Regional health care profiles - an improved method for generating case studies on the catchment areas of envisaged primary health care units in Austria: a report to the InfAct Joint Action.

BACKGROUND: The recent Austrian Primary Care Act established new primary health care units (PHCUs) and obliged them to draw up a "care strategy" specifying their focal care tasks and objectives and emphasizing the health care needs of the population in their catchment area with its specific local health and epidemiological profile. The main purpose of these care strategies is thus to ensure that care-providers meet the local needs, but they also provide a rationale for evaluation and organizational development. To assist new PHCUs in establishing care strategies it was necessary to develop a method for automatically generating comprehensive local case studies for any freely definable location in Austria. RESULTS: We designed an interactive report generator capable of producing location-specific regional health care profiles for a PHCU located in any of Austria's 2122 municipalities and of calculating the radius of its catchment area (defined by different levels of maximum car-travelling times). The reports so generated, called "regional health care profiles for primary health care" (RHCPs/PHC), are in comprehensive PDF report format. The core of each report is a set of 35 indicators, classified under five health and health service domains. The reports include an introductory text, definitions, a map, a graphic and tabular presentation of all indicator values, including information on local, supra-regional and national value distribution, a ranking, and numbers of service providers (e.g. pharmacies, surgeries, nursing homes) located within the catchment area. CONCLUSIONS: The RHCPs/PHC support primary health care planning, efforts to improve care-effectiveness, and strategic organizational development by providing comprehensive information on the health of the population, the utilization of health services and the health care structures within the catchment area. In addition to revealing the scope and nature of the health care needed, they also provide information on what public health approaches are necessary. RHCPs/PHC for different locations have already been distributed to numerous stakeholders and primary health care providers in Austria.

The long-term outcome of urethrotomy for primary urethral strictures: a population-based analysis.

OBJECTIVE: To determine the long-term outcome of endoscopic urethrotomy for primary urethral strictures based on a population-based approach. PATIENTS AND METHODS: We analysed a nationwide database of all patients with urethral stricture disease who underwent endoscopic urethrotomy as a primary intervention between January 2006 and December 2007. All patients were followed individually for 7-9 years. Frequencies and types of surgical re-interventions were documented. Repeat surgical interventions were stratified into three treatment types: urethrotomy, urethroplasty, and end-to-end urethral anastomosis. RESULTS: A total of 1203 men underwent urethrotomy during the index period. The median (SD, range) patient age was 63 (15.7, 20-85) years. A total of 136 patients (11%) died during follow-up. Within the follow-up period, 932 patients (78%) received no further surgical re-intervention for recurrent disease, and 176 patients (14.6%) required one, 53 (4.5%) two, and 41 (3.4%) three or more procedures. The mean number of re-interventions was 1.5/patient and the lowest re-intervention rate was in patients aged ≥80 years (13.9%). In 236 cases (68%) at least one repeat urethrotomy was performed. An open reconstruction was performed in 87 cases (32%), with urethroplasty in 21 patients (24%), and end-to-end anastomosis in 66 patients (76%). The mean interval until re-intervention was 29.5 months. CONCLUSIONS: This long-term population-based study suggests that the invasive re-treatment rate in men following initial urethrotomy is 22% within 8 years and lowest in the advanced age cohort.

Diagnostic Reference Levels for computed tomography in Austria: A 2018 nationwide survey on adult patients.

PURPOSE: To define National Diagnostic Reference Levels (NDRLs) for computed tomography (CT) for Austria on adult patients. METHOD: In the course of a nationwide survey on common CT-examinations between June 2018 and November 2018, datasets were requested from all Austrian hospitals and radiology centers with CT-scanners. All facilities were asked to report a minimum sample of 10 representative dose length product (DLP) values per examination type and CT-scanner, including information about scan sequences, iterative reconstruction (IR) algorithms and, if available, patient data. Examination types included into the survey were the most common CT-indications for the anatomic regions head, facial bones, thorax, abdomen and pelvis. 3rd quartiles of CT-scanner median DLPs were calculated and compared to Austrian and international NDRLs. RESULTS: For 76 % of all operating CT-scanners, DLP data was submitted varying from 13 to 172 scanners per examination type. Mean year of manufacture of the CT-scanners was 2011, ranging from 2003 to 2018. In 66 % of the examinations, IR was used. 3rd quartile is on average 21 % lower for scanners using IR algorithms as opposed to scanners or protocols not using IR. In the case of gender differences, the DLP for females is on average 17 % lower than for males. CONCLUSIONS: The new recommendations for CT NDRLs for Austria based on a nationwide survey are on average 13 % lower than the current Austrian NDRLs and correspond well to recent German and Swiss NDRLs. 3rd quartiles for DLP are dependent on gender, the use of IR and year of manufacture of the CT-scanners.

Diagnostic Reference Levels for conventional radiography and fluoroscopy in Austria: Results and updated National Diagnostic Reference Levels derived from a nationwide survey.

OBJECTIVE: Evaluation and updating of Austrian National Diagnostic Reference Levels (NDRLs). METHODS: A nationwide survey on common conventional radiography and fluoroscopy examinations was conducted. In line with Austrian radiation protection standards, all relevant Austrian hospitals and radiology offices/centers were asked to report a minimum sample of 10 representative dose-area product (DAP) values together with patient weight and fluoroscopy time, if applicable. Examinations included for conventional radiography were skull, chest, abdomen, pelvis, lumbar spine and bedside chest x-ray, for fluoroscopy barium enema (single and double contrast) and swallowing (video). Participants were invited via e-mail, followed up by reminders to increase participation rates. Plausibility checks were performed to increase data quality. 3rd quartiles of facility median and mean DAP were calculated and compared to Austrian and international NDRLs. RESULTS: 59% of invited facilities submitted DAP data, 43% submitted additional data on patient weight and 41% on fluoroscopy time. DAP case numbers varied from 1005 to 2121 for conventional radiography and from 182 to 1380 for fluoroscopy. Average patient weight was 75 kg for conventional radiography and 77 kg for fluoroscopy. CONCLUSION: 3rd quartiles derived from the survey are substantially lower than the old Austrian NDRLs (valid till early 2018). Since 3rd quartiles correspond well to European NDRLs, the update would be in accordance with European DRL harmonisation efforts.

Reoperation Rates and Mortality After Transurethral and Open Prostatectomy in a Long-term Nationwide Analysis: Have We Improved Over a Decade?

OBJECTIVE: To assess long-term reoperation rates and mortality after transurethral resection of the prostate (TURP) and open prostatectomy (PE) as therapy for lower urinary tract symptoms due to benign prostatic enlargement. METHODS: The present study analyzes a nationwide database of all patients who underwent TURP/open PE during 2002-2006 and who were followed up for 8 years. Actuarial cumulative incidences of reoperation (TURP, urethrotomy, bladder neck incision) and death were calculated. Data were provided by the Austrian Public Health Institute. This series was compared with a previously published almost equally sized nationwide cohort that underwent surgery during 1992-1996 in Austria. RESULTS: Between 2002 and 2006, a total of 21,674 patients underwent TURP (n = 20,388) or open PE (n = 1,286). At 8 years, the re-TURP rate after primary TURP was 8.3% vs 4.3% after open PE. The re-TURP rate was higher in the 80+ cohort. The overall endourological reintervention rate at 8 years was 12.7% for TURP and 8.8% for open PE. Reintervention rates did not improve compared with the 1992-1996 series. The 30-day in-hospital mortality rate was 0.1% for TURP and 0.2% for open PE. Mortality rates improved by approximately 20% compared with the 1992-1996 series. CONCLUSION: In Austria, TURP rates remained stable between 1992 and 2006, paralleled by a 50% decline of open PE. Within a decade, mortality rates declined by 20%, yet reintervention rates remained unchanged.

Health promotion implementation capacities in hospitals matter: results from the PRICES-HPH study.

In this article, organizational implementation capacities are discussed as facilitators for hospital health promotion (HP) activities, based on data from 159 sampled hospitals of the PRICES-HPH study. PRICES-HPH is a cross-sectional evaluation study of the International Network of Health Promoting Hospitals and Health Services (HPH-Network) and was conducted from 2008 to 2012. Hospitals applying elaborated HP implementation capacities such as 'regular health promotion projects and organization-wide programs', 'established health promotion management systems' or the 'integration of health promotion in existing quality management systems' have better HP activity scores as compared with hospitals that implement HP on the basis of occasional projects only. Organizational capacities are associated with considerably higher chances for the successful implementation of a multiplicity of different HP activities in hospitals. The results add further evidence to the importance of capacity building in hospital HP.

Health literacy in Europe: the development and validation of health literacy prediction models.

BACKGROUND: Health literacy is an important determinant of health, but national health literacy levels are known for only some European countries. This study aims to examine to what extent national health literacy levels can be estimated based on publicly available census data. METHOD: Multivariate models were used to predict two types of health literacy on population level. Predictors were selected based on literature, the European Health Literacy Survey (HLS-EU) and the Adult Literacy and Life Skills Survey (ALL). The HLS-EU provides insight into self-assessed health literacy and the ALL into the performance of individuals on health literacy tasks (performance-based health literacy). Dutch HLS-EU and ALL data were used to construct prediction models based on 2/3 of this data, which were validated in the remaining 1/3 of the data and (in case of self-assessed health literacy) in data from seven other European countries. RESULTS: Education is a significant predictor of perceived and performance-based health literacy. Age and working status are significant predictors of performance-based health literacy, whereas gender and income are significant predictors of self-assessed health literacy. Both typologies of health literacy can satisfactorily be predicted within samples of the Dutch population. The accuracy of estimated self-assessed health literacy varied between the seven other European countries. CONCLUSION: Prediction models based on publicly available census data can be used for estimating self-assessed and performance-based health literacy on population level. Observed health literacy levels or better prediction models are required when one is interested in ranking European countries.

Health literacy in Europe: comparative results of the European health literacy survey (HLS-EU).

BACKGROUND: Health literacy concerns the capacities of people to meet the complex demands of health in modern society. In spite of the growing attention for the concept among European health policymakers, researchers and practitioners, information about the status of health literacy in Europe remains scarce. This article presents selected findings from the first European comparative survey on health literacy in populations. M ETHODS: The European health literacy survey (HLS-EU) was conducted in eight countries: Austria, Bulgaria, Germany, Greece, Ireland, the Netherlands, Poland and Spain (n = 1000 per country, n = 8000 total sample). Data collection was based on Eurobarometer standards and the implementation of the HLS-EU-Q (questionnaire) in computer-assisted or paper-assisted personal interviews. R ESULTS: The HLS-EU-Q constructed four levels of health literacy: insufficient, problematic, sufficient and excellent. At least 1 in 10 (12%) respondents showed insufficient health literacy and almost 1 in 2 (47%) had limited (insufficient or problematic) health literacy. However, the distribution of levels differed substantially across countries (29-62%). Subgroups within the population, defined by financial deprivation, low social status, low education or old age, had higher proportions of people with limited health literacy, suggesting the presence of a social gradient which was also confirmed by raw bivariate correlations and a multivariate linear regression model. DISCUSSION: Limited health literacy represents an important challenge for health policies and practices across Europe, but to a different degree for different countries. The social gradient in health literacy must be taken into account when developing public health strategies to improve health equity in Europe.

Organizational capacities for health promotion implementation: results from an international hospital study.

In this article, organizational structures in hospitals are discussed as possible capacities for hospital health promotion (HP) implementation, based on data from the PRICES-HPH study. PRICES-HPH is a cross-sectional evaluation study of the International Network of Health Promoting Hospitals & Health Services (HPH-Network) and was conducted in 2008-2012. Data from 159 acute care hospitals were used in the analysis. Twelve organizational structures, which were denoted as possible organizational health promotion capacities in previous literature, were tested for their association with certain strategic HP implementation approaches. Four organizational structures were significantly (p = 0.05) associated with one or more elaborate and comprehensive strategic HP implementation approaches: (1) a health promotion specific quality assessment routine; (2) an official hospital health promotion team; (3) a fulltime hospital health promotion coordinator; and (4) officially documented health promotion policies, strategies or standards. The results add further evidence to the importance of organizational capacity structures for hospital health promotion and identify four tangible structures as likely candidates for organizational HP capacities in hospitals.

Managerial strategies to reorient hospitals towards health promotion: lessons from organisational theory.

PURPOSE: Reorienting health services towards health promotion is one of the major health promotion strategies stipulated by the Ottawa Charter). Important contradictions, tensions and barriers to health promotion implementation associated with organisational structures have, thus far, been underexposed in the hospital health promotion discourse. This paper aims at identifying risks and the chances for hospital management to strategically and sustainably reorient their hospitals towards health promotion. DESIGN/METHODOLOGY/APPROACH: The paper combines theories and findings from organisational science and management studies as well as from capacity development in the form of a narrative literature review. The aim is to focus on the conditions hospitals, as organisational systems with a highly professionalised workforce, provide for a strategically managed reorientation towards health promotion. Models and principles helping managers to navigate the difficulties and complexities of health promotion reorientation will be suggested. FINDINGS: Hospital managers have to deal with genuine obstacles in the complexity and structural formation of hospital organisations. Against this background, continuous management support, a transformative leadership style, participative strategic management and expert governance can be considered important organisational capacities for the reorientation towards a new concept such as health promotion. PRACTICAL IMPLICATIONS: This paper discusses managerial strategies, effective structural transformations and important organisational capacities that can contribute to a sustainable reorientation of hospitals towards health promotion. It supports hospital managers in exploring their chances of facilitating and effectively supporting a sustainable health promotion reorientation of their hospitals. ORIGINALITY/VALUE: The paper provides an innovative approach where the focus is on enhanced possibilities for hospital managers to strategically manage the reorientation towards health promotion.