The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe

dc.contributorAalto Universityen
dc.contributor.authorMahdavi, Mahdi
dc.contributor.authorVissers, Jan
dc.contributor.authorElkhuizen, Sylvia
dc.contributor.authorVan Dijk, Mattees
dc.contributor.authorVanhala, Antero
dc.contributor.authorKarampli, Eleftheria
dc.contributor.authorFaubel, Raquel
dc.contributor.authorForte, Paul
dc.contributor.authorCoroian, Elena
dc.contributor.authorVan De Klundert, Joris
dc.contributor.departmentTehran University of Medical Sciences
dc.contributor.departmentErasmus University Rotterdam
dc.contributor.departmentHook of Holland
dc.contributor.departmentAalto University
dc.contributor.departmentNational School of Public Health
dc.contributor.departmentUniversity of Valencia
dc.contributor.departmentBalance of Care Group
dc.contributor.departmentFriedrich-Alexander University Erlangen-Nürnberg
dc.contributor.departmentDepartment of Industrial Engineering and Managementen
dc.description.abstractBackground While health service provisioning for the chronic condition Type 2 Diabetes (T2D) often involves a network of organisations and professionals, most evidence on the relationships between the structures and processes of service provisioning and the outcomes considers single organisations or solo practitioners. Extending Donabedian’s Structure-Process-Outcome (SPO) model, we investigate how differences in quality of life, effective coverage of diabetes, and service satisfaction are associated with differences in the structures, processes, and context of T2D services in six regions in Finland, Germany, Greece, Netherlands, Spain, and UK. Methods Data collection consisted of: a) systematic modelling of provider network’s structures and processes, and b) a cross-sectional survey of patient reported outcomes and other information. The survey resulted in data from 1459 T2D patients, during 2011–2012. Stepwise linear regression models were used to identify how independent cumulative proportion of variance in quality of life and service satisfaction are related to differences in context, structure and process. The selected context, structure and process variables are based on Donabedian’s SPO model, a service quality research instrument (SERVQUAL), and previous organization and professional level evidence. Additional analysis deepens the possible bidirectional relation between outcomes and processes. Results The regression models explain 44% of variance in service satisfaction, mostly by structure and process variables (such as human resource use and the SERVQUAL dimensions). The models explained 23% of variance in quality of life between the networks, much of which is related to contextual variables. Our results suggest that effectiveness of A1c control is negatively correlated with process variables such as total hours of care provided per year and cost of services per year. Conclusions While the selected structure and process variables explain much of the variance in service satisfaction, this is less the case for quality of life. Moreover, it appears that the effect of the clinical outcome A1c control on processes is stronger than the other way around, as poorer control seems to relate to more service use, and higher cost. The standardized operational models used in this research prove to form a basis for expanding the network level evidence base for effective T2D service provisioning.en
dc.description.versionPeer revieweden
dc.identifier.citationMahdavi , M , Vissers , J , Elkhuizen , S , Van Dijk , M , Vanhala , A , Karampli , E , Faubel , R , Forte , P , Coroian , E & Van De Klundert , J 2018 , ' The relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europe ' , PloS one , vol. 13 , no. 2 , e0192599 .
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dc.relation.ispartofseriesPloS oneen
dc.relation.ispartofseriesVolume 13, issue 2en
dc.titleThe relationship between context, structure, and processes with outcomes of 6 regional diabetes networks in Europeen
dc.typeA1 Alkuperäisartikkeli tieteellisessä aikakauslehdessäfi