Background
Methods
Sampling and data collection
Household survey
Facility survey and structural quality of care measures
All facility types | Oblast hospital | Rayon/Town hospital | Polyclinic | |
---|---|---|---|---|
N = 261 | N = 8 | N = 128 | N = 125 | |
General Facility Information
| ||||
Age of facility
| 25.5 | 51.3 | 28 | 21.1 |
[29.4] | [73.02] | [32.1] | [19.4] | |
Population served
| 129,589.7 | 2,418,672 | 132,326.3 | 52,567.2 |
[431,184.6] | [1,197,941] | [397,339.5] | [83,040.9] | |
Number of licensed beds/facility (hospitals)
| 332.6 | 894 | 296.7 | |
[252.9] | [326.3] | [201.2] | ||
Number of beds in use/facility (hospitals)
| 302.1 | 892.4 | 263.1 | |
[239.6] | [328.9] | [173.7] | ||
Number of listed committees or bodies in place
| 3.1 | 4.3 | 3.5 | 2.7 |
[1.7] | [1.5] | [1.7] | [1.6] | |
Clinical Hours
| ||||
Total hours open (Monday-Sunday)
| 100.1 | 152.5 | 138.5 | 58.7 |
[53.9] | [43.9] | [49.3] | [9.8] | |
Total hours for emergencies
| 132.8 | 168 | 165.8 | 72.7 |
[51.1] | [0.0] | [12.01] | [38.8] | |
All facility types
|
Oblast hospital
|
Rayon/Town hospital
|
Polyclinic
| |
Patient load
| ||||
Total number of doctors
| 64.5 | 179.6 | 78.02 | 42.8 |
[64.4] | [122.4] | [69.5] | [36.1] | |
Number of nurses, other clinical staff (e.g. medical technicians, pharmacists)
| 195.5 | 681.9 | 262.2 | 90.6 |
[202.4] | [446.2] | [186.9] | [75.3] | |
Number of OP visits/month
| 17,587.1 | 13,259.2 | 14,631.2 | 20,013.4 |
[16,794.5] | [8,440.3] | [15,978.1] | [17,339.5] | |
Number of inpatient admissions/month (hospitals only)
| 1,058.8 | 4,624.3 | 857.5 | |
[1,268.95] | [3,241.5] | [651.92] | ||
% adult patients (>18)
| 73.8 | 61.5 | 71.9 | 76.4 |
[30.1] | [36.9] | [31.1] | [28.7] | |
% of adult patients >65
| 21.2 | 16.3 | 19.5 | 23.2 |
[15.4] | [9.6] | [13.04] | [17.6] | |
All facility types
|
Oblast hospital
|
Rayon/Town hospital
|
Polyclinic
| |
Facility Equipment/Supplies
| ||||
% of equipment in good working condition (out of 16 items)
| 46.0 | 80 | 55.7 | 34.7 |
[18.2] | [10.1] | [15.3] | [12.9] | |
% of tests performed (out of 15 items)
| 76.9 | 92.2 | 79.7 | 73.0 |
[19.1] | [9.9] | [15.3] | [21.97] | |
% of supplies available (out of 12 items)
| 74.8 | 85.4 | 79.2 | 69.6 |
[18.1] | [19.3] | [15.8] | [18.8] | |
Annual Expenses/facility*
| $2,220,828 | $6,411,543 | $2,208,281 | $724,702 |
[49,600,000] | [21,400,000] | [65,100,000] | [6,789,152] |
Physician survey and clinical quality of care measures
Characteristics | All facility types | All hospitals | Oblast hospital | Rayon/Town hospital | Polyclinic |
---|---|---|---|---|---|
(N = 34) | (N = 509) | (N = 500) | |||
Social Demographics
| |||||
Gender (male) %
| 24.7 | 35.2 | 35.3 | 28.3 | 20.4 |
Age
| 47.3 | 47.5 | 45.4 | 47.6 | 47.2 |
[11.1] | [11.1] | [13.2] | [10.9] | [11.1] | |
Language spoken at home (%):
| |||||
Ukrainian | 43.4 | 42.9 | 45.2 | 42.8 | 44 |
Russian | 41.7 | 42.7 | 32.3 | 43.4 | 40.5 |
Both | 13 | 13.1 | 22.6 | 12.5 | 13 |
Other | 2 | 1.3 | 0 | 1.4 | 2.6 |
Medical Training
| |||||
Years practicing as physician
| 22.2 | 22.5 | 20.7 | 22.6 | 21.9 |
[10.7] | 10.7 | [13] | [10.5] | [10.9] | |
Years practicing at the facility
| 17.6 | 17.7 | 14.1 | 17.9 | 17.4 |
[10.5] | 10.4 | [10.1] | [10.4] | [10.7] | |
Patient Load
| |||||
General Practitioners (primary care) (%)
| 25.9 | 11.2 | 5.9 | 11.6 | 41.8 |
Patients ≥ 40 years old (%)
| 58 | 57.2 | 54.8 | 59.5 | 56.6 |
Hours/week at the facility
| 42.6 | 43.8 | 39.8 | 44.1 | 41.4 |
[11] | 11.3 | [9.6] | [11.4] | [10.5] | |
Inpatients per month (number)
| 28.7 | 53.1 | 27.4 | 40.7 | 16.9 |
[54] | 88.2 | [23.9] | [65.4] | [37.9] | |
Outpatients/month (number)
| 274.3 | 107.7 | 176.6 | 132.6 | 423.7 |
[276.4] | 137.8 | [301] | [214] | [252] | |
Minutes per OP visit
| 36.6 | 51.0 | 52.7 | 51.3 | 27.2 |
[53.7] | [72.57] | [74.7] | [72.6] | [33.5] | |
Work in other facilities (%)
| 13.5 | 13 | 18.2 | 12.8 | 13.9 |
Hrs/week at other facilities
| 20.1 | 21.4 | 11.8 | 22.2 | 18.7 |
[16.1] | 16.3 | [6.1] | [16.6] | [16] | |
Case Type
| |||||
All COPD
| 41.5 ± 12.7 | 41.9 ± 12.5 | 41.7 ± 10.7 | 41.9 ± 12.6 | 41.1 ± 13.1 |
All CHF
| 53.2 ± 13.1 | 53.2 ± 13.1 | 57.3 ± 11.6 | 52.9 ± 13.2 | 53.2 ± 13.0 |
All Cases
| 47.4 ± 11.4 | 47.5 ± 11.1 | 49.5 ± 8.7 | 47.4 ± 11.3 | 47.2 ± 11.6 |
By Domain (combined COPD + CHF)
| |||||
History
| 59.9 ± 11.0 | 59.8 ± 10.9 | 61.8 ± 8.7 | 59.6 ± 11.0 | 60.0 ± 11.1 |
Physical exam
| 54.4 ± 23.8 | 55.6 ± 23.0 | 56.9 ± 24.8 | 55.5 ± 22.9 | 53.1 ± 24.5 |
Laboratory tests
| 77.5 ± 24.2 | 78.0 ± 23.9 | 81.4 ± 18.8 | 77.7 ± 24.2 | 77.0 ± 24.8 |
Diagnosis
| 56.0 ± 14.6 | 56.2 ± 15.3 | 58.8 ± 14.1 | 56.0 ± 15.3 | 55.8 ± 13.8 |
Treatment/Management
| 40.9 ± 12.9 | 40.8 ± 12.7 | 42.1 ± 12.1 | 40.7 ± 12.8 | 41.0 ± 13.2 |
Patient exit survey and health measures
Exit interviews | Household interviews | |
---|---|---|
N = 1932 | N = 3430 | |
SOCIO-DEMOGRAPHIC CHARACTERISTICS
| ||
Gender (male) %
| 39.3 | 44.7 |
Age
| 47.7 | 41.1 |
[17.2] | ||
Married (%)
| 62 | 71.5 |
Language spoken at home (%):
| ||
Ukrainian | 45.6 | 48.4 |
Russian | 41 | 37.9 |
Both | 10.6 | 11.8 |
Other | 2.7 | 1.9 |
Currently employed (%)
| 46.3 | 63.2 |
Education Level (%)
| ||
Primary | 11.7 | 4.0 |
High School | 52.9 | 46.2 |
College | 32 | 42.6 |
Graduate School | 3.5 | 7.2 |
CARE SEEKING BEHAVIORS
| ||
Travel time to facility (%)
| ||
<30 Minutes | 61.6 | 68.0 |
30 minutes to <1 hour | 31.3 | 24.7 |
1 to 4 hours | 6.9 | 6.6 |
>4 hours | 0.1 | 0.8 |
Outpatient visits in previous 12 months (mean)
| 3.6 | N.A. |
[3.5] | ||
Outpatient visit in past 30 days (% yes)
| NA | 16.6 |
Outpatient visits in past 30 days (mean)
| NA | 1.5 |
HEALTH STATUS INDICATORS
| ||
GSRH (%)
| ||
Very Good | 1.4 | 2.9 |
Good | 22.3 | 37.7 |
Satisfactory | 52.6 | 48.2 |
Bad | 22 | 10.1 |
Very Bad | 1.7 | 1.0 |
Number of Chronic Conditions
| 1.4 | 0.5 |
[1.3] | ||
Hospitalized in previous 12 months (%)
| 34.1 | 11.0 |
Average # of hospitalizations overnight care | 1.3 | 1.5 |
[1.4] | ||
Average # of hospitalizations inpatient day care | NA | 1.3 |
HEALTHY BEHAVIORS AND RISK FACTORS
| ||
Excessive waist circumference
|
NA
|
29.5
|
(>102 cm Male; >88 cm Female) | ||
Excessive alcohol consumption (5+ drinks for 1+ days in past month) | NA | 17.7 |
Physical activity
| NA | |
Sedentary | 71.8 | |
Insufficient | 24.0 | |
Active | 4.3 | |
Diet
| NA | 0.8 |
BMI
| NA | |
mean | 26.2 | |
< 25 | 46.9 | |
25-29.9 | 31.9 | |
>30 | 21.1 | |
Smoking status (%)
| ||
Daily | 16 | 27.1 |
Occasionally | 14.9 | 4.9 |
Nonsmoker | 69.1 | 67.9 |
Heavy drinker (%)
| NA | 17.6 |
Activity (% of Sedentary) | NA | 71.6 |
Healthy diet
| NA | 0.8 |
Statistical analyses
Results
COPD | CHF | |||
---|---|---|---|---|
n = 944 | n = 944 | |||
Coef | p-value | Coef | p-value | |
Constant | 43.89 | 0.00 | 49.93 | 0.00 |
CPV Taken is Complex |
-1.50
|
0.05
| -0.70 | 0.35 |
Oblast = Winnitca |
4.33
|
0.03
|
9.98
|
0.00
|
Oblast = Dnipropetrovs'k | 3.40 | 0.16 |
7.14
|
0.00
|
Oblast = Kyiv | -0.79 | 0.76 | 4.13 | 0.09 |
Oblast = Lugansk |
6.25
|
0.00
|
10.06
|
0.00
|
Oblast = Lviv | 1.89 | 0.40 |
6.12
|
0.01
|
Oblast = Odessa |
4.08
|
0.05
|
9.56
|
0.00
|
Oblast = Rivne | 0.50 | 0.84 |
5.44
|
0.02
|
Urban | -0.05 | 0.97 | 1.15 | 0.26 |
Hospital | 0.60 | 0.59 | 0.30 | 0.80 |
Equipment index | 0.02 | 0.48 | -0.02 | 0.55 |
Lab index | -0.01 | 0.65 | -0.01 | 0.58 |
Supply index | 0.02 | 0.49 | 0.03 | 0.33 |
Number of Committees | -0.40 | 0.21 | 0.17 | 0.58 |
Age of MD |
-0.15
|
0.00
|
-0.14
|
0.00
|
MD is Male |
-2.22
|
0.03
|
-2.76
|
0.00
|
MD Speaks only Russian | -1.31 | 0.27 |
-2.06
|
0.05
|
MD is generalist | -2.23 | 0.18 |
-2.80
|
0.05
|
With CME at least 3 years age that lasted at least two days |
2.38
|
0.01
|
2.22
|
0.02
|
Prop of MD patient age 55 and above | 0.04 | 0.11 | 0.03 | 0.18 |
MD works in other facility | -0.81 | 0.61 | -1.68 | 0.21 |
W/ record for at least 75% of patients | 0.73 | 0.45 | 1.12 | 0.22 |
Exit survey | ||
---|---|---|
N = 1762 | ||
Odds ratio | p-value | |
Actual CPV score (Average of COPD & CHF) |
1.03
|
0.04
|
Oblast = Winnitca | 2.02 | 0.61 |
Oblast = Dnipropetrovs'k | 2.33 | 0.29 |
Oblast = Kyiv | 1.66 | 0.57 |
Oblast = Lugansk | 2.13 | 0.39 |
Oblast = Lviv | 2.73 | 0.33 |
Oblast = Odessa | 1.62 | 0.60 |
Oblast = Rivne | 0.71 | 0.73 |
CPV*Oblast = Winnitca | 0.97 | 0.22 |
CPV*Oblast = Dnipropetrovs'k |
0.95
|
0.00
|
CPV*Oblast = Kyiv | 0.99 | 0.48 |
CPV*Oblast = Lugansk | 0.97 | 0.12 |
CPV*Oblast = Lviv | 0.97 | 0.12 |
CPV*Oblast = Odessa | 0.99 | 0.45 |
CPV*Oblast = Rivne | 0.97 | 0.18 |
Hospital |
0.63
|
0.01
|
Urban | 0.87 | 0.34 |
Patient's age |
0.97
|
0.00
|
Patient is male |
1.53
|
0.00
|
Patient is married | 1.02 | 0.86 |
Patient speaks mainly Russian | 1.02 | 0.85 |
Employed |
1.27
|
0.04
|
Years of schooling |
1.09
|
0.00
|
Asset index |
0.53
|
0.00
|
Diagnosis index‡
|
0.66
|
0.00
|
2 |
0.48
|
0.00
|
3 |
0.37
|
0.00
|
4+ |
0.28
|
0.00
|
With hospitalization |
0.55
|
0.00
|
Travel time = at least one hour |
0.69
|
0.05
|
Patient is smoker | 0.92 | 0.47 |
Household survey | ||
---|---|---|
N = 2844 | ||
Odds ratio | p-value | |
Average CPV score (average of CPVs at the facility level) |
1.02
|
0.05
|
By region: | ||
Oblast = Winnitca |
1.97
|
0.00
|
Oblast = Dnipropetrovs'k |
4.04
|
0.00
|
Oblast = Kyiv |
2.65
|
0.00
|
Oblast = Lugansk |
1.44
|
0.05
|
Oblast = Lviv | 1.34 | 0.12 |
Oblast = Odessa | 0.82 | 0.24 |
Oblast = Rivne |
1.49
|
0.02
|
Age |
0.96
|
0.00
|
Male |
1.45
|
0.00
|
Married | 0.94 | 0.44 |
Speaks mainly Russian | 0.99 | 0.93 |
Employed |
1.37
|
0.00
|
Educ = Primary Level |
0.74
|
0.10
|
Lowest wealth quintile |
0.76
|
0.00
|
Number of chronic conditions |
0.43
|
0.00
|
W/ medical assistance in past 30 days |
0.47
|
0.00
|
With hospitalization |
0.46
|
0.00
|
BMI | 0.99 | 0.78 |
Waist risk | 0.85 | 0.12 |
Smokes | 0.90 | 0.25 |
Heavy drinker | 0.91 | 0.33 |
Sufficient physical activity | 0.82 | 0.26 |