International Comparative Research in Health Care A straightforward exercise? Koen Putman

How are we doing?

(Inter)national research

EU-Funding (CORDIS)

Challenges Securing comparability Accounting for national variations Finding the data In: Burau, Curr Socio, 2012

Health systems dynamics In: van Olmen et al., Health Cult & Society, 2012

Garrido et al., in:HSREPP, 2011

UZ Pellenberg Queen’s Medical Centre City Hospital RehaClinic Zurzach Fachklinik Herzogenaurach

Admission policies in SRU SRU-GB1SRU-GB2SRU-BE1SRU-BE2SRU-CHSRU-DE Factors related to the patient physical condition +++ cognitive abilities ++++ behavioural aspects ++++ patient’s network + Factors related to the network between facilities affiliations +++ health insurance ++ other SRUs in recruitment area +++ Factors related to referring hospitals acute stroke unit +++ absence of bed managers + In: Putman K et al., J Rehabil Med, 2006

Absolute time in therapeutic activities between 7.00am and 5.00 pm * * significant difference after correction for case-mix De Wit et al., Stroke, 2005 Process of care * *

BEUKCHDE physiotherapy occupational therapy PT+OT speech therapy neuropsychology medical care nursing care other therapy TOTAL Time available per patient per week /professional group De Wit et al., Stroke, 2005

use of care after discharge (6m) Putman et al., J Rehab Med, 2007

Challenges Securing comparability Accounting for national variations Finding the data In: Burau, Curr Socio, 2012

Selection of patients Kennedy et al., Arch Phys Med Rehabil, 2012

Incentives Peltola et al., Cerebrovasc Dis, 2013

Challenges Securing comparability Accounting for national variations Finding the data In: Burau, Curr Socio, 2012

Assessment traditions and ‘culture’ Systematic collection useful for research practice (Freeman et al., JNNP, 2005) However: Heterogenity of outcome measurement in Europe (Haigh et al., J Rehab Med, 2001) example: FIM vs Barthel in stroke rehabilitation (Sangha et al. Int J Rehab Res, 2005) Finding the data

“translations” Nyein K et al., Clin Rehab 1999 Motor FIM Barthel Index Score

Uniform datasets

Questionnaires –Conceptual equivalence across cultures –e.g.: socio-economic status –Pre-study on possible answering categories –e.g.: discharge destination, post-discharge services –Translations of questionnaires Finding the data

Ethics Chaudhry et al., Clin Trials, 2013

Methodological challenges In: Horn S et al., Arch Phys Med Rehab, 2012

Priorities future research

Recommendations Inclusion of evidence in reimbursement regulations on provision of services (Weinrich et al., 2011) “Chain of care” (Ringelstein et al, 2013) Quality indicators/national audits (Ringelstein et al, 2013) Comparative effectiveness research

No stereotyping In Hell: the cooks are English, the policemen are German, the mechanics are French, the lovers are Swiss and the bankers are Italian. In Heaven: the cooks are French, the policemen are English, the mechanics are German, the lovers are Italian and the bankers are Swiss. And what about the Belgians?

International Comparative Research in Health Care A straightforward exercise? Koen Putman