IDEAS home Printed from https://ideas.repec.org/a/eee/hepoli/v126y2022i12p1291-1302.html
   My bibliography  Save this article

National clinical guidelines and treatment centralization do not guarantee consistency in healthcare delivery. A mixed-methods study of wet age-related macular degeneration treatment in Denmark

Author

Listed:
  • Kollerup, Anna
  • Wadmann, Sarah
  • Bek, Toke
  • Kjellberg, Jakob

Abstract

As clinical practice variation has been problematized as a symptom of suboptimal care and inefficient resource spending, consistency in the delivery of healthcare is a recurring policy goal. We examine a case where the introduction of a new treatment is most likely to provide consistency in healthcare delivery because it was introduced with a national clinical practice guideline representing consensus about best clinical practice among leading clinicians, and because care delivery was highly centralized to few high-volume treatment units. Despite the consensus on best clinical practice and care centralization, this study shows pronounced regional variation in patient outcomes and treatment costs that increased over time. Using a mixed-methods design, we find that the lack of consistency in care was largely unrelated to patient-specific characteristics, but seemed to reflect structural differences in the regional organization and financing of healthcare delivery. We conclude that the value of clinical practice guidelines is undermined when structural barriers limit the ability of clinicians and clinical managers to scale up treatment, and that some degree of decentralization may be a tool to maintain treatment intensity when the treatment effect is dependent on a high treatment intensity.

Suggested Citation

  • Kollerup, Anna & Wadmann, Sarah & Bek, Toke & Kjellberg, Jakob, 2022. "National clinical guidelines and treatment centralization do not guarantee consistency in healthcare delivery. A mixed-methods study of wet age-related macular degeneration treatment in Denmark," Health Policy, Elsevier, vol. 126(12), pages 1291-1302.
    • Handle: RePEc:eee:hepoli:v:126:y:2022:i:12:p:1291-1302
    DOI: 10.1016/j.healthpol.2022.10.009
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0168851022002780
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.healthpol.2022.10.009?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Avdic, Daniel, 2016. "Improving efficiency or impairing access? Health care consolidation and quality of care: Evidence from emergency hospital closures in Sweden," Journal of Health Economics, Elsevier, vol. 48(C), pages 44-60.
    2. Brigitte Dormont & Carine Milcent, 2004. "The sources of hospital cost variability," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 927-939, October.
    3. Marco D. Huesch & Mariko Sakakibara, 2009. "Forgetting the learning curve for a moment: how much performance is unrelated to own experience?," Health Economics, John Wiley & Sons, Ltd., vol. 18(7), pages 855-862, July.
    4. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    5. William C. Horrace & Peter Schmidt, 2000. "Multiple comparisons with the best, with economic applications," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 15(1), pages 1-26.
    6. Mark McClellan, 2011. "Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality?," Journal of Economic Perspectives, American Economic Association, vol. 25(2), pages 69-92, Spring.
    7. Chandra, Amitabh & Cutler, David & Song, Zirui, 2011. "Who Ordered That? The Economics of Treatment Choices in Medical Care," Handbook of Health Economics, in: Mark V. Pauly & Thomas G. Mcguire & Pedro P. Barros (ed.), Handbook of Health Economics, volume 2, chapter 0, pages 397-432, Elsevier.
    8. Hvenegaard, Anne & Street, Andrew & Sørensen, Torben Højmark & Gyrd-Hansen, Dorte, 2009. "Comparing hospital costs: What is gained by accounting for more than a case-mix index?," Social Science & Medicine, Elsevier, vol. 69(4), pages 640-647, August.
    9. Anne Hvenegaard & Jacob Arendt & Andrew Street & Dorte Gyrd-Hansen, 2011. "Exploring the relationship between costs and quality: Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 541-551, December.
    10. Eibich, Peter & Ziebarth, Nicolas R., 2014. "Analyzing regional variation in health care utilization using (rich) household microdata," Health Policy, Elsevier, vol. 114(1), pages 41-53.
    11. Adriana Lleras-Muney, 2005. "The Relationship Between Education and Adult Mortality in the United States," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 72(1), pages 189-221.
    12. J. Bonastre & C. Le Pen & P. Anderson & A. Ganz & P. Berto & G. Berdeaux, 2002. "The epidemiology, economics and quality of life burden of age-related macular degeneration in France, Germany, Italy and the United Kingdom," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 3(2), pages 94-102, June.
    13. repec:dau:papers:123456789/5426 is not listed on IDEAS
    14. Lindström Egholm, Cecilie & Rossau, Henriette Knold & Nilsen, Per & Bunkenborg, Gitte & Rod, Morten Hulvej & Doherty, Patrick & Bartels, Paul & Helmark, Lotte & Zwisler, Ann-Dorthe, 2018. "Implementation of a politically initiated national clinical guideline for cardiac rehabilitation in hospitals and municipalities in Denmark," Health Policy, Elsevier, vol. 122(9), pages 1043-1051.
    15. Nigel Rice & Andrew Jones, 1997. "Multilevel models and health economics," Health Economics, John Wiley & Sons, Ltd., vol. 6(6), pages 561-575, November.
    16. Buchmueller, Thomas C. & Jacobson, Mireille & Wold, Cheryl, 2006. "How far to the hospital?: The effect of hospital closures on access to care," Journal of Health Economics, Elsevier, vol. 25(4), pages 740-761, July.
    17. Schmidt, Peter & Sickles, Robin C, 1984. "Production Frontiers and Panel Data," Journal of Business & Economic Statistics, American Statistical Association, vol. 2(4), pages 367-374, October.
    18. Cutler, David M. & Lleras-Muney, Adriana, 2010. "Understanding differences in health behaviors by education," Journal of Health Economics, Elsevier, vol. 29(1), pages 1-28, January.
    19. Corallo, Ashley N. & Croxford, Ruth & Goodman, David C. & Bryan, Elisabeth L. & Srivastava, Divya & Stukel, Therese A., 2014. "A systematic review of medical practice variation in OECD countries," Health Policy, Elsevier, vol. 114(1), pages 5-14.
    20. Kim Rose Olsen & Andrew Street, 2008. "The analysis of efficiency among a small number of organisations: How inferences can be improved by exploiting patient‐level data," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 671-681, June.
    21. Newhouse, Joseph P., 1994. "Frontier estimation: How useful a tool for health economics?," Journal of Health Economics, Elsevier, vol. 13(3), pages 317-322, October.
    22. Pamela L. Hudak & Pamela Grassau & Richard H. Glazier & Gillian Hawker & Hans Kreder & Peter Coyte & Nizar Mahomed & James G. Wright, 2008. "``Not Everyone Who Needs One Is Going to Get One'': The Influence of Medical Brokering on Patient Candidacy for Total Joint Arthroplasty," Medical Decision Making, , vol. 28(5), pages 773-780, September.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Michaels, Jonathan A & Maheswaran, Ravi, 2023. "Conflicting perspectives during guidelines development are an important source of implementation failure," Health Policy, Elsevier, vol. 131(C).

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Nils Gutacker & Chris Bojke & Silvio Daidone & Nancy J. Devlin & David Parkin & Andrew Street, 2013. "Truly Inefficient Or Providing Better Quality Of Care? Analysing The Relationship Between Risk‐Adjusted Hospital Costs And Patients' Health Outcomes," Health Economics, John Wiley & Sons, Ltd., vol. 22(8), pages 931-947, August.
    2. Simonsen, Marianne & Skipper, Lars & Skipper, Niels & Thingholm, Peter Rønø, 2021. "Discontinuity in care: Practice closures among primary care providers and patient health care utilization," Journal of Health Economics, Elsevier, vol. 80(C).
    3. Laudicella, Mauro & Olsen, Kim Rose & Street, Andrew, 2010. "Examining cost variation across hospital departments-a two-stage multi-level approach using patient-level data," Social Science & Medicine, Elsevier, vol. 71(10), pages 1872-1881, November.
    4. Anne Hvenegaard & Jacob Arendt & Andrew Street & Dorte Gyrd-Hansen, 2011. "Exploring the relationship between costs and quality: Does the joint evaluation of costs and quality alter the ranking of Danish hospital departments?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 541-551, December.
    5. Kim Rose Olsen & Andrew Street, 2008. "The analysis of efficiency among a small number of organisations: How inferences can be improved by exploiting patient‐level data," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 671-681, June.
    6. Andrew Street & Conrad Kobel & Thomas Renaud & Josselin Thuilliez & ON BEHALF OF THE EURODRG GROUP, 2012. "How Well Do Diagnosis‐Related Groups Explain Variations In Costs Or Length Of Stay Among Patients And Across Hospitals? Methods For Analysing Routine Patient Data," Health Economics, John Wiley & Sons, Ltd., vol. 21(S2), pages 6-18, August.
    7. Avdic, Daniel & Ivets, Maryna & Lagerqvist, Bo & Sriubaite, Ieva, 2023. "Providers, peers and patients. How do physicians’ practice environments affect patient outcomes?," Journal of Health Economics, Elsevier, vol. 89(C).
    8. Kollerup, Anna, 2022. "Worth the trip? The effect of hospital clinic closures for patients undergoing scheduled surgery," Social Science & Medicine, Elsevier, vol. 314(C).
    9. Laia Bosque-Mercader & Luigi Siciliani, 2023. "The association between bed occupancy rates and hospital quality in the English National Health Service," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(2), pages 209-236, March.
    10. Chen, Yi-Yi & Schmidt, Peter & Wang, Hung-Jen, 2014. "Consistent estimation of the fixed effects stochastic frontier model," Journal of Econometrics, Elsevier, vol. 181(2), pages 65-76.
    11. Barış Alpaslan & Julide Yildirim, 2020. "The Missing Link: Are Individuals with More Social Capital in Better Health? Evidence from India," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 150(3), pages 811-834, August.
    12. Zhuang Hao & Benjamin W. Cowan, 2019. "The Effects of Graduation Requirements on Risky Health Behaviors of High School Students," American Journal of Health Economics, MIT Press, vol. 5(1), pages 97-125, Winter.
    13. I. Fraser & W. Horrace, 2003. "Technical Efficiency of Australian Wool Production: Point and Confidence Interval Estimates," Journal of Productivity Analysis, Springer, vol. 20(2), pages 169-190, September.
    14. Strulik, Holger, 2018. "The return to education in terms of wealth and health," The Journal of the Economics of Ageing, Elsevier, vol. 12(C), pages 1-14.
    15. Feng, Qu & Horrace, William C., 2012. "Estimating technical efficiency in micro panels," Economics Letters, Elsevier, vol. 117(3), pages 730-733.
    16. Raquel Fonseca Benito & Yuhui Zheng, 2011. "The Effect of Education on Health Cross-Country Evidence," Working Papers WR-864, RAND Corporation.
    17. Pradeep Kumar Choudhury, 2015. "Explaining the Role of Parental Education in the Regional Variations in Infant Mortality in India," Asia and the Pacific Policy Studies, Wiley Blackwell, vol. 2(3), pages 544-572, September.
    18. Crespo, Laura & López-Noval, Borja & Mira, Pedro, 2014. "Compulsory schooling, education, depression and memory: New evidence from SHARELIFE," Economics of Education Review, Elsevier, vol. 43(C), pages 36-46.
    19. Almas Heshmati, 2003. "Productivity Growth, Efficiency and Outsourcing in Manufacturing and Service Industries," Journal of Economic Surveys, Wiley Blackwell, vol. 17(1), pages 79-112, February.
    20. Emanuele Ciani & Claudio Deiana, 2018. "No free lunch, buddy: past housing transfers and informal care later in life," Review of Economics of the Household, Springer, vol. 16(4), pages 971-1001, December.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:126:y:2022:i:12:p:1291-1302. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or the person in charge (email available below). General contact details of provider: http://www.elsevier.com/locate/healthpol .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.