Kristian Kidholm | University of Southern Denmark (original) (raw)
Papers by Kristian Kidholm
Studies in Risk and Uncertainty, 1995
Cost-benefit analysis of road projects reducing the risk of traffic accidents presupposes an expl... more Cost-benefit analysis of road projects reducing the risk of traffic accidents presupposes an explicit valuation of increased traffic safety. In Denmark the value of avoided traffic accidents is equal to the sum of avoided direct and indirect costs of accidents plus a political estimate of the human sufferings and deprivation caused by traffic accidents called “the loss of welfare”. This
Ugeskrift for laeger, Jan 16, 2006
Ugeskrift for laeger, Jan 28, 2002
The purpose of this study was to estimate the average costs of injuries and the proportion of tot... more The purpose of this study was to estimate the average costs of injuries and the proportion of total (treatment + social) costs covered when including injuries treated at the hospital. The empirical data consisted of emergency department visits (n = 29,516) from the catchment area of Odense University Hospital in 1992 for all age groups and a representative population sample (n = 1074 injuries) for the age group 15-67 years old. The costs were assessed following the "cost of illness" principles. The average costs per injured person varied significantly by age and were 26,119 DKK for 68+ years old, 2357 DKK for 15-67 years old, and 1528 DKK for 0-14 years old. The total direct costs for hospital treated persons were 117 million DKK, of which "injuries at home among elderly women" totalled 29% and road traffic injuries 25%. The numerical proportion of hospital treated injuries was 36% (95% CI 32-39%), but in economic terms 92% for treatment costs, and 85% when inclu...
International journal of integrated care
ABSTRACT
Ugeskrift for laeger, Jan 12, 2014
The use of tele-rehabilitation (TR) is a rapidly growing area within health care with the aim of ... more The use of tele-rehabilitation (TR) is a rapidly growing area within health care with the aim of dealing with the demographics changes of a growing elderly population and increasing number of patients with chronic conditions needing rehabilitation. Results from research indicate, that TR is equally as efficient as usual care. However, there is a need for more studies of high quality on the efficacy and cost-effectiveness of TR just as the long-term effects of TR have to be determined. In addition, there is a need for qualitative studies elucidating the patients' perspective of TR.
BMC Medical Informatics and Decision Making, 2015
An essential element in the treatment of patients with chronic obstructive pulmonary disease (COP... more An essential element in the treatment of patients with chronic obstructive pulmonary disease (COPD) is rehabilitation, of which supervised training is an important part. However, not all individuals with severe COPD can participate in the rehabilitation provided by hospitals and municipal training centres due to distance to the training venues and transportation difficulties. The aim of the study was to assess the feasibility of an individualized home-based training and counselling programme via video conference to patients with severe COPD after hospitalization including assessment of safety, clinical outcomes, patients' perceptions, organisational aspects and economic aspects. The design was a pre- and post-test intervention study. Fifty patients with severe COPD were included. The telemedicine training and counselling included three weekly supervised exercise sessions by a physiotherapist and up to two supervised counselling and training sessions in energy conservation techniques by an occupational therapist. The telemedicine videoconferencing equipment was a computer containing a screen, a microphone, an on/off switch and a volume control. Thirty seven (74%) participants completed the programme, with improvements in health status assessed by the Clinical COPD Questionnaire and physical performance assessed by a sit-to-stand test and a timed-up-and-go test. There were no cases of patient fall or emergency contact with a general practitioner during the telemedicine training sessions. The study participants believed the telemedicine training and counselling was essential for getting started with being physically active in a secure manner. The business case showed that under the current financing system, the reimbursement to the hospital was slightly higher than the hospital expenditures. Thus, the business case for the hospital was positive. The organizational analysis indicated that the perceptions of the staff were that the telemedicine service had improved the continuity of the rehabilitation programme for the patients and enabled the patients' everyday lives to be included in the treatment. This study showed that home-based supervised training and counselling via video conference is safe and feasible and that telemedicine can help to ensure more equitable access to supervised training in patients with severe COPD. Clinical Trials NCT02085187 (Date of registration 10.03.2014).
Journal of Evaluation in Clinical Practice, 2014
The quality of the current literature on external validity varies considerably. An improved check... more The quality of the current literature on external validity varies considerably. An improved checklist with validated items on external validity would aid decision-makers in judging similarities among circumstances when transferring evidence from a study setting to an implementation setting. In this paper, currently available checklists on external validity are identified, assessed and used as a basis for proposing a new improved instrument. A systematic literature review was carried out in Pubmed, Embase and Cinahl on English-language papers without time restrictions. The retrieved checklist items were assessed for (i) the methodology used in primary literature, justifying inclusion of each item; and (ii) the number of times each item appeared in checklists. Fifteen papers were identified, presenting a total of 21 checklists for external validity, yielding a total of 38 checklist items. Empirical support was considered the most valid methodology for item inclusion. Assessment of methodological justification showed that none of the items were supported empirically. Other kinds of literature justified the inclusion of 22 of the items, and 17 items were included on the basis of consensus. On 36 occasions, the items were presented without methodological justification for inclusion. Assessment of frequency/occurrence showed that items were mentioned in one to at most 17 checklists. This paper provides building blocks for the development of a new checklist for external validity. The next step is provision of empirical evidence for the checklist items to be selected, and finally, development and validation of a checklist on external validity.
International Journal of Technology Assessment in Health Care, 2012
Objectives: Telemedicine applications could potentially solve many of the challenges faced by the... more Objectives: Telemedicine applications could potentially solve many of the challenges faced by the healthcare sectors in Europe. However, a framework for assessment of these technologies is need by decision makers to assist them in choosing the most efficient and cost-effective technologies. Therefore in 2009 the European Commission initiated the development of a framework for assessing telemedicine applications, based on the users' need for information for decision making. This article presents the Model for ASsessment of Telemedicine applications (MAST) developed in this study. Methods: MAST was developed through workshops with users and stakeholders of telemedicine. Results: Based on the workshops and using the EUnetHTA Core HTA Model as a starting point a three-element model was developed, including: (i) preceding considerations, (ii) multidisciplinary assessment, and (iii) transferability assessment. In the multidisciplinary assessment, the outcomes of telemedicine applications comprise seven domains, based on the domains in the EUnetHTA model. Conclusions: MAST provides a structure for future assessment of telemedicine applications. MAST will be tested during 2010-13 in twenty studies of telemedicine applications in nine European countries in the EC project Renewing Health.
International Journal of Medical Informatics, 2015
ABSTRACT
Health Policy, 2015
Assessments of new health technologies in Europe are often made at the hospital level. However, t... more Assessments of new health technologies in Europe are often made at the hospital level. However, the guidelines for health technology assessment (HTA), e.g. the EUnetHTA Core Model, are produced by national HTA organizations and focus on decision-making at the national level. This paper describes the results of an interview study with European hospital managers about their need for information when deciding about investments in new treatments. The study is part of the AdHopHTA project. Face-to-face, structured interviews were conducted with 53 hospital managers from nine European countries. The hospital managers identified the clinical, economic, safety and organizational aspects of new treatments as being the most relevant for decision-making. With regard to economic aspects, the hospital managers typically had a narrower focus on budget impact and reimbursement. In addition to the information included in traditional HTAs, hospital managers sometimes needed information on the political and strategic aspects of new treatments, in particular the relationship between the treatment and the strategic goals of the hospital. If further studies are able to verify our results, guidelines for hospital-based HTA should be altered to reflect the information needs of hospital managers when deciding about investments in new treatments.
Ugeskrift for laeger, Jan 17, 2014
The Whole Systems Demonstrator (WSD), a cluster randomized trial of effects of telehealth, was in... more The Whole Systems Demonstrator (WSD), a cluster randomized trial of effects of telehealth, was initiated in 2008 including 3.230 patients from 179 general practices. The objective of this review is to summarize the results from WSD based on publications made so far. Results from five publications show that telehealth reduces mortality (odds ratio 0.54) during 12 months. The use of secondary care is reduced, however, when including costs of telehealth, the total costs are higher for patients using telehealth. Many questions regarding differences between patient groups and the mechanism behind the effects remain unanswered.
Journal of Telemedicine and Telecare, 2015
This article has been temporarily removed so that important corrections can be made.
International Journal of Technology Assessment in Health Care, 2009
Objectives: Mini-HTA (health technology assessment) is increasingly being applied in Denmark as a... more Objectives: Mini-HTA (health technology assessment) is increasingly being applied in Denmark as an input for decisions on the use of health technologies. Mini-HTA is a form or check list with questions concerning the prerequisites for and consequences of health technologies. At the national level, the National Board of Health uses mini-HTA when hospitals apply for permission to introduce new treatments. Mini-HTA is also compulsory in Danish Regions' annual collection of early warnings. At the local level some hospitals have made mini-HTA compulsory when clinical departments apply for funding for new technologies. The objective of this study is to assess the quality of the information included in mini-HTA used at Danish hospitals and to discuss the consequences of this to decision making. Methods: The quality of mini-HTA is assessed by use of an INATHA checklist for HTA reports. Data consists of reviews of the quality in fifty-two mini-HTAs produced by Danish hospitals in 2008. Results: The mini-HTAs generally include descriptions of the assessed technology and the comparator, but information about the selection and interpretation of the clinical literature and other data is often missing. The level of evidence for the clinical effects and the main references are generally included. Only 25 percent of the mini-HTAs include a quantitative estimate of the size of the clinical effects. Organizational consequences inside the clinical department is described in 81percent of the cases and 92 percent includes a cost estimate.
International Journal of Technology Assessment in Health Care, 2006
The purpose of this project was to evaluate local decision support tools used in the Danish hospi... more The purpose of this project was to evaluate local decision support tools used in the Danish hospital sector from a theoretical and an empirical point of view. Methods: The use of local decision support was evaluated through questionnaires sent to all county health directors, all hospital managers, and all heads of clinical departments in cardiology, orthopedic surgery, and intensive care. In addition, respondents were asked to submit whatever decision support tools they were using (including mini-HTAs, other forms or checklists, and special procedures for decision making concerning new health technologies). A theoretical analysis of the decision support tools (decision theory) was performed as well as a comparison with the business case method used in private companies. Finally, the Danish mini-HTA was compared with foreign production and use of HTA and HTA-like assessments as local decision support. Results: The response rate was high (87 percent, 94 percent, 85 percent, respectively). We collected sixty different forms (of which forty-nine were mini-HTAs) and twenty variants 295 Ehlers et al. of written procedures. We found theoretical and empirical evidence that local involvement in the process of making the HTA could be important for the use of the results from the HTA and for the process of implementing the new technology. Conclusions: Doing mini-HTA in hospitals seems to balance the need for quality and depth with the limited time and resources for assessment.
Health Policy, 2004
When applying willingness-to-pay (WTP) in economic evaluations, there have been strong theoretica... more When applying willingness-to-pay (WTP) in economic evaluations, there have been strong theoretical arguments for the use of ex ante insurance-based questions, which can be framed either as insurance premiums or taxation contributions. This paper suggests theoretical reasons why respondents may value a programme differently in these two different ex ante approaches, and inquires empirically into the potential existence of such differences. A split-sample interview study was undertaken in Denmark. The proportion of respondents willing to pay is higher in the community version, and the respondents use different reasons for being and not being willing to pay.
Acta Obstetricia et Gynecologica Scandinavica, 2005
Routine pretransfusion testing for red cell alloantibodies (RBCab) in cesarean patients is standa... more Routine pretransfusion testing for red cell alloantibodies (RBCab) in cesarean patients is standard practice in many obstetric centers. The objective of the present study was to evaluate the usefulness of this test. A retrospective study was conducted using computerized registers to extract data on blood transfusions and the occurrence of RBCab in cesarean patients. A total of 4434 admissions for cesarean section were identified. Only 10 patients (0.23%) had clinically significant RBCab, which had not been previously detected. Blood transfusions were required in relation to 147 cesarean sections (3.3%). A number of preoperative conditions, traditionally believed to be risk factors for preoperative and postpartum hemorrhage, occurred more frequently in transfused patients than in nontransfused. The probability of a cesarean patient having a previously undetected clinically significant RBCab and receiving a blood transfusion during admission for delivery was estimated to be 9.0 x 10(-5) (1 in 11 050 cesarean sections). Analyses of the time relationships between cesarean sections and initiation of blood transfusions indicated that most often there would be enough time for postoperative antibody screening and/or cross matching if the routine pretransfusion testing was omitted. These findings suggest that routine pretransfusion testing in cesarean patients can be omitted.
Studies in Risk and Uncertainty, 1995
Cost-benefit analysis of road projects reducing the risk of traffic accidents presupposes an expl... more Cost-benefit analysis of road projects reducing the risk of traffic accidents presupposes an explicit valuation of increased traffic safety. In Denmark the value of avoided traffic accidents is equal to the sum of avoided direct and indirect costs of accidents plus a political estimate of the human sufferings and deprivation caused by traffic accidents called “the loss of welfare”. This
Ugeskrift for laeger, Jan 16, 2006
Ugeskrift for laeger, Jan 28, 2002
The purpose of this study was to estimate the average costs of injuries and the proportion of tot... more The purpose of this study was to estimate the average costs of injuries and the proportion of total (treatment + social) costs covered when including injuries treated at the hospital. The empirical data consisted of emergency department visits (n = 29,516) from the catchment area of Odense University Hospital in 1992 for all age groups and a representative population sample (n = 1074 injuries) for the age group 15-67 years old. The costs were assessed following the "cost of illness" principles. The average costs per injured person varied significantly by age and were 26,119 DKK for 68+ years old, 2357 DKK for 15-67 years old, and 1528 DKK for 0-14 years old. The total direct costs for hospital treated persons were 117 million DKK, of which "injuries at home among elderly women" totalled 29% and road traffic injuries 25%. The numerical proportion of hospital treated injuries was 36% (95% CI 32-39%), but in economic terms 92% for treatment costs, and 85% when inclu...
International journal of integrated care
ABSTRACT
Ugeskrift for laeger, Jan 12, 2014
The use of tele-rehabilitation (TR) is a rapidly growing area within health care with the aim of ... more The use of tele-rehabilitation (TR) is a rapidly growing area within health care with the aim of dealing with the demographics changes of a growing elderly population and increasing number of patients with chronic conditions needing rehabilitation. Results from research indicate, that TR is equally as efficient as usual care. However, there is a need for more studies of high quality on the efficacy and cost-effectiveness of TR just as the long-term effects of TR have to be determined. In addition, there is a need for qualitative studies elucidating the patients' perspective of TR.
BMC Medical Informatics and Decision Making, 2015
An essential element in the treatment of patients with chronic obstructive pulmonary disease (COP... more An essential element in the treatment of patients with chronic obstructive pulmonary disease (COPD) is rehabilitation, of which supervised training is an important part. However, not all individuals with severe COPD can participate in the rehabilitation provided by hospitals and municipal training centres due to distance to the training venues and transportation difficulties. The aim of the study was to assess the feasibility of an individualized home-based training and counselling programme via video conference to patients with severe COPD after hospitalization including assessment of safety, clinical outcomes, patients' perceptions, organisational aspects and economic aspects. The design was a pre- and post-test intervention study. Fifty patients with severe COPD were included. The telemedicine training and counselling included three weekly supervised exercise sessions by a physiotherapist and up to two supervised counselling and training sessions in energy conservation techniques by an occupational therapist. The telemedicine videoconferencing equipment was a computer containing a screen, a microphone, an on/off switch and a volume control. Thirty seven (74%) participants completed the programme, with improvements in health status assessed by the Clinical COPD Questionnaire and physical performance assessed by a sit-to-stand test and a timed-up-and-go test. There were no cases of patient fall or emergency contact with a general practitioner during the telemedicine training sessions. The study participants believed the telemedicine training and counselling was essential for getting started with being physically active in a secure manner. The business case showed that under the current financing system, the reimbursement to the hospital was slightly higher than the hospital expenditures. Thus, the business case for the hospital was positive. The organizational analysis indicated that the perceptions of the staff were that the telemedicine service had improved the continuity of the rehabilitation programme for the patients and enabled the patients' everyday lives to be included in the treatment. This study showed that home-based supervised training and counselling via video conference is safe and feasible and that telemedicine can help to ensure more equitable access to supervised training in patients with severe COPD. Clinical Trials NCT02085187 (Date of registration 10.03.2014).
Journal of Evaluation in Clinical Practice, 2014
The quality of the current literature on external validity varies considerably. An improved check... more The quality of the current literature on external validity varies considerably. An improved checklist with validated items on external validity would aid decision-makers in judging similarities among circumstances when transferring evidence from a study setting to an implementation setting. In this paper, currently available checklists on external validity are identified, assessed and used as a basis for proposing a new improved instrument. A systematic literature review was carried out in Pubmed, Embase and Cinahl on English-language papers without time restrictions. The retrieved checklist items were assessed for (i) the methodology used in primary literature, justifying inclusion of each item; and (ii) the number of times each item appeared in checklists. Fifteen papers were identified, presenting a total of 21 checklists for external validity, yielding a total of 38 checklist items. Empirical support was considered the most valid methodology for item inclusion. Assessment of methodological justification showed that none of the items were supported empirically. Other kinds of literature justified the inclusion of 22 of the items, and 17 items were included on the basis of consensus. On 36 occasions, the items were presented without methodological justification for inclusion. Assessment of frequency/occurrence showed that items were mentioned in one to at most 17 checklists. This paper provides building blocks for the development of a new checklist for external validity. The next step is provision of empirical evidence for the checklist items to be selected, and finally, development and validation of a checklist on external validity.
International Journal of Technology Assessment in Health Care, 2012
Objectives: Telemedicine applications could potentially solve many of the challenges faced by the... more Objectives: Telemedicine applications could potentially solve many of the challenges faced by the healthcare sectors in Europe. However, a framework for assessment of these technologies is need by decision makers to assist them in choosing the most efficient and cost-effective technologies. Therefore in 2009 the European Commission initiated the development of a framework for assessing telemedicine applications, based on the users' need for information for decision making. This article presents the Model for ASsessment of Telemedicine applications (MAST) developed in this study. Methods: MAST was developed through workshops with users and stakeholders of telemedicine. Results: Based on the workshops and using the EUnetHTA Core HTA Model as a starting point a three-element model was developed, including: (i) preceding considerations, (ii) multidisciplinary assessment, and (iii) transferability assessment. In the multidisciplinary assessment, the outcomes of telemedicine applications comprise seven domains, based on the domains in the EUnetHTA model. Conclusions: MAST provides a structure for future assessment of telemedicine applications. MAST will be tested during 2010-13 in twenty studies of telemedicine applications in nine European countries in the EC project Renewing Health.
International Journal of Medical Informatics, 2015
ABSTRACT
Health Policy, 2015
Assessments of new health technologies in Europe are often made at the hospital level. However, t... more Assessments of new health technologies in Europe are often made at the hospital level. However, the guidelines for health technology assessment (HTA), e.g. the EUnetHTA Core Model, are produced by national HTA organizations and focus on decision-making at the national level. This paper describes the results of an interview study with European hospital managers about their need for information when deciding about investments in new treatments. The study is part of the AdHopHTA project. Face-to-face, structured interviews were conducted with 53 hospital managers from nine European countries. The hospital managers identified the clinical, economic, safety and organizational aspects of new treatments as being the most relevant for decision-making. With regard to economic aspects, the hospital managers typically had a narrower focus on budget impact and reimbursement. In addition to the information included in traditional HTAs, hospital managers sometimes needed information on the political and strategic aspects of new treatments, in particular the relationship between the treatment and the strategic goals of the hospital. If further studies are able to verify our results, guidelines for hospital-based HTA should be altered to reflect the information needs of hospital managers when deciding about investments in new treatments.
Ugeskrift for laeger, Jan 17, 2014
The Whole Systems Demonstrator (WSD), a cluster randomized trial of effects of telehealth, was in... more The Whole Systems Demonstrator (WSD), a cluster randomized trial of effects of telehealth, was initiated in 2008 including 3.230 patients from 179 general practices. The objective of this review is to summarize the results from WSD based on publications made so far. Results from five publications show that telehealth reduces mortality (odds ratio 0.54) during 12 months. The use of secondary care is reduced, however, when including costs of telehealth, the total costs are higher for patients using telehealth. Many questions regarding differences between patient groups and the mechanism behind the effects remain unanswered.
Journal of Telemedicine and Telecare, 2015
This article has been temporarily removed so that important corrections can be made.
International Journal of Technology Assessment in Health Care, 2009
Objectives: Mini-HTA (health technology assessment) is increasingly being applied in Denmark as a... more Objectives: Mini-HTA (health technology assessment) is increasingly being applied in Denmark as an input for decisions on the use of health technologies. Mini-HTA is a form or check list with questions concerning the prerequisites for and consequences of health technologies. At the national level, the National Board of Health uses mini-HTA when hospitals apply for permission to introduce new treatments. Mini-HTA is also compulsory in Danish Regions' annual collection of early warnings. At the local level some hospitals have made mini-HTA compulsory when clinical departments apply for funding for new technologies. The objective of this study is to assess the quality of the information included in mini-HTA used at Danish hospitals and to discuss the consequences of this to decision making. Methods: The quality of mini-HTA is assessed by use of an INATHA checklist for HTA reports. Data consists of reviews of the quality in fifty-two mini-HTAs produced by Danish hospitals in 2008. Results: The mini-HTAs generally include descriptions of the assessed technology and the comparator, but information about the selection and interpretation of the clinical literature and other data is often missing. The level of evidence for the clinical effects and the main references are generally included. Only 25 percent of the mini-HTAs include a quantitative estimate of the size of the clinical effects. Organizational consequences inside the clinical department is described in 81percent of the cases and 92 percent includes a cost estimate.
International Journal of Technology Assessment in Health Care, 2006
The purpose of this project was to evaluate local decision support tools used in the Danish hospi... more The purpose of this project was to evaluate local decision support tools used in the Danish hospital sector from a theoretical and an empirical point of view. Methods: The use of local decision support was evaluated through questionnaires sent to all county health directors, all hospital managers, and all heads of clinical departments in cardiology, orthopedic surgery, and intensive care. In addition, respondents were asked to submit whatever decision support tools they were using (including mini-HTAs, other forms or checklists, and special procedures for decision making concerning new health technologies). A theoretical analysis of the decision support tools (decision theory) was performed as well as a comparison with the business case method used in private companies. Finally, the Danish mini-HTA was compared with foreign production and use of HTA and HTA-like assessments as local decision support. Results: The response rate was high (87 percent, 94 percent, 85 percent, respectively). We collected sixty different forms (of which forty-nine were mini-HTAs) and twenty variants 295 Ehlers et al. of written procedures. We found theoretical and empirical evidence that local involvement in the process of making the HTA could be important for the use of the results from the HTA and for the process of implementing the new technology. Conclusions: Doing mini-HTA in hospitals seems to balance the need for quality and depth with the limited time and resources for assessment.
Health Policy, 2004
When applying willingness-to-pay (WTP) in economic evaluations, there have been strong theoretica... more When applying willingness-to-pay (WTP) in economic evaluations, there have been strong theoretical arguments for the use of ex ante insurance-based questions, which can be framed either as insurance premiums or taxation contributions. This paper suggests theoretical reasons why respondents may value a programme differently in these two different ex ante approaches, and inquires empirically into the potential existence of such differences. A split-sample interview study was undertaken in Denmark. The proportion of respondents willing to pay is higher in the community version, and the respondents use different reasons for being and not being willing to pay.
Acta Obstetricia et Gynecologica Scandinavica, 2005
Routine pretransfusion testing for red cell alloantibodies (RBCab) in cesarean patients is standa... more Routine pretransfusion testing for red cell alloantibodies (RBCab) in cesarean patients is standard practice in many obstetric centers. The objective of the present study was to evaluate the usefulness of this test. A retrospective study was conducted using computerized registers to extract data on blood transfusions and the occurrence of RBCab in cesarean patients. A total of 4434 admissions for cesarean section were identified. Only 10 patients (0.23%) had clinically significant RBCab, which had not been previously detected. Blood transfusions were required in relation to 147 cesarean sections (3.3%). A number of preoperative conditions, traditionally believed to be risk factors for preoperative and postpartum hemorrhage, occurred more frequently in transfused patients than in nontransfused. The probability of a cesarean patient having a previously undetected clinically significant RBCab and receiving a blood transfusion during admission for delivery was estimated to be 9.0 x 10(-5) (1 in 11 050 cesarean sections). Analyses of the time relationships between cesarean sections and initiation of blood transfusions indicated that most often there would be enough time for postoperative antibody screening and/or cross matching if the routine pretransfusion testing was omitted. These findings suggest that routine pretransfusion testing in cesarean patients can be omitted.