Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries.
Journal: BMC health services research
Volume: 20
Issue: 1
Year of Publication: 2020
Affiliated Institutions:
KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer , Box , B-, Leuven, Belgium.
KU Leuven School Psychology and Development in Context, KU Leuven - University of Leuven, Leuven, Belgium.
Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium.
Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada.
Center for Congenital Heart Disease, Inselspital - Bern University Hospital, University of Bern, Bern, Switzerland.
Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium.
Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan.
Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA.
Adult Congenital Heart Center, Montreal Heart Institute, Université de Montréal, Montreal, Canada.
Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA.
Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India.
Division of Cardiology, Hospital de Niños, Córdoba, Argentina.
Adult Congenital Heart Disease Center, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Division of Cardiology, Stollery Children's Hospital, University of Alberta, Edmonton, Canada.
Monash Heart, Monash Medical Centre, Monash University, Melbourne, Australia.
Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Msida, Malta.
Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France.
Adult Congenital Heart Disease Program at Stanford, Lucile Packard Children's Hospital and Stanford Health Care, Palo Alto, CA, USA.
Adult Congenital Heart Disease Center, Washington University and Barnes Jewish Heart & Vascular Center, University of Missouri, Saint Louis, MO, USA.
Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy.
Adult Congenital Heart Disease Center University of Nebraska Medical Center/ Children's Hospital and Medical Center, Omaha, NE, USA.
KU Leuven Department of Public Health and Primary Care, KU Leuven - University of Leuven, Kapucijnenvoer , Box , B-, Leuven, Belgium. philip.moons@kuleuven.be.
Abstract summary
The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries' healthcare system on patient-reported outcomes in adults with congenital heart disease.This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences.Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed.This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn.ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.
Authors & Co-authors:
Van Bulck Liesbet L
Goossens Eva E
Luyckx Koen K
Apers Silke S
Oechslin Erwin E
Thomet Corina C
Budts Werner W
Enomoto Junko J
Sluman Maayke A MA
Lu Chun-Wei CW
Jackson Jamie L JL
Khairy Paul P
Cook Stephen C SC
Chidambarathanu Shanthi S
Alday Luis L
Eriksen Katrine K
Dellborg Mikael M
Berghammer Malin M
Johansson Bengt B
Mackie Andrew S AS
Menahem Samuel S
Caruana Maryanne M
Veldtman Gruschen G
Soufi Alexandra A
Fernandes Susan M SM
White Kamila K
Callus Edward E
Kutty Shelby S
Moons Philip P
Study Outcome
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