Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countriesToronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada (CAN).
University of Bern, Center for Congenital Heart Disease, Inselspital - Bern University Hospital, Bern, Switzerland (CHE).
Division of Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium (BEL); KU Leuven - University of Leuven, KU Leuven Department of Cardiovascular Sciences, Leuven, Belgium (BEL).
Department of Adult Congenital Heart Disease, Chiba Cardiovascular Center, Chiba, Japan (JPN).
Department of Cardiology, Academic Medical Center, Amsterdam, the Netherlands (NLD).
National Taiwan University Children’s Hospital, Adult Congenital Heart Center, Taiwan (TWN).
Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA (USA).
Université de Montréal, Adult Congenital Heart Center, Montreal Heart Institute, Montreal, Canada (CAN).
Adult Congenital Heart Disease Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA (USA).
Pediatric Cardiology, Frontier Lifeline Hospital (Dr. K. M. Cherian Heart Foundation), Chennai, India (IND).
Division of Cardiology, Hospital de Niños, Córdoba, Argentina (ARG).
Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway (NOR).
Adult Congenital Heart Unit, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden; Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden; University of Gothenburg, Centre for Person-Centred Care (GPCC), Gothenburg, Sweden.
Umeå University, Department of Public Health and Clinical Medicine, Umeå, Sweden.
University of Alberta, Division of Cardiology, Stollery Children's Hospital, Edmonton, Canada (CAN).
Monash University, Monash Heart, Monash Medical Centre, Melbourne, Australia (AUS).
Department of Cardiology, Mater Dei Hospital, Birkirkara Bypass, Malta (MLT).
Adult Congenital Heart Disease Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA (USA).
Department of Congenital Heart Disease, Louis Pradel Hospital, Hospices civils de Lyon, Lyon, France (FRA).
Adult Congenital Heart Program at Stanford, Lucile Packard Children’s Hospital and Stanford Health Care, USA (USA).
Washington University, Adult Congenital Heart Disease Center ; University of Missouri, Barnes Jewish Heart & Vascular Center, Saint Louis, Missouri USA (USA).
Clinical Psychology Service, IRCCS Policlinico San Donato, Milan, Italy (ITA); Università degli Studi di Milano, Department of Biomedical Sciences for Health, Milan, Italy (ITA).
University of Nebraska Medical Center, Adult Congenital Heart Disease Center, Children's Hospital and Medical Center, Omaha, NE, USA (USA).
KU Leuven - University of Leuven, KU Leuven Department of Public Health and Primary Care, Leuven, Belgium (BEL); Centre for Person-Centred Care (GPCC), Gothenburg, Sweden; University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden; University of Cape Town, Department of Paediatrics and Child Health, Cape Town, South Africa (ZAF).
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2020 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 20, no 1, article id 496Article in journal (Refereed) Published
Abstract [en]
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.
TRIAL REGISTRATION: ClinicalTrials.gov: NCT02150603. Registered 30 May 2014.
Place, publisher, year, edition, pages
2020. Vol. 20, no 1, article id 496
Keywords [en]
Congenital Heart Defects, Health Resources, Healthcare workforce, Patient Reported Outcome Measures, Quality of life, Staffing
National Category
Public Health, Global Health, Social Medicine and Epidemiology Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-15714DOI: 10.1186/s12913-020-05361-9ISI: 000540258000007PubMedID: 32493367Scopus ID: 2-s2.0-85086062750OAI: oai:DiVA.org:hv-15714DiVA, id: diva2:1460336
Funder
Swedish Heart Lung Foundation, 20130607
Note
Funders: Research Fund – KU Leuven (Leuven, Belgium) [OT/11/033]; Cardiac Children’s Foundation (Taiwan)[CCF2013_02].
2020-08-242020-08-242022-09-15Bibliographically approved