6 de març 2021

Physician health management skills and patient outcomes


There are large, persistent differences in patient outcomes across physicians and health facilities. The root causes of these differences are not well understood. One reason could be to find if physicians’ health management styles can affect patient health outcomes and health costs.

As quality contracts become increasingly popular across various health care systems, it is important to highlight what facets of individual physicians’ health management styles have meaningful impact on health outcomes and to what extent they vary across physicians. The physician’s ability to correctly diagnose and treat common conditions is one of the central tenets of quality contracts. But the link between these skills and patient outcomes is at best tenuous. Critics have emphasized that unobserved patient-specific characteristics are important and under-researched contributors to the variability of patient health outcomes conditional on physician clinical skill.

Emilia Simeonova et al. published a working paper in 2020 in the NBER where using data on the population of statin users in Denmark between 2004 and 2008 and matching patients to their primary care physicians, they demostrated that

  • The physician’s ability to facilitate adherence with prescription medications (as a proxie of physicians's health management skills) has significant positive effects on patient outcomes and health costs even after controlling for observable and unobservable patient characteristics.
  • It is important to know that when we talk of physician skills is more than reflecting the clinical quality of the physician. Physician skills are related to their ability to make an adequate diagnosis and prescribe the correct treatment.
  • Younger physicians have on average more adherent patients.There didn't find substantial difference in health management skills between male and female physicians after they controlled for physician age and the patient mix. 
  • The interventions aiming at improving physicians’ health management skills as they relate to patient adherence with prescribed therapy will have positive impacts on patient health outcome

Access to NBER working paper (pdf)

photo: Homenatge a Ramon Llull (1976) Josep M. Subirachs ______________________________________________________________________

7 de febr. 2021

Public engagement for technological innovations: new evidence



With the promise to improve lives, and the offer of abundant opportunities, technological innovation is regarded as a crucial enabler for the advancement of societies and economies at large.

Technologies and their applications, however, also present an array of social, economic and regulatory challenges. How to harness the benefits of technological innovation while addressing the risks associated with these developments is the subject of much discussion by governments, regulators, industry, academia and the general public.

A key aspect associated with these discussions and debates is public engagement, which is increasingly being recognised by stakeholders as a critical instrument to encourage transparency and openness, increase representativeness, and build trust in decision making and the technologies themselves. Public engagement is a broad term that is used in a variety of sectors (e.g. in research, healthcare and policymaking). In the context of technological innovation, public engagement is used to describe the involvement of a diverse group of people (the general public, but also other key groups such as lobbyists, civil society organisations and social influencers) in discussions and debates about potential applications of new and emerging technologies, their governance, regulation and the wider issues that could arise from the way that they are developed and adopted.

Better Regulation Executive (BRE), a unit from the Department for Business, Energy and Industrial Strategy in Uk commisioned a report to find recent evidence, in the form of a literature review and case studies, on the use of public engagement for technological innovation.

BRE Report (2021) PDF and data

The report describes the evidence including:

  • Existing examples of public engagement techniques and ten case studies to illustrate how public engagement has been applied around technological innovation
  • The impact of the public engagement techniques on, for example, the design of regulatory frameworks, business models, technology adoption and public trust
  • Formal evaluation of the effectiveness of the public engagement techniques around technological innovation

The report offer some cross-cutting lessons:

  • The use of multiple techniques over the course of the public engagement process can help to engage different ‘publics’ appropriately.
  • Spreading public engagement over time allows for reflection and embedding of concepts.
  • Having an impact on trust in technologies and technological innovation requires time and considered debate to increase accountability and more systematic public engagement.
  • A multi-stakeholder, collaborative approach to public engagement helps to develop informed and considered judgements.
  • Using online and digital-enabled public engagement techniques can potentially increase the speed, scale, inclusivity,and geographical coverage of engagement.
  • Using some atypical techniques can potentially render public engagement more tangible and user-friendly and could also increase the diversity of participation.
  • Having an impact on outcomes such as regulation, policy and market adoption of technological innovation typically requires buy-in and engagement with the right stakeholders.
  • It is important to build evaluation into public engagement processes to track impacts and outcomes over time.

photo:NASA (Jan 29, 2021, the day after its full Moon phase. International Space Station orbited 264 miles above China near the Mongolian border.

26 de des. 2020

How to build effective teams in primary care


Teamworking is fundamental to the future of general practice. Practices are coming together at scale in primary care networks and new roles are being introduced, creating multidisciplinary and multi-agency teams. Making these teams function effectively is a complex task. King’s Fund published a guide with insights from research, policy analysis and leadership practice.

What are the fundamentals of effective teams?

  • A small number of meaningful objectives
  • Clear roles and responsibilities among team members
  • Reflect on how the team is working together
  • Introduce new roles into the teams
  • Create a multidisciplinary team
  • Ensure good communication within your teams.
  • Effective information-sharing systems
  • Re-design the physical space into shaered working spaces
  • Clinical supervision
  • Gather feedback from colleagues and patients
  • Access to learning and development
  • Give space for team members to talk about their experiences

Access Publication: Effective teams in General Practice (january 2020)

Merry christmas and happy new year 2021. Stay safe.

photo: Children’s Christmas play, 1958. (Nina Leen / The LIFE Picture Collection) ______________________________________________________________________

1 de nov. 2020

false optimism not to be at risk of COVID-19






Koula Asimakopoulou et al. from King’s College London investigated comparative optimism for infection and recovery from COVID-19, and the implications this may have on the second wave and the possible lockdown. The study found that during the first lockdown period, most respondents believed that compared to others, they were unlikely to be at risk of COVID-19.

Data were collected through an international survey (N = 6485) exploring people’s thoughts and psychosocial behaviours relating to COVID‐19. The paper reports UK data.

They found the belief that negative events surrounding risk and recovery from COVID‐19 are perceived as more likely to happen to others rather than to oneself. Researchers believe that comparative optimism may have brought out the anecdotally observed, lack of compliance with lockdown guidelines in the UK. People who believe COVID‐19 is less likely to happen to them than to others may infer that their actual risk is much smaller than that communicated in the media, and thus the strict adherence to lockdown restrictions is unnecessary in their case.

The results showed how participants overwhelmingly believed that as compared to people of their age and gender, they were somewhat or extremely unlikely to have accidentally infected people with COVID‐19 in the past and to infect others or get infected themselves in the next month. They were also comparatively optimistic, but to a lesser extent, about their likelihood of getting hospitalized due to COVID‐19, finding themselves in an ICU, being ventilated, and making a full recovery.

In contrast, participants showed comparative pessimism about COVID‐19 infections in the more distant future. As compared to the average person of their age and gender they felt likely to get infected by COVID‐19 in the next year and to develop COVID‐19‐related symptoms. The authors argued that this finding supports earlier research that shows that people who have experienced some ill health tend to unduly exaggerate their future risk of experiencing further ill health. One important difference between COVID‐19 and other risks is that controlling the pandemic was very much placed in the hands of individuals restricting their lives in the UK—as seen in the slogan urging people to ‘Stay at home’. It is reasonable that participants would reason that in the long term, staying at home would be less possible, plausible or practical. Feeling that compliance with social distancing rules cannot be maintained indefinitely may thus explain these perceptions, in line with research showing that high prevalence negative events may engender comparative pessimism.

The implication for a second lockdown is that where people's experience so far may be that they have not been ill with COVID, they are likely to be even more comparatively optimistic than they were in March. Thinking that COVID has not happened to you so far so it is unlikely to happen to you now, can be even more dangerous than it was earlier in the spring. Both comparative optimism and comparative pessimism may have important consequences for people’s psychological well‐being and their likelihood of engaging in risk behaviours or responding to further lockdown measures.

Acces article (pdf free) Comparative optimism about infection and recovery from COVID‐19; Implications for adherence with lockdown advice

Obra 'Sense títol' d'Eulàlia Valldosera, (Vertical)

18 d’oct. 2020

Why is independent evaluation so important? The simple answer is trust.








Evaluation is an assessment, as systematic and impartial as possible, of an activity, project, programme, strategy, policy, topic, theme, sector, operational area, or institutional performance. It analyses the level of achievement of both expected and unexpected results by examining the results chain, processes, contextual factors and causality using appropriate criteria such as relevance, effectiveness, efficiency, impact and sustainability. This definition of evaluation further states that evaluation “should provide credible, useful evidence-based information that enables the timely incorporation of its findings, recommendations and lessons into the decision-making processes of the organizations and stakeholders”

The best way to ensure an evaluation is credible, reliable and useful is to ensure that it meets high quality and professional standards. The main principles of good evaluation practice are:

  • Independent and impartial: evaluation processes need to be separated from policymaking, implementation and management of the intervention. It has to be without undue influence by any party. Independent evaluation assesses, as objectively as humanly possible, the success and failure of policies and interventions, and reports critical findings without fear of repercussion. Why is independence so important? The simple answer is trust. Independence is necessary for credibility, influences the ways in which an evaluation is used and allows evaluators to be impartial and free from undue pressure throughout the evaluation process.
  • Independent evaluation team: Evaluators must have the full freedom to conduct their evaluative work impartially, without the risk of negative effects on their career development, and must be able to freely express their assessment.  How and independent evaluation team should be:
  1. External of the organization being evaluated and with no conflicts of interest
  2. Geographically diverse: professionals around the world outside of the country where the institution is being evaluated.
  3. Gender balanced
  4. Half members with extensive expertise in evaluation and the other half with expertise in the substantive topic to be evaluated.
  5. Recruited on a competitive and transparent basis 

  • Transparent, participatory and inclusive: evaluations need to be conducted in an open, respectful and consultative manner creating spaces for all relevant stakeholders, including those in a more disadvantaged position, to engage directly in the evaluation and take ownership of the evaluation process. 
  • Robust in methodological approach: evaluations need to be conducted in a systematic manner, using sound approaches and methods.
  • Utilization focused: there needs to be clear intent about the purpose and use of findings to improve the organization’s work.
  • Ethically conducted: evaluations need to be carried out according to professional and ethical guidelines and codes of conduct

photo: William Klein

12 de jul. 2020

Alert: health care professionals and stress impact during the COVID-19

Healthcare professionals (HCPs) on the front lines against COVID-19 may face increased workload, and stress. Understanding HCPs’ risk for burnout is critical to supporting HCPs and maintaining the quality of healthcare during the pandemic.

Large numbers of healthcare professionals (HCPs) on the frontlines against COVID-19 face high adversity, workloads, and stress, making them vulnerable to burnout.
  • Burnout: Defined as emotional exhaustion, depersonalization, and low personal achievement, is known to detract from optimal working capacities, It has been found to be driven by high job stress, high time pressure and workload, and poor organizational support.

We present a preprint article: Factors Contributing to Healthcare Professional Burnout During the COVID-19 Pandemic: A Rapid Turnaround Global Survey (2020)

Method: To assess exposure, perceptions, workload, and possible burnout of HCPs during the COVID-19 pandemic the authors conducted a cross-sectional survey.

The main outcomes and measures were HCPs’ self-assessment of burnout and other experiences and attitudes associated with working during the COVID-19 pandemic.

Results: Burnout was associated with:
  • Work impacting household activities
  • Feeling pushed beyond training
  • Exposure to COVID-19 patients
  • Making life prioritizing decisions
  • Lack of adequate personal protective equipment (PPE)
  • Limited organizatins support
Implications: Athough the results have multiple limitations including a non-validated questionnaire, minimal demographic data collection, and sampling method using social media the institutions should put the emphasis in support these individuals as they face enormous stress that can negatively impact their emotional and physical well-being.

Some actions that proactively instituions should do:
  • Develop a resilience training: resilience refers to an individual’s ability to handle stress and recover quickly from the effects of adversity
  • Cut drastically the belief of  HCP feeling that their organization doesn’t value their well-being.
  • HCPs should feel secure knowing that management care about them and the management are doing as much as possible to handle with the adverse situation
  • Support for HCPs’ families,
  • Provide PPE,
  • Provide mental health resources

photo: Life

3 de maig 2020

Florence Nightingale bicentenary 2020

Florence Nightingale "the Lady of the Lamp" was born on May 12, 1820, in Florence. This 2020 the worldwide celebrates of Florence Nightingale’s bicentenary. In her honour The World Health Organisation have named 2020 the Year of the Nurse and Midwife.

Despite family pressures to marry and live as a conventional wealthy woman, she considered her dedication to nursing to be a response to the call of God to care for the sick. Her success in radically lowering the death rate of wounded soldiers in the Crimean War led to society’s acceptance of her proposals for better sanitation and nutrition, accurate medical knowledge, and professionally trained nurses.

While Nightingale is best known worldwide for revolutionising nursing and healthcare through her campaigning for health reform, her far-reaching recommendations were based on impressive statistical work and popularised through pioneering data visualisation and her evidence-based approach to healthcare.

Florence Nigthtingale was the first female fellow in 1858 from Royal Statistical Society. The Significance magazine from Royal Statistical Society and American Statistical Association has published a special issue: Significance magazine, 2020, Volume 17, Issue 2: Florence Nightingale

More information:
Celebrating Nightingale 2020 Bicentenary
Mujeres con ciencia: Florence Nightingale (in spanish)
Florence Nightingale foundation
Guys and St Thomas Hospital

picture: Helping the wounded. Shutterstock/Everett Historical