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Role of Health Services Research in Producing High-Value Rehabilitation Care.

ABSTRACT: The concept of value is receiving greater attention in rehabilitation and the broader health care environment. The overall purpose of this article is to present a framework to help clinicians, researchers, educators, and policy makers better understand the role of health services research in developing and evaluating evidence on value in rehabilitation. Value in health care is a multidimensional concept and may be defined differently by various stakeholders, but assessing value typically involves considering a combination of several health and economic outcomes. However, health care stakeholders often lack sufficient information on these outcomes to make well-informed decisions. Health services approaches such as comparative effectiveness research, patient-centered outcomes research, and health economics assessments are some ways to evaluate value. The evidence generated from such studies directly informs decision making and health policy. Rehabilitation professionals have a great opportunity to increase their engagement in describing, evaluating, delivering, and disseminating high-value care, but there are several barriers they need to consider to be most successful. Embracing health services research best practices is essential for advancing appropriate rehabilitation practice, research, and policy and for addressing challenges to implementing high-value care.

SUBMITTER: Rundell SD

PROVIDER: S-EPMC4667153 | biostudies-other | 2015 Dec

REPOSITORIES: biostudies-other

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Role of Health Services Research in Producing High-Value Rehabilitation Care.

Rundell Sean D SD Goode Adam P AP Friedly Janna L JL Jarvik Jeffrey G JG Sullivan Sean D SD Bresnahan Brian W BW

Physical therapy 20150827 12

The concept of value is receiving greater attention in rehabilitation and the broader health care environment. The overall purpose of this article is to present a framework to help clinicians, researchers, educators, and policy makers better understand the role of health services research in developing and evaluating evidence on value in rehabilitation. Value in health care is a multidimensional concept and may be defined differently by various stakeholders, but assessing value typically involve ...[more]

PMID: 26316531

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Project description:BackgroundThe evidence-based interventions of exercise and education have been strongly recommended as part of prominent clinical guidelines for hip and knee osteoarthritis (OA) for more than ten years. Despite the wealth of strong evidence that exists, implementation in practice is sub-optimal. This paper describes the key methodologies used in the co-design, tailoring, and evaluation of the IMPACT project implementation strategies, to confront this problem across multiple levels (micro, meso, macro) in public and private healthcare settings in Ireland.MethodsUsing a type III hybrid implementation-effectiveness design, a participatory, dynamic and iterative process will be used to tailor and evaluate multi-level implementation strategies using the following stages: 1) Co-design the implementation strategies with key stakeholders using best evidence, a theory-driven implementation framework (Consolidated Framework for Implementation Research), local context and expert consensus; 2) Pilot and evaluate the implementation strategies by training physiotherapists to deliver the evidence-based Good Life with osteoArthritis Denmark (GLA:D®) education and exercise programme using the implementation strategies, and conduct a mixed-methods process evaluation; 3) Adapt the implementation strategies based on implementation process evaluation indicators from stage two. The adapted strategies will be used for scale-up and sustainability in subsequent GLA:D® Ireland training programmes that will be rolled out nationally. Evaluation of effectiveness on patient and cost outcomes will continue up to 12 months post-programme delivery, using an online patient registry and pre-post design.DiscussionThis implementation science project aims to use participatory health research to address a gap in management of OA across public and private healthcare settings. This research has the potential to change practice and promote a policy of exercise and physical activity referral for chronic musculoskeletal disease that utilises community engagement effectively and enacts change 'together', with involvement of researchers, decision-makers, clinicians and patients.

Project description:BackgroundSpecialty societies in the United States identified low-value tests and procedures that contribute to waste and poor health care quality via implementation of the American Board of Internal Medicine Foundation's Choosing Wisely initiative.ObjectiveTo develop claims-based algorithms, to use them to estimate the prevalence of select Choosing Wisely services and to examine the demographic, health and health care system correlates of low-value care at a regional level.DesignUsing Medicare data from 2006 to 2011, we created claims-based algorithms to measure the prevalence of 11 Choosing Wisely-identified low-value services and examined geographic variation across hospital referral regions (HRRs). We created a composite low-value care score for each HRR and used linear regression to identify regional characteristics associated with more intense use of low-value services.PatientsFee-for-service Medicare beneficiaries over age 65.Main measuresPrevalence of selected Choosing Wisely low-value services.Key resultsThe national average annual prevalence of the selected Choosing Wisely low-value services ranged from 1.2% (upper urinary tract imaging in men with benign prostatic hyperplasia) to 46.5% (preoperative cardiac testing for low-risk, non-cardiac procedures). Prevalence across HRRs varied significantly. Regional characteristics associated with higher use of low-value services included greater overall per capita spending, a higher specialist to primary care ratio and higher proportion of minority beneficiaries.ConclusionsIdentifying and measuring low-value health services is a prerequisite for improving quality and eliminating waste. Our findings suggest that the delivery of wasteful and potentially harmful services may be a fruitful area for further research and policy intervention for HRRs with higher per-capita spending. These findings should inform action by physicians, health systems, policymakers, payers and consumer educators to improve the value of health care by targeting services and areas with greater use of potentially inappropriate care.

Project description:ImportancePolicy makers envision synergistic benefits from primary care reform programs that advance infrastructure and processes in the context of a supportive payment environment. However, these programs have been operationalized and implemented separately, raising the question of whether synergies are achieved.ObjectiveTo evaluate associations between primary care engagement in voluntary delivery system and/or payment reform programs and health services outcomes.Design setting and participantsThis was an observational longitudinal analysis of US ambulatory primary care organizations (PCOs) with attributed Medicare fee-for-service beneficiaries (1.6-1.9 million unique beneficiaries annually) using data for 2009, 2010, and 2015 to 2017; PCOs included multispecialty practices that delivered primary care. Data analyses were performed from January 2020 to December 2021.ExposuresAnnual PCO participation in or recognition by (1) the Centers for Medicare & Medicaid's meaningful use (MU) program, (2) the National Committee for Quality Assurance's Patient-Centered Medical Home (PCMH) program, and/or (3) the Medicare Shared Savings Program (MSSP), an Accountable Care Organizations program.Main outcomes and measuresIndependent and joint associations between an additional year of participation by a PCO in each of the 3 reform programs, and 3 types of outcomes: (1) hospital utilization (all-cause admissions, ambulatory care sensitive admissions, all-cause readmissions, all-cause emergency department visits); (2) evidence-based diabetes guideline adherence (≥1 annual glycated hemoglobin test, low-density lipoprotein cholesterol test, nephropathy screening, and eye examination); and (3) Medicare spending (total, acute inpatient, and skilled nursing facility).ResultsThe study sample comprised 47 880 unique PCOs (size ≤10 beneficiaries, 50%; ≤1-2 clinicians, 65%) and approximately 5.61 million unique Medicare beneficiaries (mean [SD] age, 71.4 [12.7] years; 3 207 568 [57.14%] women; 4 474 541 [79.71%] non-Hispanic White individuals) across the study years (2009, 2010, 2015-2017). Of the hospital utilization measures, only ambulatory care sensitive admission was associated with improved performance, showing a statistically significant marginal effect size for joint participation in MU and MSSP (-0.0002; 95% CI, -0.0005 to 0.0000) and MSSP alone (-0.0003; 95% CI, -0.0005 to -0.0001). For diabetes adherence, joint participation in PCMH and MU was associated with 0.06 more measures met (95% CI, 0.03 to 0.10) while participation in all 3 programs was associated with 0.05 more measures met (95% CI, 0.02 to 0.09). Stand-alone PCMH and stand-alone MU participation were also associated with improved performance. Joint participation in MU and MSSP was associated with $33.89 lower spending (95% CI, -$65.79 to -$1.99) as was stand-alone MSSP participation (-$37.04; 95% CI, -$65.73 to -$8.35).Conclusions and relevanceThis longitudinal observational study found that participation by PCOs in single or multiple reform programs was associated with better performance for only a subset of health services outcomes. More consistent and larger synergies may be realized with improved alignment of program requirements and goals.

Project description:ObjectiveThe Learning Health Systems Rehabilitation Research Network (LeaRRn), an NIH-funded rehabilitation research resource center, aims to advance the research capacity of learning health systems (LHSs) within the rehabilitation community. A needs assessment survey was administered to inform development of educational resources.MethodsThe online survey included 55 items addressing interest in and knowledge of 33 LHS research core competencies in 7 domains and additional items on respondent characteristics. Recruitment targeting rehabilitation researchers and health system collaborators was conducted by LeaRRn, LeaRRn health system partners, rehabilitation professional organizations, and research university program directors using email, listservs, and social media announcements.ResultsOf the 650 people who initiated the survey, 410 respondents constituted the study sample. Respondents indicated interest in LHS research and responded to at least 1 competency item and/or demographic question. Two-thirds of the study sample had doctoral research degrees, and one-third reported research as their profession. The most common clinical disciplines were physical therapy (38%), communication sciences and disorders (22%), and occupational therapy (10%). Across all 55 competency items, 95% of respondents expressed "a lot" or "some" interest in learning more, but only 19% reported "a lot" of knowledge. Respondents reported "a lot" of interest in a range of topics, including selecting outcome measures that are meaningful to patients (78%) and implementing research evidence in health systems (75%). "None" or "some" knowledge was reported most often in Systems Science areas such as understanding the interrelationships between financing, organization, delivery, and rehabilitation outcomes (93%) and assessing the extent to which research activities will improve the equity of health systems (93%).ConclusionResults from this large survey of the rehabilitation research community indicate strong interest in LHS research competencies and opportunities to advance skills and training.ImpactCompetencies where respondents indicated high interest and limited knowledge can inform development of LHS educational content that is most needed.

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Role of Health Services Research in Producing High-Value Rehabilitation Care.

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Role of Health Services Research in Producing High-Value Rehabilitation Care.

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