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| 2. |
- Anttila, Sten, et al.
(författare)
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Program för att förebygga psykisk ohälsa hos barn : En systematisk litteraturöversikt
- 2010
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Det är angeläget att finna metoder för att förebygga psykisk ohälsa hos barn. Det finns tecken på att psykisk ohälsa hos barn kan ha ökat under de senaste decennierna och strukturerade insatser för att komma till rätta med problemen blir allt vanligare såväl inom kommunal verksamhet som inom hälso- och sjukvård. Interventionen utgörs av så kallade program som är standardiserade och finns beskrivna i manual eller motsvarande. Här sammanfattas det vetenskapliga underlaget för två typer av program: dels de som främst syftar till att förebygga utagerande beteenden hos barn och ungdomar, dels de som i första hand syftar till att förebygga inåtvända problem som ångest, depression och självskadebeteende. Program som har en allmänt hälsobefrämjande effekt, t ex för att förebygga drogmissbruk och våldshandlingar ingår följaktligen inte. Programmen är avsedda att ha effekt, inte bara direkt efter att programmet har avslutats utan även i framtiden. Rapporten har tagits fram på förfrågan av Kungliga Vetenskapsakademien och UPP-centrum (Utvecklingscentrum för barns psykiska hälsa) vid Socialstyrelsen. Båda har efterfrågat en systematisk litteraturöversikt för att klarlägga nyttan med att använda program för att förebygga psykisk ohälsa hos barn. Slutsatser: - Av 33 bedömda standardiserade och strukturerade insatser (program) som syftar till att förebygga psykisk ohälsa hos barn har sju ett begränsat vetenskapligt stöd i den internationella litteraturen. Det är föräldrastödsprogrammen Incredible Years och Triple P, familjestödsprogrammet Family Check-Up samt skolprogrammen Good Behavior Game, Coping Power, Coping with Stress och FRIENDS. Effekterna är med få undantag små. Studierna är utförda i andra länder. Eftersom effekterna sannolikt varierar med sociala och kulturella sammanhang är det oklart i vilken utsträckning som programmen kan överföras till Sverige med bibehållen effekt. Programmen kan också behöva anpassas så att de överensstämmer med svenska värderingar och syn på barns rätt. - I Sverige används ett hundratal olika program för att förebygga psykisk ohälsa hos barn, i huvudsak av utagerande typ. Inget av dem har utvärderats i Sverige i randomiserade studier med minst sex månaders uppföljning. Programmen De otroliga åren (översatt från Incredible Years), Triple P och Family Check-Up har enligt internationella studier begränsat vetenskapligt stöd för förebyggande effekt. Programmen KOMET, COPE, SET, StegVis, Beardslees familjeintervention, Connect och DISA har undersökts i minst en kontrollerad studie vardera men har inte tillräckligt vetenskapligt stöd för förebyggande effekt. Övriga program som används i Sverige är inte vetenskapligt utprövade som preventionsprogram. - Program som bygger på att ungdomar med utagerande problem träffas i grupp kan öka risken för normbrytande beteenden. Andra negativa effekter för såväl program för utagerande som för inåtvända problem är tänkbara men ofullständigt belysta. - Det behövs randomiserade studier som undersöker om de program som används har förebyggande effekt i svenska populationer och inte medför risker. Det behövs också hälsoekonomiska studier som undersöker om programmen är kostnadseffektiva.
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| 4. |
- Eckerlund, Ingemar, et al.
(författare)
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Benchmarking in obstetric care : a comparative study based on data envelopment analysis (DEA)
- 2001
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Benchmarking is increasingly used in performance monitoring of the health care sector, for self-assessment as well as external accountability - in order to promote efficiency. However, a prerequisite for achieving this objective is that the benchmarking process is based on scientifically sound methods. Using DRG-data from 19 Swedish hospitals in 1994-1995, we apply data envelopment analysis (DEA) to compare technical efficiency (productivity) of inpatient obstetric care. The results indicate an average potential for enhanced productivity of at least six-seven percent each year. Most hospitals show decreasing productivity between 1994 and 1995, partly due to their inability to adjust production capacity and costs to decreasing demand, From a policy perspective, DEA could be very useful in performance monitoring. An important advantage ofthe DEA method is that it helps identify the strengths and weaknesses of the various units (hospital departments) studied. We conclude that there are good reasons for adopting the DEA method for benchmarking in other types of hospital departments as well, and preferably on a larger scale, Le., with more observations, and also for including health outcome and quality indicators among the output variables.
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| 5. |
- Eckerlund, Ingemar, et al.
(författare)
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Change-oriented patient questionnaires : testing a new method at three departments of ophthalmology.
- 1997
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Ingår i: International journal of health care quality assurance incorporating Leadership in health services. - : MCB University Press. - 1366-0756. ; 10, s. 254-259
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The use of patient questionnaires has increased widely in recent years. Their purpose, to incorporate patient perspectives into the orientation and design of health care, is, of course, commendable. However, the survey methods themselves have been less adequate, both in terms of validity and reliability, and with respect to the potential for using the results to improve the quality of health care. Presents a pilot study at three departments of ophthalmology in Sweden, involving a new method which meets reasonable demands for validity and reliability, and is explicitly change-oriented.
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| 6. |
- Eckerlund, Ingemar, et al.
(författare)
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Econometric analysis of variation in cesarean section rates : a cross-sectional study of 59 obstetrical departments in Sweden
- 1998
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press (CUP): HSS Journals. - 1471-6348 .- 0266-4623. ; 14:4, s. 774-787
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to explain the variation in cesarean section rates among hospitals (obstetrical departments) in Sweden, and to discuss its potential economic consequences. Using data from The Swedish Medical Birth Registry 1991, we made a cross-sectional study of the cesarean section rate at the departmental level. We identified some 20 determinants, demand-related as well as supply-related. A general model including all these regressors was specified, After reducing this model, we were able to explain about one-quarter of the variation, We conclude that the large variation in cesarean section rates indicates inefficiency, due mainly to overutilization, but perhaps also underutilization. It is difficult to calculate the economic consequences or the welfare loss to society, We estimated an additional cost for unnecessary cesarean sections of 13-16 million Swedish crowns (SEK) per year.
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| 7. |
- Eckerlund, Ingemar
(författare)
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Essays on the economics of medical practice variations
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis consists of an overview and five essays. The purpose of the thesis is to show how economics can contribute to a better understanding of medical practice variations why they exist, their consequences, and the extent to which they can and should be influenced. The first essay, Econometric analysis of variation in cesarean section rates a cross-sectional study of 59 obstetrical departments in Sweden, is an attempt to identify the causes of variation in cesarean section rates, and to discuss their economic consequences. The econometric model applied explains 27 percent of the variation. We conclude that the unexplained variation in cesarean section rates indicates inefficiency, mainly due to over-utilisation. Estimates of the economic consequences indicate an additional cost for "unnecessary" cesarean sections of 13-16 million SEK per year. The welfare loss to society due to undesired variation is tentatively estimated to be about twice as high. In the second essay, Estimating the effect of cesarean section rate on health outcome evidence from Swedish hospital data, we test the null hypothesis of a zero effect of cesarean section rate on health outcome, against the alternative of a positive effect. We could not reject the null hypothesis of a zero effect, i.e., we did not find any significant positive relationship between cesarean section rate and health outcome, in terms of perinatal mortality or rate of asphyxia. In the third essay, Benchmarking in obstetric care a comparative study based on data envelopment analysis (DEA), we apply the DEA method to compare technical efficiency (productivity) of inpatient obstetric care in Swedish hospitals in 1994 and 1995. The results indicate an average potential for enhanced productivity of at least 6-7 percent each year. Most hospitals show decreasing productivity 1994-1995, partly due to inability to adjust production capacity and costs to a decreasing demand. The last two essays apply a new method Quality Satisfaction Performance (QSP) for incorporating patient perspectives into the management of health care, i.e., as a basis for quality improvement.Change-oriented patient questionnaires testing a new method at three departments of ophthalmology, is a pilot study. The results show consistently high patient satisfaction indices. Satisfaction varies somewhat among the different patient segments and departments. We conclude that decisions on improvements must be preceded by thorough assessment of costs as well as effects associated with the various changes. The last essay, Patient satisfaction and priority setting an economic approach, aims at analysing if and how priorities according to the QSP approach are influenced when an economic perspective is explicitly included. This is accomplished by a cost-effectiveness analysis of certain proposed changes/improvements, and a cost-benefit analysis based upon the patients` willingness-to-pay for these changes. Our results show that the ranking between various improvements is strongly influenced when an economic dimension is included. We conclude that even a methodologically appropriate measurement of patient satisfaction may lead to cost-ineffective priority setting, unless economic consequences are explicitly considered.
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| 8. |
- Eckerlund, Ingemar, et al.
(författare)
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Estimating the effect of cesarean section rate on health outcome : Evidence from Swedish hospital data
- 1999
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Ingår i: International Journal of Technology Assessment in Health Care. - : Cambridge University Press. - 1471-6348 .- 0266-4623. ; 15:1, s. 123-135
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This paper tests the null hypothesis of a zero effect of cesarean section rate on health outcome against the alternative of a positive effect. Using data from 59 hospitals in Sweden from 1988-92, we specify two separate linear regression models for health outcome, one with perinatal mortality, and the other with rate of asphyxia, as dependent variable, We estimate the models by single-year cross-section regressions and as pooled data systems. The null hypothesis cannot be rejected, i.e., we do not find any significant positive effect of cesarean section rate on health outcome. Thus, we conclude that an increase in cesarean section rate does not imply lower perinatal mortality or lower rate of asphyxia. This in turn indicates that the minimum cesarean section rate is optimal.
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| 9. |
- Eklöf, Jan A., et al.
(författare)
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Patient satisfaction and priority setting in ambulatory health care
- 2000
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Ingår i: Total quality management. - : Taylor & Francis Group. - 1360-0613 .- 0954-4127. ; 11:7, s. 967-978
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Tidskriftsartikel (refereegranskat)abstract
- In this study we consider a general model for analysing the preferences, satisfaction and actual cost-benefit valuation of provided health care services as they are explicitly perceived by the patients. The model is employed for analysing the quality and value of treatment in one of the main clinics in a large hospital in Stockholm. Data from patients are combined with financial information from the hospital authority to estimate the cost per unit of improved patient satisfaction and to specify a cost-benefit model for priority setting and resource allocation. Using a combination of a patient satisfaction and a willingness to pay approach is found to be functional. The respondents are in a position to give specific and consistent information concerning their perception and relative valuation. The results obtained from the empirical survey point at improvements where both the satisfaction and the willingness to pay are strong. It is seen that most of the major improvements proposed in the health personnel-patient relationship are more expensive to implement than the customers (patients) are willing to pay for. At the same time these also imply the most significant increases in satisfaction. This emphasizes the importance of looking at both the revenue and the cost side when designing modifications in the provision of service.
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| 10. |
- Eklöf, Jan, et al.
(författare)
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Patient satisfaction and priority setting : an economic approach
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In recent years, various methods for measuring patient satisfaction have been applied as part of quality improvement programmes. However, the validity and reliability as well as the applicability and change-orientation of adopted methods have been questioned. Furthermore, most methods pay no specific attention to economic aspects. The purpose of this study is to analyse if and how priorities are influenced when an economic perspective is explicitly included. Data were compiled by a patient survey at a gynaecology clinic, inquiring about the patients' views on various quality dimensions, and their willingness to pay for proposed improvements. The parameters of the model are estimated with simultaneous equation methods, based on partial least squares technique. We compare the ranking of proposed improvements derived from a patient satisfaction index, a cost-effectiveness analysis and a cost-benefit analysis, respectively. Our results show that even a methodologically appropriate measurement of patient satisfaction may lead to a cost-ineffective priority setting unless economic consequences are explicitly taken into consideration. Further, it is demonstrated how an analysis including patient preferences as well as economic aspects may be carried out.
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| 11. |
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| 12. |
- Heijl, Anders, et al.
(författare)
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Öppenvinkelglaukom: diagnostik, uppföljning och behandling : En systematisk litteraturöversikt från SBU
- 2010
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 107:19-20, s. 1311-1313
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Tidskriftsartikel (refereegranskat)abstract
- Sänkning av ögontrycket fördröjer synfältsförsämringen vid glaukom och minskar risken för utveckling av glaukom vid okulär hypertension. Det är oklart om laserbehandling eller kirurgi är bättre än behandling med ögondroppar. Modern, snabb synfältstestning har hög diagnostisk träffsäkerhet (sensitivitet och specificitet). Diagnostik baserad på expertbedömning av papillfoton har låg till måttligt hög diagnostisk träffsäkerhet. Moderna instrument baserade på datoriserad bildanalys har likvärdig diagnostisk träffsäkerhet. Särskild uppmärksamhet bör ägnas åt att säkerställa att gruppen glaukompatienter inte eftersätts i sjukvården. Behandlingen av glaukom och uppföljningen behöver individualiseras i ökad omfattning. Synfältsundersökning bör göras mer frekvent de första åren efter diagnos.
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| 13. |
- Lindén, Christina, et al.
(författare)
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Glaucoma management in Sweden : results from a nationwide survey
- 2013
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Ingår i: Acta Ophthalmologica. - : Wiley. - 1755-375X .- 1755-3768. ; 91:1, s. 20-24
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To report the results from a nationwide survey on glaucoma management in Sweden, performed as a part of an Open Angle Glaucoma project conducted by the Swedish Council on Health Technology Assessment 2004-2008. Methods: In 2005, a survey was distributed to all providers of glaucoma care in Sweden: public eye departments, public outpatient departments and private practices. The questionnaire included questions on number of examined patients, types of examinations during one defined week, internal organization and access to diagnostic equipment. The questionnaire was endorsed by the Swedish Ophthalmological Society. Reminders were sent out to nonresponders. Results: Response rate was high; 97% (33/34) of eye departments, 85% (39/46) of outpatient departments and 55% (69/125) of private practices. Out of 29 282 visits in ophthalmic care during the study week, 7737 (26%) were related to glaucoma. Diagnostic equipment was generally available; all public eye facilities and 92% of private practices had at least one computerized perimeter, while equipment for fundus photography/imaging was available at 100% of eye departments, 82% of outpatient departments and 62% of private practices. The number of visual field tests and fundus images was rather low. Survey results indicate that patients on the average underwent bilateral field testing every 2nd year and fundus imaging every 8th year. Conclusion: Glaucoma care generated about a quarter of all patient visits in Swedish ophthalmic care. Access to diagnostic facilities was good. To meet modern standards of glaucoma care, glaucoma damage must be measured and followed more closely than at the time of the survey.
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| 16. |
- Zethraeus, Niklas, et al.
(författare)
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Value for money? A contingent valuation study of the optimal size of the Swedish health care budget
- 1995
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Ingår i: Health policy (Amsterdam). - : Elsevier Ireland Ltd. - 1872-6054 .- 0168-8510. ; 34:2, s. 135-143
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Tidskriftsartikel (refereegranskat)abstract
- The contingent valuation method has been developed in the environmental field to measure the willingness to pay for environmental changes using survey methods. In this exploratory study the contingent valuation method was used to analyse how much individuals are willing to spend in total in the form of taxes for health care in Sweden, i.e. to analyse the optimal size of the ‘health care budget’ in Sweden. A binary contingent valuation question was included in a telephone survey of a random sample of 1260 households in Sweden. With a conservative interpretation of the data the result shows that 50% of the respondents would accept an increased tax payment to health care of about SEK 60 per month ($1 = SEK 8). It is concluded that the results indicate that the population overall thinks that the current spending on health care in Sweden is on a reasonable level. There seems to be a willingness to increase the tax payments somewhat, but major increases does not seem acceptable to a majority of the population.
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