Patient-reported outcome measures and risk factors in a quality registry: a basis for more patient-centered diabetes care in Sweden.

Diabetes is one of the chronic diseases that constitute the greatest disease burden in the world. The Swedish National Diabetes Register is an essential part of the diabetes care system. Currently it mainly records clinical outcomes, but here we describe how it has started to collect patient-reported outcome measures, complementing the standard registry data on clinical outcomes as a basis for evaluating diabetes care. Our aims were to develop a questionnaire to measure patient abilities and judgments of their experience of diabetes care, to describe a Swedish diabetes patient sample in terms of their abilities, judgments, and risk factors, and to characterize groups of patients with a need for improvement. Patient abilities and judgments were estimated using item response theory. Analyzing them together with standard risk factors for diabetes comorbidities showed that the different types of data describe different aspects of a patient's situation. These aspects occasionally overlap, but not in any particularly useful way. They both provide important information to decision makers, and neither is necessarily more relevant than the other. Both should therefore be considered, to achieve a more complete evaluation of diabetes care and to promote person-centered care.

Measuring worksite health promotion programs: an application of structural equation modeling with ordinal data.

This paper presents a model for measuring the outcome of Worksite Health Promotion Programs through an application of Structural Equation Modeling with ordinal data. We model the function "being healthy" as a vector comprised of three latent or unobservable variables: Health Status, Lifestyle and Stress. Each variable can be measured only indirectly through a set of manifest or observable ordinal indicators. The objective is to derive and analyze the distributions, and changes in distributions over time, of the latent variables on an individual level. The model is analyzed empirically on data from three large Swedish manufacturing firms.

Immediate versus delayed sequential bilateral cataract surgery: an analysis of costs and patient value.

PURPOSE: To compare resource utilization of two different strategies for bilateral cataract surgery: immediate sequential cataract surgery (ISCS) versus delayed sequential cataract surgery (DSCS). The purpose was also to analyse the value for the patient of undergoing ISCS versus DSCS. METHODS: Differences in routines and resource utilization between ISCS (n = 17) and DSCS (n = 80) were studied in a cohort of cataract surgery patients at our clinic in Karlskrona, Sweden. Costs were extracted from an earlier publication by the same clinic. The value for the patient was studied using the capability index, based on published data on the benefit to the patient of ISCS or DSCS using the Catquest questionnaire. RESULTS: Operating both eyes of a patient was 1.14 times more expensive with DSCS than with ISCS including all surgical costs. The value to the patient of undergoing ISCS depended on the time between first- and second-eye surgery in DSCS and the remaining lifetime after both-eye surgery. A long waiting time for second-eye surgery and a short remaining lifetime decreased the patient value of DSCS compared to ISCS. CONCLUSION: DSCS is 14% more expensive than ISCS. The value for the patient of ISCS compared to DSCS depends on how long the period will be between first- and second-eye surgery in DSCS and also on the patient's survival time after surgery.

Evaluating health care efficiency.

In this chapter we propose a three-pronged approach to assessing efficiency of health care, including financial performance, performance in the production of (intermediate) medical outcomes and performance relating medical outcomes to patient health outcomes. Throughout we use frontier models which can be estimated in a number of ways, including DEA, stochastic frontiers and index numbers. We illustrate the health outcomes model with an application to cataract surgery patients in Sweden and use DEA as our estimator. Again, other frontier estimation methods as well as index numbers could be employed to explore other procedures' effectiveness and overall performance of services and/or hospitals and clinics.

A new index approach to measure lost benefits from progression to blindness.

OBJECTIVES: An index approach for measuring the reduction in daily activities of patients suffering from an eye disease associated with progressive visual loss is proposed. The approach is illustrated using data collected from patients with cataract. METHOD: The approach uses recently developed methods based on index theory together with measurements of daily activities. In a simulation based on observations of visual acuity and daily activities in patients with cataract, indexes of changes in benefits were estimated for varying levels of visual acuity. RESULTS: Results show the development of loss in benefits resulting from a progressive deterioration in visual acuity. The results indicate a 40% loss in benefits at low levels of visual acuity, equivalent to a potential increase in benefits of 75% for these individuals following successful treatment. CONCLUSIONS: The proposed index approach may prove useful for measuring reductions in daily activities resulting from the progressive loss of vision in eye disease. The approach has successfully measured the reduction in daily activities in patients with cataract and may be applicable in patients with other eye diseases, including age-related macular degeneration and open-angle glaucoma.