Hospital financial performance and quality of care – a scoping review of empirical studies

Abstract

Purpose: To estimate the cost-effectiveness of genetic testing for Lynch syndrome among newly diagnosed patients with colorectal cancer and targeted testing for their relatives in Switzerland. Methods: We integrated decision tree and Markov model to calculate incremental costs per quality adjusted life-year saved for universal genetic testing for Lynch syndrome relative to using preliminary tumor tests (immunohistochemistry or micro-satellite instability) followed by DNA sequencing test for patients with colorectal cancer. Results: The incremental cost-effectiveness ratio (ICER) of the proposed strategy using universal genetic testing for Lynch syndrome with systematic CASCADE testing of their relatives is CHF 65,058 per QALY saved, which is cost-effective in Swiss settings where cost-effectiveness threshold is CHF 100,000 per QALY saved. The gained utility is 361,358 QALYs saved. Sensitivity analysis demonstrated cost-effectiveness of the proposed strategies in most of the scenarios. Conclusions: The overall effectiveness of the universal genetic testing is greatly dependent on willingness of patients and relatives to be tested and compliance with the increased surveillance. Therefore, close cooperation across different stakeholders such as family doctors, oncologists, genetic clinicians, and laboratories is crucial to encourage and educate patients about the importance of the LS screening. Key messages: Universal genetic testing for Lynch syndrome for all patients with colorectal caner is cost-effective in Swiss settings. Close cooperation across all stakeholders such as family doctors, oncologists, genetic clinicians, and laboratories is crucial to encourage and educate patients about the importance of the LS testing. Problem: The World Health Organization's 2008 World Health Report, entitled 'Primary care now more than ever,' clearly states the need of knowledge about primary care not as one of the ordinary structures of the national health system, but as its leading priority. Description of the problem: Since the start of health reform in Bulgaria, the choice and change of a GP by patients is most often spontaneous, random, and without enough specific information about the qualities of the GP. This reduces the effectiveness of the free choice of a doctor. The purpose of this study was to analyze the patient's motives for changing their GP. A survey was conducted among respondents in the period from September 1st to 30th, 2018 in the Pleven Region, Bulgaria. Patients who visited their GPs during the study period were interviewed. The results were processed using Microsoft Office Excel 2007. Results: It was established that 830 (78.8%) of the 1053 respondents in the territory of Pleven Region have changed their personal doctor. The three leading motives were: long waiting times in front of the GP's office-30.2%, change of residence-19%, and lack of sufficient referrals from a physician to the specialist-11.7%. Most of the surveyed patients assessed their GP as having a positive attitude toward them. 132 (12.6%) of the participants rate their personal doctor as rude, always being in a hurry, and nervous or not giving them any answers at all. Lessons: When choosing a GP, the patient's prior information about the qualities and competencies of the personal physician of his\her choice is very low. It is necessary to create a system for the informed choice of a personal physician which will have a double effect, 1) a more adequate and more critically justified choice of a GP by the patient, and 2) a clearer, more stable commitment and responsibility of the GPs to the patients who chose them. Key messages: It is necessary to improve the overall organization of the work of GPs. Healthcare is a type of interaction between the doctor and the patient during the diagnostic and treatment process. Background: Hospitals operate under constant pressure to contain costs and improve the quality of care (Q). The potential association between hospital financial performance (FP) and Q can have two directions: (1) providers with better FP might have a greater capacity to maintain and/or improve Q; (2) a better Q might lead to better FP, i.e. increased revenues, and/or lower costs. The general objective of this study was to identify and map the available evidence on the association between hospital FP and Q. Methods: A scoping review based on the methodological framework outlined by Arksey and O'Malley was conducted. Five databases were used: (1) Medline via PubMed; (2) Embase; (3) Web of Science; (4) Scopus; and (5) EconLit. Search strategy combined multiple terms from three topics: (1) hospital,(2) FP and (3) Q. There was no limit for publication years, but only studies in English were included. Results: After screening 8,015 records and 129 full text papers, 54 empirical studies were included. They are mostly observational studies, applying diverse regression models, published between 1992 and 2019. FP is most often measured by profitability indicators while Q measures are much more diverse. In the majority of studies, FP measures are used as dependent variables, thus the impact of Q on FP is assessed. The comparability of the studies' results is limited, yet a general overview shows that in the majority of papers, a positive iii464 association between hospital FP and Q is identified (positive in 24 studies and positive or mixed in 10). The studies' authors emphasize numerous limitations related to both, the data used and the methods applied including the ability to identify associations yet not causality. Conclusions: There seems to be a growing interest in exploring the association between FP and Q. Our review provides a broad overview of the existing literature and helps to identify areas for further investigations. Key messages: There is a great diversity of empirical studies on the association between hospital FP and Q, but the majority focuses solely on the United States market. An overview of the existing studies suggests that, although numerous additional factors need to be considered, hospitals might be able to simultaneously improve Q and profitability. Background: Proper disposal of household pharmaceutical waste can reduce the negative influence of medicines on the environment. Environmental awareness do not necessarily equate with proper behavior, as other issues, such as the availability of an organized disposal system, play an important role. The aim was to examine the current disposal methods of unused medicines from households, and the willingness of Serbian residents to participate and bear the costs of an organized collection program. Also, we wanted to define factors contributing to an individual's willingness to participate and pay for a disposal program. Methods: The survey included randomly selected patients older than 18 years visiting private pharmacies in the four largest Serbian cities. The questionnaire included information on the presence of unwanted medicines in the household, general medicine disposal practices, the likelihood to participate in a medicine takeback program, willingness to pay for a disposal program, importance to the environment, and demographic variables. Results: The majority of Serbian people dispose unused medicines into household garbage. 80% of respondents are likely to participate, however less than half are willing to pay for the collection of unused medicines. The factors that influenced willingness to participate are environmental awareness and income, while the factors affecting willingness to pay, are previously received advice about proper disposal, education level, number of unwanted medicines in the household and gender. Conclusions: Awareness campaigns advising the general public on proper medicine disposal and well-organized and easily accessible collection programs are essential in order to enable the general public to return unused medicines for proper disposal. Key messages: Household pharmaceutical waste is a major public health issue in Serbia. Residents in Serbia are willing to participate in collection programs, thus building legislative into practice is urgent.