Predicting non-response in patient-reported outcome measures: results from the Swiss quality assurance programme in cardiac inpatient rehabilitation.

BACKGROUND: Quality assurance programmes measure and compare certain health outcomes to ensure high-quality care in the health-care sector. The outcome of health-related quality of life is typically measured by patient-reported outcome measures (PROMs). However, certain patient groups are less likely to respond to PROMs than others. This non-response bias can potentially distort results in quality assurance programmes. OBJECTIVE: Our study aims to identify relevant predictors of non-response during assessment using the PROM MacNew Heart Disease questionnaire in cardiac rehabilitation. METHODS: This is a cross-sectional study based on data from the Swiss external quality assurance programme. All patients aged 18 years or older who underwent inpatient cardiac rehabilitation in 16 Swiss rehabilitation clinics between 2016 and 2019 were included. Patients' socio-demographic and basic medical data were analysed descriptively by comparing two groups: non-responders and responders. We used a random intercept logistic regression model to estimate the associations of patient characteristics and clinic differences with non-response. RESULTS: Of 24 572 patients, there were 33.3% non-responders and 66.7% responders. The mean age was 70 years, and 31.0% were women. The regression model showed that being female was associated with non-response [odds ratio (OR) 1.22; 95% confidence interval (CI) 1.14-1.30], as well as having no supplementary health insurance (OR 1.49; 95% CI 1.39-1.59). Each additional year of age increased the chance of non-response by an OR of 1.02 (95% CI 1.02-1.02). Not being a first language speaker of German, French or Italian increased the chance of non-response by an OR of 6.94 (95% CI 6.03-7.99). Patients admitted directly from acute care had a higher chance of non-response (OR 1.23; 95% CI 1.10-1.38), as well as patients being discharged back into acute care after rehabilitation (OR 3.89; 95% CI 3.00-5.04). Each point on the cumulative illness rating scale total score increased the chance of non-response by an OR of 1.05 (95% CI 1.04-1.05). Certain diagnoses also influenced the chance of non-response. Even after adjustment for known confounders, response rates differed substantially between the 16 clinics. CONCLUSION: We have found significant non-response bias among certain patient groups, as well as across different treatment facilities. Measures to improve response rates among patients with known barriers to participation, as well as among different treatment facilities, need to be considered, particularly when PROMs are being used for comparison of providers in quality assurance programmes or outcome evaluation.

Measuring patient satisfaction in acute care hospitals: nationwide monitoring in Switzerland.

The National Association for Quality Development in Hospitals and Clinics (ANQ) has conducted patient satisfaction measurements in the inpatient sector in Switzerland since 2009. Specifically designed for this measurement, an instrument consisting of five questions was evaluated on an 11-point rating scale. Nevertheless, the instrument showed substantial ceiling effects, which did not allow for hospital discrimination. Therefore, ANQ initiated a revision testing different scales in a pilot study. The results showed that a 5-point verbal scale displayed good psychometric properties. Compared to the 7- or 11-point scales, the 5-point verbal scale exhibited reduced ceiling effects, which was more appropriate to compare hospitals. For the national public reporting of hospitals and clinics, risk adjustment by age and self-reported health status was recommended, which was not the case for gender, principal diagnosis, type of admission and insurance status.

Self-reported work ability predicts health-related exit and absence from work, work participation, and death: longitudinal findings from a sample of German employees.

OBJECTIVE: The cohort study examined the performance of the Work Ability Index in predicting health-related exit and absence from work, work participation, and death among a sample of workers previously receiving sickness absence benefits. METHODS: Workers aged 40-54 years who received sickness absence benefits in 2012 completed the Work Ability Index in 2013. Outcomes were extracted from administrative data records covering the period until the end of 2016. RESULTS: Data for 2266 participants were included (mean age: 47.9 years; 54.4% women). Maximum follow-up was 43 months. In terms of work ability, 38.4% had good scores, 38.2% moderate scores, and 23.4% poor scores. Fully adjusted analyses showed an increased risk of a disability pension in workers with poor (HR = 12.98; 95% CI 5.81-28.99) and moderate Work Ability Index scores (HR = 3.17; 95% CI 1.36-7.38) compared to workers with good or excellent scores. The risk of a rehabilitation measure was also significantly increased for workers with poor and moderate scores. In addition, poor scores were prospectively associated with a longer duration of sickness absence and unemployment benefits, and fewer employment days and less income from regular employment. Those with poor Work Ability Index scores also had a significantly increased risk of premature death. CONCLUSIONS: The Work Ability Index is a potential tool to identify individuals with previous long-term sickness absence having an increased risk of health-related exit and absence from work and poor work participation outcomes.

[Prevalence of Mycoplasmas in commercial layer flocks during laying period]. / Vorkommen von Mykoplasmen in Legehennenbeständen im Verlauf der Legeperiode.

Within this study's range, laying hens from different housing systems were investigated on prevalence of Mycoplasma sp. for the duration of one laying period, with an emphasis on the two clinically relevant species M. synoviae and M. gallisepticum. Tracheal swabs were analysed for mycoplasms by genus- and species-specific amplification after DNA extraction. Of 919 collected tracheal swabs, 84% were positive for the genus-specific test, while 75% turned out positive for M. synoviae. Mycoplasms were detected at some time during the laying period in all 19 flocks included in this investigation. Using a species-specific PCR, only one flock of a free-range system was free of M. synoviae. On the contrary, PCR analysis did not detect M. gallisepticum in any of the collected samples. Individual and flock examinations revealed no correlation between clinical symptoms and the presence of M. synoviae in hens and flocks, respectively. As the majority of the examined flocks were already positive for M. synoviae upon entry, the establishment of a control regime for Mycoplasma sp. would be advisable for parent stock and rearing facilities.