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Multilevel analysis and COPD

Myriam Calle Rubio, José Luis López-Campos, Juan J Soler-Cataluña, Bernardino Alcázar Navarrete, Joan B Soriano, José Miguel Rodríguez González-Moro, Manuel E Fuentes Ferrer, Juan Luis Rodríguez Hermosa
BACKGROUND: Clinical audits have reported considerable variability in COPD medical care and frequent inconsistencies with recommendations. The objectives of this study were to identify factors associated with a better adherence to clinical practice guidelines and to explore determinants of this variability at the the hospital level. METHODS: EPOCONSUL is a Spanish nationwide clinical audit that evaluates the outpatient management of COPD. Multilevel logistic regression with two levels was performed to assess the relationships between individual and disease-related factors, as well as hospital characteristics...
December 2, 2017: Respiratory Research
Pernille Heyckendorff Lilholt, Flemming Witt Udsen, Lars Ehlers, Ole K Hejlesen
OBJECTIVE: To assess the effect of telehealthcare compared with usual practice in patients with chronic obstructive pulmonary disease (COPD). DESIGN: A cluster-randomised trial with 26 municipal districts that were randomly assigned either to an intervention group whose members received telehealthcare in addition to usual practice or to a control group whose members received usual practice only (13 districts in each arm). SETTING: Twenty-six municipal districts in the North Denmark Region of Denmark...
May 9, 2017: BMJ Open
Mamta Ruparel, Jose Luis López-Campos, Ady Castro-Acosta, Sylvia Hartl, Francisco Pozo-Rodriguez, C Michael Roberts
Chronic obstructive pulmonary disease (COPD) care across Europe has high heterogeneity with respect to cost and the services available. Variations in length of stay (LOS) may be attributed to patient characteristics, resource and organisational characteristics, and/or the so-called hospital cluster effect. The European COPD Audit in 13 countries included data from 16 018 hospitalised patients. The recorded variables included information on patient and disease characteristics, and resources available. Variables associated with LOS were evaluated by a multivariate, multilevel analysis...
January 2016: ERJ Open Research
Hoda Badr, Alex D Federman, Michael Wolf, Tracey A Revenson, Juan P Wisnivesky
OBJECTIVE: Individuals with chronic obstructive pulmonary disease (COPD) and their caregivers are at high risk for developing depression. Depression can adversely affect the quality of life of patients and caregivers; however, studies in COPD have largely examined predictors of patient and caregiver depression in isolation. This dyadic study examined individual-level predictors of patient and caregiver depression in COPD (i.e. actor effects) as well as how dyad members effect each other's depression (i...
September 2017: Aging & Mental Health
Ana Delgado, Lorena Saletti-Cuesta, Luis Andrés López-Fernández, Natalia Gil-Garrido, Juan de Dios Luna Del Castillo
BACKGROUND: COPD is a frequent severe illness that increasingly affects females. Gender inequalities have been reported in COPD care. OBJECTIVE: To analyze decision-making in primary care for men and women with identical COPD as a function of the gender of the family physician (FP). METHODS: Cross-sectional, multicenter study in 457 Andalusian FPs, using a self-administered vignette-based questionnaire on COPD featuring a male or female patient, with four variables on clinical reasoning: "tobacco as most important risk factor (RF)", "ordering of spirometry", "COPD as most likely diagnosis", and "referral"...
May 2016: Respiratory Medicine
Melinde R S Boland, Annemarije L Kruis, Simone A Huygens, Apostolos Tsiachristas, Willem J J Assendelft, Jacobijn Gussekloo, Coert M G Blom, Niels H Chavannes, Maureen P M H Rutten-van Mölken
This study aims to (1) examine the variation in implementation of a 2-year chronic obstructive pulmonary disease (COPD) management programme called RECODE, (2) analyse the facilitators and barriers to implementation and (3) investigate the influence of this variation on health outcomes. Implementation variation among the 20 primary-care teams was measured directly using a self-developed scale and indirectly through the level of care integration as measured with the Patient Assessment of Chronic Illness Care (PACIC) and the Assessment of Chronic Illness Care (ACIC)...
2015: NPJ Primary Care Respiratory Medicine
Shobhit V Minhas, Preeya Goyal, Alpesh A Patel
BACKGROUND: Perioperative cerebrovascular accidents (CVAs) are one of the leading causes of patient morbidity, mortality, and medical costs. However, little is known regarding the rates of these events and risk factors for CVA after elective orthopaedic surgery. QUESTIONS/PURPOSES: Our goals were to (1) establish the national, baseline proportion of patients experiencing a 30-day CVA and the timing of CVA; and (2) determine independent risk factors for 30-day CVA rates after common elective orthopaedic procedures...
March 2016: Clinical Orthopaedics and related Research
F Pozo-Rodríguez, A Castro-Acosta, C J Alvarez, J L López-Campos, A Forte, A López-Quilez, A Agustí, V Abraira
BACKGROUND: Previous studies have demonstrated significant variability in the processes of care and outcomes of chronic obstructive pulmonary disease (COPD) exacerbations. The AUDIPOC is a Spanish nationwide clinical audit that identified large between-hospital variations in care and clinical outcomes. Here, we test the hypothesis that these variations can be attributed to either patient characteristics, hospital characteristics and/or the so-called hospital-clustering effect, which indicates that patients with similar characteristics may experience different processes of care and outcomes depending on the hospital to which they are admitted...
September 2015: International Journal of Clinical Practice
Mohamad Bydon, Mohamed Macki, Rafael De la Garza-Ramos, Daniel M Sciubba, Jean-Paul Wolinsky, Ziya L Gokaslan, Timothy F Witham, Ali Bydon
OBJECT: This study aimed to identify the factors predicting an increased risk for reoperation in patients who had undergone a lumbar laminectomy. METHODS: The authors retrospectively reviewed the electronic medical records of all patients who had undergone firsttime, bilateral laminectomy at 1, 2, or 3 levels for lumbar spondylosis at the authors' institution. Patients who underwent fusion, laminotomy, discectomy, or complete facetectomy were excluded. The patients' preoperative symptoms and comorbidities were also obtained from their medical records...
March 2015: Journal of Neurosurgery. Spine
Rachel E Jordan, Peymané Adab, Sue Jowett, Jen L Marsh, Richard D Riley, Alexandra Enocson, Martin R Miller, Brendan G Cooper, Alice M Turner, Jon G Ayres, Kar Keung Cheng, Kate Jolly, Robert A Stockley, Sheila Greenfield, Stanley Siebert, Amanda Daley, David A Fitzmaurice
BACKGROUND: Many people with clinically significant chronic obstructive pulmonary disease (COPD) remain undiagnosed worldwide. There are a number of small studies which have examined possible methods of case finding through primary care, but no large RCTs that have adequately assessed the most cost-effective approach. METHODS/DESIGN: In this study, using a cluster randomised controlled trial (RCT) in 56 general practices in the West Midlands, we plan to investigate the effectiveness and cost-effectiveness of a Targeted approach to case finding for COPD compared with routine practice...
October 4, 2014: BMC Pulmonary Medicine
Timothy C Harrold, Deborah A Randall, Michael O Falster, Sanja Lujic, Louisa R Jorm
OBJECTIVES: To quantify the independent roles of geography and Indigenous status in explaining disparities in Potentially Preventable Hospital (PPH) admissions between Indigenous and non-Indigenous Australians. DESIGN, SETTING AND PARTICIPANTS: Analysis of linked hospital admission data for New South Wales (NSW), Australia, for the period July 1 2003 to June 30 2008. MAIN OUTCOME MEASURES: Age-standardised admission rates, and rate ratios adjusted for age, sex and Statistical Local Area (SLA) of residence using multilevel models...
2014: PloS One
Pamela Barbadoro, Anna Marigliano, Elena Di Tondo, Carlos Chiatti, Francesco Di Stanislao, Marcello M D'Errico, Emilia Prospero
We analyzed seasonal influenza vaccination coverage among the Italian healthcare workers (HCW) in order to identify socio-demographic and clinical determinants of vaccination. We used data from the survey "Health and health care use in Italy," which comprised interviews of 5,336 HCWs For each respondent, information on socioeconomic, health conditions, self-perceived health and smoking status were obtained. After bivariate analysis, we used multilevel regression models to assess determinants of immunization...
April 2013: Human Vaccines & Immunotherapeutics
Jean-Frédéric Lévesque, Debbie Ehrmann Feldman, Valérie Lemieux, André Tourigny, Jean-Pierre Lavoie, Pierre Tousignant
PURPOSE: To measure patients' assessment of chronic illness care and its variation across primary healthcare (PHC) models. METHODS: We recruited 776 patients with diabetes, heart failure, arthritis or chronic obstructive pulmonary disease from 33 PHC clinics. Face-to-face interviews, followed by a telephone interview at 12 months, were conducted using the Patient Assessment of Chronic Illness Care (PACIC). Multilevel regression was used in the analysis. RESULTS: The mean PACIC score was low at 2...
November 2012: Healthcare Policy, Politiques de Santé
Rachael Boggon, Richard Hubbard, Liam Smeeth, Martin Gulliford, Jackie Cassell, Susan Eaton, Munir Pirmohamed, Tjeerd-Pieter van Staa
BACKGROUND: The role of antibiotics in treating mild or moderate exacerbations in patients with acute chronic obstructive pulmonary disease (COPD) is unclear. The aims were to: (i) describe patient characteristics associated with acute exacerbations amongst a representative COPD population, (ii) explore the relationship between COPD severity and outcomes amongst patients with exacerbations, and (iii) quantify variability by general practice in prescribing of antibiotics for COPD exacerbations...
May 31, 2013: BMC Pulmonary Medicine
Martin Cartwright, Shashivadan P Hirani, Lorna Rixon, Michelle Beynon, Helen Doll, Peter Bower, Martin Bardsley, Adam Steventon, Martin Knapp, Catherine Henderson, Anne Rogers, Caroline Sanders, Ray Fitzpatrick, James Barlow, Stanton P Newman
OBJECTIVE: To assess the effect of second generation, home based telehealth on health related quality of life, anxiety, and depressive symptoms over 12 months in patients with long term conditions. DESIGN: A study of patient reported outcomes (the Whole Systems Demonstrator telehealth questionnaire study; baseline n=1573) was nested in a pragmatic, cluster randomised trial of telehealth (the Whole Systems Demonstrator telehealth trial, n=3230). General practice was the unit of randomisation, and telehealth was compared with usual care...
February 26, 2013: BMJ: British Medical Journal
Svin Deneckere, Martin Euwema, Cathy Lodewijckx, Massimiliano Panella, Timothy Mutsvari, Walter Sermeus, Kris Vanhaecht
BACKGROUND: Effective interprofessional teamwork is an essential component for the delivery of high-quality patient care in an increasingly complex medical environment. The objective is to evaluate whether the implementation of care pathways (CPs) improves teamwork in an acute hospital setting. DESIGN AND MEASURES: A posttest-only cluster randomized controlled trial was performed in Belgian acute hospitals. Teams caring for patients hospitalized with a proximal femur fracture and those hospitalized with an exacerbation of chronic obstructive pulmonary disease, were randomized into intervention and control groups...
January 2013: Medical Care
Svin Deneckere, Martin Euwema, Cathy Lodewijckx, Massimiliano Panella, Walter Sermeus, Kris Vanhaecht
BACKGROUND: Although care pathways are often said to promote teamwork, high-level evidence that supports this statement is lacking. Furthermore, knowledge on conditions and facilitators for successful pathway implementation is scarce. The objective of the European Quality of Care Pathway (EQCP) study is therefore to study the impact of care pathways on interprofessional teamwork and to build up understanding on the implementation process. METHODS/DESIGN: An international post-test-only cluster Randomised Controlled Trial (cRCT), combined with process evaluations, will be performed in Belgium, Ireland, Italy, and Portugal...
2012: Implementation Science: IS
Evangelos Kontopantelis, Tim Doran, Hugh Gravelle, Rosalind Goudie, Luigi Siciliani, Matt Sutton
OBJECTIVE: To analyze the effect of setting higher targets, in a primary care pay-for-performance scheme, on rates of influenza immunization and exception reporting. STUDY SETTING: The U.K. Quality and Outcomes Framework links financial rewards for family practices to four separate influenza immunization rates for patients with coronary heart disease (CHD), chronic obstructive pulmonary disease, diabetes, and stroke. There is no additional payment for immunization rates above an upper threshold...
June 2012: Health Services Research
X Li, K Sundquist, J Sundquist
BACKGROUND: The objective was to analyze the association between neighborhood deprivation and prostate cancer mortality, after adjusting for individual characteristics. METHODS: This study was designed as a follow-up study of prostate cancer mortality between 1 January 1990 and 31 December 2008 in patients aged 25-74 years (a total of 73 159 patients). Multilevel logistic regression analyses were performed with individual-level characteristics at the first level and level of neighborhood deprivation at the second level...
June 2012: Prostate Cancer and Prostatic Diseases
Carlos Chiatti, Pamela Barbadoro, Anna Marigliano, Alessandra Ricciardi, Francesco Di Stanislao, Emilia Prospero
We analyzed seasonal flu vaccination rates among the Italian population suffering from Chronic Obstructive Pulmonary Disease (COPD) in order to identify socio-demographic and clinical determinants for vaccination. We used data from the survey "Health and health care use in Italy", which interviewed 5,935 persons (age 15 - 102 years) suffering from COPD in the period 2004-2005. For each respondent, information on socioeconomic and health conditions, smoking status and patterns of health care utilization were retrieved...
October 2011: Human Vaccines
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