Identifying subgroups of high-need, high-cost, chronically ill patients in primary care: A latent class analysis

Smeets, Rowan G. M.; Elissen, Arianne; Kroese, Mariëlle; Hameleers, Niels; Ruwaard, Dirk

doi:10.1371/journal.pone.0228103

Cited by 23 publications

(33 citation statements)

References 53 publications

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“…Findings from a recent Dutch study, including persons with T2DM diabetes (40%), suggest that 'high-need, high-cost' patients tend to have a combination of somatic and psychiatric disorders as well as socioeconomic disparities. 18 In Germany, mean costs per person with T2DM were €4957 7 in 2010. These costs were €3661 (in 2003) in Italy and €2578 (in 2010) in the UK.…”

Section: Open Accessmentioning

confidence: 99%

Distribution of care expenditures for men and women with type 2 diabetes treated in primary care in the Netherlands: a case–control study (ZODIAC-59)

Mevissen

Geurten

Hendriks³

et al. 2022

BMJ Open

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ObjectiveThis study aims to provide insight into the distribution of care expenditures for patients with type 2 diabetes mellitus (T2DM)— across multiple healthcare service categories and medical specialties—who receive diabetes care in the primary care setting.DesignObservational, matched case–control study.SettingIn the Netherlands, T2DM-specific care is mainly provided in the primary care setting. However, many patients with T2DM also use secondary care for complications and comorbidities, either related or unrelated to their diabetes.ParticipantsPatients with T2DM receiving diabetes care in primary care and participating in the Dutch Zwolle Outpatient Diabetes project Integrating Available Care cohort in the year 2011 were matched to persons without T2DM. Matching (1:2 ratio) was performed based on age, gender and socioeconomic status. Clinical data were combined with an all-payer claims database from 2011.ResultsIn total, 43 775 patients with T2DM were identified of whom 37 240 could be matched with 74 480 controls. Total secondary care expenditures were €94 705 814, with a total annual median expenditure per patient of €2133 (1161 to 3340) for men and €2,535 (1374 to 5105) for women. The largest share of expenditures was on medication (26%), followed by secondary care (23%) and primary care services related (23%) to T2DM. The five most expensive specialties were: cardiology, surgery, internal medicine, orthopaedics and ophthalmology. Care expenditures for T2DM patients were twofold higher than those for persons without T2DM. Healthcare expenditures showed a skewed distribution, indicating that a small part of the studied population is responsible for a considerable part of the costs.ConclusionsExpenditures among primary care treated T2DM patients are higher than non-diabetic matched controls. Medication is the largest share of T2DM care expenditures. The present study provides insights into healthcare expenditures for T2DM; this may enable more efficient healthcare planning and reimbursement.

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Section: Open Accessmentioning

confidence: 99%

Distribution of care expenditures for men and women with type 2 diabetes treated in primary care in the Netherlands: a case–control study (ZODIAC-59)

Mevissen

Geurten

Hendriks³

et al. 2022

BMJ Open

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“…First, as this study was conducted in a predominantly rural area of the Netherlands, with less deprivation than in other, more urban regions of the country, the prevalence of financial issues may actually be lower [38]. However, previous research shows that the target population of this study, i.e., high care need patients, more often has financial problems than found in this study [39][40][41][42]. Therefore, a second possible explanation is that financial problems were not always identified and acted upon.…”

Section: Discussionmentioning

confidence: 88%

The Patient Centered Assessment Method (PCAM) for Action-Based Biopsychosocial Evaluation of Patient Needs: Validation and Perceived Value of the Dutch Translation

Smeets

Hertroijs

Kroese

et al. 2021

IJERPH

Self Cite

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The Patient Centered Assessment Method (PCAM) is an action-based tool that supports professionals to engage in a biopsychosocial assessment with patients and measure their needs. It is a promising tool for person-centered care. As the Netherlands lacks such a tool, a Dutch version was developed. Furthermore, we aimed to contribute to the relatively limited insights into the psychometric properties and value of the tool when used as part of a needs assessment in primary care. Confirmatory factor analysis was used to study construct validity and Cronbach’s alpha was computed to assess reliability. Furthermore, we interviewed 15 primary care professionals who used the PCAM. It was confirmed that each PCAM domain measures a separate construct, informed by the biopsychosocial model. The tool showed adequate reliability (Cronbach’s alpha = 0.83). Despite face validity concerns, the tool was mainly valued for measurement of patient needs and to facilitate action planning. Criticism of the PCAM pertained to a limited focus on the patient perspective, which is one of the crucial aspects of person-centered care. These rich, mixed-method insights can help to improve the value of the PCAM, as one of the few multifunctional tools to support professionals in holistic assessments.

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“…Next, the social and living environment of the patient, such as whether they have caretakers at home or need for assistive equipment, can inform the decisions related to patients' rehabilitation outcomes [29]. Finally, the patient's income level can specify patients' ability to access medical services or regimens, such as purchasing certain prescriptions [45].…”

Section: Discussionmentioning

confidence: 99%

Information Design for Personas in Four Professional Domains of User Experience Design, Healthcare, Market Research, and Social Media Strategy

Guan¹,

Salminen²,

Nielsen³

et al. 2021

Proceedings of the Annual Hawaii International Conference on System Sciences

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Practitioners in user-centric industries have increasingly recognized the applicability of personas. However, the methods used to create personas in different domains remain inconsistent and unsystematic. We analyzed 51 studies focused on designing personas for professional purposes and find the practice most prevalent in the user experience (UX) design, healthcare, market research, and social media strategy domains. Within these domains, UX design personas are characterized by their focus on user activity and goals, market research personas on customers' lifestyles, health personas on medical patients' physical symptoms, and social media strategy personas on interactions within online communities. We identify and compare the elements in the personas. Based on this, we provide guidelines for professionals interested in developing personas for recruiting users, understanding barriers to positive user experience, and building online communities, including how to represent persona details related to lifestyle, contexts of product usage, and scaling of online data.

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Identifying subgroups of high-need, high-cost, chronically ill patients in primary care: A latent class analysis

Cited by 23 publications

References 53 publications

Distribution of care expenditures for men and women with type 2 diabetes treated in primary care in the Netherlands: a case–control study (ZODIAC-59)

Distribution of care expenditures for men and women with type 2 diabetes treated in primary care in the Netherlands: a case–control study (ZODIAC-59)

The Patient Centered Assessment Method (PCAM) for Action-Based Biopsychosocial Evaluation of Patient Needs: Validation and Perceived Value of the Dutch Translation

Information Design for Personas in Four Professional Domains of User Experience Design, Healthcare, Market Research, and Social Media Strategy

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