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Anja Yvonne Bischof
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PublicationType: journal article
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PublicationGender health gap pre- and post-joint arthroplasty: Identifying affected patient-reported health domains( 2024-02-27)
;Viktoria Steinbeck ;Lukas Schöner ;Benedikt Langenberger ;Christoph Pross ;Reinhard BusseBackground As patient-reported outcomes (PROs) gain prominence in hip and knee arthroplasty (HA and KA), studies indicate PRO variations between genders. Research on the specific health domains particularly impacted is lacking. Hence, we aim to quantify the gender health gap in PROs for HA/KA patients, differentiating between general health, health-related quality of life (HrQoL), physical functioning, pain, fatigue, and depression. Methods The study included 3,693 HA patients (1,627 men, 2,066 women) and 3,110 KA patients (1,430 men, 1,680 women) receiving surgery between 2020 to 2021 in nine German hospitals, followed up until March 2022. Questionnaires used were: EQ-VAS, EQ-5D-5L, HOOS-PS, KOOS-PS, PROMIS-F-SF, PROMIS-D-SF, and a joint-specific numeric pain scale. PROs at admission, discharge, 12-months post-surgery, and the change from admission to 12-months (PRO-improvement) were compared by gender, tested for differences, and assessed using multivariate linear regressions. To enable comparability, PROs were transformed into z-scores (standard deviations from the mean). Results Observed differences between genders were small in all health domains and differences reduced over time. Men reported significantly better health versus women pre-HA (KA), with a difference of 0.252 (0.224) standard deviations from the mean for pain, 0.353 (0.243) for fatigue (PROMIS-F-SF), 0.327 (0.310) for depression (PROMIS-D-SF), 0.336 (0.273) for functionality (H/KOOS-PS), 0.177 (0.186) for general health (EQ-VAS) and 0.266 (0.196) for HrQoL (EQ-5D-5L). At discharge, the gender health gap reduced and even disappeared for some health dimensions since women improved in health to a greater extent than men. No gender health gap was observed in most PRO-improvements and at month 12. Conclusions Men experiencing slightly better health than women in all health dimensions before surgery while experiencing similar health benefits 12-months post-surgery, might be an indicator of men receiving surgery inappropriately early, women unnecessarily late or both. As studies often investigate the PRO-improvement, they miss pre-surgery gender differences, which could be an important target for improvement initiatives in patient-centric care. Moreover, future research on cutoffs for meaningful between-group PRO differences per measurement time would aid the interpretation of gender health disparities. Trial registration German Register for Clinical Trials, DRKS00019916, 26 November 2019.Type: journal articleJournal: International Journal for Equity in HealthVolume: 23Issue: 44 -
PublicationWhat is the association between gender and self-perceived health status when controlling for disease-specific conditions? A retrospective data analysis of pre- and post-operative EQ-5D-5L differences in total hip and knee arthroplasty( 2023-11-27)
;Viktoria Steinbeck ;Carlos J. Marques ;Karina Bohlen ;Karl C. Westphal ;Frank LampeBackground The self-perceived health status of patients undergoing total hip and knee arthroplasty (THA and TKA) might differ post-operatively due to gender, age, or comorbidities. Patient-reported outcome measures (PROMs) such as the EQ-5D-5L measure the self-perceived health status. This study investigates whether the index score of the EQ-5D-5L is a valid tool for interpreting gender differences in outcomes for patients undergoing THA and TKA. Methods Routine and PROM-data of elective primary THA or TKA patients in two German hospitals between 2016 and 2018 were analyzed. Univariate analysis with Pearson’s chi-square was conducted to identify control variables for gender. To quantify the association between gender and the EQ-5D-5L dimensions, a cumulative odds ordinal logistic regression with proportional odds was conducted. Results Two thousand three hundred sixty-eight THA patients (m = 978; f = 1390) and 1629 TKA patients (m = 715; f = 914) were considered. The regression analysis of the individual EQ-5D-5L dimensions showed that female gender was significantly associated with better self-care (THA and TKA) and better post-operative mobility (THA). In contrast, male gender was significantly associated with less pain/discomfort (TKA) and less anxiety/depression (THA) pre-surgery and 3-months post-surgery. Conclusion Our results confirmed that the self-perceived health status improved after surgery. However, due to the different associations of gender to the individual dimensions of the EQ-5D-5L, the weighted index score clouds the comparability between patients with different gender undergoing THA or TKA. Therefore, we argue to use the individual five dimensions for health status analysis, to reveal relevant additional information.Type: journal articleVolume: 24 -
PublicationMaking the cut on caesarean section: a logistic regression analysis on factors favouring caesarean sections without medical indication in comparison to spontaneous vaginal birth( 2023)Background: In the absence of medical necessity, opting for caesarean sections exposes mothers and neonates to increased risks of enduring long-term health problems and mortality. This ultimately results in greater economic burden when compared to the outcomes of spontaneous vaginal births. In Switzerland around 33% of all births are by caesarean section. However, the rate of caesarean sections without medical indication is still unknown. Therefore, we devise an identification strategy to differentiate caesarean sections without medical indication using routine data. In addition, we aim to categorize the influencing factors for women who undergo spontaneous vaginal births as opposed to those with caesarean sections without medical indication. Method: We use Swiss Federal Statistics data including 98.3% of all women giving birth from 2014 to 2018. To determine non-medically indicated caesarean sections in our dataset, we base our identification strategy on diagnosis-related groups, diagnosis codes, and procedure classifications. Subsequently, we compare characteristics of women who give birth by non-medically CS and external factors such as the density of practicing midwives to women with spontaneous vaginal birth. Logistic regression analysis measures the effect of factors, such as age, insurance class, income, or density of practicing midwives on non-medically indicated caesarean sections. Results: Around 8% of all Swiss caesarean sections have no medical indication. The regression analysis shows that higher age, supplemental insurance, higher income, and living in urban areas are associated with non-medically indicated caesarean sections, whereas a higher density of midwives decreases the likelihood of caesarean sections without medical indication. Conclusions: By identifying non-medically indicated caesarean sections using routine data, it becomes feasible to gain insights into the characteristics of impacted mothers as well as the external factors involved. Illustrating these results, our recommendation is to revise the incentive policies directed towards healthcare professionals. Among others, future research may investigate the potential of midwife-assisted pregnancy programs on strengthening spontaneous vaginal births in absence of medical complications.Type: journal articleJournal: BMC Pregnancy and ChildbirthVolume: 23Issue: 1
Scopus© Citations 2 -
PublicationAdvocating for Harnessing the Power of Ecosystems in Healthcare: The Case of an Ecosystem in the Realm of Parkinson's Disease -A Position Paper( 2024)
;Lucarelli, PhilippeIn the contemporary healthcare landscape, organizations largely operate on their own, potentially limiting comprehensive care for complex diseases. This position paper underscores the potential of utilizing the power of an ecosystem as a structure for value creation within the realm of Parkinson`s disease. We analyze the potential values that arise from utilizing an ecosystem for three entities, the organizations, the healthcare system and the patients. In so doing, we propose a first set of benefits, i.e., values, that arise subdivided into financial and non-financial values.Type: conference paper -
PublicationDon’t cheat on your prescription! – A retrospective study on COPD patients’ medication adherence based on Swiss sickness fund data( 2023)
;Johannes CordierResearch question: How high is medication adherence among COPD patients in Switzerland and what is the impact of inadequate medication adherence with respect to exacerbation likelihood?Type: conference contribution -
PublicationWhat matters when interpreting patient-reported outcomes? - Adjusted minimal clinically important differences for hip and knee replacement patients( 2023)Research question: What are the minimal clinically important differences between pre-and post-surgery EQ-5D-3Lindicating a successful hip or knee replacement for different subgroups of patients?Type: conference contribution
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PublicationType: forthcoming
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PublicationType: forthcoming
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PublicationThe power of knowledge: A survey on COPD patients' health literacy in Switzerland(Universität St.Gallen, School of Medicine, Lehrstuhl für Management im Gesundheitswesen, St.Gallen, 2023)Background: Health literacy (HL) is one of the major levers to increase the self-management ca-pabilities of patients suffering from Chronic Obstructive Pulmonary Disease (COPD). However, HL is often insufficient in individuals suffering from COPD. Therefore, this study investigates which factors are associated with HL and whether patients with varying HL states desire different support in digital health interventions to better manage COPD-specific symptoms. Methods: In total, 203 participants completed a web-based survey that collected information on patient's health-related quality of life (HRQoL), possible impairments, and areas of improvement in their daily lives. The HLS-EU-Q16 was applied to assess HL. A chi-square test and an analysis of variances were performed to compare variable characteristics across COPD patients with dif-ferent HL. An ordinal logistic regression was used to identify variables significantly associated with HL. Based on the survey's responses, the patients' desire for daily support were identified. Results: Of the 203 participants, 53.2% demonstrated sufficient HL, 27.6% indicated problematic HL, and 19.2% displayed inadequate HL. Significant differences in the requirement of support in daily life (χ²=0.032), length of diagnosis (χ²=0.015), and confidence in medication intake (χ²﹤0.001) were observable. Furthermore, significant differences in age (p﹤0.001), EQ-5D-5L (p﹤0.001), EQ-VAS (p﹤0.001), and CAT (p=0.004) were identified. The ordinal logistic regression revealed age and the EQ-5D-5L as significantly associated with HL. COPD patients expressed consistent pref-erences for support in digital health interventions, irrespective of their HL state. Conclusion: The study reveals that age and HRQoL, represented by the EQ-5D-5L, are signifi-cantly associated with HL. Approaches to improving HRQoL might be considered to strengthen HL. Additionally, the study identifies desired support mechanisms for COPD patients when de-veloping digital health interventions for this patient group. Future research could explore the in-terplay between HRQoL, HL, and self-management and the potential of digital health interven-tion in this interplay.Type: working paperJournal: Schriftenreihe in Health Economics, Management and Policy