Healthcare system inputs and patient-reported outcomes: a study in adults with congenital heart defect from 15 countries

• Main Authors: Liesbet Van Bulck, Eva Goossens, Koen Luyckx, Silke Apers, Erwin Oechslin, Corina Thomet, Werner Budts, Junko Enomoto, Maayke A. Sluman, Chun-Wei Lu, Jamie L. Jackson, Paul Khairy, Stephen C. Cook, Shanthi Chidambarathanu, Luis Alday, Katrine Eriksen, Mikael Dellborg, Malin Berghammer, Bengt Johansson, Andrew S. Mackie, Samuel Menahem, Maryanne Caruana, Gruschen Veldtman, Alexandra Soufi, Susan M. Fernandes, Kamila White, Edward Callus, Shelby Kutty, Philip Moons, on behalf of the APPROACH-IS consortium and the International Society for Adult Congenital Heart Disease (ISACHD)
• Format: Article
• Language: English
• Published: BMC 2020-06-01
• Series: BMC Health Services Research
• Subjects: Congenital Heart Defects; Health Resources; Healthcare workforce; Patient Reported Outcome Measures; Quality of life; Staffing
• Online Access: http://link.springer.com/article/10.1186/s12913-020-05361-9

Abstract Background The relationship between healthcare system inputs (e.g., human resources and infrastructure) and mortality has been extensively studied. However, the association between healthcare system inputs and patient-reported outcomes remains unclear. Hence, we explored the predictive value of human resources and infrastructures of the countries’ healthcare system on patient-reported outcomes in adults with congenital heart disease. Methods This cross-sectional study included 3588 patients with congenital heart disease (median age = 31y; IQR = 16.0; 52% women; 26% simple, 49% moderate, and 25% complex defects) from 15 countries. The following patient-reported outcomes were measured: perceived physical and mental health, psychological distress, health behaviors, and quality of life. The assessed inputs of the healthcare system were: (i) human resources (i.e., density of physicians and nurses, both per 1000 people) and (ii) infrastructure (i.e., density of hospital beds per 10,000 people). Univariable, multivariable, and sensitivity analyses using general linear mixed models were conducted, adjusting for patient-specific variables and unmeasured country differences. Results Sensitivity analyses showed that higher density of physicians was significantly associated with better self-reported physical and mental health, less psychological distress, and better quality of life. A greater number of nurses was significantly associated with better self-reported physical health, less psychological distress, and less risky health behavior. No associations between a higher density of hospital beds and patient-reported outcomes were observed. Conclusions This explorative study suggests that density of human resources for health, measured on country level, are associated with patient-reported outcomes in adults with congenital heart disease. More research needs to be conducted before firm conclusions about the relationships observed can be drawn. Trial registration ClinicalTrials.gov: NCT02150603 . Registered 30 May 2014,