Chronic Disease Management Programs: An International perspective

Introduction

In this welcome speech, Professor Paolucci introduces the overall project, and the multiple outcomes of the international collaboration between the University of Newcastle (Australia) and the University of Bologna (Italy).

This research collaboration influences the policy design and development for chronic disease management (CDM) through a series of projects. Specifically this is achieved through an examination of the morbidities on healthcare utilisation, informal care use and mortality in Europe's ageing population, barriers to the implementation of digital technologies in mental health systems, an examination of chronic kidney disease in Italy and investigating the institutional influences on patient-related outcomes and Comparing risk-adjustment estimation methods under regional data availability constraints to propose general guidelines for policymakers who have various scenarios of data granularity and/or range of variables (as they relate to expenditures underlying health conditions) and to provide a set of applicable statistical tools.

Below, join Gianluca Fiorentini and Luke Connelly, our partners from the University of Bologna for a live presentation and debate, find our asynchronous research sessions and presentation of associated research.

Online Live Event

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Live Presentation

WEDNESDAY 9 DECEMBER

7.00pm - 8.30pm (Sydney)

9.00am - 10.30am (Bologna)
 

Gianluca Fiorentini is a professor of Public Economics at the University of Bologna (Italy). Luke Connelly is a professor of Health at the University of Bologna (Italy) and the University of Queensland (Australia). Their main research interests converge towards health economics. As part of the University of Newcastle - University of Bologna International Research Collaboration, Professor Fiorentini and Connelly will be presenting two of their joined research and debating with Dr David Savage, University of Newcastle, on the following​: 

Compliance with Clinical Guidelines in a Chronic Disease Management Program: The role of Competition between GPs and Specialist Practitioners, by Gianluca Fiorentini, Luke Connelly 

 

Abstract: The paper investigates the factors affecting the compliance of GPs and other specialist practitioners with the organizational guidelines of a chronic care management program. A relatively recent literature shows that such programs are not as effective as expected at improving the patients’ health outcomes or increasing benefit/cost ratios. The main objective of the paper is to show that effective implementation requires not only a solid epidemiological and clinical basis for the program, but also a sound understanding of the incentives of different professionals – often in competition between themselves - whose decisions largely determine the success of the programs. More specifically, we are interested to test how differences in the competitive pressure between GPs and/or between specialists across disciplines may play a crucial role in explaining deviations from the appropriate implementation of a chronic management program explaining its reduced impact on clinical outcomes.

Supply-side Solutions Targeting Demand-Side Characteristics: Causal Effects of a Chronic Disease Management Program on Adherence and Health Outcomes, by Luke Connelly, Gianluca Fiorentini, Marica Iommi

 

Abstract: The paper investigates the effects of a chronic disease management program (CDMP) which adapts various supply-side interventions to specific demand-side conditions (disease-staging) for patients with Chronic Kidney Disease (CKD). We estimate the causal effects of the CDMP on adherence indicators and health outcomes using an inverse probability weighting (IPW) approach and formally testing the common support assumption. Our empirical work produces statistically significant and sizeable causal effects on many adherence and health outcome indicators across all CKD patients. More interestingly, we show that the CDMP produces larger effects on patients with early-stage CKD, which is at odds with some of the literature on CDMP that advocates intensifying interventions for high-cost (or late-stage) patients. Our results suggest that at least in single-payer, vertically-integrated systems, it may be more efficient to target early-stage patients in order chronic patients to slow the deterioration of their health capital.

Asynchronous Paper Presentations

The influence of morbidities on healthcare utilisation, informal care use and mortality in Europe's ageing population

 

Nader Mahmoudi, Naomi Maloy, Nicholas Sarich, Emmanouil Mentzakis, Gianluca Fiorentini, Adrian Melia, Francesco Paolucci, Heidi Wechtler

Highlights: An ageing and increasingly chronically ill population across the globe poses an issue to future health expenditure at the individual and government level as it increases occurrence of morbidities (co-morbidities and multi-morbidities). Using the Survey of Health, Ageing and Retirement in Europe (SHARE) dataset, we evaluate the impact of multi-morbidities on mortality, healthcare utilisation, out-of-pocket (OOP) expenditure, informal care, and self-assessed health. The results show that the presence of multimorbidity is positively influencing the death rate in the next wave, hospital stays, OOP expenditure, informal care use, and self-assessed health. This paper demonstrates that while the effect of multi-morbidities on mortality and self-assessed health increases for countries with social insurance system, the social insurance system illustrates a negative impact on healthcare utilisation, OOP, and informal care use.

Barriers to the implementation of digital technologies in mental health systems: A systematic review

Chiara Berardi, Heidi Wechtler, Madeleine Hinwood, Adrian Melia, and Francesco Paolucci

Highlights: eHealth technologies, such as mobile apps, virtual reality, serious gaming, and artificial intelligence are playing a growing role in the improvement of mental health treatments provision and health system outcomes. The COVID-19 crisis and global pandemic has highlighted the role of telehealth and digital tools like apps to offer care in times of need. In this study, we conducted a review based on 663 articles on the implementation on digital technologies in order to investigate existing mental health system barriers. Global digital strategy and policymaking implications to prevent and address digital divide are discussed.

 

Research Collaboration on Chronic Conditions

Ayman Fouda, Francesco Paolucci, Naomi Moy

Highlights: Researchers from the University of Newcastle, Australia and the University of Bologna, Italy have been collaborating on a number of projects surrounding a chronic disease and a chronic disease management program. In particular, the two projects discussed examine the chronic kidney disease in Italy and investigate the institutional influences on patient-related outcomes. 

Comparing risk-adjustment estimation methods under regional data availability constraints

Marica Iommi, Savannah Bergquist, Gianluca Fiorentini, Francesco Paolucci

Highlights: A country may face data constraints to develop an effective risk-adjustment model to predict individual healthcare costs. Policymakers should optimize their data availability in the short-medium term, pending an improvement in the granularity and/or enrichment of the range of variables of their data. Our study examines the case of the Italian National Healthcare Service (NHS) as an example of a healthcare system with heterogeneity in data collection. We evaluate the sum of hospital, pharmaceutical, and outpatient care services expenditure of Emilia-Romagna Region residents during 2016 using different machine learning techniques. We provide a framework and toolkit for policymakers by selecting well-established ML algorithms that required minimal tuning or could be implemented “off the shelf”. Our primary contribution is to propose general guidelines for policymakers who have various scenarios of data granularity and/or range of variables and to provide a set of applicable statistical tools.

 

Associated Research

Image by Kadir Celep

The COVID-19 pandemic provided an opportunity to investigate (consistent with the aims of the project) a comparison of health care system responses to COVID-19 and what lessons can be learnt internationally. Four projects were undertaken in this regard and have been published in 2020 in Health Policy and Technology [access the special issue here]. These can be found below:

Categorising Policy & Technology Interventions for a Pandemic: A Comparative and Conceptual Framework

Naomi Moy, Marcello Antonini, Mattias Kyhlstedt, and Francesco Paolucci

Highlights: A number of government measures and interventions are implemented in response to viral outbreaks or declared global pandemics. To examine the impact government and non-government interventions and technological responses have on individual behaviour, epidemiology, and economic outcomes, we propose a conceptual framework that categorises government policy directives. This framework assigns a gradient indicating the severity or impact of the measure. In doing so we provide a measure that examines the effect of dominant policy initiatives on the outcomes. We demonstrate the value of the categorisation process using the interventions for the SARS-CoV-2 pandemic in Italy, New Zealand, the United Kingdom and the United States of America.    

Cite: Moy, N., Antonini, M., Kyhlstedt, M., & Paolucci, F. (2020). Categorising Policy & Technology Interventions for a Pandemic: A Comparative and Conceptual Framework. Available at SSRN 3622966.

The COVID-19 Pandemic in Italy: Policy and Technology Impact on Health and Non-Health Outcomes

Chiara Berardi, Marcello Antonini, Mesfin Genie, Giovanni Cotugno, Alessandro Lanteri, Adrian Melia, and Francesco Paolucci

Highlights: The outbreak of COVID-19 significantly affected Italy with severe health, social and economic consequences. The strictness and timing of escalating and de-escalating containment and prevention measures played a major role in health and non-health outcomes. Technological interventions are far from having any impact on the outcomes considered due to delayed implementation. The production of evidence-based interventions is relevant for reducing uncertainty around the interventions, thereby maximising the resource and investment allocations. Our findings are relevant not only for Italy but for all countries worldwide.

Cite: Berardi, C., Antonini, M., Genie, M. G., Cotugno, G., Lanteri, A., Melia, A., & Paolucci, F. (2020). The COVID-19 pandemic in Italy: policy and technology impact on health and non-health outcomes. Health Policy and Technology. Access here.

COVID-19: The Need for an Australian Economic Pandemic Response Plan

Shannen Higginson, Katarina Milovanovic, James Gillespie, Laura Wall, Naomi Moy, Madeleine Hinwood, Andrew Matthews, Christopher Williams, Adrian Melia, and Francesco Paolucci

Highlights: Australian government COVID-19 pandemic policy response impacts GDP, unemployment. Government policymaker guide for holistic, robust solutions to health emergencies. Australian Economic Pandemic Response Plan: effective fiscal and monetary policy. Healthcare system demand and supply shocks PPE, ICU bed capacity, surgery, PHI. Epidemiological and econometric modelling, disease transmission and risky behavior.

Cite: Higginson, S., Milovanovic, K., Gillespie, J., Matthews, A., Williams, C., Wall, L., ... & Paolucci, F. (2020). COVID-19: the need for an Australian Economic Pandemic Response Plan. Health policy and technology. Access here.

The First Months of the COVID-19 Pandemic in Spain

Josefa Henriquez, Eduardo Gonzalo Almorox, Francesco Paolucci and Manuel Garcia-Goñi

Highlights: The COVID-19 outbreak has led to an unprecedented crisis in Spain. This paper examines the spread of COVID-19 and the policies and technologies used. A stringent confinement, paired with substantial reduction in mobility showed positive epidemiological results.

Cite: Henríquez, J., Gonzalo-Almorox, E., Garcia-Goñi, M., & Paolucci, F. (2020). The first months of the COVID-19 pandemic in Spain. Health Policy and TechnologyAccess here.

Research Team