1
|
Waitzberg R, Pfundstein I, Maresso A, Rechel B, van Ginneken E, Quentin W. Health system description and assessment: a scoping review of templates for systematic analyses. Health Res Policy Syst 2024; 22:82. [PMID: 38992666 PMCID: PMC11238392 DOI: 10.1186/s12961-024-01166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/23/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Understanding and comparing health systems is key for cross-country learning and health system strengthening. Templates help to develop standardised and coherent descriptions and assessments of health systems, which then allow meaningful analyses and comparisons. Our scoping review aims to provide an overview of existing templates, their content and the way data is presented. MAIN BODY Based on the WHO building blocks framework, we defined templates as having (1) an overall framework, (2) a list of indicators or topics, and (3) instructions for authors, while covering (4) the design of the health system, (5) an assessment of health system performance, and (6) should cover the entire health system. We conducted a scoping review of grey literature published between 2000 and 2023 to identify templates. The content of the identified templates was screened, analyzed and compared. We found 12 documents that met our inclusion criteria. The building block `health financing´ is covered in all 12 templates; and many templates cover ´service delivery´ and ´health workforce'. Health system performance is frequently assessed with regard to 'access and coverage', 'quality and safety', and 'financial protection'. Most templates do not cover 'responsiveness' and 'efficiency'. Seven templates combine quantitative and qualitative data, three are mostly quantitative, and two are primarily qualitative. Templates cover data and information that is mostly relevant for specific groups of countries, e.g. a particular geographical region, or for high or for low and middle-income countries (LMICs). Templates for LMICs rely more on survey-based indicators than administrative data. CONCLUSIONS This is the first scoping review of templates for standardized descriptions of health systems and assessments of their performance. The implications are that (1) templates can help analyze health systems across countries while accounting for context; (2) template-guided analyses of health systems could underpin national health policies, strategies, and plans; (3) organizations developing templates could learn from approaches of other templates; and (4) more research is needed on how to improve templates to better achieve their goals. Our findings provide an overview and help identify the most important aspects and topics to look at when comparing and analyzing health systems, and how data are commonly presented. The templates were created by organizations with different agendas and target audiences, and with different end products in mind. Comprehensive health systems analyses and comparisons require production of quantitative indicators and complementing them with qualitative information to build a holistic picture. CLINICAL TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
- Ruth Waitzberg
- Department of Health Care Management, Faculty of Economics and Management, Technische Universität Berlin, Straße Des 17. Juni 135, 10623, Berlin, Germany.
| | - Isabel Pfundstein
- Department of Health Care Management, Faculty of Economics and Management, Technische Universität Berlin, Berlin, Germany
| | - Anna Maresso
- European Observatory on Health Systems and Policies, Berlin, Germany
| | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Department of Health Care Management, Technische Universität Berlin, Strasse Des 17. Juni 135, 10623, Berlin, Germany
| | - Wilm Quentin
- Planetary & Public Health, University of Bayreuth, Bayreuth, Germany
- German West-African Centre for Global Health and Pandemic Prevention, Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| |
Collapse
|
2
|
Gardner AJ, Kristensen SR. A multivariable analysis to predict variations in hospital mortality using systems-based factors of healthcare delivery to inform improvements to healthcare design within the English NHS. PLoS One 2024; 19:e0303932. [PMID: 38968314 PMCID: PMC11226030 DOI: 10.1371/journal.pone.0303932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 05/03/2024] [Indexed: 07/07/2024] Open
Abstract
Over the last decade, the strain on the English National Health Service (NHS) has increased. This has been especially felt by acute hospital trusts where the volume of admissions has steadily increased. Patient outcomes, including inpatient mortality, vary between trusts. The extent to which these differences are explained by systems-based factors, and whether they are avoidable, is unclear. Few studies have investigated these relationships. A systems-based methodology recognises the complexity of influences on healthcare outcomes. Rather than clinical interventions alone, the resources supporting a patient's treatment journey have near-equal importance. This paper first identifies suitable metrics of resource and demand within healthcare delivery from routinely collected, publicly available, hospital-level data. Then it proceeds to use univariate and multivariable linear regression to associate such systems-based factors with standardised mortality. Three sequential cross-sectional analyses were performed, spanning the last decade. The results of the univariate regression analyses show clear relationships between five out of the six selected predictor variables and standardised mortality. When these five predicators are included within a multivariable regression analysis, they reliably explain approximately 36% of the variation in standardised mortality between hospital trusts. Three factors are consistently statistically significant: the number of doctors per hospital bed, bed occupancy, and the percentage of patients who are placed in a bed within four hours after a decision to admit them. Of these, the number of doctors per bed had the strongest effect. Linear regression assumption testing and a robustness analysis indicate the observations have internal validity. However, our empirical strategy cannot determine causality and our findings should not be interpreted as established causal relationships. This study provides hypothesis-generating evidence of significant relationships between systems-based factors of healthcare delivery and standardised mortality. These have relevance to clinicians and policymakers alike. While identifying causal relationships between the predictors is left to the future, it establishes an important paradigm for further research.
Collapse
Affiliation(s)
- Andrew J. Gardner
- Centre for Health Policy, Imperial College London, London, United Kingdom
- William Harvey Research Institute, Critical Care and Perioperative Medicine Research Group, Queen Mary University of London, London, United Kingdom
| | | |
Collapse
|
3
|
Dufour E, Duhoux A. How can strategies based on performance measurement and feedback support changes in nursing practice? A theoretical reflection drawing on Habermas' social perspective. Nurs Inq 2024; 31:e12628. [PMID: 38409735 DOI: 10.1111/nin.12628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
Strategies based on performance measurement and feedback are commonly used to support quality improvement among nurses. These strategies require practice change, which, for nurses, rely to a large extent on their capacity to coordinate with each other effectively. However, the levers for coordinated action are difficult to mobilize. This discussion paper offers a theoretical reflection on the challenges related to coordinating nurses' actions in the context of practice changes initiated by performance measurement and feedback strategies. We explore how Jürgen Habermas' theory of Communicative Action may shed light on the issues underlying nurses' collective actions and self-determination in practice change and the implications for the design of strategies based on performance measurement and feedback. Based on this theory, we propose differences between communicative and functional coordination according to the nature of the actions and the purposes involved. The domains of action underlying these coordination processes, which Habermas referred to as the lifeworld and the system, are then used to draw a parallel with aspects of nursing practice. Further exploration of these concepts allows us to consider the tensions between the demands of the system and the self-determination of nurses within their practice.
Collapse
Affiliation(s)
- Emilie Dufour
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
4
|
Otero-Varela L, Sandhu N, Walker RL, Southern DA, Quan H, Eastwood CA. Development of Data Quality Indicators for Improving Hospital International Classification of Diseases-coded Health Data Quality Globally. Med Care 2024:00005650-990000000-00249. [PMID: 38986115 DOI: 10.1097/mlr.0000000000002024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND Hospital inpatient data, coded using the International Classification of Diseases (ICD), is widely used to monitor diseases, allocate resources and funding, and evaluate patient outcomes. As such, hospital data quality should be measured before use; however, currently, there is no standard and international approach to assess ICD-coded data quality. OBJECTIVE To develop a standardized method for assessing hospital ICD-coded data quality that could be applied across countries: Data quality indicators (DQIs). RESEARCH DESIGN To identify a set of candidate DQIs, we performed an environmental scan, reviewing gray and academic literature on data quality frameworks and existing methods to assess data quality. Indicators from the literature were then appraised and selected through a 3-round Delphi process. The first round involved face-to-face group and individual meetings for idea generation, while the second and third rounds were conducted remotely to collect online ratings. Final DQIs were selected based on the panelists' quantitative and qualitative feedback. SUBJECTS Participants included international experts with expertise in administrative health data, data quality, and ICD coding. RESULTS The resulting 24 DQIs encompass 5 dimensions of data quality: relevance, accuracy and reliability; comparability and coherence; timeliness; and Accessibility and clarity. These will help stakeholders (eg, World Health Organization) to assess hospital data quality using the same standard across countries and highlight areas in need of improvement. CONCLUSIONS This novel area of research will facilitate international comparisons of ICD-coded data quality and be valuable to future studies and initiatives aimed at improving hospital administrative data quality.
Collapse
Affiliation(s)
| | | | - Robin L Walker
- Community Health Sciences, Cumming School of Medicine, University of Calgary
- Alberta Health Services, Calgary, AB, Canada
| | | | - Hude Quan
- Centre for Health Informatics
- Libin Cardiovascular Institute of Alberta
- Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Cathy A Eastwood
- Centre for Health Informatics
- Libin Cardiovascular Institute of Alberta
- Community Health Sciences, Cumming School of Medicine, University of Calgary
| |
Collapse
|
5
|
Polin K, Shuftan N, Webb E, Opoku D, Droti B, Quentin W. Data for health system comparison and assessment in the African Region: A review of 63 indicators available in international databases. J Glob Health 2024; 14:04118. [PMID: 38904344 PMCID: PMC11191675 DOI: 10.7189/jogh.14.04118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
Background Achieving universal health coverage in the African region requires health systems strengthening. Assessing and comparing health systems contributes to this process, but requires internationally comparable data. The European Observatory on Health Systems and Policies has produced Health Systems in Transition (HiT) reviews in Europe, Asia, North America and the Caribbean with a standardised template. This study explores data availability in international databases for the quantitative health and health system indicators in the HiT template for the WHO African region. Methods We identified ten databases which contained data for 40 of the 80 original HiT indicators and an additional 23 proxy indicators to fill some gaps. We then assessed data availability for the resulting 63 indicators by country and time, i.e. first/last year of data, years of data available overall and since 2000, and we explored for each indicator (1) against the country with the greatest availability overall and (2) against annual availability for all years since 2000. Results Overall data availability was greatest in South Africa (93.0% of possible total points) and least in South Sudan (59.5%). Since 2000, Uganda (60.4%) has had the highest data availability and South Sudan (37.2%) the lowest. By topic, data availability was the highest for health financing (91.4%; median start/end date 2000/2019) and background characteristics (88.5%; 1990/2020) and was considerably lower for health system performance (54.5%; 2000/2018) and physical and human resources (44.8%; 2004/2013). Data are available for different years in different countries, and at irregular intervals, complicating time series analysis. No data are available for service provision indicators. Conclusions Gaps in data in international databases across time, countries, and topics undermine systematic health systems comparisons and assessments, regional health systems strengthening, and efforts to achieve universal health coverage. More efforts are needed to strengthen national data collection and management and integrate national data into international databases to support cross-country assessments, peer learning, and planning. In tandem, more research is needed to understand the specific historical, cultural, administrative, and technological determinants influencing country data availability, as well as the facilitators and barriers of data sharing between countries and international databases, and the potential of new technologies to increase timeliness of data.
Collapse
Affiliation(s)
- Katherine Polin
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Nathan Shuftan
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Erin Webb
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Daniel Opoku
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
- German West-African Centre for Global Health and Pandemic Prevention, Kumasi, Ghana
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Benson Droti
- Health Information Systems, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Wilm Quentin
- European Observatory on Health Systems and Policies, Brussels, Belgium
- German West-African Centre for Global Health and Pandemic Prevention, Kumasi, Ghana
- Chair of Planetary & Public Health, University of Bayreuth, Bayreuth, Germany
| |
Collapse
|
6
|
Merola R, Vargas M. Economic Indicators, Quantity and Quality of Health Care Resources Affecting Post-surgical Mortality. J Epidemiol Glob Health 2024:10.1007/s44197-024-00249-x. [PMID: 38801492 DOI: 10.1007/s44197-024-00249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE to identify correlations between quality and quantity of health care resources, national economic indicators, and postoperative in-hospital mortality as reported in the EUSOS study. METHODS Different variables were identified from a series of publicly available database. Postoperative in-hospital mortality was identified as reported by EUSOS study. Spearman non-parametric and Coefficients of non-linear regression were calculated. RESULTS Quality of health care resources was strongly and negatively correlated to postoperative in-hospital mortality. Quantity of health care resources were negatively and moderately correlated to postoperative in-hospital mortality. National economic indicators were moderately and negatively correlated to postoperative in-hospital mortality. General mortality, as reported by WHO, was positively but very moderately correlated with postoperative in-hospital mortality. CONCLUSIONS Postoperative in-hospital mortality is strongly determined by quality of health care instead of quantity of health resources and health expenditures. We suggest that improving the quality of health care system might reduce postoperative in-hospital mortality.
Collapse
Affiliation(s)
- Raffaele Merola
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy.
| | - Maria Vargas
- Anesthesia and Intensive Care Medicine, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| |
Collapse
|
7
|
Mehl C, Müller T, Nau T, Bachmann C, Geraedts M. [Development of an indicator set for the evaluation of the quality of routine ambulatory health care for common disorders in children and adolescents]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024; 186:69-76. [PMID: 38631959 DOI: 10.1016/j.zefq.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/28/2024] [Accepted: 03/13/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND In Germany, no consented quality indicator set (QI set) exists to date that can be used to assess the quality of pediatric care. Therefore, the aim of the project "Assessment of the quality of routine ambulatory health care for common disorders in children and adolescents" (QualiPäd) funded by the Innovation Committee of the Federal Joint Committee (grant no.: 01VSF19035) was to develop a QI set for the diseases asthma, atopic eczema, otitis media, tonsillitis, attention-deficit hyperactivity disorder (ADHD), depression and conduct disorder. METHODS For the observation period 2018/2019, quality indicators (QIs) were searched in indicator databases, guidelines and literature databases and complemented in part by newly formulated QIs (e.g., derived from guideline recommendations). The QIs were then assigned to content categories and dimensions according to Donabedian and OECD and reduced by removing duplicates. Finally, a panel of experts consulted the QIs using the modified RAND-UCLA Appropriateness Method (RAM). RESULTS The search resulted in a preliminary QI set of 2324 QIs. After the reduction steps and the evaluation of the experts, 282 QIs were included in the QI set (asthma: 72 QIs, atopic eczema: 25 QIs, otitis media: 31 QIs, tonsillitis: 12 QIs, ADHD: 53 QIs, depression: 43 QIs, conduct disorder: 46 QIs). The QIs are distributed among the following different categories: Therapy (138 QIs), Diagnostics (95 QIs), Patient-reported outcome measures/Patient-reported experience measures (PROM/PREM) (45 QIs), Practice management (31 QIs), and Health reporting (4 QIs). In the Donabedian model, 89% of the QIs capture process quality, 9% outcome quality, and 2% structural quality; according to the OECD classification, 61% measure effectiveness, 23% patient-centeredness, and 16% safety of care. CONCLUSION The consented QI set is currently being tested and can subsequently be used (possibly modified) to measure the quality of routine outpatient care for children and adolescents in Germany, in order to indicate the status quo and potential areas for improvement in outpatient care.
Collapse
Affiliation(s)
- Claudia Mehl
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland.
| | - Teresa Müller
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
| | - Thorsten Nau
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
| | - Christian Bachmann
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Max Geraedts
- Institut für Versorgungsforschung und Klinische Epidemiologie, Fachbereich Medizin der Philipps-Universität Marburg, Marburg, Deutschland
| |
Collapse
|
8
|
Cossio-Gil Y, Pérez-Sádaba FJ, Ribera J, Giménez E, Marte L, Ramos R, Aurin E, Peterlunger M, Steinbrink J, Bottinelli EAM, Nelson N, Seveke L, Garin N, Velasco C. Identifying potential predictable indicators for the management of tertiary hospitals. Int J Health Plann Manage 2024; 39:278-292. [PMID: 37910590 DOI: 10.1002/hpm.3710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/28/2023] [Accepted: 09/19/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The European University Hospitals Alliance (EUHA) recognises the need to move from the classical approach of measuring key performance indicators (KPIs) to an anticipative approach based on predictable indicators to take decisions (Key Decision Indicators, KDIs). It might help managers to anticipate poor results before they occur to prevent or correct them early. OBJECTIVE This paper aims to identify potential KDIs and to prioritize those most relevant for high complexity hospitals. METHODS A narrative review was performed to identify KPIs with the potential to become KDIs. Then, two surveys were conducted with EUHA hospital managers (n = 51) to assess potential KDIs according to their relevance for decision-making (Value) and their availability and effort required to be predicted (Feasibility). Potential KDIs are prioritized for testing as predictable indicators and developing in the short term if they were classified as highly Value and Feasible. RESULTS The narrative review identified 45 potential KDIs out of 153 indicators and 11 were prioritized. Of nine EUHA hospitals, 25 members from seven answered, prioritizing KDIs related to the emergency department (ED), hospitalisation and surgical processes (n = 8), infrastructure and resources (n = 2) and health outcomes and quality (n = 1). The highest scores in this group were for those related to ED. The results were homogeneous among the different hospitals. CONCLUSIONS Potential KDIs related to care processes and hospital patient flow was the most prioritized ones to test as being predictable. KDIs represent a new approach to decision-making, whose potential to be predicted could impact the planning and management of hospital resources and, therefore, healthcare quality.
Collapse
Affiliation(s)
- Yolima Cossio-Gil
- Department of Evaluation and Information Systems, Vall d'Hebron University Hospital, Barcelona, Spain
- Grup de Recerca en Serveis Sanitaris, Vall d'Hebron University Hospital, Barcelona, Spain
- European University Hospitals Alliance, Barcelona, Spain
| | | | - Jaume Ribera
- Center for Research in Healthcare Innovation Management (CRHIM), IESE Business School, Barcelona, Spain
| | - Emmanuel Giménez
- Department of Evaluation and Information Systems, Vall d'Hebron University Hospital, Barcelona, Spain
- Grup de Recerca en Serveis Sanitaris, Vall d'Hebron University Hospital, Barcelona, Spain
- European University Hospitals Alliance, Barcelona, Spain
| | - Luís Marte
- Department of Evaluation and Information Systems, Vall d'Hebron University Hospital, Barcelona, Spain
- Grup de Recerca en Serveis Sanitaris, Vall d'Hebron University Hospital, Barcelona, Spain
- European University Hospitals Alliance, Barcelona, Spain
| | - Rosa Ramos
- Department of Evaluation and Information Systems, Vall d'Hebron University Hospital, Barcelona, Spain
- Grup de Recerca en Serveis Sanitaris, Vall d'Hebron University Hospital, Barcelona, Spain
- European University Hospitals Alliance, Barcelona, Spain
| | - Eva Aurin
- Department of Evaluation and Information Systems, Vall d'Hebron University Hospital, Barcelona, Spain
- European University Hospitals Alliance, Barcelona, Spain
- Department of Innovation and Digital Health, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Michael Peterlunger
- European University Hospitals Alliance, Barcelona, Spain
- Medical University of Vienna and Vienna General Hospital, Vienna, Austria
| | - Jens Steinbrink
- European University Hospitals Alliance, Barcelona, Spain
- Corporate Strategic Development, Charité - Universitätsmedizin, Berlin, Germany
| | | | - Nina Nelson
- European University Hospitals Alliance, Barcelona, Spain
- Karolinska University Hospital, Stockholm, Sweden
| | - Lynn Seveke
- European University Hospitals Alliance, Barcelona, Spain
| | - Noe Garin
- Hospital de la Santa Creu i Sant Pau, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Cesar Velasco
- Health Evaluation and Quality Agency of Catalonia (AQuAS), Barcelona, Spain
| |
Collapse
|
9
|
Barber C, van der Vleuten C, Chahine S. Validity evidence and psychometric evaluation of a socially accountable health index for health professions schools. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024; 29:147-172. [PMID: 37347458 DOI: 10.1007/s10459-023-10248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
There is an expectation that health professions schools respond to priority societal health needs. This expectation is largely based on the underlying assumption that schools are aware of the priority needs in their communities. This paper demonstrates how open-access, pan-national health data can be used to create a reliable health index to assist schools in identifying societal needs and advance social accountability in health professions education. Using open-access data, a psychometric evaluation was conducted to examine the reliability and validity of the Canadian Health Indicators Framework (CHIF) conceptual model. A non-linear confirmatory factor analysis (CFA) on 67 health indicators, at the health-region level (n = 97) was used to assess the model fit of the hypothesized 10-factor model. Reliability analysis using McDonald's Omega were conducted, followed by Pearson's correlation coefficients. Findings from the non-linear CFA rejected the original conceptual model structure of the CHIF. Exploratory post hoc analyses were conducted using modification indices and parameter constraints to improve model fit. A final 5-factor multidimensional model demonstrated superior fit, reducing the number of indicators from 67 to 32. The 5-factors included: Health Conditions (8-indicators); Health Functions (6-indicators); Deaths (5-indicators); Non-Medical Health Determinants (7-indicators); and Community & Health System Characteristics (6-indicators). All factor loadings were statistically significant (p < 0.001) and demonstrated excellent internal consistency ( ω >0.95). Many schools struggle to identify and measure socially accountable outcomes. The process highlighted in this paper and the indices developed serve as starting points to allow schools to leverage open-access data as an initial step in identifying societal needs.
Collapse
Affiliation(s)
- Cassandra Barber
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Cees van der Vleuten
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Saad Chahine
- Faculty of Education, Queen's University, Kingston, ON, Canada
| |
Collapse
|
10
|
Fiore M, Bianconi A, Acuti Martellucci C, Rosso A, Zauli E, Flacco ME, Manzoli L. Impact of the Italian Healthcare Outcomes Program (PNE) on the Care Quality of the Poorest Performing Hospitals. Healthcare (Basel) 2024; 12:431. [PMID: 38391807 PMCID: PMC10887701 DOI: 10.3390/healthcare12040431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
One of the main aims of the Italian National Healthcare Outcomes Program (Programma Nazionale Esiti, PNE) is the identification of the hospitals with the lowest performance, leading them to improve their quality. In order to evaluate PNE impact for a subset of outcome indicators, we evaluated whether the performance of the hospitals with the lowest scores in 2016 had significantly improved after five years. The eight indicators measured the risk-adjusted likelihood of the death of each patient (adjusted relative risk-RR) 30 days after the admission for acute myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease, chronic kidney disease, femur fracture or lung and colon cancer. In 2016, the PNE identified 288 hospitals with a very low performance in at least one of the selected indicators. Overall, 51.0% (n = 147) of these hospitals showed some degree of improvement in 2021, and 27.4% of them improved so much that the death risk of their patients fell below the national mean value. In 34.7% of the hospitals, however, the patients still carried a mean risk of death >30% higher than the average Italian patient with the same disease. Only 38.5% of the hospitals in Southern Italy improved the scores of the selected indicators, versus 68.0% in Northern and Central Italy. Multivariate analyses, adjusting for the baseline performance in 2016, confirmed univariate results and showed a significantly lower likelihood of improvement with increasing hospital volume. Despite the overall methodological validity of the PNE system, current Italian policies and actions aimed at translating hospital quality scores into effective organizational changes need to be reinforced with a special focus on larger southern regions.
Collapse
Affiliation(s)
- Matteo Fiore
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Alessandro Bianconi
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | | | - Annalisa Rosso
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Enrico Zauli
- Department of Medical Translation, University of Ferrara, 44121 Ferrara, Italy
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| |
Collapse
|
11
|
Barcellona C, Mariñas YB, Tan SY, Lee G, Ko KC, Chham S, Chhorvann C, Leerapan B, Pham Tien N, Lim J. Measuring health equity in the ASEAN region: conceptual framework and assessment of data availability. Int J Equity Health 2023; 22:251. [PMID: 38053205 PMCID: PMC10696689 DOI: 10.1186/s12939-023-02059-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Existing research on health equity falls short of identifying a comprehensive set of indicators for measurement across health systems. Health systems in the ASEAN region, in particular, lack a standardised framework to assess health equity. This paper proposes a comprehensive framework to measure health equity in the ASEAN region and highlights current gaps in data availability according to its indicator components. METHODS A comprehensive literature review was undertaken to map out a core set of indicators to evaluate health equity at the health system level. Secondary data collection was subsequently conducted to assess current data availability for ASEAN states in key global health databases, national health accounts, and policy documents. RESULTS A robust framework to measure health equity was developed comprising 195 indicators across Health System Inputs and Processes, Outputs, Outcomes, and Contextual Factors. Total indicator data availability equated to 72.9% (1423/1950). Across the ASEAN region, the Inputs and Processes sub-component of Health Financing had complete data availability for all indicators (160/160, 100%), while Access to Essential Medicine had the least data available (6/30, 20%). Under Outputs and Outcomes, Coverage of Selected Interventions (161/270, 59.63%) and Population Health (350/350, 100%) respectively had the most data available, while other indicator sub-components had little to none (≤ 38%). 72.145% (384/530) of data is available for all Contextual Factors. Out of the 10 ASEAN countries, the Philippines had the highest data availability overall at 77.44% (151/195), while Brunei Darussalam and Vietnam had the lowest data availability at 67.18% (131/195). CONCLUSIONS The data availability gaps highlighted in this study underscore the need for a standardised framework to guide data collection and benchmarking of health equity in ASEAN. There is a need to prioritise regular data collection for overlooked indicator areas and in countries with low levels of data availability. The application of this indicator framework and resulting data availability analysis could be conducted beyond ASEAN to enable cross-regional benchmarking of health equity.
Collapse
Affiliation(s)
- Capucine Barcellona
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | | | - Si Ying Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Gabriel Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Savina Chham
- National Institute of Public Health Cambodia, Phnom Penh, Cambodia
| | - Chhea Chhorvann
- National Institute of Public Health Cambodia, Phnom Penh, Cambodia
| | - Borwornsom Leerapan
- Faculty of Medicine Ramathibodi Hospital, Hanoi University of Public Health, Hanoi, Vietnam
| | | | - Jeremy Lim
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| |
Collapse
|
12
|
Walters JK, Sharma A, Boyce J, Harrison R. Analysis of Centralized Efficiency Improvement Practices in Australian Public Health Systems. J Healthc Leadersh 2023; 15:313-326. [PMID: 38020720 PMCID: PMC10657544 DOI: 10.2147/jhl.s435035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023] Open
Abstract
Aim Analysis of centralized efficiency improvement practices in Australian public health systems. Introduction Public health systems seek to maximize outcomes generated for resources used through efficiency improvement (EI) in response to funding and demand pressures. Despite this focus, evidence for EI approaches at the whole-of-system level is lacking in the literature. There is an urgent need for evidence-based approaches to centralized EI to address these pressures. This study aims to address this gap by answering the research question "How is EI conceptualized and managed by central public health system management entities in Australia?". Material and Methods Document analysis was selected due to its suitability for systematically searching and appraising health system documentation, with this study following Altheide's approach focusing on whole-of-system strategic plan and management framework documents originating from Australian public health organizations. Results Conceptualization of efficiency varied substantially with no consistent definition identified, however common attributes included resource use, management, service and delivery. Forty-two of 43 documents contained approaches associated with improving efficiency at the whole of system level. Discussion While no comprehensive framework for centralized EI was evident, we identified nine core approaches which together characterize centralized EI. Together these approaches represent a comprehensive evidence-based approach to EI at the whole of system level. Conclusion The approaches to whole-of-system EI identified in this study are likely to be highly transferable across health systems internationally with approaches including strategic priority setting, incentivization, performance support, use of EI evidence, digital enablement and workforce capability development.
Collapse
Affiliation(s)
| | - Anurag Sharma
- School of Population Health, UNSW, Sydney, NSW, Australia
| | - Jamie Boyce
- HealthShare NSW, NSW Health, St Leonards, NSW, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| |
Collapse
|
13
|
Rockstroh J, Laut KG, Jakobsen SF, Raben D, Verluyten J, Behrens G, Martinez E, Noori T, Pharris A, Simões D, Sullivan A. An opinion piece on how we move towards common European standards of care for people with HIV. AIDS 2023; 37:1941-1948. [PMID: 37428204 DOI: 10.1097/qad.0000000000003652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
| | - Kamilla G Laut
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Stine F Jakobsen
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Dorthe Raben
- Centre of Excellence for Health, Immunity and Infections, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | | | - Georg Behrens
- Department for Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Esteban Martinez
- Infectious Diseases Unit, Hospital Clínic/University of Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Daniel Simões
- Coalition PLUS/GAT- Grupo de Ativistas em Tratamentos, Lisbon, Portugal
| | - Ann Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
14
|
Gaspar T, Gomez-Baya D, Guedes FB, Correia MF. Health Management: Evaluating the Relationship between Organizational Factors, Psychosocial Risks at Work, Performance Management, and Hospital Outcomes. Healthcare (Basel) 2023; 11:2744. [PMID: 37893818 PMCID: PMC10606603 DOI: 10.3390/healthcare11202744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/21/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Introduction-Health system (HS) health organizations are complex and are in constant dynamic interaction with multiple elements, including political, environmental, societal, legal, and organizational factors, along with human components, such as human resources, patients, and other stakeholders. Objective-This research aimed to study three HS organizations, identifying and characterizing the elements of health organizations and the factors related to professionals, determining their influence on economic and financial performance results, as well as results related to the professionals and to the patients comprising the institutions. Method-A quantitative study was conducted in which data were collected through questionnaires from various sources to better understand and characterize the factors related to organizations, professionals, and patients (470 health professionals and 768 patients). To test the integrated evaluation model for health organizations, path analysis was used. Results-The results reveal that the organizational culture (OC) presents a positive relationship between the professional's quality of life (QL) and the performance management (PM) of the professionals, along with a negative relationship with the psychosocial work risks (PWR). There is also a relationship between the OC and patient satisfaction (PS), professional job satisfaction (PJS), and economic and financial results (EFR). In the relationship between the processes and the results, there are significant relationships between PM and PJS and PWR and PJS. In terms of the results, there is a significant relationship between the EFR and the PS. Conclusions-This study contributes to a deeper knowledge of the factors that influence the quality of health organizations and their results and produces recommendations for health organizations to address the current challenges.
Collapse
Affiliation(s)
- Tânia Gaspar
- Digital Human-Environment Interaction Labs (HEI-LAB), Universidade Lusófona, 1749-024 Lisbon, Portugal
- Institute of Environmental Health (ISAMB), Lisbon University, 1649-028 Lisbon, Portugal; (F.B.G.); (M.F.C.)
| | - Diego Gomez-Baya
- Department of Social, Developmental and Educational Psychology, Universidad de Huelva, 21004 Huelva, Spain;
| | - Fábio Botelho Guedes
- Institute of Environmental Health (ISAMB), Lisbon University, 1649-028 Lisbon, Portugal; (F.B.G.); (M.F.C.)
| | - Manuela Faia Correia
- Institute of Environmental Health (ISAMB), Lisbon University, 1649-028 Lisbon, Portugal; (F.B.G.); (M.F.C.)
- COMEGI—Centro de Investigação em Organizações, Mercados e Gestão Industrial, Lusiada University, 1349-001 Lisbon, Portugal
| |
Collapse
|
15
|
Poroes C, Seematter-Bagnoud L, Wyss K, Peytremann-Bridevaux I. Health System Performance and Resilience in Times of Crisis: An Adapted Conceptual Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6666. [PMID: 37681806 PMCID: PMC10487449 DOI: 10.3390/ijerph20176666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
With the COVID-19 pandemic, the notion of health system (HS) performance has been discussed, and the notion of resilience has become increasingly important. Lacking a recognised framework that measures the performance of HSs throughout a crisis, i.e., one that explicitly includes time as a key aspect, we examined the literature about conceptual frameworks for measuring the performance and the resilience of HSs. This review highlighted a significant diversity among 18 distinct HS performance frameworks and 13 distinct HS resilience frameworks. On this basis, we developed a model that integrates the WHO's widely recognised six building block framework in a novel approach derived from the European Observatory on HSs and Policies. The resulting framework adapts the building blocks to the different stages of a crisis, thereby allowing for a comprehensive assessment of an entire health system's performance throughout the crisis's duration, while also considering the key aspect of resilience. For a more pragmatic use of this framework in the future, indicators will be developed as a next step.
Collapse
Affiliation(s)
- Camille Poroes
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| | - Laurence Seematter-Bagnoud
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, 4123 Allschwil, Switzerland
- Faculty of Natural Science, University of Basel, 4001 Basel, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, 1010 Lausanne, Switzerland
| |
Collapse
|
16
|
Patel C, Rendell N, Sargent GM, Ali A, Morgan C, Fields R, Sheel M. Measuring National Immunization System Performance: A Systematic Assessment of Available Resources. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:e220055. [PMID: 37348935 PMCID: PMC10285727 DOI: 10.9745/ghsp-d-22-00555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/16/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Vaccination coverage is widely used to assess immunization performance but, on its own, provides insufficient information to drive improvements. Assessing the performance of underlying components of immunization systems is less clear, with several monitoring and evaluation (M&E) resources available for use in different operational settings and for different purposes. We studied these resources to understand how immunization system performance is measured. METHODS We reviewed peer-reviewed and gray literature published since 2000 to identify M&E resources that include national-level indicators measuring the performance of immunization systems or their components (governance, financing, regulation, information systems, vaccine logistics, workforce, service delivery, and demand generation). We summarize indicators by the system components or outcomes measured and describe findings narratively. RESULTS We identified 20 resources to monitor immunization program objectives and guide national strategic decision-making, encompassing 631 distinct indicators. Indicators for immunization program outcomes comprised the majority (124/631 [19.7%]), largely vaccination coverage (110/124 [88.7%]). Almost all resources (19/20 [95%]) included indicators for vaccine logistics (83/631 [13.2%]), and those for regulation (19/631 [3.0%]) and demand generation (28/631 [4.4%]) were least common. There was heterogeneity in how information systems (92/563 [14.6%]) and workforce (47/631 [7.4%]) were assessed across resources. Indicators for vaccination coverage in adults, data use in decision-making, equity and diversity, effectiveness of safety surveillance, and availability of a public health workforce were notably lacking. CONCLUSIONS Between the resources identified in this review, we identified considerable variability and gaps in indicators assessing the performance of some immunization system components. Given the multitude of indicators, policymakers may be better served by tailoring evaluation resources to their specific context to gain useful insight into health system performance and improve data use in decision-making for immunization programs.
Collapse
Affiliation(s)
- Cyra Patel
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia.
| | - Nicole Rendell
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
| | - Ginny M Sargent
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
| | - Akeem Ali
- World Health Organization, Seoul, Republic of Korea
| | - Christopher Morgan
- Jhpiego, Baltimore, MD, USA
- School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Burnet Institute, Melbourne, Australia
| | - Rebecca Fields
- JSI Research & Training Institute, Inc., Arlington, VA, USA
| | - Meru Sheel
- National Centre for Epidemiology and Population Health, Australian National University, Acton, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| |
Collapse
|
17
|
Di Fazio N, Scopetti M, Delogu G, La Russa R, Foti F, Grassi VM, Vetrugno G, De Micco F, De Benedictis A, Tambone V, Rinaldi R, Frati P, Fineschi V. Analysis of Medico-Legal Complaint Data: A Retrospective Study of Three Large Italian University Hospitals. Healthcare (Basel) 2023; 11:healthcare11101406. [PMID: 37239691 DOI: 10.3390/healthcare11101406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Identifying hospital-related critical, and excellent, areas represents the main goal of this paper, in both a national and local setting. Information was collected and organized for an internal company's reports, regarding civil litigation that has been affecting the hospital, to relate the obtained results with the phenomenon of medical malpractice on a national scale. This is for the development of targeted improvement strategies, and for investing available resources in a proficient way. (2) Methods: In the present study, data from claims management in Umberto I General Hospital, Agostino Gemelli University Hospital Foundation and Campus Bio-Medico University Hospital Foundation, from 2013 to 2020 were collected. A total of 2098 files were examined, and a set of 13 outcome indicators in the assessment of "quality of care" was proposed. (3) Results: From the total number, only 779 records (37.1%) were attributable to the categories indexable for the present analysis. This data highlights how, following a correct and rigorous categorization of hospital events, it is possible to analyze these medico-legal aspects using a small number of indicators. Furthermore, it is important to consider how a consistent percentage of remaining events was difficult to index, and was also of poor scientific interest. (4) Conclusions: The proposed indicators do not require standards to be compared to, but provide a useful instrument for comparative purposes. In fact, in addition to comparative assessment between different business realities distributed throughout the territory, the use of outcome indicators allows for a longitudinal analysis evaluating the performance of an individual structure over time.
Collapse
Affiliation(s)
- Nicola Di Fazio
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Matteo Scopetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Giuseppe Delogu
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Raffaele La Russa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy
| | - Federica Foti
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo M Grassi
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Vetrugno
- Risk Management Unit, Fondazione Policlinico Universitario "A Gemelli" IRCCS-Legal Medicine, Department of Health Surveillance and Bioethics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco De Micco
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus 12 Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Anna De Benedictis
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Research Unit of Nursing Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Vittoradolfo Tambone
- Research Unit of Bioethics and Humanities, Department of Medicine and Surgery, Università Campus 12 Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
| | - Raffaella Rinaldi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00128 Rome, Italy
| |
Collapse
|
18
|
Mejia GC, Ju X, Kumar S, Soares GH, Balasubramanian M, Sohn W, Jamieson L. Immigrants experience oral health care inequity: findings from Australia's National Study of Adult Oral Health. Aust Dent J 2023; 68:7-18. [PMID: 36229042 PMCID: PMC10952364 DOI: 10.1111/adj.12942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Oral health service utilization contributes to positive oral health and indicates realised access to services. The study aimed to describe patterns of oral health service use among overseas-born and Australian-born populations and assess equity in access to services. METHODS The study used data from Australia's National Study of Adult Oral Health 2017-2018 and was guided by the Aday and Andersen framework of access to health and Australia's National Oral Health Plan. Descriptive analyses of service use by perceived need, enabling and predisposing factors were compared between four groups: Australian-born and overseas-born who mainly speak English and Australian-born and overseas-born who mainly speak a language other than English. RESULTS Overseas-born who mainly speak a language other than English experienced greater oral health care inequity, largely driven by financial difficulty (avoided care due to cost: 42% vs 27%-28%; avoided/delayed visiting due to cost: 48% vs. 37%-38%; cost prevented treatment: 32% vs. 18%-24%). The most favourable visiting patterns were among the Australian-born population who speak a language other than English. CONCLUSIONS The study shows clear inequity experienced among immigrants in accessibility as measured through indicators of oral health care utilization and factors related to inequity, such as the ability to pay for services.
Collapse
Affiliation(s)
- GC Mejia
- Australian Research Centre for Population Oral HealthAdelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - X Ju
- Australian Research Centre for Population Oral HealthAdelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - S Kumar
- Allied Health and Human PerformanceUniversity of South AustraliaAdelaideSouth AustraliaAustralia
| | - GH Soares
- Australian Research Centre for Population Oral HealthAdelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| | - M Balasubramanian
- Health Care ManagementCollege of Business, Government and Law, Flinders UniversityAdelaideSouth AustraliaAustralia
- Menzies Centre for Health Policy and EconomicsSchool of Public Health, The University of SydneySydneyNew South WalesAustralia
| | - W Sohn
- Population Oral Health, Sydney Dental School, Faculty of Medicine and HealthThe University of SydneyAdelaideSouth AustraliaAustralia
| | - L Jamieson
- Australian Research Centre for Population Oral HealthAdelaide Dental School, University of AdelaideAdelaideSouth AustraliaAustralia
| |
Collapse
|
19
|
Santos JV, Martins FS, Pestana J, Souza J, Freitas A, Cylus J. Should we adjust health expenditure for age structure on health systems efficiency? A worldwide analysis. HEALTH ECONOMICS REVIEW 2023; 13:11. [PMID: 36781709 PMCID: PMC9926817 DOI: 10.1186/s13561-023-00421-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Healthcare expenditure, a common input used in health systems efficiency analyses is affected by population age structure. However, while age structure is usually considered to adjust health system outputs, health expenditure and other inputs are seldom adjusted. We propose methods for adjusting Health Expenditure per Capita (HEpC) for population age structure on health system efficiency analyses and assess the goodness-of-fit, correlation, reliability and disagreement of different approaches. METHODS We performed a worldwide (188 countries) cross-sectional study of efficiency in 2015, using a stochastic frontier analysis. As single outputs, healthy life expectancy (HALE) at birth and at 65 years-old were considered in different models. We developed five models using as inputs: (1) HEpC (unadjusted); (2) age-adjusted HEpC; (3) HEpC and the proportion of 0-14, 15-64 and 65 + years-old; (4) HEpC and 5-year age-groups; and (5) HEpC ageing index. Akaike and Bayesian information criteria, Spearman's rank correlation, intraclass correlation coefficient and information-based measure of disagreement were computed. RESULTS Models 1 and 2 showed the highest correlation (0.981 and 0.986 for HALE at birth and HALE at 65 years-old, respectively) and reliability (0.986 and 0.988) and the lowest disagreement (0.011 and 0.014). Model 2, with age-adjusted HEpC, presented the lowest information criteria values. CONCLUSIONS Despite different models showing good correlation and reliability and low disagreement, there was important variability when age structure is considered that cannot be disregarded. The age-adjusted HE model provided the best goodness-of-fit and was the closest option to the current standard.
Collapse
Affiliation(s)
- João Vasco Santos
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal.
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal.
- Public Health Unit, ARS Norte, Espinho/Gaia, Portugal.
| | | | - Joana Pestana
- Nova School of Business and Economics, Universidade Nova de Lisboa, Carcavelos, Portugal
| | - Júlio Souza
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Alberto Freitas
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
- CINTESIS - Centre for Health Technology and Services Research, Porto, Portugal
| | - Jonathan Cylus
- Department of Health Policy, London School of Economics and Political Science, London, UK
- European Observatory On Health Systems and Policies, London, UK
| |
Collapse
|
20
|
Al-Ghamdi M, AlTamimi M, Al-Azmi N, Al-Ghaith T, AlMuaither F, AlThunayyan R, AlDlaigan F, Bazaid AS, AlShehri A. Development of national framework for health status and health system performance indicators in Saudi Arabia. J Infect Public Health 2023; 16:295-302. [PMID: 36630837 DOI: 10.1016/j.jiph.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/15/2022] [Accepted: 12/26/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The global shift to value-based care has highlighted the necessity for performance measurement in healthcare. While the implementation may be incomplete, governments and providers have been moving towards value-based models of care delivery, funding and performance measurement. OBJECTIVES The purpose of this report is to illustrate the steps taken in designing the framework in Kingdom of Saudi Arabia (KSA), using a 4-step approach: Key Input Analysis, Hierarchy Design, Indicator Analysis and Selection, and Indicator Profile Development. Furthermore, it presents a comprehensive view of the indicators collected to measure performance at the level of the Health System and Health Status in KSA and highlights main patient concerns, thus providing an overview of a new, unified national framework. METHODS The methodology entailed examined the following components' remits and roles, reporting mechanisms and channels, and performance indicators across all pertinent National Health agencies (NHA), by conducting a SWOT analysis of each of the components across the ecosystem. Engagement with the Steering Committee members was achieved through research and interviews. RESULTS A total of 109 indicators were identified, of which 51 were Health Status Indicator Profiles and 58 Health System Indicators. The indicator profiles were developed with consideration of the KSA context in terms of the healthcare ecosystem as it stands today. The findings of this report, alongside the best practices arising from the benchmarking, will be key inputs into the design of the National Framework. CONCLUSION The regulatory entity has set out to establish a National Framework, which aims to unify performance measurement in KSA from both health system and public health perspectives across all sectors providing healthcare services, based on a list of prioritized KPIs and their complete profiles, outlining the formulae, key responsibilities, and reporting mechanisms pertaining to each one.
Collapse
Affiliation(s)
- Mohammed Al-Ghamdi
- National Health Care Strategy Department, National Health Economics and Policies, National Health Care Strategy Department, Saudi Health Council, 13315, Saudi Arabia.
| | - Mohammed AlTamimi
- National Health Care Strategy Department, National Health Economics and Policies, Saudi Health Council, 13315, Saudi Arabia.
| | | | - Taghred Al-Ghaith
- National Health Economics and Policies, National Health Economics and Policies, Saudi Health Council, 13315, Saudi Arabia.
| | - Farah AlMuaither
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University. 11451 Riyadh, Saudi Arabia.
| | - Reema AlThunayyan
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University. 11451 Riyadh, Saudi Arabia.
| | - Farah AlDlaigan
- Community Health Sciences Department, College of Applied Medical Sciences, King Saud University. 11451 Riyadh, Saudi Arabia.
| | - Abdulrahman S Bazaid
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Hail, Hail 53962, Saudi Arabia.
| | - Ahlam AlShehri
- National Health Economics Department, National Health Economics and Policies, Saudi Health Council, 13315, Saudi Arabia.
| |
Collapse
|
21
|
Rasooly A, Pan Y, Tang Z, Jiangjiang H, Ellen ME, Manor O, Hu S, Davidovitch N. Quality and Performance Measurement in Primary Diabetes Care: A Qualitative Study in Urban China. Int J Health Policy Manag 2022; 11:3019-3031. [PMID: 35942954 PMCID: PMC10105207 DOI: 10.34172/ijhpm.2022.6372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 05/17/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Quality measurements in primary healthcare (PHC) have become an essential component for improving diabetes outcomes in many high-income countries. However, little is known about their implementation within the Chinese health-system context and how they are perceived by patients, physicians, and policy-makers. We examined stakeholders' perceptions of quality and performance measurements for primary diabetes care in Shanghai, China, and analyzed facilitators and barriers to implementation. METHODS In-depth interviews with 26 key stakeholders were conducted from 2018 to 2019. Participants were sampled from two hospitals, four community healthcare centers (CHCs), and four institutes involved in regulating CHCs. The Consolidated Framework for Implementation Research (CFIR) guided data analysis. RESULTS Existing quality measurements were uniformly implemented via a top-down process, with daily monitoring of family doctors' work and pay-for-performance incentives. Barriers included excluding frontline clinicians from indicator planning, a lack of transparent reporting, and a rigid organizational culture with limited bottom-up feedback. Findings under the CFIR construct "organizational incentives" suggested that current pay-for-performance incentives function as a "double-edged sword," increasing family doctors' motivation to excel while creating pressures to "game the system" among some physicians. When considering the CFIR construct "reflecting and evaluating," policy-makers perceived the online evaluation application - which provides daily reports on family doctors' work - to be an essential tool for improving quality; however, this information was not visible to patients. Findings included under the "network and communication" construct showed that specialists support the work of family doctors by providing training and patient consultations in CHCs. CONCLUSION The quality of healthcare could be considerably enhanced by involving patients and physicians in decisions on quality measurement. Strengthening hospital-community partnerships can improve the quality of primary care in hospital-centric systems. The case of Shanghai provides compelling policy lessons for other health systems faced with the challenge of improving PHC.
Collapse
Affiliation(s)
- Alon Rasooly
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Yancen Pan
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Zhenqing Tang
- Shanghai Health Development Research Center, Shanghai, China
| | - He Jiangjiang
- Shanghai Health Development Research Center, Shanghai, China
| | - Moriah E. Ellen
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel. 5 School of Public Health, Fudan University, Shanghai, China
| | - Shanlian Hu
- School of Public Health, Fudan University, Shanghai, China
| | - Nadav Davidovitch
- School of Public Health, Ben-Gurion University of the Negev, Beer Sheva, Israel
| |
Collapse
|
22
|
Rendell N, Rosewell A, Lokuge K, Field E. Common Features of Selection Processes of Health System Performance Indicators in Primary Healthcare: A Systematic Review. Int J Health Policy Manag 2022; 11:2805-2815. [PMID: 35368205 PMCID: PMC10105193 DOI: 10.34172/ijhpm.2022.6239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 03/06/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Health system performance indicators are widely used to assess primary healthcare (PHC) performance. Despite the numerous tools and some convergence on indicator criteria, there is not a clear understanding of the common features of indicator selection processes. We aimed to review the literature to identify papers that document indicator selection processes for health system performance indicators in PHC. METHODS We searched the online databases Scopus, Medline, and CINAHL, as well as the grey literature, without time restrictions, initially on July 31, 2019 followed by an update November 13, 2020. Empirical studies or reports were included if they described the selection of health system performance indicators or frameworks, that included PHC indicators. A combination of the process focussed research question and qualitative analysis meant a quality appraisal tool or assessment of bias could not meaningfully be applied to assess individual studies. We undertook an inductive analysis based on potential indicator selection processes criteria, drawn from health system performance indicator appraisal tools reported in the literature. RESULTS We identified 16 503 records of which 28 were included in the review. Most studies used a descriptive case study design. We found no consistent variations between indicator selection processes of health systems of high income and low- or lower-middle income countries. Identified common features of selection processes for indicators in PHC include literature review or adaption of an existing framework as an initial step; a consensus building process with stakeholders; structuring indicators into categories; and indicator criteria focusing on validity and feasibility. The evidence around field testing with utility and consideration of reporting burden was less clear. CONCLUSION Our findings highlight several characteristics of health system indicator selection processes. These features provide the groundwork to better understand how to value indicator selection processes in PHC.
Collapse
Affiliation(s)
- Nicole Rendell
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Alexander Rosewell
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Emma Field
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
- Menzies School of Health Research, Brisbane, QLD, Australia
| |
Collapse
|
23
|
Shah V, Yassa B, Khajuria A, Khajuria A. Impact of
COVID
‐19, gender, race, specialty and seniority on mental health during surgical training: an international study. ANZ J Surg 2022; 92:3117. [DOI: 10.1111/ans.18048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/04/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Viraj Shah
- Department of Medicine, Faculty of Medicine Imperial College London London UK
| | - Bishoy Yassa
- Barts and The London School of Medicine and Dentistry Queen Mary University of London London UK
| | - Apoorva Khajuria
- Department of Trauma & Orthopaedics The Royal National Orthopaedic Hospital Stanmore UK
| | - Ankur Khajuria
- Department of Surgery & Cancer Imperial College London London UK
- Kellogg College University of Oxford Oxford UK
| |
Collapse
|
24
|
Sevilla JP. The value of vaccines. Curr Opin Immunol 2022; 78:102243. [PMID: 36156412 DOI: 10.1016/j.coi.2022.102243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 06/24/2022] [Accepted: 08/11/2022] [Indexed: 01/28/2023]
Abstract
Optimizing vaccine spending depends on recognizing the full value of vaccination (VoV). Existing taxonomies of such value are not comprehensive because they are not guided by general theories. I rely on two such theories: subjective-value theory claims that what has value is determined by what people actually or ideally want in life. A welfarist theory of government states that a fundamental objective of government is to promote social value (or social welfare). These jointly imply that any aspect of life that individuals actually or ideally value and that could be negatively affected by vaccine-preventable diseases (and therefore positively affected by preventive vaccines) is an element of VoV. I build a more comprehensive-value taxonomy than currently exists based on this implication.
Collapse
Affiliation(s)
- J P Sevilla
- Data for Decisions, LLC, Harvard T. H. Chan School of Public Health, USA.
| |
Collapse
|
25
|
Kamran H, Piske M, Min JE, Pearce LA, Zhou H, Homayra F, Wang L, Small W, Nosyk B. Validation and endorsement of health system performance measures for opioid use disorder in British Columbia, Canada: A Delphi panel study. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100095. [PMID: 36844158 PMCID: PMC9948861 DOI: 10.1016/j.dadr.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/16/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2022]
Abstract
Background Limited data exists on the performance of the healthcare system in opioid use disorder (OUD). We evaluated the face validity and potential risks of a set of health system performance measures for OUD collaboratively with clinicians, policymakers and people with lived experience of opioid use (PWLE) in the interest of establishing an endorsed set of measures for public reporting. Methods Through a two-stage Delphi-panel approach, a panel of clinical and policy experts validated and considered 102 previously constructed OUD performance measures for endorsement using information on measurement construction, sensitivity analyses, quality of evidence, predictive validity, and feedback from local PWLE. We collected quantitative and qualitative survey responses from 49 clinicians and policymakers, and 11 PWLE. We conducted inductive and deductive thematic analysis to present qualitative responses. Results A total of 37 measures of 102 were strongly endorsed (9/13 cascade of care, 2/27 clinical guideline compliance, 17/44 healthcare integration, and 9/18 healthcare utilization measures). Thematic analysis of responses revealed several themes regarding measurement validity, unintended consequences, and key contextual considerations. Overall, measures related to the cascade of care (excluding opioid agonist treatment dose tapering) received strong endorsements. PWLE highlighted barriers to accessing treatment, undignified aspects of treatment, and lack of a full continuum of care as their concerns. Conclusion We defined 37 endorsed health system performance measures for OUD and presented a range of perspectives on their validity and use. These measures provide critical considerations for health system improvement in the care of people with OUD.
Collapse
Affiliation(s)
- Hasham Kamran
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Micah Piske
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jeong Eun Min
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Lindsay A Pearce
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Haoxuan Zhou
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Fahmida Homayra
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Linwei Wang
- BC Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, Vancouver, British Columbia, Canada
| | - Bohdan Nosyk
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| |
Collapse
|
26
|
Sheikh K, Peters D, Agyepong IA, Abimbola S, Ghaffar A, Swaminathan S. Learning is a means to progress and empowerment for health systems. BMJ Glob Health 2022; 7:bmjgh-2022-010572. [PMID: 36130795 PMCID: PMC9490602 DOI: 10.1136/bmjgh-2022-010572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/31/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- Kabir Sheikh
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | - David Peters
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Irene Akua Agyepong
- Dodowa Health Research Centre, Ghana Health Service, Accra, Greater Accra, Ghana
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, World Health Organization, Geneve, Switzerland
| | | |
Collapse
|
27
|
McDonald PL, Phillips J, Harwood K, Maring J, van der Wees PJ. Identifying requisite learning health system competencies: a scoping review. BMJ Open 2022; 12:e061124. [PMID: 35998963 PMCID: PMC9403130 DOI: 10.1136/bmjopen-2022-061124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Learning health systems (LHS) integrate knowledge and practice through cycles of continuous quality improvement and learning to increase healthcare quality. LHS have been conceptualised through multiple frameworks and models. Our aim is to identify and describe the requisite individual competencies (knowledge, skills and attitudes) and system competencies (capacities, characteristics and capabilities) described in existing literature in relation to operationalising LHS. METHODS A scoping review was conducted with descriptive and thematic analysis to identify and map competencies of LHS for individuals/patients, health system workers and systems. Articles until April 2020 were included based on a systematic literature search and selection process. Themes were developed using a consensus process until agreement was reached among team members. RESULTS Eighty-nine articles were included with most studies conducted in the USA (68 articles). The largest number of publications represented competencies at the system level, followed by health system worker competencies. Themes identified at the individual/patient level were knowledge and skills to understand and share information with an established system and the ability to interact with the technology used to collect data. Themes at the health system worker level were skills in evidence-based practice, leadership and teamwork skills, analytical and technological skills required to use a 'digital ecosystem', data-science knowledge and skill and self-reflective capacity. Researchers embedded within LHS require a specific set of competencies. Themes identified at the system level were data, infrastructure and standardisation; integration of data and workflow; and culture and climate supporting ongoing learning. CONCLUSION The identified individual stakeholder competencies within LHS and the system capabilities of LHS provide a solid base for the further development and evaluation of LHS. International collaboration for stimulating LHS will assist in further establishing the knowledge base for LHS.
Collapse
Affiliation(s)
- Paige L McDonald
- Department of Clinical Research and Leadership, The George Washington University, Washington, District of Columbia, USA
| | - Jessica Phillips
- Department of Clinical Research and Leadership, The George Washington University, Washington, District of Columbia, USA
| | - Kenneth Harwood
- College of Health and Education, Marymount University, Arlington, Virginia, USA
| | - Joyce Maring
- Department of Health, Human Function, The George Washington University, Washington, District of Columbia, USA
| | - Philip J van der Wees
- Department of Clinical Research and Leadership, The George Washington University, Washington, District of Columbia, USA
- Rehabilitation and IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| |
Collapse
|
28
|
Healthcare Service Interventions to Improve the Healthcare Outcomes of Hospitalised Patients with Extreme Obesity: Protocol for an Evidence and Gap Map. Methods Protoc 2022; 5:mps5030048. [PMID: 35736549 PMCID: PMC9228870 DOI: 10.3390/mps5030048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/05/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
Hospitalised patients with extreme obesity have poorer healthcare outcomes compared to normal weight patients. How hospital services are coordinated and delivered to meet the care needs of patients with extreme obesity is not well understood. The aim of the proposed evidence gap map (EGM) is to identify and assess the available evidence on healthcare interventions to improve healthcare outcomes for hospitalised patients with extreme obesity. This research will use standardised evidence gap map methods to undertake a five-stage process to develop an intervention–outcome framework; identify the current evidence; critically appraise the quality of the evidence, extract, code, and summarise the data in relation to the EGM objectives; and create a visualisation map to present findings. This EGM will provide a means of determining the nature and quality of health service initiatives available, identify the components of the services delivered and the outcome measures used for evaluation, and will identify areas where there is a lack of research that validates the funding of new research studies.
Collapse
|
29
|
Nosyk B, Min JE, Pearce LA, Zhou H, Homayra F, Wang L, Piske M, McCarty D, Gardner G, O'Briain W, Wood E, Daly P, Walsh T, Henry B. Development and validation of health system performance measures for opioid use disorder in British Columbia, Canada. Drug Alcohol Depend 2022; 233:109375. [PMID: 35231716 DOI: 10.1016/j.drugalcdep.2022.109375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/11/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Performance measurement provides an evidence-based means to inform development of interventions to improve the quality of care for people who use opioids. We aimed to develop and assess the predictive validity of health system performance measures for opioid use disorder (OUD) in British Columbia (BC), Canada. METHODS Performance measures were generated using retrospective population-level administrative datasets (both provincial and regional) and publicly-reported retrospective data according to four domains (care engagement, clinical guideline compliance, integration, and healthcare utilization). The adjusted odds ratio was estimated via generalized linear mixed models to determine predictive validity for all-cause hospitalization or mortality within 6 months of measurement. FINDINGS A total of 102 performance measures were constructed. We identified 55,470 diagnosed PWOUD, and 39,456 ever engaged in opioid agonist treatment (OAT). We found divergent rates of treatment for concurrent conditions (7.4% for alcohol use disorder to 80.1% for HIV/AIDS), low levels of linkage to OAT and other outpatient care following acute care, and increasing levels of service provision, including increases in OAT prescribers and pharmacies, naloxone kit distribution and overdose prevention site visitation. Our analyses on the predictive validity measures largely supported a priori hypotheses on the direction of effect on the outcome. CONCLUSIONS We identified a range of priorities to improve the quality of care for PWOUD, with critical gaps in linkage to care through acute care settings and long-term engagement in OAT. The proposed measures can be derived for geographic and clinical subgroups and updated over time, providing a basis to monitor and evaluate efforts to address the public health burden of OUD.
Collapse
Affiliation(s)
- B Nosyk
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Rm 11300 8888 University Drive, Burnaby, British Columbia V5A 1S6, Canada.
| | - J E Min
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - L A Pearce
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - H Zhou
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - F Homayra
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - L Wang
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - M Piske
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St Paul's Hospital, 588-1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - D McCarty
- Oregon Health & Science University, 1810 SW 5th Ave, Flrs 2 5 and 6, Portland, OR 97201, USA
| | - G Gardner
- British Columbia Ministry of Mental Health and Addictions, PO Box 9672 Stn Prov Govt, Victoria, British Columbia V8W 9P6, Canada
| | - W O'Briain
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada
| | - E Wood
- British Columbia Centre on Substance Use, 1045 Howe St Suite 400, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317 -2194 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - P Daly
- Vancouver Coastal Health Authority, 601 West Broadway, Vancouver, British Columbia V5Z 4C2, Canada
| | - T Walsh
- British Columbia Ministry of Mental Health and Addictions, PO Box 9672 Stn Prov Govt, Victoria, British Columbia V8W 9P6, Canada
| | - B Henry
- Office of the Provincial Health Officer, PO Box 9648, Stn Prov Govt, Victoria, British Columbia V8W 9P4, Canada
| |
Collapse
|
30
|
Kielmann K, Hutchinson E, MacGregor H. Health systems performance or performing health systems? Anthropological engagement with health systems research. Soc Sci Med 2022; 300:114838. [DOI: 10.1016/j.socscimed.2022.114838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
31
|
Feng C, Zhu J, Chen Y. The evolution and inter-sectoral interaction mechanism of China's national medical alliance: An analysis based on complex systems theory. Int J Health Plann Manage 2022; 37:1454-1476. [PMID: 34984751 DOI: 10.1002/hpm.3413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/27/2021] [Accepted: 12/21/2021] [Indexed: 11/09/2022] Open
Abstract
This work investigates the performance and inter-sectoral interaction mechanism of China's largest vertically integrated care network, the national medical alliance (NMA). The data collected derive from the China Health Statistics Bulletin and the China Health Statistical Yearbook for the period 2009-2018. The data include 64 observation indicators for five medical sectors in the NMA, namely, tertiary hospitals (THS), secondary hospitals (SHS), community health centres (CHCS), township hospitals (TsHS) and professional public health institutions (PPHIS). This research combines complex systems theory with a multilevel structural dynamic factor model, and yields two main results. First, although the trend for the NMA's global factor is increasing, the evolutionary paths for sectoral factors differ substantially. Among the sectoral factors, the sectoral factor of THS continued to decline, and neither the sectoral factor of CHCS nor the sectoral factor of TsHS has significantly improved. Then, the interaction mechanism between the various NMA sectors is investigated. While a close relationship has been formed between THS and CHCS and between SHS and CHCS, there remains no close two-way relationship between either THS and TsHS or THS and SHS. Thus, going forward, to reach the policy expectations, China's NMA implementation must consider the interaction between different constituent sectors.
Collapse
Affiliation(s)
- Chong Feng
- Management School, Xiamen University, Xiamen, China.,Data Mining Research Center, Xiamen University, Xiamen, China
| | - Jianping Zhu
- Management School, Xiamen University, Xiamen, China.,Data Mining Research Center, Xiamen University, Xiamen, China
| | - Yusheng Chen
- Data Mining Research Center, Xiamen University, Xiamen, China.,School of Finance and Economics, Jimei University, Xiamen, China
| |
Collapse
|
32
|
Corrao G, Barbato A, D’Avanzo B, Di Fiandra T, Ferrara L, Gaddini A, Monzio Compagnoni M, Saponaro A, Scondotto S, Tozzi VD, Carle F, Lora A. Does the mental health system provide effective coverage to people with schizophrenic disorder? A self-controlled case series study in Italy. Soc Psychiatry Psychiatr Epidemiol 2022; 57:519-529. [PMID: 34132836 PMCID: PMC8934324 DOI: 10.1007/s00127-021-02114-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 06/02/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To measure indicators of timeliness and continuity of treatments on patients with schizophrenic disorder in 'real-life' practice, and to validate them through their relationship with relapse occurrences. METHODS The target population was from four Italian regions overall covering 22 million beneficiaries of the NHS (37% of the entire Italian population). The cohort included 12,054 patients newly taken into care for schizophrenic disorder between January 2015 and June 2016. The self-controlled case series (SCCS) design was used to estimate the incidence rate ratio of relapse occurrences according to mental healthcare coverage. RESULTS Poor timeliness (82% and 33% of cohort members had not yet started treatment with psychosocial interventions and antipsychotic drug therapy within the first year after they were taken into care) and continuity (27% and 23% of patients were persistent with psychosocial interventions, and antipsychotic drug therapy within the first 2 years after starting the specific treatment) were observed. According to SCCS design, 4794 relapses occurred during 9430 PY (with incidence rate of 50.8 every 100 PY). Compared with periods not covered by mental healthcare, those covered by psychosocial intervention alone, antipsychotic drugs alone and by psychosocial intervention and antipsychotic drugs together were, respectively, associated with relapse rate reductions of 28% (95% CI 4-46%), 24% (17-30%) and 44% (32-53%). CONCLUSION Healthcare administrative data may contribute to monitor and to assess the effectiveness of a mental health system. Persistent use of both psychosocial intervention and antipsychotic drugs reduces risk of severe relapse.
Collapse
Affiliation(s)
- Giovanni Corrao
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy ,grid.7563.70000 0001 2174 1754Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, 20126 Milan, Italy
| | - Angelo Barbato
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Barbara D’Avanzo
- Unit for Quality of Care and Rights Promotion in Mental Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Di Fiandra
- grid.415788.70000 0004 1756 9674General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Lucia Ferrara
- grid.7945.f0000 0001 2165 6939Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | | | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy. .,Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, 20126, Milan, Italy.
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy ,Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D. Tozzi
- grid.7945.f0000 0001 2165 6939Centre of Research on Health and Social Care Management, SDA Bocconi School of Management, Bocconi University, Milan, Italy
| | - Flavia Carle
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy ,grid.7010.60000 0001 1017 3210Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Antonio Lora
- grid.7563.70000 0001 2174 1754National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy ,Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | | |
Collapse
|
33
|
Dudley L, Mamdoo P, Naidoo S, Muzigaba M. Towards a harmonised framework for developing quality of care indicators for global health: a scoping review of existing conceptual and methodological practices. BMJ Health Care Inform 2022; 29:e100469. [PMID: 35078776 PMCID: PMC8796246 DOI: 10.1136/bmjhci-2021-100469] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 12/08/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Despite significant advances in the science of quality of care measurement over the last decade, approaches to developing quality of care indicators for global health priorities are not clearly defined. We conducted a scoping review of concepts and methods used to develop quality of healthcare indicators to better inform ongoing efforts towards a more harmonised approach to quality of care indicator development in global health. METHODS We conducted a systematic search of electronic databases, grey literature and references for articles on developing quality of care indicators for routine monitoring in all healthcare settings and populations, published in English between 2010 and 2020. We used well-established methods for article screening and selection, data extraction and management. Results were summarised using a descriptive analysis and a narrative synthesis. RESULTS The 221 selected articles were largely from high-income settings (89%), particularly the USA (46%), Canada (9%), UK (9%) and Europe (17%). Quality of care indicators were developed mainly for healthcare providers (56%), for benchmarking or quality assurance (37%) and quality improvement (29%), in hospitals (32%) and primary care (26%), across many diseases. The terms 'quality indicator' and 'quality measure' were the most frequently encountered terms (50% and 21%, respectively). Systematic approaches for quality of care indicator development emerged within national quality of care systems or through cross-country collaborations in high-income settings. Maternal, neonatal and child health (33%), mental health (26%) and primary care (57%) studies applied most components of systematic approaches, but not consistently or rigorously. DISCUSSION The current evidence shows variations in concepts and approaches to developing quality of care indicators, with development and application mainly in high-income countries. CONCLUSION Additional efforts are needed to propose 'best-practice' conceptual frameworks and methods for developing quality of care indicators to improve their utility in global health measurement.
Collapse
Affiliation(s)
- Lilian Dudley
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Puni Mamdoo
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Selvan Naidoo
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Moise Muzigaba
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| |
Collapse
|
34
|
Brito Fernandes Ó, Barbazza E, Ivanković D, Jansen T, Klazinga NS, Kringos DS. Engaging citizens in the development of a health system performance assessment framework: a case study in Ireland. Health Res Policy Syst 2021; 19:148. [PMID: 34930309 PMCID: PMC8685819 DOI: 10.1186/s12961-021-00798-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/25/2021] [Indexed: 12/05/2022] Open
Abstract
Background The launch in 2017 of the Irish 10-year reform programme Sláintecare represents a key commitment in the future of the health system. An important component of the programme was the development of a health system performance assessment (HSPA) framework. In 2019, the Department of Health of Ireland (DoH) and Health Service Executive (HSE) commissioned the technical support of researchers to develop an outcome-oriented HSPA framework which should reflect the shared priorities of multiple stakeholders, including citizens. This study describes the method applied in the Irish context and reflects on the added value of using a citizen panel in the development of an HSPA framework. Methods A panel of 15 citizens was convened, recruited by a third-party company using a sampling strategy to achieve a balanced mix representing the Irish society. Panellists received lay-language preparatory materials before the meeting. Panellists used a three-colour scheme to signal the importance of performance measures. An exit questionnaire was administered to understand how participants experienced being part of the panel. The citizen panel was the first in a series of three panels towards the development of the HSPA framework, followed by panels including representatives of the DoH and HSE, and representatives from professional associations and special interest groups. Results The citizen panel generated 249 health performance measures ranging across 13 domains. Top-ranking domains to the citizen panel (people-centredness, coordination of care, and coverage) were less prioritized by the other panels; domains less prioritized by the citizen panel, such as accessibility, responsiveness, efficiency, and effectiveness, were of higher priority in the other panels. Citizen panellists shared a similar understanding of what a citizen panel involves and described their experience at the panel as enjoyable, interesting, and informative. Conclusions The priorities of the citizen panel were accounted for during all phases of developing the HSPA framework. This was possible by adopting an inclusive development process and by engaging citizens early on. Citizen engagement in HSPA development is essential for realizing citizen-driven healthcare system performance and generating trust and ownership in performance intelligence. Future research could expand the use of citizen panels to assess, monitor, and report on the performance of healthcare systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-021-00798-8.
Collapse
Affiliation(s)
- Óscar Brito Fernandes
- Department of Health Economics, Corvinus University of Budapest, Fővám tér 8, 1093, Budapest, Hungary. .,Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Erica Barbazza
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Damir Ivanković
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Tessa Jansen
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Niek S Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Dionne S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health research institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
35
|
Barbazza E, Klazinga NS, Kringos DS. Exploring the actionability of healthcare performance indicators for quality of care: a qualitative analysis of the literature, expert opinion and user experience. BMJ Qual Saf 2021; 30:1010-1020. [PMID: 33963072 PMCID: PMC8606459 DOI: 10.1136/bmjqs-2020-011247] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND This study explores the meaning of actionable healthcare performance indicators for quality of care-related decisions. To do so, we analyse the constructs of fitness for purpose and fitness for use across healthcare systems and in practice based on the literature, expert opinion and user experience. METHODS A multiphase qualitative study was undertaken. Phases included a literature review, a first round of one-on-one interviews with a panel of academics and thought leaders in the field (n=16), and a second round of interviews with real-world users of performance indicators (n=16). Thematic analysis was conducted between phases in order to triangulate findings in a stepwise process. RESULTS Common uses of healthcare performance indicators were differentiated within micro-meso-macro contexts of healthcare systems. Each purpose of use signals different decision-making tasks, and in effect information needs. An indicator's fitness for use can be appraised by three clusters of considerations: methodological, contextual and managerial. Methodological considerations gauge an indicator's perceived importance, engagement potential, interpretability, standardisation, feasibility of remedial actions, alignment to care models and sensitivity to change. Information infrastructure, system governance, workforce capacity and learning culture were found as enabling contextual considerations. Managerial considerations influencing an indicator's use in practice were found to span the selection of indicators, data collection, analysis, display of results and delivery of information to decision-makers. CONCLUSION The actionability of a healthcare performance indicator should be appraised by its alignment with the intended purpose of use beyond aggregate healthcare system levels, in combination with the extent to which methodological, contextual and managerial fitness for use considerations are met. Striking a better balance between the importance weighted to an indicator's statistical merits and emphasis put to its fitness for purpose and use is needed for indicators that are ultimately actionable for quality of care-related decision-making.
Collapse
Affiliation(s)
- Erica Barbazza
- Department of Public and Occupational Health, Academic Medical Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Niek S Klazinga
- Department of Public and Occupational Health, Academic Medical Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne S Kringos
- Department of Public and Occupational Health, Academic Medical Centre, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
36
|
Luzi D, Rocco I, Tamburis O, Corso B, Minicuci N, Pecoraro F. Variability in the assessment of children's primary healthcare in 30 European countries. Int J Qual Health Care 2021; 33:6101213. [PMID: 33449077 PMCID: PMC7869189 DOI: 10.1093/intqhc/mzab007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 12/12/2020] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
Background The high variability in the types and number of measures adopted to evaluate childcare across European countries makes it necessary to investigate country practices to identify trends in setting national priorities in the assessment of child well-being. Objective This paper intends to investigate country practices under the lens of variability to explore possible trends in setting national priority in the evaluation of childcare. In particular, it analyses variability considering to what extent this depends on the tendency of adopting a broad vision (i.e. selecting measures for a larger variety of aspects) or whether this is influenced by the choice of adopting an in-depth approach (i.e. using more measures to analyse a specific aspect) Methods An ad hoc questionnaire was administered to a national expert in each country and yielded 352 measures. To analyse variability, the breadth in the number of aspects considered was explored using a convergence index, while the depth in the distribution of measures in each aspect was investigated by computing a coefficient of variation. Countries were grouped by adopting a hierarchical clustering approach. Results There is a high variability across countries in the selection of measures that cover different aspects of childcare. Preferences in the distribution of measures are significant even at the domain level and in countries that use a limited number of measures and become more evident at the category and sub-category levels. The statistical analysis clusters countries in four main groups and two outliers. The in-depth distribution of measures focused on a specific aspect shows a homogeneous pattern, with the identification of two main groups of countries. Conclusions A limited set of measures are shared across countries hampering a robust comparison of paediatric models. The selection of measures shows that the evaluation is closely related to national priorities as resulting from the number and types of measures adopted. Moreover, a range of a reasonable number of measures can be hypothesized to address the quality of childcare under a multi-dimensional perspective.
Collapse
Affiliation(s)
- daniela Luzi
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy
| | - Ilaria Rocco
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Oscar Tamburis
- National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy
| | - Barbara Corso
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Nadia Minicuci
- National Research Council, Neuroscience Institute, Via Giustiniani 2, Padua, Veneto 35128, Italy
| | - Fabrizio Pecoraro
- Address reprint requests to: Fabrizio Pecoraro, National Research Council, Institute for Research on Population and Social Policies, via Palestro, 32, Rome, Lazio 00185, Italy. Tel: +39-06492724278; Fax: 39-06-4938-3724; E-mail:
| |
Collapse
|
37
|
Stover AM, Kurtzman R, Walker Bissram J, Jansen J, Carr P, Atkinson T, Ellis CT, Freeman AT, Turner K, Basch EM. Stakeholder Perceptions of Key Aspects of High-Quality Cancer Care to Assess with Patient Reported Outcome Measures: A Systematic Review. Cancers (Basel) 2021; 13:cancers13143628. [PMID: 34298841 PMCID: PMC8306432 DOI: 10.3390/cancers13143628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary We conducted a review to identify important symptoms reported by patients on questionnaires (e.g., pain) that can be used to compare cancer centers on how well they provide care. For example, cancer centers could be compared on the percentage of patients with controlled pain after adjusting for demographic and clinical characteristics. Standard review methods were used to identify studies through August 2020. Searches generated 1813 articles and 1779 were coded as not relevant. The remaining 34 studies showed that patients, caregivers, clinicians, and healthcare administrators identify psychosocial care (e.g., distress) and symptom management as critical parts of high-quality care. Patients and caregivers also perceive that maintaining physical function and daily activities are important. Clinicians and healthcare administrators perceive control of specific symptoms to be important (e.g., pain, poor sleep, diarrhea). Results were used to inform testing of symptom questionnaires to compare the quality of care provided by six cancer centers. Abstract Performance measurement is the process of collecting, analyzing, and reporting standardized measures of clinical performance that can be compared across practices to evaluate how well care was provided. We conducted a systematic review to identify stakeholder perceptions of key symptoms and health domains to test as patient-reported performance measures in oncology. Stakeholders included cancer patients, caregivers, clinicians, and healthcare administrators. Standard review methodology was used, consistent with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). MEDLINE/PubMed, EMBASE, and the Cochrane Library were searched to identify relevant studies through August 2020. Four coders independently reviewed entries and conflicts were resolved by a fifth coder. Efficacy and effectiveness studies, and studies focused exclusively on patient experiences of care (e.g., communication skills of providers) were excluded. Searches generated 1813 articles and 1779 were coded as not relevant, leaving 34 international articles for extraction. Patients, caregivers, clinicians, and healthcare administrators prioritize psychosocial care (e.g., distress) and symptom management for patient-reported performance measures. Patients and caregivers also perceive that maintaining physical function and daily activities are critical. Clinicians and administrators perceive control of specific symptoms to be critical (gastrointestinal symptoms, pain, poor sleep). Results were used to inform testing at six US cancer centers.
Collapse
Affiliation(s)
- Angela M. Stover
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Correspondence:
| | - Rachel Kurtzman
- Department of Health Behavior, University of North Carolina, Chapel Hill, NC 27599, USA;
| | | | - Jennifer Jansen
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Philip Carr
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
| | - Thomas Atkinson
- Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - C. Tyler Ellis
- Department of Surgery, University of Louisville Health, Louisville, KY 40202, USA;
| | | | - Kea Turner
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA;
| | - Ethan M. Basch
- Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA; (J.J.); (P.C.)
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA;
| |
Collapse
|
38
|
Newton-Lewis T, Munar W, Chanturidze T. Performance management in complex adaptive systems: a conceptual framework for health systems. BMJ Glob Health 2021; 6:e005582. [PMID: 34326069 PMCID: PMC8323386 DOI: 10.1136/bmjgh-2021-005582] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 12/14/2022] Open
Abstract
Existing performance management approaches in health systems in low-income and middle-income countries are generally ineffective at driving organisational-level and population-level outcomes. They are largely directive: they try to control behaviour using targets, performance monitoring, incentives and answerability to hierarchies. In contrast, enabling approaches aim to leverage intrinsic motivation, foster collective responsibility, and empower teams to self-organise and use data for shared sensemaking and decision-making.The current evidence base is too limited to guide reforms to strengthen performance management in a particular context. Further, existing conceptual frameworks are undertheorised and do not consider the complexity of dynamic, multilevel health systems. As a result, they are not able to guide reforms, particularly on the contextually appropriate balance between directive and enabling approaches. This paper presents a framework that attempts to situate performance management within complex adaptive systems. Building on theoretical and empirical literature across disciplines, it identifies interdependencies between organisational performance management, organisational culture and software, system-level performance management, and the system-derived enabling environment. It uses these interdependencies to identify when more directive or enabling approaches may be more appropriate. The framework is intended to help those working to strengthen performance management to achieve greater effectiveness in organisational and system performance. The paper provides insights from the literature and examples of pitfalls and successes to aid this thinking. The complexity of the framework and the interdependencies it describes reinforce that there is no one-size-fits-all blueprint for performance management, and interventions must be carefully calibrated to the health system context.
Collapse
Affiliation(s)
| | - Wolfgang Munar
- Department of Global Health, George Washington University Milken Institute of Public Health, Washington, District of Columbia, USA
| | | |
Collapse
|
39
|
Segelov E, Carrington C, Aranda S, Currow D, Zalcberg JR, Heriot AG, Mileshkin L, Coutsouvelis J, Millar JL, Collopy BT, Emery JD, Zhang P, Cooper S, O'Kane C, Wale J, Hancock SJ, Sulkowski A, Bashford J. Developing clinical indicators for oncology: the inaugural cancer care indicator set for the Australian Council on Healthcare Standards. Med J Aust 2021; 214:528-531. [PMID: 34053081 DOI: 10.5694/mja2.51087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
INTRODUCTION The Australian Council on Healthcare Standards (ACHS) sponsored an expert-led, consensus-driven, four-stage process, based on a modified Delphi methodology, to determine a set of clinical indicators as quality measures of cancer service provision in Australia. This was done in response to requests from institutional health care providers seeking accreditation, which were additional and complementary to the existing radiation oncology set. The steering group members comprised multidisciplinary key opinion leaders and a consumer representative. Five additional participants constituted the stakeholder group, who deliberated on the final indicator set. METHODS AND RECOMMENDATIONS An initial meeting of the steering group scoped the high level nature of the desired set. In stage 2, 65 candidate indicators were identified by a literature review and a search of international metrics. These were ranked by survey, based on ease of data accessibility and collectability and clinical relevance. The top 27 candidates were debated by the stakeholder group and culled to a final set of 16 indicators. A user manual was created with indicators mapped to clinical codes. The indicator set was ratified by the Clinical Oncology Society of Australia and is now available for use by health care organisations participating in the ACHS Clinical Indicator Program. This inaugural cancer clinical indicator set covers high level assessment of various critical processes in cancer service provision in Australia. Regular reviews and updates will ensure usability. CHANGES IN MANAGEMENT AS A RESULT OF THIS STATEMENT This is the inaugural indicator set for cancer care for use across Australia and internationally under the ACHS Clinical Indicator Program. Multidisciplinary involvement through a modified Delphi process selected indicators representing both generic and specific aspects of care across the cancer journey pathway and will provide a functional tool to compare health care delivery across multiple settings. It is anticipated that this will drive continual improvement in cancer care provision.
Collapse
Affiliation(s)
- Eva Segelov
- Monash University, Melbourne, VIC.,Monash Health, Melbourne, VIC
| | | | | | | | | | - Alexander G Heriot
- Epworth HealthCare, Melbourne, VIC.,Peter MacCallum Cancer Centre, Melbourne, VIC
| | | | | | - Jeremy L Millar
- Monash University, Melbourne, VIC.,Alfred Health, Melbourne, VIC
| | - Brian T Collopy
- CQM Consultants, Melbourne, VIC.,Australian Council on Healthcare Standards, Sydney, NSW
| | | | - Phoebe Zhang
- Australian Council on Healthcare Standards, Sydney, NSW
| | - Simon Cooper
- Australian Council on Healthcare Standards, Sydney, NSW
| | - Carmel O'Kane
- Wimmera Cancer Centre, Wimmera Health Care Group, Horsham, VIC
| | - Janet Wale
- Australian Council on Healthcare Standards, Sydney, NSW
| | | | | | | |
Collapse
|
40
|
Wronski P, Koetsenruijter J, Ose D, Paulus J, Szecsenyi J, Wensing M. Healthcare planning across healthcare sectors in Baden-Wuerttemberg, Germany: a stakeholder online survey to identify indicators. BMC Health Serv Res 2021; 21:510. [PMID: 34039315 PMCID: PMC8157415 DOI: 10.1186/s12913-021-06514-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 05/10/2021] [Indexed: 12/03/2022] Open
Abstract
Background Stakeholders in the German state of Baden-Wuerttemberg agreed upon the central aims for healthcare planning. These include a focus on geographical districts; a comprehensive, cross-sectoral perspective on healthcare needs and services; and use of regional data for healthcare planning. Therefore, healthcare data at district level is needed. Nevertheless, decision makers face the challenge to make a selection from numerous indicators and frameworks, which all have limitations or do not well apply to the targeted setting. The aim of this study was to identify district level indicators to be used in Baden-Wuerttemberg for the purpose of cross-sectoral and needs-based healthcare planning involving stakeholders of the health system. Methods A conceptual framework for indicators was developed. A structured search for indicators identified 374 potential indicators in indicator sets of German and international institutions and agencies (n = 211), clinical practice guidelines (n = 50), data bases (n = 35), indicator databases (n = 25), published literature (n = 35), and other sources (n = 18). These indicators were categorised according to the developed framework dimensions. In an online survey, institutions of various stakeholders were invited to assess the relevance of these indicators from December 2016 until January 2017. Indicators were selected in terms of a median value of the assessed relevance. Results 22 institutions selected 212 indicators for the five dimensions non-medical determinants of health (20 indicators), health status (25), utilisation of the health system (34), health system performance (87), and healthcare provision (46). Conclusions Stakeholders assessed a large number of indicators as relevant for use in healthcare planning on district level. Trial registration Not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06514-0.
Collapse
Affiliation(s)
- Pamela Wronski
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Jan Koetsenruijter
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Dominik Ose
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.,Present address: Department of Family and Preventive Medicine, University of Utah School of Medicine, 375 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Jan Paulus
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice & Health Services Research, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| |
Collapse
|
41
|
Molloy C, Moore T, O'Connor M, Villanueva K, West S, Goldfeld S. A Novel 3-Part Approach to Tackle the Problem of Health Inequities in Early Childhood. Acad Pediatr 2021; 21:236-243. [PMID: 33359515 DOI: 10.1016/j.acap.2020.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/24/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022]
Abstract
The first 5 years of a child's life are crucial in laying the foundation for their health and developmental trajectory into adulthood. These early years are especially influenced by the surrounding environments in which children live and grow. A large international body of evidence demonstrates that children who experience disadvantage tend to fall increasingly behind over time. At the societal level, these inequities can cause substantial social burdens and significant costs across health, education, and welfare budgets. A contributing factor is that children experiencing adversity are less likely to have access to the environmental conditions that support them to thrive. Many of these factors are modifiable at the community or place level. We argue for three key-though not exhaustive-ideas that collectively could achieve more equitable outcomes for children facing disadvantage and experiencing adversity:We conclude that if adopted, these 3 ideas could contribute to the ability of local communities and networks to identify and respond to factors that address early childhood inequalities.
Collapse
Affiliation(s)
- Carly Molloy
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Tim Moore
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Meredith O'Connor
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia
| | - Karen Villanueva
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Centre for Urban Research, RMIT University (K Villanueva), Melbourne, Victoria, Australia
| | - Sue West
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia
| | - Sharon Goldfeld
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Royal Children's Hospital (C Molloy, T Moore, M O'Connor, K Villanueva, S West, and S Goldfeld), Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne (C Molloy, T Moore, M O'Connor, and S Goldfeld), Melbourne, Victoria, Australia.
| |
Collapse
|
42
|
Parmelli E, Langendam M, Piggott T, Adolfsson J, Akl EA, Armstrong D, Braithwaite J, Brignardello-Petersen R, Follmann M, Leś Z, Meerpohl JJ, Neamtiu L, Qaseem A, Rossi PG, Saz-Parkinson Z, van der Wees PJ, Schünemann HJ. Guideline-based quality assurance: a conceptual framework for the definition of key elements. BMC Health Serv Res 2021; 21:173. [PMID: 33627092 PMCID: PMC7903784 DOI: 10.1186/s12913-021-06148-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In 2017, the European Commission's Joint Research Centre (JRC) started developing a methodological framework for a guideline-based quality assurance (QA) scheme to improve cancer quality of care. During the first phase of the work, inconsistency emerged about the use of terminology for the definition, the conceptual underpinnings and the way QA relates to health questions that are answered in guidelines. The objective of this final of three articles is to propose a conceptual framework for an integrated approach to guideline and QA development and clarify terms and definitions for key elements. This work will inform the upcoming European Commission Initiative on Colorectal Cancer (ECICC). METHODS A multidisciplinary group of 23 experts from key organizations in the fields of guideline development, performance measurement and quality assurance participated in a mixed method approach including face-to-face dialogue and several rounds of virtual meetings. Informed by results of a systematic literature review that indicated absence of an existing framework and practical examples, we first identified the relations of key elements in guideline-based QA and then developed appropriate concepts and terminology to provide guidance. RESULTS Our framework connects the three key concepts of quality indicators, performance measures and performance indicators integrated with guideline development. Quality indicators are constructs used as a guide to monitor, evaluate, and improve the quality of the structure, process and outcomes of healthcare services; performance measures are tools that quantify or describe measurable elements of practice performance; and performance indicators are quantifiable and measurable units or scores of practice, which should be guided by guideline recommendations. CONCLUSIONS The inconsistency in the way key terms of QA are used and defined has confused the field. Our conceptual framework defines the role, meaning and interactions of the key elements for improving quality in healthcare. It directly builds on the questions asked in guidelines and answered through recommendations. These findings will be applied in the forthcoming ECICC and for the future updates of ECIBC. These are large-scale integrated projects aimed at improving healthcare quality across Europe through the development of guideline-based QA schemes; this will help in implementing and improving our approach.
Collapse
Affiliation(s)
- Elena Parmelli
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749 - TP 127, I-21027, Ispra, Italy.
| | - Miranda Langendam
- Department of Epidemiology and Data Science, Amsterdam UMC, Amsterdam Public Health institute, University of Amsterdam, Amsterdam, Netherlands
| | - Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street, West Hamilton, ON, L8N 4K1, Canada
| | - Jan Adolfsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Sweden & The Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Elie A Akl
- American University of Beirut, Beirut, Lebanon
| | - David Armstrong
- Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Romina Brignardello-Petersen
- Department of Health Research Methods, Evidence, and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street, West Hamilton, ON, L8N 4K1, Canada
| | | | | | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Cochrane Germany, Cochrane Germany Foundation, Freiburg, Germany
| | - Luciana Neamtiu
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749 - TP 127, I-21027, Ispra, Italy
| | - Amir Qaseem
- American College of Physicians, Philadelphia, PA, USA
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Zuleika Saz-Parkinson
- European Commission, Joint Research Centre (JRC), Via E. Fermi 2749 - TP 127, I-21027, Ispra, Italy
| | - Philip J van der Wees
- Department of Rehabilitation and IQ Healthcare, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact McMaster University Health Sciences Centre, Room 2C16, 1280 Main Street, West Hamilton, ON, L8N 4K1, Canada.
- Department of Medicine, McMaster University, Hamilton, ON, Canada.
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
43
|
Fischer B, Daldegan-Bueno D, Jones W. Comparison of Crude Population-Level Indicators of Opioid Use and Related Harm in New Zealand and Ontario (Canada). Pain Ther 2020; 10:15-23. [PMID: 33382438 PMCID: PMC8119530 DOI: 10.1007/s40122-020-00229-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/09/2020] [Indexed: 11/30/2022] Open
Abstract
North America and select other Commonwealth jurisdictions have been experiencing unprecedented opioid epidemics characterized by excessive and persistently high levels of opioid misuse, morbidity and mortality, and related disease burden. Recent discussions have considered whether New Zealand might undergo or needs to expect a similar ‘opioid crisis’. Towards further informing these considerations, we examine and compare essential, publicly available indicators of opioid utilization and harms (mortality) from New Zealand and the Canadian province of Ontario, due to the fact that both operate public health care systems in similar socio-cultural settings. We find that the two jurisdictions have featured vastly different population levels of opioid exposure, opioid consumption patterns (e.g., high-dose/long-term/high-risk prescribing) known as key predictors of adverse outcomes, and levels of opioid mortality as evidenced by concrete epidemiological indicators and data. Specifically for opioid-related death rates, these were already approximately threefold higher in Ontario compared to New Zealand based on most recent comparison data (e.g., 2012); these differentials have likely further grown more recently given major and distinct changes in population-level opioid exposure and risks, and subsequent opioid-related deaths since then in Ontario. Based on the present data and related evidence, New Zealand does not seem to need to anticipate an opioid mortality epidemic similar to that experienced in North America; however, it would be of interest to establish more comprehensive and timely surveillance of key system-level indicators of opioid use and harms as are standard in North America. As such, this inter-jurisdictional comparison makes for a case study in starkly contrasting scenarios of opioid use and harms, the drivers behind which deserve further systematic examination.
Collapse
Affiliation(s)
- Benedikt Fischer
- Faculty of Medical and Health Sciences, Schools of Population Health and Pharmacy, University of Auckland, Auckland, New Zealand. .,Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada. .,Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
| | - Dimitri Daldegan-Bueno
- Faculty of Medical and Health Sciences, Schools of Population Health and Pharmacy, University of Auckland, Auckland, New Zealand
| | - Wayne Jones
- Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada
| |
Collapse
|
44
|
Domingues MAP, Camacho R, Rodrigues PP. CMIID: A comprehensive medical information identifier for clinical search harmonization in Data Safe Havens. J Biomed Inform 2020; 114:103669. [PMID: 33359111 DOI: 10.1016/j.jbi.2020.103669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/28/2020] [Accepted: 12/16/2020] [Indexed: 11/27/2022]
Abstract
Over the last decades clinical research has been driven by informatics changes nourished by distinct research endeavors. Inherent to this evolution, several issues have been the focus of a variety of studies: multi-location patient data access, interoperability between terminological and classification systems and clinical practice and records harmonization. Having these problems in mind, the Data Safe Haven paradigm emerged to promote a newborn architecture, better reasoning and safe and easy access to distinct Clinical Data Repositories. This study aim is to present a novel solution for clinical search harmonization within a safe environment, making use of a hybrid coding taxonomy that enables researchers to collect information from multiple repositories based on a clinical domain query definition. Results show that is possible to query multiple repositories using a single query definition based on clinical domains and the capabilities of the Unified Medical Language System, although it leads to deterioration of the framework response times. Participants of a Focus Group and a System Usability Scale questionnaire rated the framework with a median value of 72.5, indicating the hybrid coding taxonomy could be enriched with additional metadata to further improve the refinement of the results and enable the possibility of using this system as data quality tagging mechanism.
Collapse
Affiliation(s)
| | - Rui Camacho
- Faculty of Engineering of the University of Porto, Portugal; LIAAD-INESC TEC, Porto, Portugal
| | - Pedro Pereira Rodrigues
- CINTESIS - Center for Health Technology and Services Research, Portugal; Faculty of Medicine of the University of Porto, Portugal
| |
Collapse
|
45
|
Daube D, Ruhrmann G. [Introduction to the quality of medical journalism and initial assessments of COVID-19 media coverage]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 64:3-11. [PMID: 33252701 PMCID: PMC7703508 DOI: 10.1007/s00103-020-03249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022]
Abstract
Die Medienlandschaft unterliegt einem stetigen Wandel, innovative Medientechnologien beeinflussen in immer stärkerem Maße unsere Lebenswelt. Da digitale Medien zunehmend in allen Altersklassen konsumiert werden und Laien sich im Internet auch häufig zu gesundheitlichen und medizinischen Themen informieren, stellt sich die Frage nach der Qualität dieser (journalistischen) Inhalte im Web. Die Rolle von Journalistinnen und Journalisten wandelt sich und für die Wissenschaft gibt es neue Möglichkeiten und Herausforderungen bei der digitalen Verbreitung von Forschungsergebnissen. Welchen qualitativen Ansprüchen müssen diese Inhalte genügen und welche Potenziale und Chancen, aber eben auch Risiken bringen online verbreitete und rezipierte Informationen mit sich? Im vorliegenden Beitrag werden Themen der Medizin- und Gesundheitskommunikation und Prozesse der journalistischen Berichterstattung beschrieben. Anschließend diskutieren wir das in der Medizin bereits etablierte Kriterium der „Evidenz“ als möglichen Ansatz zur Beurteilung gesundheitsrelevanter und medizinischer Informationen. Abschließend wird die COVID-19-Pandemie im Kontext des wachsenden Medienpopulismus diskutiert.
Collapse
Affiliation(s)
- Dominik Daube
- Institut für Kommunikationswissenschaft, Friedrich-Schiller-Universität Jena, Ernst-Abbe-Platz 8, 07743, Jena, Deutschland.
| | - Georg Ruhrmann
- Institut für Kommunikationswissenschaft, Friedrich-Schiller-Universität Jena, Ernst-Abbe-Platz 8, 07743, Jena, Deutschland
| |
Collapse
|
46
|
Barr ML, Welberry H, Hall J, Comino EJ, Harris E, Harris-Roxas BF, Jackson T, Donnelly D, Harris MF. General practitioner follow-up after hospitalisation in Central and Eastern Sydney, Australia: access and impact on health services. AUST HEALTH REV 2020; 45:247-254. [PMID: 33087226 DOI: 10.1071/ah19285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/02/2020] [Indexed: 11/23/2022]
Abstract
Objectives General practitioner (GP) follow-up after a hospital admission is an important indicator of integrated care. We examined the characteristics of patients who saw a GP within 2 weeks of hospital discharge in the Central and Eastern Sydney (CES) region, Australia, and the relationship between GP follow-up and subsequent hospitalisation. Methods This data linkage study used a cohort of 10240 people from the 45 and Up Study who resided in CES and experienced an overnight hospitalisation in the 5 years following recruitment (2007-14). Characteristics of participants who saw a GP within 2 weeks of discharge were compared with those who did not using generalised linear models. Time to subsequent hospitalisation was compared for the two groups using Cox proportional hazards regression models stratified by prior frequency of GP use. Results Within 2 weeks of discharge, 64.3% participants saw a GP. Seeing a GP within 2 weeks of discharge was associated with lower rates of rehospitalisation for infrequent GP users (i.e. <8 visits in year before the index hospitalisation; hazard ratio (HR) 0.83; 95% confidence interval (CI) 0.70-0.97) but not frequent GP users (i.e. ≥8 plus visits; HR 1.02; 95% CI 0.90-1.17). Conclusion The effect of seeing a GP on subsequent hospitalisation was protective but differed depending on patient care needs. What is known about the topic? There is general consensus among healthcare providers that primary care is a significant source of ongoing health care provision. What does this paper add? This study explored the relationship between GP follow-up after an uncomplicated hospitalisation and its effect on rehospitalisation. What are the implications for practitioners? Discharge planning and the transfer of care from hospital to GP through discharge arrangements have substantial benefits for both patients and the health system.
Collapse
Affiliation(s)
- Margo Linn Barr
- Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, UNSW, Sydney, NSW 2052, Australia. ; ; ; ; ; and Corresponding author.
| | - Heidi Welberry
- Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, UNSW, Sydney, NSW 2052, Australia. ; ; ; ;
| | - John Hall
- Faculty of Medicine, Wallace Wurth Building, 18 High Street, UNSW, Sydney, NSW 2052, Australia.
| | - Elizabeth J Comino
- Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, UNSW, Sydney, NSW 2052, Australia. ; ; ; ;
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, UNSW, Sydney, NSW 2052, Australia. ; ; ; ;
| | - Ben F Harris-Roxas
- Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, UNSW, Sydney, NSW 2052, Australia. ; ; ; ;
| | - Tony Jackson
- South Eastern Sydney Local Health District, NSW Health, District Executive Unit, Locked Mail Bag 21, Tarren Point, NSW 2229, Australia.
| | - Debra Donnelly
- Sydney Local Health District, NSW Health, Level 11, KGV Building, Missenden Road, Camperdown, NSW 2050, Australia.
| | - Mark Fort Harris
- Centre for Primary Health Care and Equity, Faculty of Medicine, Level 3, AGSM Building, UNSW, Sydney, NSW 2052, Australia. ; ; ; ;
| |
Collapse
|
47
|
Stirling R, Ritter A, Rawstorne P, Nathan S. Contracting treatment services in Australia: Do measures adhere to best practice? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102947. [PMID: 33059119 DOI: 10.1016/j.drugpo.2020.102947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/02/2020] [Accepted: 09/07/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Contracting non-government services to provide alcohol and other drug (AOD) treatment requires the specification of performance measures to ensure accountability for public funds. There is currently no standardised approach by funders to the measurement of performance of AOD treatment in Australia. Funding to non-government organisations (NGOs) is complex, with NGOs managing funding agreements from a range of sources that contain a large number of differing performance measures. This study aimed to assess performance measures used in contracts for NGO AOD treatment providers and how they align with best practice. METHODS Performance measures contained in funding agreements for treatment providers were collected from a diverse sample of both funders (n=8) and treatment providers (n=20) resulting in more than 1,100 measures. The list of measures was synthesized to a finite, non-duplicative list (n=537). Measures were assessed by three raters against 11 criteria (for example, measurable and timely) documented as best practice elements of performance measures (Council of Australian Governments, 2011a). Measures were also coded into different measurement types (such as outcome and process). RESULTS None of the 537 unique performance measures used in funding agreements for treatment providers fully met the criteria for best practice in performance measurement. Whilst the literature and government policy is being directed towards outcomes-based funding and reporting, only 7.6% of measures were classified as outcome measures. The majority of measures were classified at output (41.3%) and process (23.6%) measures. CONCLUSION Current measures in contracts applied by funders to treatment services do not adhere to best practice. The development and implementation of new performance measures is required to inform AOD policy and accountability of public funds. Further, identifying more robust performance measures has the potential to lead to reduced reporting burden on service providers and better monitoring of service quality and outcomes.
Collapse
Affiliation(s)
- Robert Stirling
- School of Population Health, UNSW Sydney, Australia; Network of Alcohol and other Drugs Agencies, Sydney, Australia.
| | - Alison Ritter
- Drug Policy Modelling Program, Social Policy Research Centre, UNSW Sydney, Australia
| | | | - Sally Nathan
- School of Population Health, UNSW Sydney, Australia
| |
Collapse
|
48
|
Dieckelmann M, Petersen JJ, Güthlin C, Reinhardt F, Plath J, Jeitler K, Semlitsch T, Gerlach FM, Siebenhofer A. Healthcare experiences of patients with chronic heart failure in Germany: a scoping review. BMJ Open 2020; 10:e037158. [PMID: 33039995 PMCID: PMC7549456 DOI: 10.1136/bmjopen-2020-037158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To review systematically the past 10 years of research activity into the healthcare experiences (HCX) of patients with chronic heart failure (CHF) in Germany, in order to identify research foci and gaps and make recommendations for future research. DESIGN In this scoping review, six databases and grey literature sources were systematically searched for articles reporting HCX of patients with CHF in Germany that were published between 2008 and 2018. Extracted results were summarised using quantitative and qualitative descriptive analysis. RESULTS Of the 18 studies (100%) that met the inclusion criteria, most were observational studies (60%) that evaluated findings quantitatively (60%). HCX were often concerned with patient information, global satisfaction as well as relationships and communication between patients and providers and generally covered ambulatory care, hospital care and rehabilitation services. Overall, the considerable heterogeneity of the included studies' outcomes only permitted relatively trivial levels of synthesis. CONCLUSION In Germany, research on HCX of patients with CHF is characterised by missing, inadequate and insufficient information. Future research would benefit from qualitative analyses, evidence syntheses, longitudinal analyses that investigate HCX throughout the disease trajectory, and better reporting of sociodemographic data. Furthermore, research should include studies that are based on digital data, reports of experiences gained in under-investigated yet patient-relevant healthcare settings and include more female subjects.
Collapse
Affiliation(s)
- Mirjam Dieckelmann
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Juliana J Petersen
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Corina Güthlin
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Felix Reinhardt
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jasper Plath
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Klaus Jeitler
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Thomas Semlitsch
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andrea Siebenhofer
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Germany
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| |
Collapse
|
49
|
Emiru AA, Alene GD, Debelew GT. Women's satisfaction with the quality of antenatal care services rendered at public health facilities in Northwest Ethiopia: the application of partial proportional odds model. BMJ Open 2020; 10:e037085. [PMID: 32948558 PMCID: PMC7500293 DOI: 10.1136/bmjopen-2020-037085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The study was aimed: (1) to describe the quality of antenatal care (ANC) at public health facilities in Northwest Ethiopia, including dimensions of the structure, process and outcome; and (2) to assess the relationship between ANC satisfaction and structure and process dimension of ANC quality. DESIGN Cross sectional. SETTING Healthcare facilities providing ANC services in Northwest Ethiopia. PARTICIPANTS 795 pregnant women attending the antenatal clinics at 15 public health facilities and 41 health workers working for the surveyed facilities. OUTCOME MEASURES The outcome variable, women's satisfaction with ANC, was constructed from multiple satisfaction items using principal component analysis on an ordered, categorical and three-point Likert scale. The key hypothesised factors considered were structural and process aspects of care. Data were analysed using the partial proportional odds model with 95% CI. RESULTS The result revealed that only 30.3% of the pregnant women were highly satisfied, whereas 31.7% had a lower satisfaction level. The findings showed that process quality indicators better predicted client satisfaction. In relation to this, better scores in history taking (aOR1=aOR2; 1.81 (95% CI 1.25 to 2.60)), counselling (aOR1 = aOR2; 1.89 (95% CI 1.33 to 2.69)) and screening (aOR1= aOR2; 18.10 (95% CI 11.52 to 28.39)) were associated with achieving higher satisfaction. We also observed a significant but lower satisfaction among women in the late trimester of pregnancy (aOR1 = aOR2; 0.87 (95% CI 0.78 to 0.97)). However, we did not see any significant relationship between structural variables and client satisfaction. CONCLUSIONS The study demonstrated that women's satisfaction with ANC was low. The contents of ANC services covered during client-provider interaction were the main factors affecting client satisfaction. This suggests that efforts are required to improve the competencies of health professionals to make them more effective while dealing with clients.
Collapse
Affiliation(s)
- Amanu Aragaw Emiru
- Reproductive Health and Population Studies, Bahir Dar University, Bahir Dar, Ethiopia
| | - G D Alene
- Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gurmesa Tura Debelew
- Department of Population and Family Health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| |
Collapse
|
50
|
Levesque JF, Corscadden L, Dave A, Sutherland K. Assessing Performance in Health Care Using International Surveys: Are Patient and Clinician Perspectives Complementary or Substitutive. J Patient Exp 2020; 7:169-180. [PMID: 32851137 PMCID: PMC7427366 DOI: 10.1177/2374373519830711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Over the last decade, international surveys of patients and clinicians have been used to compare health care across countries. Findings from these surveys have been extensively used to create aggregate scores and rankings. Objective: To assess the concordance of survey responses provided by patients and clinicians. Methods: Analysis of 16 pairs of questions that focused on coordination, organizational factors, and patient-centered competencies from the Commonwealth Fund International Health Policy Survey of older adults (2014) and of primary care physicians (2015). Concordance was assessed by comparing absolute rates and relative rankings. Results: In absolute terms, patients and clinicians gave differing responses for questions about coordination of care (patients were more positive) and provision of after-hours care (patients were less positive). In relative terms, country rankings were positively correlated for 5 of 16 question pairs (Spearman ρ > .6 and P < .05). Conclusion: Patterns of concordance between patient and clinician perspectives provides information to guide the use of survey data in performance assessment. However, this study highlights the need to assess the complementarity and substitutive nature of patients’ and clinicians’ perspectives before combining them to create aggregate assessments of performance.
Collapse
Affiliation(s)
- Jean-Frederic Levesque
- Agency for Clinical Innovation, Chatswood, New South Wales, Australia
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia
- Jean-Frederic Levesque, Agency for Clinical Innovation, 67 Albert Avenue, Chatswood, New South Wales 2067, Australia.
| | - Lisa Corscadden
- Centre for Primary Health Care and Equity, University of New South Wales Australia, Sydney, New South Wales, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - Anushree Dave
- Bureau of Health Information, Chatswood, New South Wales, Australia
- McGill University, Montreal, Quebec, Canada
| | - Kim Sutherland
- Agency for Clinical Innovation, Chatswood, New South Wales, Australia
| |
Collapse
|