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International Comparative Research in Health Care
A straightforward exercise?
Koen Putman
How are we doing?
(Inter)national research
EU-Funding (CORDIS)
Challenges
Securing comparability Accounting for national variations Finding the data
In: Burau, Curr Socio, 2012
Health systems dynamics
In: van Olmen et al., Health Cult & Society, 2012
Garrido et al., in:HSREPP, 2011
UZ Pellenberg
Queen’s Medical CentreCity Hospital
RehaClinic Zurzach
Fachklinik Herzogenaurach
Admission policies in SRU
SRU-GB1 SRU-GB2 SRU-BE1 SRU-BE2 SRU-CH SRU-DE
Factors related to the patient
physical condition ++ +
cognitive abilities + + + +
behavioural aspects + + + +
patient’s network +
Factors related to the network between facilitiesaffiliations + + +
health insurance ++
other SRUs in recruitment area
+ ++
Factors related to referring hospitalsacute stroke unit + + +
absence of bed managers +
In: Putman K et al., J Rehabil Med, 2006
0
20
40
60
80
100
120
140
160
total therapy physio-therapy
occupationaltherapy
speechtherapy
neuro.training nursing care medical care sports autonomexercise
other therapy
tim
e (
min
.)
Pellenberg
Nottingham
Zurzach
Herzogenaurach
Absolute time in therapeutic activities between7.00am and 5.00 pm
*
* significant difference after correction for case-mixDe Wit et al., Stroke, 2005
Process of care
*
*
BE UK CH DE
physiotherapy 3.94 7.35 10.54 4.90
occupational therapy 2.24 4.06 5.69 2.56
PT+OT 6.18 11.41 16.23 7.46
speech therapy 1.30 1.35 1.52 1.10
neuropsychology 0.57 0.49 1.71 1.70
medical care 2.33 3.31 2.28 3.07
nursing care 20.76 52.98 19.00 13.80
other therapy 0.77 0.00 2.24 3.14
TOTAL 31.91 69.54 42.98 30.27
Time available per patient per week/professional group
beds#
hrs/week x workingstaff FTE#
De Wit et al., Stroke, 2005
use of care after discharge (6m)
Putman et al., J Rehab Med, 2007
Challenges
Securing comparability Accounting for national variations Finding the data
In: Burau, Curr Socio, 2012
Selection of patients
Kennedy et al., Arch Phys Med Rehabil, 2012
Incentives
Peltola et al., Cerebrovasc Dis, 2013
Challenges
Securing comparability Accounting for national variations Finding the data
In: Burau, Curr Socio, 2012
Assessment traditions and ‘culture’Systematic collection useful for research
practice (Freeman et al., JNNP, 2005)
However: Heterogenity of outcome measurement in
Europe (Haigh et al., J Rehab Med, 2001)
example: FIM vs Barthel in stroke rehabilitation (Sangha et al. Int J Rehab Res, 2005)
Finding the data
“translations”
Nyein K et al., Clin Rehab 1999
Motor FIM
Barthel Index Score
Uniform datasets
Questionnaires– Conceptual equivalence across cultures
– e.g.: socio-economic status– Pre-study on possible answering categories
– e.g.: discharge destination, post-discharge services
– Translations of questionnaires
Finding the data
Ethics
Chaudhry et al., Clin Trials, 2013
Methodological challenges
In: Horn S et al. , Arch Phys Med Rehab, 2012
Priorities future research
Recommendations
Inclusion of evidence in reimbursement regulations on provision of services (Weinrich et al., 2011)
“Chain of care” (Ringelstein et al, 2013)
Quality indicators/national audits (Ringelstein et al, 2013)
Comparative effectiveness research
No stereotyping
In Hell: the cooks are English, the policemen are German, the mechanics are French, the lovers are Swiss and the bankers are Italian.
In Heaven: the cooks are French, the policemen are English, the mechanics are German, the lovers are Italian and the bankers are Swiss.
And what about the Belgians?
International Comparative Research in Health Care
A straightforward exercise?
Koen Putman
[email protected]@uclan.ac.uk
