

PMID: 23964905

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Project description:BackgroundIn a woman's life, labor pain is the most severe pain that they have ever faced. In Ethiopia, the provision of pain relief in labor is often neglected. Furthermore, evidence strongly urged that further research is needed on non-pharmacological labor pain management. Therefore, obstetrics care providers' attitudes and utilization of non-pharmacological labor pain management need to be assessed.MethodA facility-based cross-sectional study was conducted from May 20 to June 10, 2021, in Harari regional state health facilities, Ethiopia. All obstetric caregivers in Harari regional state health facilities were included in the study. A structured questionnaire adapted from the previous studies was used to collect data. The data was entered into Epi-data version 3.1 statistical software. Statistical analysis was carried out by using SPSS for windows version 22. Multivariate linear regression analysis was employed to determine the association between independent variables and the outcome variable.ResultThe overall utilization of non-pharmacological labor pain relief methods was 59.3% [(95% CI (53.9,63.4)]. Three hundred five (65.5%) of the study participants had unfavorable attitudes. Females compared to males (β = - 0.420; 95% CI: - 0.667, - 0.173), clinical experience (β = - 0.201; 95% CI: - 0.268, - 0.134), knowledge sum score (β =0.227: 95%; CI: 0.18,0.247), and attitude sum score (β = 0.376; 95% CI: 0.283, 0.47) were showed significantly association with utilization of non-pharmacological labor pain management.ConclusionThe overall utilization of non-pharmacological labor pain relief methods was relatively good compared to other studies done in Ethiopia but all women's need for labor relief methods should not be ignored. In this study sex of the respondents, clinical experience, individual preference, attitude and knowledge were factors associated with the utilization of non-pharmacological labor pain management. All stake holds need to work together to improve the attitude of health providers and to increase the utilization of non-pharmacologic labor pain management.

Project description:Although there is some evidence of improved quality in nursing home care after the implementation of the 1987 Omnibus Budget Reconciliation Act regulations, the nursing processes that contribute to that improvement are not well understood. Assumptions that the mandated tools for resident assessment and care planning account for the change remain uninvestigated.To generate an empirically supported conceptual model of care planning integrity, incorporating five subconstructs: coordination, integration, interdisciplinary team, restorative perspective, and quality.A correlational, model generation-model selection design guided the study. Using a random sample of 107 facilities, the research team combined primary data collected from care planning team members (n = 508) via a telephone survey, with variables extracted from the Medicaid Cost Reports and the Centers for Medicaid and Medicare Services Online Survey, Certification, and Reporting System (OSCAR) database. Primary and alternative models of care planning integrity were examined for fit to the data using structural equation modeling procedures.Using preliminary analyses, 18 observed indicators to represent the five latent subconstructs were identified. Fit indices for the primary model were borderline (comparative fit index =.892; root mean square error of approximation = .048), but were excellent for the alternative model (comparative fit index = .972; root mean square error of approximation = .026). Care planning integrity is demonstrated within nursing facilities through direct relationships with coordination, integration, and quality, and indirect relationships through integration with interdisciplinary team and restorative perspective.Care planning integrity captures differences in the way nursing facilities implement the care planning process, using the mandated standardized tools, that may make a difference in resident outcomes. Subsequent research is indicated to address those dynamics.

Project description:BackgroundLyme disease is the most frequently reported vector borne infection in the United States. The Centers for Disease Control have estimated that approximately 10% to 20% of individuals may experience Post-Treatment Lyme Disease Syndrome - a set of symptoms including fatigue, musculoskeletal pain, and neurocognitive complaints that persist after initial antibiotic treatment of Lyme disease. Little is known about the impact of Lyme disease or post-treatment Lyme disease symptoms (PTLDS) on health care costs and utilization in the United States.Objectives1) to examine the impact of Lyme disease on health care costs and utilization, 2) to understand the relationship between Lyme disease and the probability of developing PTLDS, 3) to understand how PTLDS may impact health care costs and utilization.MethodsThis study utilizes retrospective data on medical claims and member enrollment for persons aged 0-64 years who were enrolled in commercial health insurance plans in the United States between 2006-2010. 52,795 individuals treated for Lyme disease were compared to 263,975 matched controls with no evidence of Lyme disease exposure.ResultsLyme disease is associated with $2,968 higher total health care costs (95% CI: 2,807-3,128, p<.001) and 87% more outpatient visits (95% CI: 86%-89%, p<.001) over a 12-month period, and is associated with 4.77 times greater odds of having any PTLDS-related diagnosis, as compared to controls (95% CI: 4.67-4.87, p<.001). Among those with Lyme disease, having one or more PTLDS-related diagnosis is associated with $3,798 higher total health care costs (95% CI: 3,542-4,055, p<.001) and 66% more outpatient visits (95% CI: 64%-69%, p<.001) over a 12-month period, relative to those with no PTLDS-related diagnoses.ConclusionsLyme disease is associated with increased costs above what would be expected for an easy to treat infection. The presence of PTLDS-related diagnoses after treatment is associated with significant health care costs and utilization.

Project description:BackgroundUnintended pregnancy due to disuse of family planning is the main cause of abortion globally. Women with a history of abortion are at higher risk of developing another unintended pregnancy, which may lead to repeated abortions and life-threatening complications. The immediate post-abortion period before women leave health institutions is a crucial time to provide family planning services. In Ethiopia, many women leave health facilities without using family planning methods. Therefore, this study aimed to determine the utilization of post-abortion family planning and its associated factors in health institutions in Wolaita Zone, Southern Ethiopia.MethodsFacility-based mixed cross sectional study was conducted between April 1 and June 30, 2018. A systematic sampling method was used to select the 408 participants. Seven key informants were selected for in-depth interviews and observations were made using a checklist. Data were collected through face-to-face interviews using a structured questionnaire. Data were entered into EPI INFO 3.5.1 and exported to SPSS 21 for cleaning and analysis. Bivariate analysis was employed and a P-value <0.25 was considered for the multivariable analysis. Qualitative data were coded and thematically analyzed to support the quantitative findings.ResultsData were obtained from 400 participants (response rate, 98%). The magnitude of post-abortion family planning was 67.3% [95% CI (62.8, 71.8)]. Marital status [AOR 95% CI 3.86(1.9, 7.8)], Good knowledge about post-abortion family planning [AOR 95% CI 2.48(1.22, 5.03)], Non-governmental health facility [AOR 95% CI 6.62(3.47, 12.6)] Counseling [AOR 95% CI 3.6(2.02, 6.4)] and husbands' support [AOR 95% CI 3.21(1.81-5.7)] were significantly associated with Post-abortion family planning utilization.ConclusionThe utilization of post-abortion family planning was low in Wolaita Sodo health institutions. Marital status, knowledge of post-abortion family planning, use of services at non-governmental health facilities, counseling, and husbands' support were determinants of post-abortion family planning.

Project description:Importance:Although advance care planning is known to increase patient and caregiver satisfaction, its association with health care utilization is not well understood. Objective:To examine the association between billed advance care planning encounters and subsequent health care utilization among seriously ill patients. Design, Setting, and Participants:This retrospective cohort study conducted from October 1, 2015, to May 31, 2018, used a national commercial insurance claims database to retrieve data from 18 484 Medicare Advantage members 65 years or older who had a claim that contained a serious illness diagnosis. Exposure:A claim that contained an advance care planning billing code between October 1, 2016, and November 30, 2017. Main Outcomes and Measures:Receipt of intensive therapies, hospitalization, emergency department use, hospice use, costs, and death during the 6-month follow-up period. Results:The final study sample included 18 484 seriously ill patients (mean [SD] age, 79.7 [7.9] years; 10 033 [54.3%] female), 864 (4.7%) of whom had a billed advanced care planning encounter between October 1, 2016, and November 30, 2017. In analyses adjusted for patient characteristics and a propensity score for advance care planning, the presence of a billed advance care planning encounter was associated with a higher likelihood of hospice enrollment (incidence rate ratio [IRR], 2.52; 95% CI, 2.22-2.86) and mortality (hazard ratio, 2.27; 95% CI, 1.79-2.88) compared with no billed advance care planning encounter. Although patients with billed advance care planning encounters were also more likely to be hospitalized (IRR, 1.37; 95% CI, 1.26-1.49), including in the intensive care unit (IRR, 1.25; 95% CI, 1.08-1.45), they were less likely to receive any intensive therapies (IRR, 0.85; 95% CI, 0.78-0.92), such as chemotherapy (IRR, 0.65; 95% CI, 0.55-0.78). Similar results were observed in a propensity score-matched analysis (99% matched) and in a decedent analysis of patients who died during the 6-month follow-up period. Conclusions and Relevance:Patients with billed advance care planning encounters were more likely than those without these encounters to receive hospice services and less likely to receive any intensive therapies, such as chemotherapy. However, they were also hospitalized more frequently than patients without billed advance care planning encounters. Although these findings were robust to multiple analytic methods, the results may be attributable to residual confounding because of a higher unmeasured severity of illness in the advance care planning group. Additional evidence appears to be needed to understand the effect of advance care planning on these outcomes.

Project description:BackgroundThis study explored the role of health facility availability as it relates to maternal and newborn PNC use in rural Malawi.MethodsMalawi Demographic and Health Survey (MDHS) 2015-16 data, MDHS 2015-16 household cluster GPS data, Malawi Service Provision Assessment (MSPA) 2013-14 data and MSPA 2013-14 facility GPS data were used. Household clusters were spatially linked with facilities using buffers. Descriptive analyses were performed and generalized estimating equations (GEE) were used to determine the effects of having different types of facilities at varying distances from household clusters on receipt of maternal and newborn PNC in rural Malawi.ResultsIn rural Malawi, around 96% of women had facilities providing PNC within 10?km of where they live. Among women who have clinic-level facilities within 5?km of where they live, around 25% had clinic-level facilities that provide PNC. For rural women who gave birth in the past 5?years preceding the survey, only about 3% received maternal PNC within 24?h and about 16% received maternal PNC within the first week. As for newborn PNC, 3% of newborns had PNC within 24?h and about 26% had newborn PNC within the first week. PNC mostly took place at facilities (94% for women and 95% for newborns). For women who delivered at home, having a health center providing PNC within 5?km was positively associated with maternal and newborn PNC. For women who delivered at facilities, having a health center providing PNC within 5?km was positively associated with maternal PNC and having a health center providing PNC between 5?km and 10?km was positively associated with both maternal and newborn PNC. Regardless of the place of delivery and distance band, having a clinic-level facility providing PNC did not have significant positive effects on maternal and newborn PNC.ConclusionsProviders should be trained to perform quality PNC at all facilities. It would also be important to address concerns related to health workers. Lastly, it would be key to increase community awareness about the importance of seeking timely PNC and about the utility of lower-level facilities for receiving preventative PNC.

Project description:BackgroundMost randomised controlled trials on advance care planning were conducted in people with advanced, life-limiting illnesses or in institutional settings. There are few studies on its effect in older people living in the community.AimTo determine the effects of advance care planning in older community dwelling people.DesignThe STADPLAN study was a cluster-randomised trial with 12 months follow-up. The complex intervention comprised a 2-days training for nurse facilitators that delivered a formal advance care planning counselling and a written information brochure. Patients in the control group received optimised usual care, that is, provision of a short information brochure.Setting/participantsHome care services in three regions of Germany were randomised using concealed allocation. Care dependent clients of participating home care services, aged 60 years or older, and rated to have a life-expectancy of at least 4 weeks were included. Primary outcome was active participation in care at 12 months, assessed by blinded investigators using the Patient Activation Measure (PAM-13).ResultsTwenty-seven home care services and 380 patients took part. Three hundred seventy-three patients were included in the primary analysis (n = 206 in the intervention and n = 167 in the control group). There was no statistically significant difference between the intervention and control group with regard to the PAM-13 after 12 months (75.7 vs 78.4; p = 0.13). No differences in quality of life, anxiety and depression, advance care planning engagement, and in proportion of participants with advance directives were found between groups.ConclusionsThe intervention showed no relevant effects on patient activation or quality of life in community dwelling older persons, possibly indicating the need for more tailored interventions. However, results are limited by a lack of statistical power.Trial registrationGerman Clinical Trials Register: DRKS00016886.

Dataset Information

Regional health care planning: a methodology to cluster facilities using community utilization patterns.

Background

Methods

Results

Conclusions

Publications

Regional health care planning: a methodology to cluster facilities using community utilization patterns.

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