Patient Mobility for Elective Secondary Health Care Services in Response to Patient Choice Policies: A Systematic Review

Aggarwal, Ajay; Lewis, Daniel; Mason, Malcolm David; Sullivan, Richard; Meulen, Jan van der

doi:10.1177/1077558716654631

Cited by 74 publications

(89 citation statements)

References 56 publications

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“…They may not be adequately aware of the referral system and its significance as evidenced that only 19.6% having some form of referral note. The similar findings were reported in other studies [10,13,[24][25][26].…”

Section: Discussionsupporting

confidence: 92%

Reasons Why Patients Bypass Lower Level Public Facilities: A Cross Sectional Study From Uganda

OKORI¹,

Besigye

Namatovu

2019

Preprint

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Background The quality of services in Uganda at higher level health facilities are usually affected negatively by congestion when patients bypass care from their primary care health facilities (PCHF). The reason behind this bypass phenomenon in Uganda is limited. This study was conducted among patients receiving care at Lira Regional Referral Hospital in northern Uganda to identify reasons why patients bypass their PCHF. Methods We performed a descriptive cross-sectional study between 29/12/2014 & 30/1/2015, 484 respondents attending the outpatient department were recruited by systematic random sampling. Four focus group discussions (FGDs) each involving 10 participants were conducted. Quantitative data was collected using a validated questionnaire, entered, analysed by Epidata Entry 3.1 and SPSS 18 versions respectively. Descriptive statistics and chi square test for differences in the study population were used. For qualitative data, thematic analysis of transcripts was done. Codes and categories were developed and interrogated following an iterative process based on grounded theory. Results The majority (80.4%) of respondents (71.7% females, mean age 18-35 years, SD 0.85) bypassed their PCHF. Factors associated with bypass were: marital status, distance travelled of >10 km and tertiary education. FGDs reported lack of trust in the health care providers, lack of medicines and diagnostic equipment. Conclusions Poor quality of health services at PCHF encourages seeking care from higher-level facilities. Utilization of PCHF is limited due to poor infrastructure, shortage of medicines and human resource. Improvement of these issues will support PCHF which in turn can help reverse bypass phenomenon.

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Section: Discussionsupporting

confidence: 92%

Reasons Why Patients Bypass Lower Level Public Facilities: A Cross Sectional Study From Uganda

OKORI¹,

Besigye

Namatovu

2019

Preprint

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“…In addition to the impact on outcomes, it is also important to consider how patient choice and provider competition will affect equity of access to surgery and the efficiency of delivering health care services. For example, the closure of units that are identified as unsuccessful competitors may require some patients to travel further to receive care, which may have an impact on access to cancer surgery for patients who are less able to travel for treatment because of physical or financial constraints . At the same time, competition, in the absence of publically available information on the quality of surgery, can create perverse incentives for hospitals to invest in unproven technology to attract patients and to prevent closures, potentially escalating the cost of treatment without improving the quality of care …”

Section: Discussionmentioning

confidence: 99%

“…For example, the closure of units that are identified as unsuccessful competitors may require some patients to travel further to receive care, which may have an impact on access to cancer surgery for patients who are less able to travel for treatment because of physical or financial constraints. 8,36 At the same time, competition, in the absence of publically available information on the quality of surgery, can create perverse incentives for hospitals to invest in unproven technology to attract patients and to prevent closures, potentially escalating the cost of treatment without improving the quality of care. 9 Conversely, competition may create inefficiencies, because unsuccessful competitors will lose patients to other centers and will not use their available surgical capacity.…”

Section: Policy Implicationsmentioning

confidence: 99%

Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: A national population‐based study

Aggarwal

Sujenthiran

Lewis

et al. 2019

Cancer

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Background Policies that encourage patient choice and hospital competition have been introduced across several countries with the purpose of improving the quality of health care services. The objective of the current national cohort study was to analyze the correlation between choice and competition on outcomes after cancer surgery using prostate cancer as a case study. Methods The analyses included all men who underwent prostate cancer surgery in the United Kingdom between 2008 and 2011 (n = 12,925). Multilevel logistic regression was used to assess the effect of a radical prostatectomy center being located in a competitive environment (based on the number of centers within a threshold distance) and being a successful competitor (based on the ability to attract patients from other hospitals) on 3 patient‐level outcomes: postoperative length of hospital stay >3 days, 30‐day emergency readmissions, and 2‐year urinary complications. Results With adjustment for patient characteristics, men who underwent surgery in centers located in a stronger competitive environment were less likely to have a 30‐day emergency readmission, irrespective of the type or volume of procedures performed at each center (odds ratio, 0.46; 95% confidence interval, 0.36‐0.60; P = .005). Men who received treatment at centers that were successful competitors were less likely to have a length of hospital stay >3 days (odds ratio, 0.49; 95% confidence interval, 0.25‐0.94; P = .02). Conclusions The current results suggest for the first time that hospital competition improves short‐term outcomes after prostate cancer surgery. Further evaluation of the potential role of patient choice and hospital competition is required to inform health service design in contrast to the role of top‐down–driven approaches, which have focused on centralization of services.

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“…Much of the prior literature finds that proximity plays a central role in selection of hospital for elective care (17,18,33,34), while quality of care and waiting times information for hospital treatment are more difficult to be ascertained by patients. Although hospitals with poorer than expected outcomes attracted significantly fewer admissions (35) there is limited evidence about the effectiveness of quality information on patient choice (36).…”

Section: Discussionmentioning

confidence: 99%

“…The study could benefit from improved information on additional clinical and patient characteristics, such as patient knowledge of alternative providers, job, income, migrant status, family circumstances (e.g., cohabitation status), and social networks. Overall, the model only ascertained where patients had been treated and not whether they made an active choice (33). interpretation.…”

Section: Limitationsmentioning

confidence: 99%

Women’s choices for breast cancer surgery in Italy: quality and equity implications

Ferrè

Seghieri

Nuti

2019

Preprint

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Background Equity and quality in healthcare are key goals embraced by universal healthcare systems; however, inequalities in access and unwarranted variations in quality of care are well documented in the Italian healthcare system. To reduce unwarranted variation and improve equal utilization of services at hospital level, national quality standards have been applied for selected clinical procedures including oncological surgery for which there is evidence of a positive relationship between volumes and clinical outcomes. However, high dispersion of surgical interventions across hospitals still exists highlighting the need to understand the determinants behind women’s choice for hospital for breast surgery. Methods We apply mixed logit regression to investigate the determinants, both at patient and provider level, associated with women’s choice of hospital for breast surgery. Patient level non-emergency hospital data are used to model breast cancer surgical choices in Tuscany region, Italy. We considered hospitalizations occurring during 2016. We focused on the effects of travel time and hospital performance for breast cancer treatments (elective surgery) in different patient groups. Hospital quality indicators include structural variables (volumes), measurement of process (timeliness) and quality of surgical procedures as recommended by clinical guidelines (proportion of breast-conservative surgery and execution of the sentinel lymph node biopsy). Results Results reveal that women prefer hospitals nearby, delivering high volumes of interventions with an appropriate surgical approach. Differences in women choice depend on education and age. Highly educated patients travelled further to seek surgical intervention for breast cancer and were likely to select high performing hospitals. Moreover, older women preferred quicker response compared to younger women when awaiting surgical interventions. Conclusions Differences in patient choice highlight equity concerns in access to elective breast cancer surgery. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.

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Patient Mobility for Elective Secondary Health Care Services in Response to Patient Choice Policies: A Systematic Review

Cited by 74 publications

References 56 publications

Reasons Why Patients Bypass Lower Level Public Facilities: A Cross Sectional Study From Uganda

Reasons Why Patients Bypass Lower Level Public Facilities: A Cross Sectional Study From Uganda

Impact of patient choice and hospital competition on patient outcomes after prostate cancer surgery: A national population‐based study

Women’s choices for breast cancer surgery in Italy: quality and equity implications

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