Assembling a population health management maturity index using a Delphi method.

BACKGROUND: Although local initiatives commonly express a wish to improve population health and wellbeing using a population health management (PHM) approach, implementation is challenging and existing tools have either a narrow focus or lack transparency. This has created demand for practice-oriented guidance concerning the introduction and requirements of PHM. METHODS: Existing knowledge from scientific literature was combined with expert opinion obtained using an adjusted RAND UCLA appropriateness method, which consisted of six Dutch panels in three Delphi rounds, followed by two rounds of validation by an international panel. RESULTS: The Dutch panels identified 36 items relevant to PHM, in addition to the 97 items across six elements of PHM derived from scientific literature. Of these 133 items, 101 were considered important and 32 ambiguous. The international panel awarded similar scores for 128 of 133 items, with only 5 items remaining unvalidated. Combining literature and expert opinion gave extra weight and validity to the items. DISCUSSION: In developing a maturity index to help assess the use and progress of PHM in health regions, input from experts counterbalanced a previous skewedness of item distribution across the PHM elements and the Rainbow Model of Integrated Care (RMIC). Participant expertise also improved our understanding of successful PHM implementation, as well as how the six PHM elements are best constituted in a first iteration of a maturity index. Limitations included the number of participants in some panels and ambiguity of language. Further development should focus on item clarity, adoption in practice and item interconnectedness. CONCLUSION: By employing scientific literature enriched with expert opinion, this study provides new insight for both science and practice concerning the composition of PHM elements that influence PHM implementation. This will help guide practices in their quest to implement PHM.

How to successfully implement population health management: a scoping review.

BACKGROUND: Despite international examples, it is unclear for multisector initiatives which want to sustainably improve the health of a population how to implement Population Health Management (PHM) and where to start. Hence, the main purpose of this research is to explore current literature about the implementation of PHM and organising existing knowledge to better understand what needs to happen on which level to achieve which outcome. METHODS: A scoping review was performed within scientific literature. The data was structured using Context-Mechanism-Outcome, the Rainbow model of integrated care and six elements of PHM as theoretical concepts. RESULTS: The literature search generated 531 articles, of which 11 were included. Structuring the data according to these three concepts provided a framework that shows the skewed distribution of items that influence the implementation of PHM. It highlights that there is a clear focus on normative integration on the organisational level in 'accountable regional organisation'. There is less focus on the normative integration of 'cross domain business model', 'integrated data infrastructure', and 'population health data analytics', and overall the perspective of citizen and professionals, indicating possible gaps of consideration. CONCLUSIONS: A first step is taken towards a practical guide to implement PHM by illustrating the depth of the complexity and showing the partial interrelatedness of the items. Comparing the results with existing literature, the analysis showed certain gaps that are not addressed in practice, but should be according to other frameworks. If initiators follow the current path in literature, they may be missing out on some important components to achieve proper implementation of PHM.

Sickness absence due to back pain or depressive episode and the risk of all-cause and diagnosis-specific disability pension: A Swedish cohort study of 4,823,069 individuals.

BACKGROUND: The aim of this study was to investigate the associations between sickness absence due to back pain or depressive episode with future all-cause and diagnosis-specific disability pension, while adjusting for comorbidity and socio-demographics, for all and stratifying for sex. METHOD: In total, 4,823,069 individuals aged 16-64 years, living in Sweden at the end of 2004, not on old-age or disability pension in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the study population. Crude and adjusted hazard ratios (HRs) for all-cause and diagnosis-specific disability pension (2006-2010) in relation to diagnosis-specific sickness absence with sickness benefits paid by the Social Insurance Agency were estimated using Cox regression. RESULTS: The HR for all-cause disability pension was 7.52 (7.25-7.52) in individuals with an incident sick-leave spell due to back pain, compared to individuals without sickness absence in 2005 in the fully adjusted (socio-demographics and comorbidity) model. The fully adjusted (multivariate) HRs for diagnosis-specific disability pension were musculoskeletal diagnoses 23.87 (22.75-25.04), mental 2.49 (2.27-2.73) or all other diagnoses, 3.44 (3.17-3.75). In individuals with an incident sick-leave spell due to a depressive episode in 2005, the multivariate adjusted HR for all-cause disability pension was 12.87 (12.42-13.35), while the multivariate HRs for disability pension due to musculoskeletal diagnoses were 4.39 (3.89-4.96), for mental diagnoses 25.32 (24.29-26.38) and for all other somatic diagnoses 3.44 (3.09-3.82). Men who were sickness absent due to a depressive episode had a higher HR for disability pension compared to women. CONCLUSION: Results indicate that sickness absence due to a depressive episode or back pain is a strong risk factor for a future disability pension due to mental, musculoskeletal or other somatic diagnoses.

Association between nutritional status (MNA®-SF) and frailty (SHARE-FI) in acute hospitalised elderly patients.

OBJECTIVE: This study aimed to explore the association between the impaired nutritional status and frailty in acute hospitalised elderly patients by using two tools, the MNA®-SF (Mini Nutritional Assessment® short-form) and the SHARE-FI (Frailty Instrument for Primary Care of the Survey of Health, Ageing and Retirement in Europe). DESIGN: Cross-sectional study. SETTING: Acute hospitalised, community-dwelling elderly patients were recruited at internal medicine wards in Vienna, Austria. PARTICIPANTS: 133 men (39%) and women (61%) aged 74 (65-97) years. MEASUREMENTS: MNA®-SF was used to investigate malnutrition (<7 points) and patients at risk of malnutrition (8 to 11 points). By using the SHARE-FI, subjects were classified as frail, pre-frail or robust. A factor analysis was applied to identify overlaps between the MNA®-SF and SHARE-FI items. Internal consistency of different dimensions was assessed by using Cronbach's Alpha. RESULTS: Malnutrition or risk of malnutrition was found in 76.7% of the total sample and in 46.8% of robust, in 69.0% of pre-frail, and in 93.0% of frail participants. Frailty or prefrailty was found in 75.9% of the total sample and in 45.1% of the subjects with no risk of malnutrition, in 80.9% of subjects at risk of malnutrition, and in 94.1% of malnourished patients. The two used tools show overlaps in three dimensions: (1) nutrition problems, (2) mobility problems and (3) anthropometric items with a moderate to strong internal consistency (Cronbach's Alpha of 0.670, 0.834 and 0.946, respectively). 64.7% of the total sample (79.5% of frail and 87.9% of malnourished subjects) would participate in a home-based muscle training and nutritional intervention program. CONCLUSIONS: This study underlines the association and the overlap between frailty and impaired nutritional status. There is a high readiness to participate in a program to tackle the problems associated with malnutrition and frailty, especially in those, who would benefit most from it.

[A survey on the patient's perspective in chronic care: discussion of the "Austrian Patients Report"]. / Erhebung der Patientenperspektive bei chronischer Krankheit: Diskussion des Instruments "Österreichischer Patientenbericht"

AIM: The provision of adequate care for patients with chronic conditions necessitates the knowledge of their perspectives and opinions in order to plan and deliver health services appropriately. The aim of the initiative "Austrian Patients Report" is to collect information on the expectations and requirements of Austrian chronic care patients towards the Austrian health-care system and its actors. METHOD: The basis of the "Austrian Patients Report" is an anonymous, structured paper and pencil questionnaire which is adapted to the specific requirements of the chronic condition with the help of patient focus groups. The questionnaire is distributed to the patients via self-help groups, doctor's offices and outpatient centres. RESULTS: The results clearly indicate that patients expect not only the provision of medical and medicinal care from their doctors, they also value a comprehensive consultation with their doctors, information on different treatment options and a good cooperation between specialists and primary care doctors as highly important. Another important aspect is the respect and understanding of the society concerning the problems which arise from living with a chronic condition. CONCLUSION: The "Austrian Patients Report" provides an opportunity to look at aspects of health-care provision from the patient's perspective. The standardisation of the method makes comparisons between patient groups with different chronic conditions possible. This in turn, gives insights into those areas of service provision where improvements need to be made and what is especially important from the patient's view.

[Chronic pain patients and their expectations towards physician care. Results from the Austrian Patient Report]. / Schmerzpatienten und ihre Erwartungen an die ärztliche Versorgung. Ergebnisse aus dem Osterreichischen Patientenbericht.

BACKGROUND: The Austrian Patient Report illustrates the preferences of Austrian chronic disease patients for the first time. MATERIAL AND METHODS: A standardised, self-administered questionnaire was used with items in the fields of general information, information flow, medicine and health, social and societal aspects and statistics. RESULTS: The most important item for Austrian chronic pain patients is a comprehensive discussion with their physician, which is even more important than a reduction in pain intensity. CONCLUSIONS: More efforts have to be made to educate and inform chronic pain patients adequately from the doctor's side.