Τίτλος:
The relationship between context, structure, and processes with outcomes
of 6 regional diabetes networks in Europe
Περίληψη:
Background
While health service provisioning for the chronic condition Type 2
Diabetes (T2D) often involves a network of organisations and
professionals, most evidence on the relationships between the structures
and processes of service provisioning and the outcomes considers single
organisations or solo practitioners. Extending Donabedian’s
Structure-Process-Outcome (SPO) model, we investigate how differences in
quality of life, effective coverage of diabetes, and service
satisfaction are associated with differences in the structures,
processes, and context of T2D services in six regions in Finland,
Germany, Greece, Netherlands, Spain, and UK.
Methods
Data collection consisted of: a) systematic modelling of provider
network’s structures and processes, and b) a cross-sectional survey of
patient reported outcomes and other information. The survey resulted in
data from 1459 T2D patients, during 2011-2012. Stepwise linear
regression models were used to identify how independent cumulative
proportion of variance in quality of life and service satisfaction are
related to differences in context, structure and process. The selected
context, structure and process variables are based on Donabedian’s SPO
model, a service quality research instrument (SERVQUAL), and previous
organization and professional level evidence. Additional analysis
deepens the possible bidirectional relation between outcomes and
processes.
Results
The regression models explain 44% of variance in service satisfaction,
mostly by structure and process variables (such as human resource use
and the SERVQUAL dimensions). The models explained 23% of variance in
quality of life between the networks, much of which is related to
contextual variables. Our results suggest that effectiveness of A1c
control is negatively correlated with process variables such as total
hours of care provided per year and cost of services per year.
Conclusions
While the selected structure and process variables explain much of the
variance in service satisfaction, this is less the case for quality of
life. Moreover, it appears that the effect of the clinical outcome A1c
control on processes is stronger than the other way around, as poorer
control seems to relate to more service use, and higher cost. The
standardized operational models used in this research prove to form a
basis for expanding the network level evidence base for effective T2D
service provisioning.
Συγγραφείς:
Mahdavi, Mahdi
Vissers, Jan
Elkhuizen, Sylvia
van Dijk,
Mattees
Vanhala, Antero
Karampli, Eleftheria
Faubel, Raquel
and Forte, Paul
Coroian, Elena
van de Klundert, Joris
