Suchergebnisse

Listening to citizens is seen as an important source of information about public service performance. In Sweden, to secure the quality of elderly care, the National Board of Health and Welfare conducts a yearly survey of in-home elderly care services and nursing homes. A central problem of the existing survey methodology is the interpersonal incomparability of survey responses due to differences in preferences and health conditions. One way to deal with this problem is to use the survey methodology with anchoring vignettes. The purpose of the paper is to investigate the possibilities and limitations of using anchoring vignettes as a general survey method and specifically to test the method for measuring elderly care quality. The vignettes were developed interactively with professionals working in elderly care and evaluated with 1600 users of in-home elderly care services and nursing homes. The results showed that anchoring vignettes reduce the impact of respondents personal characteristics on survey results. In general, anchoring vignettes give more robust answers that reduce the problem of incomparability. However, anchoring vignettes increase the complexity of the questionnaire and have limited value in elderly care. Our results indicate that the method might be applicable when using healthier and younger respondents. ; Funding Agencies|Swedish Agency for Health and Care Services Analysis [0821/2012]

Purpose The Swedish health-care system currently implements cancer care pathways (CCPs) for better and more timely cancer diagnostics. The purpose of this paper is to elucidate and define "crowding out" effects associated with the CCP implementation. Design/methodology/approach A document study based on implementation reports and action plans from Swedish county councils (n = 21) and a case study in one county council were conducted. Qualitative data collection and analysis were used to acquire more knowledge about the "crowding out" effects associated with the CCP implementation. Findings Three effects discussed under "crowding out" were defined. The first effect, called the push-out effect, occurs when other patients have to wait for care longer in favour of CCP patients. Another effect is the inclusion effect, whereby "crowding out" is reduced for vulnerable patients due to the standardised procedures and criteria in the referral process. The final effect is the exclusion effect, where patients in need of cancer diagnostics are, for some reason, not referred to CCP. These patients are either not diagnosed at all or diagnosed outside CCP by a non-standard process, with the risk of longer waiting times. Originality/value "Crowding out" effects are an urgent topic related to CCP implementation. While these effects have been reported in international research studies, no shared definition has been established to describe them. The present paper creates a common base to measure the "crowding out" effects and support further development of CCPs to avoid the negative effects on waiting times.

Background Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. Methods This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Results Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Conclusions Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients. ; Funding agencies: The Swedish Institute

Introduction The provision of healthcare services is not dedicated to promoting maintenance of function and does not target frail older persons at high risk of the main causes of morbidity and mortality. The aim of this study is to evaluate the effects of a proactive medical and social intervention in comparison with conventional care on a group of persons aged 75 and older selected by statistical prediction. Methods and analysis In a pragmatic multicentre primary care setting (n=1600), a prediction model to find elderly (75+) persons at high risk of complex medical care or hospitalisation is used, followed by proactive medical and social care, in comparison with usual care. The study started in April 2017 with a run-in period until December 2017, followed by a 2-year continued intervention phase that will continue until the end of December 2019. The intervention includes several tools (multiprofessional team for rehabilitation, social support, medical care home visits and telephone support). Primary outcome measures are healthcare cost, number of hospital care episodes, hospital care days and mortality. Secondary outcome measures are number of outpatient visits, cost of social care and informal care, number of prescribed drugs, health-related quality of life, cost-effectiveness, sense of security, functional status and ability. We also study the care of elderly persons in a broader sense, by covering the perspectives of the patients, the professional staff and the management, and on a political level, by using semistructured interviews, qualitative methods and a questionnaire. Ethics and dissemination Approved by the regional ethical review board in Linköping (Dnr 2016/347-31). The results will be presented in scientific journals and scientific meetings during 2019–2022 and are planned to be used for the development of future care models. ; Funding Agencies|County Council of Ostergotland; Linkoping University [2016186-14]