populations

10 05, 2019

Paper of the Week: 10th May 2019: Better payment systems can support, but not replace, culture change

2019-05-10T08:24:07+00:00

  Full reference: Maryland’s Experiment With Capitated Payments For Rural Hospitals: Large Reductions In Hospital-Based Care. Jesse M. Pines, Sonal Vats, Mark S. Zocchi, Bernard Black. (2019) HEALTH AFFAIRS . Vol. 38, NO. 4 Link to Paper This week’s blog is brought to you by: Dr Tim Wilson, Managing Director Authors conclusion Inpatient admissions and outpatient services fell sharply at [study] hospitals, increasingly so over the period that [capitated payment] was in effect. Emergency department (ED) admission rates declined 12 percent, direct (non-ED) admissions fell 23 percent, ambulatory surgery center visits fell 45 percent, and outpatient clinic visits and services fell 40 percent. However, for residents of [capitated payment] counties, visits to all Maryland hospitals fell by lesser amounts and Medicare spending increased, [...]

Paper of the Week: 10th May 2019: Better payment systems can support, but not replace, culture change2019-05-10T08:24:07+00:00
27 03, 2019

Paper of the Week 27.03.2019: Toward Precision Policy — The Case of Cardiovascular Care

2019-03-27T16:12:11+00:00

This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V’s Founding Director. Author’s conclusion “If we are serious about improving quality of care and patient outcomes — whether mortality, readmissions, or patient centered [clinical] outcomes such as freedom from angina or heart failure symptoms — we have a responsibility to ensure that policies are grounded in evidence. We believe it’s imperative that before policies are implemented widely, rigorous studies be conducted to determine whether they achieve their goals. In addition to taking an evidence- first approach to policy implementation, we can better target policies toward specific diseases… As we move toward precision medicine and the delivery of diagnostic and therapeutic advances individualized [...]

Paper of the Week 27.03.2019: Toward Precision Policy — The Case of Cardiovascular Care2019-03-27T16:12:11+00:00
21 03, 2019

Paper of the Week 21.03.2019: Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years

2019-03-21T16:17:14+00:00

  This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V's Founding Director. Bottom line, chosen by Muir from the paper Among patients who were scheduled for CABG and had been randomly assigned to undergo bilateral or single internal-thoracic-artery grafting, there was no significant between-group difference in the rate of death from any cause at 10 years in the intention-to-treat analysis. The conclusion is This study shows that in the case of CABG more in healthcare is often no better. Once again Avedis Donabedian’s illustration about optimality has been demonstrated. Implications for value improvement  This is another example of the principle first described by Avedis Donabedian and expressed through his diagrammatic representation [...]

Paper of the Week 21.03.2019: Bilateral versus Single Internal-Thoracic-Artery Grafts at 10 Years2019-03-21T16:17:14+00:00
14 03, 2019

Paper of the Week 14.03.2019: Digital Smoking Cessation

2019-03-14T11:01:16+00:00

  Reference: Tang, J., & Liao, Y. (2018). Effectiveness of a text messaging-based smoking cessation intervention (Happy Quit) in China: a randomised controlled trial. The Lancet, 392, S6.  https://doi.org/10.1016/S0140-6736(18)32635-7 This week’s paper of the week is brought to you by Dr Tim Wilson, 3V’s Managing Director. Bottom line, chosen by Tim from the paper “a mobile phone-based text messaging intervention (Happy Quit), with either high-frequency or low-frequency messaging, is effective to Chinese cigarette smokers. It should be considered for inclusion in smoking cessation services. … One limitation is that we could not prevent participants from using other smoking cessation services.” Smoking cessations services are generally going to be a higher value intervention, so finding lower cost ways of [...]

Paper of the Week 14.03.2019: Digital Smoking Cessation2019-03-14T11:01:16+00:00
7 03, 2019

Paper of the Week 07.03.2019: Future Directions in Valuing Benefits for Estimating QALYs: Is Time Up for the EQ-5D?

2019-03-07T12:21:36+00:00

Reference: Brazier J. E. et al (2019  This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V’s Founding Director. Bottom line, chosen by Muir from the paper This raises the issue of what is meant by “well-being.” A broad conception of well-being is how well an individual’s life is going on. Subjective well-being (SWB) has been described or categorised into 3 types: hedonism (well-being increases when an individual experiences more pleasure and/or less pain), flourishing theories (well-being increases when an individual fulfils their nature as a human being, or “flourishes”), and life evaluation or life satisfaction (well-being increases when an individual positively assesses his or her life). The notion of SWB is [...]

Paper of the Week 07.03.2019: Future Directions in Valuing Benefits for Estimating QALYs: Is Time Up for the EQ-5D?2019-03-07T12:21:36+00:00
1 03, 2019

Paper of the week 27.02.19: Has the NHS Long Term Plan forgotten we are all going to die?

2019-03-01T11:14:40+00:00

Reference: Has the Long Term Plan forgotten we are all going to die? (Bleakley T., Smith R., Taylor R) This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V’s Founding Director. Bottom line, chosen by Muir from the paper "One certainty is that there will be a lot of dying in the next 10 years as the baby boomers become the dying boomers... Increasingly, people endure slow deaths of frailty, often with dementia in the final years. Increased life expectancy is generally regarded as a cause for celebration, but many people fear dependency and dementia more than they fear death... Between a quarter and a third of health-care expenditure is for care [...]

Paper of the week 27.02.19: Has the NHS Long Term Plan forgotten we are all going to die?2019-03-01T11:14:40+00:00
13 02, 2019

Issue of the month – February 2019: End of Life Care

2019-02-13T08:55:47+00:00

Authors: Dr Karen Chumbley, Medical Director, St Helena Hospice and Dr Tim Wilson, 3V Bottom Line Much progress has been made since the End of Life strategy was published by the NHS in 2008. But more needs to be done; depending on where you live will alter the chance that you will die in the place you wish. For people dying with some conditions, more work is needed. And sadly, inequity appears to persist, even at this most moment in our life. We might hope that when we are dying, the health and care services, and the voluntary sector would work together to achieves the outcomes we wish. Multiple surveys have confirmed, for instance, that most people would [...]

Issue of the month – February 2019: End of Life Care2019-02-13T08:55:47+00:00
8 02, 2019

Paper of the week 08.02.19: The Medicalization of Population Health

2019-02-08T13:04:49+00:00

Reference: The Medicalization of Population Health: Who Will Stay Upstream? Paula M. Lantz  December 2018 Millbank Quarterly This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V’s Founding Director. Bottom line, chosen by Muir from the paper Population health management can be described as a collection of downstream efforts earnestly working to build a strong scaffolding from which people can be pulled from treacherous waters… …Although these efforts are indeed necessary and generally positive, they are also woefully insufficient if the overarching goal is improved health outcomes and health equity at the societal level… Implications for value improvement  Population health management has become fashionable and who could gainsay this trend? It seems right and [...]

Paper of the week 08.02.19: The Medicalization of Population Health2019-02-08T13:04:49+00:00
10 01, 2019

Paper of the week 10.01.19: International variation in radiation dose for computed tomography examinations

2019-01-10T12:00:47+00:00

Reference: International variation in radiation dose for computed tomography examinations: prospective cohort study. Rebecca Smith-Bindman et al BMJ 2019;364:k4931 This week’s paper of the week is brought to you by Professor Sir Muir Gray, 3V Executive Director. Bottom line The authors conclusion was that: Variation was chiefly driven by how machines were used, rather than by patient or machine manufacturer or model.       Implications for value improvement  This is an example of what has been called a ‘one tailed curve’ namely a distribution curve where we are clear about what is good and what is not good. In this case lower doses are better than higher doses because there is no evidence that the higher dose improves outcome. [...]

Paper of the week 10.01.19: International variation in radiation dose for computed tomography examinations2019-01-10T12:00:47+00:00
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