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Winblad, Ulrika
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Publications (10 of 100) Show all publications
Winblad, U., Mor, V., McHugh, J. P. & Rahman, M. (2017). ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals. Health Affairs, 36(1), 67-73.
Open this publication in new window or tab >>ACO-Affiliated Hospitals Reduced Rehospitalizations From Skilled Nursing Facilities Faster Than Other Hospitals
2017 (English)In: Health Affairs, ISSN 0278-2715, E-ISSN 1544-5208, Vol. 36, no 1, 67-73 p.Article in journal (Refereed) Published
Abstract [en]

Medicare's more than 420 accountable care organizations (ACOs) provide care for a considerable percentage of the elderly in the United States. One goal of ACOs is to improve care coordination and thereby decrease rates of rehospitalization. We examined whether ACO-affiliated hospitals were more effective than other hospitals in reducing rehospitalizations from skilled nursing facilities. We found a general reduction in rehospitalizations from 2007 to 2013, which suggests that all hospitals made efforts to reduce rehospitalizations. The ACO-affiliated hospitals, however, were able to reduce rehospitalizations more quickly than other hospitals. The reductions suggest that ACO-affiliated hospitals are either discharging to the nursing facilities more effectively compared to other hospitals or targeting at-risk patients better, or enhancing information sharing and communication between hospitals and skilled nursing facilities. Policy makers expect that reducing readmissions to hospitals will generate major savings and improve the quality of life for the frail elderly. However, further work is needed to investigate the precise mechanisms that underlie the reduction of readmissions among ACO-affiliated hospitals.

Place, publisher, year, edition, pages
PROJECT HOPE, 2017
National Category
Health Sciences
Identifiers
urn:nbn:se:uu:diva-319305 (URN)10.1377/hlthaff.2016.0759 (DOI)000396336500009 ()28069848 (PubMedID)
Available from: 2017-04-18 Created: 2017-04-18 Last updated: 2017-04-25
von Granitz, H., Reine, I., Sonnander, K. & Winblad Spångberg, U. (2017). Do personal assistance activities promote participation for persons with disabilities in Sweden?. Disability and Rehabilitation, 39(24), 2512-2521.
Open this publication in new window or tab >>Do personal assistance activities promote participation for persons with disabilities in Sweden?
2017 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 39, no 24, 2512-2521 p.Article in journal (Refereed) Published
Abstract [en]

ABSTRACT

Purpose: To examine how the right to participation according to Article 19 of the United Nations’ Convention on the Rights of Persons with Disabilities (UNCRPD) is promoted by personal assistance use in Sweden across age, gender and eligible person categories.

Method: Register data and data from a questionnaire were used (N¼15,289). Principal component analysis was performed and the internal consistency was tested. Descriptive statistics (v2 test) were used across age, gender and eligible person categories and components.

Results: An uneven distribution of personal assistance across the components Health and Care; Home, Leisure and Social Interaction; and Daily Occupation was found. Significant differences in personal assistance reported were found between children and adults, men and women and between the three eligible person categories.

Conclusions: The discrepancy between reported and expected outcome of personal assistance indicates that Article 19 of the UNCRPD has not been met. The unequal access to participation across age, gender and eligible person categories would seem to further signify that the Act concerning Support and Service for Persons with Certain Functional Impairments is promoting activities of a caring nature rather than fulfilling Article 19 of the UNCRPD, i.e. ensuring full participation in society.

Keyword
CRPD, disability rights, independent living, social insurance, social policy
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-306679 (URN)10.1080/09638288.2016.1236405 (DOI)000410565300008 ()
Projects
Avhandlingsarbete; Att styra rättigheter rättsäkert: Har socialförsäkringens implementering av personlig assistans uppfyllt LSS värdegrund för goda levnadsvillkor?
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2012-0921
Available from: 2016-11-01 Created: 2016-11-01 Last updated: 2017-12-19Bibliographically approved
Winblad, U., Blomqvist, P. & Karlsson, A. (2017). Do public nursing home care providers deliver higher quality than private providers?: Evidence from Sweden. BMC Health Services Research, 17, Article ID 487.
Open this publication in new window or tab >>Do public nursing home care providers deliver higher quality than private providers?: Evidence from Sweden
2017 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 17, 487Article in journal (Refereed) Published
Abstract [en]

Background: Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies.

Methods: The source of data is a national survey conducted by the Swedish National Board of Health and Welfare in 2011 at 2710 nursing homes. Data from 14 quality indicators are analyzed, including structure and process measures such as staff levels, staff competence, resident participation, and screening for pressure ulcers, nutrition status, and risk of falling. The main statistical method employed is multiple OLS regression analysis. We differentiate in the analysis between structural and processual quality measures.

Results: The results indicate that public nursing homes have higher quality than privately operated homes with regard to two structural quality measures: staffing levels and individual accommodation. Privately operated nursing homes, on the other hand, tend to score higher on process-based quality indicators such as medication review and screening for falls and malnutrition. No significant differences were found between different ownership categories of privately operated nursing homes.

Conclusions: Ownership does appear to be related to quality outcomes in Swedish nursing home care, but the results are mixed and inconclusive. That staffing levels, which has been regarded as a key quality indicator in previous research, are higher in publicly operated homes than private is consistent with earlier findings. The fact that privately operated homes, including those operated by for-profit companies, had higher processual quality is more unexpected, given previous research. Finally, no significant quality differences were found between private ownership types, i.e. for-profit, non-profit, and private equity companies, which indicates that profit motives are less important for determining quality in Swedish nursing home care than in other countries where similar studies have been carried out.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2017
Keyword
Privatization, Nursing homes, Quality of care, New public management, For-profit care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-331238 (URN)10.1186/s12913-017-2403-0 (DOI)000405664100004 ()28709461 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2017-10-16 Created: 2017-10-16 Last updated: 2017-11-29Bibliographically approved
Burström, B., Burström, K., Nilsson, G., Tomson, G., Whitehead, M. & Winbland, U. (2017). Equity aspects of the Primary Health Care Choice Reform in Sweden - a scoping review. International Journal for Equity in Health, 16, Article ID 29.
Open this publication in new window or tab >>Equity aspects of the Primary Health Care Choice Reform in Sweden - a scoping review
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2017 (English)In: International Journal for Equity in Health, ISSN 1475-9276, E-ISSN 1475-9276, Vol. 16, 29Article in journal (Refereed) Published
Abstract [en]

Background: Good health and equal health care are the cornerstones of the Swedish Health and Medical Service Act. Recent studies show that the average level of health, measured as longevity, improves in Sweden, however, social inequalities in health remain a major issue. An important issue is how health care services can contribute to reducing inequalities in health, and the impact of a recent Primary Health Care (PHC) Choice Reform in this respect. This paper presents the findings of a review of the existing evidence on impacts of these reforms. Methods: We reviewed the published accounts (reports and scientific articles) which reported on the impact of the Swedish PHC Choice Reform of 2010 and changes in reimbursement systems, using Donabedian's framework for assessing quality of care in terms of structure, process and outcomes. Results: Since 2010, over 270 new private PHC practices operating for profit have been established throughout the country. One study found that the new establishments had primarily located in the largest cities and urban areas, in socioeconomically more advantaged populations. Another study, adjusting for socioeconomic composition found minor differences. The number of visits to PHC doctors has increased, more so among those with lesser needs of health care. The reform has had a negative impact on the provision of services for persons with complex needs. Opinions of doctors and staff in PHC are mixed, many state that persons with lesser needs are prioritized. Patient satisfaction is largely unchanged. The impact of PHC on population health may be reduced. Conclusions: The PHC Choice Reform increased the average number of visits, but particularly among those in more affluent groups and with lower health care needs, and has made integrated care for those with complex needs more difficult. Resource allocation to PHC has become more dependent on provider location, patient choice and demand, and less on need of care. On the available evidence, the PHC Choice Reform may have damaged equity of primary health care provision, contrary to the tenets of the Swedish Health and Medical Service Act. This situation needs to be carefully monitored.

Keyword
Equity, Inequalities, Health care need, Primary Health Care Choice Reform, Quality of care, Reimbursement system, Resource allocation
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-316411 (URN)10.1186/s12939-017-0524-z (DOI)000392763600001 ()28129771 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2017-03-02 Created: 2017-03-02 Last updated: 2017-11-29Bibliographically approved
Tyler, D. A., Gadbois, E. A., McHugh, J. P., Shield, R. R., Winblad, U. & Mor, V. (2017). Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals. Health Affairs, 36(8), 1385-1391.
Open this publication in new window or tab >>Patients Are Not Given Quality-Of-Care Data About Skilled Nursing Facilities When Discharged From Hospitals
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2017 (English)In: Health Affairs, ISSN 0278-2715, E-ISSN 1544-5208, Vol. 36, no 8, 1385-1391 p.Article in journal (Refereed) Published
Abstract [en]

Hospitals are now being held at least partly accountable for Medicare patients' care after discharge, as a result of regulations and incentives imposed by the Affordable Care Act. However, little is known about how patients select a postacute care facility. We used a multiple case study approach to explore both how patients requiring postacute care decide which skilled nursing facility to select and the role of hospital staff members in this decision. We interviewed 138 staff members of sixteen hospitals and twenty-five skilled nursing facilities and 98 patients in fourteen of the skilled nursing facilities. Most patients described receiving only lists of skilled nursing facilities from hospital staff members, while staff members reported not sharing data about facilities' quality with patients because they believed that patient choice regulations precluded them from doing so. Consequently, patients' choices were rarely based on readily available quality data. Proposed changes to the Medicare conditions of participation for hospitals that pertain to discharge planning could rectify this problem. In addition, less strict interpretations of choice requirements would give hospitals flexibility in the discharge planning process and allow them to refer patients to higher-quality facilities.

Keyword
Medicare; discharge planning; post acute care; re-hospitalization
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-332672 (URN)10.1377/hlthaff.2017.0155 (DOI)000407080200006 ()28784730 (PubMedID)
Available from: 2017-10-31 Created: 2017-10-31 Last updated: 2017-11-21Bibliographically approved
Eldh, A. C., Wallin, L., Fredriksson, M., Vengberg, S., Winblad, U., Halford, C. & Dahlström, T. (2016). Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey. BMJ Open, 6(11), Article ID e011562.
Open this publication in new window or tab >>Factors facilitating a national quality registry to aid clinical quality improvement: findings of a national survey
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2016 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, e011562Article in journal (Refereed) Published
Abstract [en]

Objectives: While national quality registries (NQRs) are suggested to provide opportunities for systematic follow-up and learning opportunities, and thus clinical improvements, features in registries and contexts triggering such processes are not fully known. This study focuses on one of the world's largest stroke registries, the Swedish NQR Riksstroke, investigating what aspects of the registry and healthcare organisations facilitate or hinder the use of registry data in clinical quality improvement. Methods: Following particular qualitative studies, we performed a quantitative survey in an exploratory sequential design. The survey, including 50 items on context, processes and the registry, was sent to managers, physicians and nurses engaged in Riksstroke in all 72 Swedish stroke units. Altogether, 242 individuals were presented with the survey; 163 responded, representing all but two units. Data were analysed descriptively and through multiple linear regression. Results: A majority (88%) considered Riksstroke data to facilitate detection of stroke care improvement needs and acknowledged that their data motivated quality improvements (78%). The use of Riksstroke for quality improvement initiatives was associated (R-2=0.76) with 'Colleagues' call for local results' (p=<0.001), 'Management Request of Registry data' (p=<0.001), and it was said to be 'Simple to explain the results to colleagues' (p=0.02). Using stepwise regression, 'Colleagues' call for local results' was identified as the most influential factor. Yet, while 73% reported that managers request registry data, only 39% reported that their colleagues call for the unit's Riksstroke results. Conclusions: While an NQR like Riksstroke demonstrates improvement needs and motivates stakeholders to make progress, local stroke care staff and managers need to engage to keep the momentum going in terms of applying registry data when planning, performing and evaluating quality initiatives.

National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-315937 (URN)10.1136/bmjopen-2016-011562 (DOI)000391303400046 ()28128099 (PubMedID)
Funder
Swedish Association of Local Authorities and Regions
Available from: 2017-02-22 Created: 2017-02-22 Last updated: 2018-01-13Bibliographically approved
Isaksson, D., Blomqvist, P. & Winblad, U. (2016). Free establishment of primary health careproviders: effects on geographical equity. BMC Health Services Research, 16, Article ID 28.
Open this publication in new window or tab >>Free establishment of primary health careproviders: effects on geographical equity
2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, 28Article in journal (Refereed) Published
Abstract [en]

Background

A reform in 2010 in Swedish primary care made it possible for private primary care providers to establish themselves freely in the country. In the former, publicly planned system, location was strictly regulated by local authorities. The goal of the new reform was to increase access and quality of health care. Critical arguments were raised that the reform could have detrimental effects on equity if the new primary health care providers chose to establish foremost in socioeconomically prosperous areas.

The aim of this study is to examine how the primary care choice reform has affected geographical equity by analysing patterns of establishment on the part of new private providers.

Methods

The basis of the design was to analyse socio-economic data on individuals who reside in the same electoral areas in which the 1411 primary health care centres in Sweden are established. Since the primary health care centres are located within 21 different county councils with different reimbursement schemes, we controlled for possible cluster effects utilizing generalized estimating equations modelling. The empirical material used in the analysis is a cross-sectional data set containing socio-economic data of the geographical areas in which all primary health care centres are established.

Results

When controlling for the effects of the county council regulation, primary health care centres established after the primary care choice reform were found to be located in areas with significantly fewer older adults living alone as well as fewer single parents – groups which generally have lower socio-economic status and high health care needs. However, no significant effects were observed for other socio-economic variables such as mean income, percentage of immigrants, education, unemployment, and children <5 years.

Conclusions

The primary care choice reform seems to have had some negative effects on geographical equity, even though these seem relatively minor.

Keyword
Patient choice; Equity; Marketization; Sweden; Primary health care; Geographic location
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-274995 (URN)10.1186/s12913-016-1259-z (DOI)000368550800001 ()26803298 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare
Available from: 2016-01-27 Created: 2016-01-27 Last updated: 2017-11-30Bibliographically approved
Winblad, U., McHugh, J., Shield, R., Gadbois, E. & Tyler, D. A. (2016). How Do Hospitals That Are Part Of ACOS Lower Readmission Rates?. The Gerontologist, 56, 496-496.
Open this publication in new window or tab >>How Do Hospitals That Are Part Of ACOS Lower Readmission Rates?
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2016 (English)In: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 56, 496-496 p.Article in journal, Meeting abstract (Refereed) Published
National Category
Geriatrics
Identifiers
urn:nbn:se:uu:diva-313847 (URN)000388585002319 ()
Available from: 2017-01-26 Created: 2017-01-25 Last updated: 2017-11-29Bibliographically approved
Wisell, K., Winblad, U. & Sporrong, S. K. (2016). Stakeholders’ expectations and perceived effects of the pharmacy ownership liberalization reform in Sweden: a qualitative interview study. BMC Health Services Research, 16, Article ID 379.
Open this publication in new window or tab >>Stakeholders’ expectations and perceived effects of the pharmacy ownership liberalization reform in Sweden: a qualitative interview study
2016 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, 379Article in journal (Refereed) Published
Abstract [en]

Background: Reforms in the health-care sector, including the pharmacy sector, can have different rationales. The Swedish pharmacies were prior to 2009 organized in a state-owned monopoly. In 2009, a liberalization of the ownership took place, in which a majority of the pharmacies were sold to private owners. The rationales for this liberalization changed profoundly during the preparatory work, making it probable that other rationales than the ones first expressed existed. The aim of this study was to explore the underlying rationales (not stated in official documents) for the liberalization in the Swedish pharmacy sector, and also to compare the expectations with the perceived outcomes.

Methods: Semi-structured interviews were conducted with representatives from key stakeholder organizations; i.e., political, patient, and professional organizations. The analysis was performed in steps, and themes were developed in an inductive manner.

Results: One expectation among the political organization participants was that the ownership liberalization would create opportunities for ideas. The competition introduced in the market was supposed to lead to a more diversified pharmacy sector. After the liberalization, the participants in favor of the liberalization were surprised that the pharmacies were so similar.

Among the professional organization participants, one important rationale for the liberalization was to get better use of the pharmacists’ knowledge. However, all the professional, and some of the patient organization participants, thought that the counseling in the pharmacies had deteriorated after the liberalization.

As expected in the interviews, the post-liberalization pharmacy sector consists of more pharmacies. However, an unexpected perceived effect of the liberalization was, among participants from all the stakeholder groups, less access to prescription medicines in the pharmacies.

Conclusions: This study showed that the political organization participants had an ideological basis for their opinion. The political stakeholders did not have a clear view about what the liberalization should lead to, apart from abolishing the monopoly. The perceived effects are quite similar in the different stakeholder groups, and not as positive as were expected.

Keyword
community pharamcy, regulation, pharmacy policy, Sweden
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-301433 (URN)10.1186/s12913-016-1637-6 (DOI)000381258500001 ()27519573 (PubMedID)
Projects
The monopoly experiment
Available from: 2016-08-23 Created: 2016-08-23 Last updated: 2018-01-10Bibliographically approved
Gray, B. H., Winblad, U. & Sarnak, D. O. (2016). Sweden’s Esther Model: Improving Care for Elderly Patients with Complex Needs.. The Commonwealth Fund.
Open this publication in new window or tab >>Sweden’s Esther Model: Improving Care for Elderly Patients with Complex Needs.
2016 (English)Report (Other academic)
Place, publisher, year, edition, pages
The Commonwealth Fund, 2016. 9 p.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-329029 (URN)
Available from: 2017-09-06 Created: 2017-09-06 Last updated: 2017-09-08Bibliographically approved
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