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MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme,

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Presentation on theme: "MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme,"— Presentation transcript:

1 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros New Professional Roles: Processes, Productivity and Health Outcomes Jan Erik Askildsen Kamrul Islam University of Bergen, Norway

2 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Overall objective assess the impact of the new professional roles – new roles mean undertaking roles that have traditionally been carried out by another profession as a formal part of his/her job – AMI, beast cancer, diabetes II study how the new roles have changed – health outcomes – processes outcomes – patient experiences – health care use

3 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Formal representation Identify impact on clinical practice and outcomes – Outcome = f(personnel, share ‘new’, other) = f(L, L 2 /(L 1 +L 2 ), K) or 0 idh1c = f(L 1dh1c, K) 0 idh2c = f(L 1dh1c, L 2dh1c, K) where L is labour, and L 1 and L 2 are ‘traditional’ and ‘new’ health care professionals respectively

4 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Outcome indicators Indicators suggested by EU ECHIM project and/or OECD HCQI project Outcomes must be hypothesized to be sensitive to changes in the types of professions involved in the provision of care, and in particular whether it is a new profession or new role

5 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Data sources Questionnaires – distributed to patients and professionals in 9 countries Register (administrative) data Patient records

6 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Possible indicators  Health outcomes (HO)  Mortality within 30 days  Self assessed health  Morbidity index hour?  Process measures (PM)  Unplanned readmission within 30 days after discharge from hospital  Patient experiences (PS)  Patient satisfaction  Waiting times  Health care use (HC)  Length of stay (LOS)  Number of outpatient visits  Number of GP visits

7 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Empirical strategy Outcomes hypothesized to depend on – patients’ individual characteristics age, sex, comorbidities, severity of the disease – hospital characteristics new professionals combination of the services provided by health care professionals hospital type, size – hospital care use where patient has been treated e.g. LOS → Nested structure: - Individual and hospital level sources of variation

8 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros New professional roles Variation over hospitals and diagnoses when it comes to share of specialists – Nurses and physicians Will construct a measure for new professional roles based on questionnaires to health care professionals – Diagnoses and hospital specific – Simple measure: Share of APN, share of specialist nurse; in team

9 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Formalization

10 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Diagnoses and Inclusion Criteria AMI/Heart attack  Male or female  Age 21 years or older  Having a diagnosis of ICD-9: 410 or ICD-10: I21 or I22. Breast Cancer  Female  Age 21 years or older  Having a diagnosis of ICD-9: 174-175 or ICD-10: C50 Empirical analyses ( An Example based on Norwegian data)

11 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Data and Variables Data come from Norwegian Patient Register (NPR) for the years 2008-2013 Dependent Variables: Dead within 30 days Unplanned readmission within 28 days Hospital length of Stay (LOS) – Independent Variables: Demographic: Age, gender Disease Severity: DRG weight Whether patient changed their residence from home to institution: home_inst

12 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Descriptive Statistics AMI/Heart AttackBreast Cancer VariableNMeanStd. Dev.ObsMeanStd. Dev. dead_30126 4150.0580.234448 2430.0070.086 readm_28126 4150.2790.449448 2430.4000.490 LOS105 7913.7834.64227 0183.8925.026 Age126 41567.7513.58448 24359.2012.28 Male126 4150.6770.4680.0070.082 drg_weight125 0061.2041.487415 8440.1600.323 home_inst126 4150.3570.479448 2430.0080.091 Year 2009126 4150.1580.364448 2430.0970.298 2010126 4150.1730.379448 2430.1000.301 2011126 4150.1780.384448 2430.2210.415 2012126 4150.1770.381448 2430.2440.429 2013126 4150.1770.381448 2430.2510.434

13 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

14 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

15 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

16 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

17 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

18 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

19 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros AMI/Heart Attack: Dead within 30 days Multilevel Logistic Regression Results Model 1Model 2 dead_30 Odds RatioStd. Err.zP>zdead_30 Odds RatioStd. Err.zP>z age1.0990.00169.0190.00 male0.9820.027-0.5410.51 drg_weight1.0970.00714.0400.00 home_inst5.5210.16557.2350.00 LOS0.9890.003-4.4280.00 year 20090.7790.034-5.7290.0020090.8920.042-2.6110.02 20100.8820.037-3.0420.0020100.8840.041-2.6950.00 20110.9010.037-2.5540.0120110.8450.038-3.7190.00 20120.8870.037-2.9100.0020120.8040.037-4.7910.00 20130.6610.029-9.4250.0020130.6050.029-10.4460.00 _cons0.0740.002-85.9280.00_cons0.000 -87.5020.00 Model 1Model 2 Residual intra-class correlation Level ICC Std. Err.Level ICC Std. Err. Hospital 0.467 0.180Hospital 0.479 0.177

20 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros AMI/Heart Attack: Unplanned Readmission within 28 days Multilevel Logistic Regression Results Model 1Model 2 readm_28 Odds RatioStd. Err.zP>zreadm_28Odds RatioStd. Err.zP>z age0.9770.001-37.0410.00 male1.1730.0219.0450.00 drg_weight1.0460.0067.4540.01 home_inst8.7660.143-133.290.00 LOS0.8290.003-89.3490.00 year 20090.8640.021-6.1540.0020091.0180.0300.5910.23 20101.0200.0230.8530.3920101.1890.0346.0800.00 20111.1850.0277.5660.0020111.3780.03911.4020.00 20121.0960.0254.0700.0020121.2880.0369.0000.00 20131.1050.0254.4270.0020131.3710.03811.3050.00 _cons0.3700.006-58.2160.00_cons0.8750.044-2.6710.00 Model 1Model 2 Residual intra-class correlation LevelICCStd. Err.LevelICCStd. Err. Hospital 0. 0003 0.014Hospital 0.036 0.027

21 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros AMI/Heart Attack: Length of Hospital Stay (LOS) Multilevel Linear Regression Results Model 1Model 2 LOSCoef.Std. Err.zP>zLOSCoef.Std. Err.zP>z age0.0630.00164.7590.00 male-0.3190.028-11.2830.00 drg_weight1.0200.009117.5540.00 home_inst-0.3580.026-13.5560.00 year 2009-0.0710.051-1.4580.172009-0.0700.047-1.4890.14 2010-0.1280.049-2.6830.012010-0.1330.045-2.9230.01 2011-0.3250.049-6.7470.002011-0.8800.045-19.6130.00 2012-0.3920.049-8.0970.002012-0.9010.045-19.9090.00 2013-0.5720.049-11.7190.002013-0.6890.045-15.2320.00 _cons4.0320.31712.7400.00_cons-1.0120.320-3.1600.00 Model 1Model 2 Residual intra-class correlation Level ICC Std. Err.Level ICC Std. Err. Hospital 0.082 0.025Hospital 0.093 0.028

22 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Breast Cancer: Dead within 30 days Multilevel Linear Regression Results Model 1Model 2 dead_30Coef.Std. Err.zP>zdead_30Coef.Std. Err.zP>z age-0.0000.000-3.7480.00 drg_weight0.0470.00218.8990.00 home_inst0.3430.00572.8830.00 LOS0.0050.00016.5650.00 year 2009-0.0050.001-9.0750.002009-0.0090.004-2.1100.03 2010-0.0060.001-10.7740.002010-0.0060.004-1.4310.15 2011-0.0110.001-21.0310.002011-0.0130.004-2.9420.00 2012-0.0120.001-23.8100.002012-0.0220.004-4.9980.00 2013-0.0110.001-22.5540.002013-0.0310.004-7.2510.00 _cons0.0410.0133.1110.00_cons0.0100.0091.1140.27 Model 1Model 2 Residual intra-class correlation LevelICCStd. Err.LevelICCStd. Err. Hospital0.3230.069Hospital0.0120.006

23 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Breast Cancer: Unplanned Readmission within 28 days Multilevel Linear Regression Results Model 1Model 2 readm_28Coef.Std. Err.zP>zreadm_28Coef.Std. Err.zP>z age-0.0010.000-5.3820.00 drg_weight0.0330.0049.0330.00 home_inst0.0370.0075.3910.00 LOS0.0010.0002.2550.02 year 20090.0000.0030.1150.9120090.0140.0062.2120.03 2010-0.0020.003-0.7590.4520100.0120.0061.8720.06 20110.4650.003184.0010.0020110.0620.0069.8010.00 20120.4610.002184.9540.0020120.0400.0066.2450.00 20130.4460.002179.6770.0020130.0460.0067.2070.00 _cons-0.0280.034-0.8320.41_cons0.0910.0185.0090.00 Model 1Model 2 Residual intra-class correlation LevelICCStd. Err.LevelICCStd. Err. Hospital0.1100.033Hospital0.0370.015

24 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Breast Cancer: Length of Hospital Stay (LOS) Multilevel Regression Results MODEL 1Model 2 LOSCoef.Std. Err.zP>zLOSCoef.Std. Err.zP>z age0.0350.00217.1360.00 drg_weight2.9210.05157.1870.00 home_inst3.5350.10134.9770.00 year 20090.0270.1040.2610.792009-0.1140.094-1.2050.23 2010-0.3050.105-2.9120.002010-0.5340.095-5.6420.00 2011-0.1580.104-1.5240.132011-0.4930.094-5.2440.00 2012-0.8300.105-7.8970.002012-1.0750.095-11.3210.00 2013-0.7620.102-7.4670.002013-1.7230.094-18.4020.00 _cons4.8320.43211.1910.00_cons-0.7290.238-3.0600.00 Model 1Model 2 Residual intra-class correlation Level ICC Std. Err.Level ICC Std. Err. Hospital 0.107 0.039Hospital 0.025 0.011

25 MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Conclusion Variations over hospitals in use of health care personnel Multi-level analyses indicate some possibility for this variation to result in different health outcomes – Mortality rates, unplanned readmission, LOS Questionnaires will provide more information on outcomes and health care personnel mix

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