Liesbet Van Bulck1, Koen Luyckx2,3, Eva Goossens1,4,5, Silke Apers1, Adrienne H Kovacs6,7, Corina Thomet8, Werner Budts5,9, Maayke A Sluman10,11,12, Katrine Eriksen13, Mikael Dellborg14,15,16, Malin Berghammer14,17, Bengt Johansson18, Maryanne Caruana19, Alexandra Soufi20, Edward Callus21,22, Philip Moons1,23,24. 1. 1 Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium. 2. 2 School Psychology and Development in Context, KU Leuven - University of Leuven, Belgium. 3. 3 UNIBS, University of the Free State, South Africa. 4. 4 Research Foundation Flanders (FWO), Belgium. 5. 5 Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium. 6. 6 Peter Munk Cardiac Centre, University of Toronto, Canada. 7. 7 Knight Cardiovascular Institute, Oregon Health & Science University, USA. 8. 8 Center for Congenital Heart Disease, Bern University Hospital, Switzerland. 9. 9 Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Belgium. 10. 10 Department of Cardiology, Academic Medical Center, The Netherlands. 11. 11 Department of Cardiology, Jeroen Bosch Hospital, The Netherlands. 12. 12 Coronel Institute for Occupational Health, Academic Medical Centre, The Netherlands. 13. 13 Department of Cardiology, Oslo University Hospital - Rikshospitalet, Norway. 14. 14 Centre for Person-Centred Care (GPCC), University of Gothenburg, Sweden. 15. 15 Adult Congenital Heart Unit, Sahlgrenska University Hospital, Sweden. 16. 16 Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Sweden. 17. 17 Department of Health Sciences, University West, Sweden. 18. 18 Department of Public Health and Clinical Medicine, Umeå University, Sweden. 19. 19 Department of Cardiology, Mater Dei Hospital, Malta. 20. 20 Department of Congenital Heart Disease, Louis Pradel Hospital, France. 21. 21 Clinical Psychology Service, IRCCS Policlinico San Donato, Italy. 22. 22 Department of Biomedical Sciences for Health, Università degli Studi di Milano, Italy. 23. 23 Institute of Health and Care Sciences, University of Gothenburg, Sweden. 24. 24 Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Abstract
BACKGROUND: Inter-country variation in patient-reported outcomes of adults with congenital heart disease has been observed. Country-specific characteristics may play a role. A previous study found an association between healthcare system performance and patient-reported outcomes. However, it remains unknown which specific components of the countries' healthcare system performance are of importance for patient-reported outcomes. AIMS: The aim of this study was to investigate the relationship between components of healthcare system performance and patient-reported outcomes in a large sample of adults with congenital heart disease. METHODS: A total of 1591 adults with congenital heart disease (median age 34 years; 51% men; 32% simple, 48% moderate and 20% complex defects) from eight European countries were included in this cross-sectional study. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviours and quality of life. The Euro Health Consumer Index 2015 and the Euro Heart Index 2016 were used as measures of healthcare system performance. General linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. RESULTS: Health risk behaviours were associated with the Euro Health Consumer Index subdomains about patient rights and information, health outcomes and financing and access to pharmaceuticals. Perceived physical health was associated with the Euro Health Consumer Index subdomain about prevention of chronic diseases. Subscales of the Euro Heart Index were not associated with patient-reported outcomes. CONCLUSION: Several features of healthcare system performance are associated with perceived physical health and health risk behaviour in adults with congenital heart disease. Before recommendations for policy-makers and clinicians can be conducted, future research ought to investigate the impact of the healthcare system performance on outcomes further.
BACKGROUND: Inter-country variation in patient-reported outcomes of adults with congenital heart disease has been observed. Country-specific characteristics may play a role. A previous study found an association between healthcare system performance and patient-reported outcomes. However, it remains unknown which specific components of the countries' healthcare system performance are of importance for patient-reported outcomes. AIMS: The aim of this study was to investigate the relationship between components of healthcare system performance and patient-reported outcomes in a large sample of adults with congenital heart disease. METHODS: A total of 1591 adults with congenital heart disease (median age 34 years; 51% men; 32% simple, 48% moderate and 20% complex defects) from eight European countries were included in this cross-sectional study. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviours and quality of life. The Euro Health Consumer Index 2015 and the Euro Heart Index 2016 were used as measures of healthcare system performance. General linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. RESULTS: Health risk behaviours were associated with the Euro Health Consumer Index subdomains about patient rights and information, health outcomes and financing and access to pharmaceuticals. Perceived physical health was associated with the Euro Health Consumer Index subdomain about prevention of chronic diseases. Subscales of the Euro Heart Index were not associated with patient-reported outcomes. CONCLUSION: Several features of healthcare system performance are associated with perceived physical health and health risk behaviour in adults with congenital heart disease. Before recommendations for policy-makers and clinicians can be conducted, future research ought to investigate the impact of the healthcare system performance on outcomes further.
Entities:
Keywords:
Healthcare system performance; congenital; health services accessibility; heart defect; patient reported outcome measures
Authors: Liesbet Van Bulck; Eva Goossens; Koen Luyckx; Silke Apers; Erwin Oechslin; Corina Thomet; Werner Budts; Junko Enomoto; Maayke A Sluman; Chun-Wei Lu; Jamie L Jackson; Paul Khairy; Stephen C Cook; Shanthi Chidambarathanu; Luis Alday; Katrine Eriksen; Mikael Dellborg; Malin Berghammer; Bengt Johansson; Andrew S Mackie; Samuel Menahem; Maryanne Caruana; Gruschen Veldtman; Alexandra Soufi; Susan M Fernandes; Kamila White; Edward Callus; Shelby Kutty; Philip Moons Journal: BMC Health Serv Res Date: 2020-06-03 Impact factor: 2.655