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Metrics and indicators used to assess health system resilience in response to shocks to health systems in high income countries-A systematic review. Health Policy 2022; 126:1195-1205. [PMID: 36257867 PMCID: PMC9556803 DOI: 10.1016/j.healthpol.2022.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022]
Abstract
Health system resilience has never been more important than with the COVID-19 pandemic. There is need to identify feasible measures of resilience, potential strategies to build resilience and weaknesses of health systems experiencing shocks. The purpose of this systematic review is to examine how the resilience of health systems has been measured across various health system shocks. Following PRISMA guidelines, with double screening at each stage, the review identified 3175 studies of which 68 studies were finally included for analysis. Almost half (46%) were focused on COVID-19, followed by the economic crises, disasters and previous pandemics. Over 80% of studies included quantitative metrics. The most common WHO health system functions studied were resources and service delivery. In relation to the shock cycle, most studies reported metrics related to the management stage (79%) with the fewest addressing recovery and learning (22%). Common metrics related to staff headcount, staff wellbeing, bed number and type, impact on utilisation and quality, public and private health spending, access and coverage, and information systems. Limited progress has been made with developing standardised qualitative metrics particularly around governance. Quantitative metrics need to be analysed in relation to change and the impact of the shock. The review notes problems with measuring preparedness and the fact that few studies have really assessed the legacy or enduring impact of shocks.
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Joshipura KJ, Martínez-Lozano M, Ríos-Jiménez PI, Camacho-Monclova DM, Noboa-Ramos C, Alvarado-González GA, Lowe SR. Preparedness, Hurricanes Irma and Maria, and Impact on Health in Puerto Rico. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2022; 67:102657. [PMID: 35036300 PMCID: PMC8754401 DOI: 10.1016/j.ijdrr.2021.102657] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Only few studies evaluated whether hurricane preparedness impacts health. The PREPARE study addresses this gap. METHODS We recruited participants who had pertinent pre-hurricane data from the San Juan Overweight Adults Longitudinal Study (SOALS: n=364) and 125 patients with diabetes from Federally Qualified Health Center (COSSMA) in Puerto Rico. Participants aged 42-75 years completed interviews 20-34 months after Hurricanes Irma and Maria. We evaluated associations between self-reported hurricane preparedness and health and other related associations using logistic regression controlling for age, location, education and interview date. RESULTS Only 41% of participants reported high pre-hurricane preparedness; 25% reported gaps (moderate/low availability) in information and 48% reported gaps in resources for hurricane preparedness. Participants reporting lower pre-hurricane preparedness had higher reported hurricane-related detrimental health impact (OR=1.96; 95% CI: 1.31, 2.95) and higher odds (OR=2.07; 95% CI: 0.92, 4.68) of developing new non-communicable disease (NCD) compared to others. Post-hurricane drinking water disruption for ≥ 3 months versus none or less (OR=2.76; 95% CI: 1.39, 5.47) and similarly diet changes due to cooking/refrigeration access (OR=1.96; 95% CI: 1.24, 3.07), and diet changes for ≥ 20 months due to finances/access to shops (OR=2.83; 95% CI: 1.85, 4.32) were also associated with detrimental health impact. CONCLUSION Lower preparedness was associated with higher detrimental impact of the hurricanes on overall health, and marginally significant impact on NCD. Future preparedness efforts could especially target means of coping with disruption of water services and regular diet, as these were also associated with detrimental health impact.
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Affiliation(s)
- K J Joshipura
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - M Martínez-Lozano
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - P I Ríos-Jiménez
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - D M Camacho-Monclova
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | - C Noboa-Ramos
- Center for Clinical Research and Health Promotion, School of Dental Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR, USA
| | | | - S R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Papautsky EL, Rice DR, Ghoneima H, McKowen ALW, Anderson N, Wootton AR, Veldhuis C. Characterizing Health Care Delays and Interruptions in the United States During the COVID-19 Pandemic: Internet-Based, Cross-sectional Survey Study. J Med Internet Res 2021; 23:e25446. [PMID: 33886489 PMCID: PMC8136407 DOI: 10.2196/25446] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/16/2021] [Accepted: 04/20/2021] [Indexed: 12/14/2022] Open
Abstract
Background The COVID-19 pandemic has broader geographic spread and potentially longer lasting effects than those of previous disasters. Necessary preventive precautions for the transmission of COVID-19 has resulted in delays for in-person health care services, especially at the outset of the pandemic. Objective Among a US sample, we examined the rates of delays (defined as cancellations and postponements) in health care at the outset of the pandemic and characterized the reasons for such delays. Methods As part of an internet-based survey that was distributed on social media in April 2020, we asked a US–based convenience sample of 2570 participants about delays in their health care resulting from the COVID-19 pandemic. Participant demographics and self-reported worries about general health and the COVID-19 pandemic were explored as potent determinants of health care delays. In addition to all delays, we focused on the following three main types of delays, which were the primary outcomes in this study: dental, preventive, and diagnostic care delays. For each outcome, we used bivariate statistical tests (t tests and chi-square tests) and multiple logistic regression models to determine which factors were associated with health care delays. Results The top reported barrier to receiving health care was the fear of SARS-CoV-2 infection (126/374, 33.6%). Almost half (1227/2570, 47.7%) of the participants reported experiencing health care delays. Among those who experienced health care delays and further clarified the type of delay they experienced (921/1227, 75.1%), the top three reported types of care that were affected by delays included dental (351/921, 38.1%), preventive (269/921, 29.2%), and diagnostic (151/921, 16.4%) care. The logistic regression models showed that age (P<.001), gender identity (P<.001), education (P=.007), and self-reported worry about general health (P<.001) were significantly associated with experiencing health care delays. Self-reported worry about general health was negatively related to experiencing delays in dental care. However, this predictor was positively associated with delays in diagnostic testing based on the logistic regression model. Additionally, age was positively associated with delays in diagnostic testing. No factors remained significant in the multiple logistic regression for delays in preventive care, and although there was trend between race and delays (people of color experienced fewer delays than White participants), it was not significant (P=.06). Conclusions The lessons learned from the initial surge of COVID-19 cases can inform systemic mitigation strategies for potential future disruptions. This study addresses the demand side of health care delays by exploring the determinants of such delays. More research on health care delays during the pandemic is needed, including research on their short- and long-term impacts on patient-level outcomes such as mortality, morbidity, mental health, people’s quality of life, and the experience of pain.
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Affiliation(s)
- Elizabeth Lerner Papautsky
- Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Dylan R Rice
- Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Hana Ghoneima
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Anna Laura W McKowen
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Nicholas Anderson
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
| | - Angie R Wootton
- School of Social Welfare, University of California Berkeley, Berkeley, CA, United States
| | - Cindy Veldhuis
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, New York, NY, United States
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Hassan S, Nguyen M, Buchanan M, Grimshaw A, Adams OP, Hassell T, Ragster L, Nunez-Smith M. Management Of Chronic Noncommunicable Diseases After Natural Disasters In The Caribbean: A Scoping Review. Health Aff (Millwood) 2020; 39:2136-2143. [PMID: 33284688 PMCID: PMC8142319 DOI: 10.1377/hlthaff.2020.01119] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Extreme weather events in the Caribbean region are becoming increasingly severe because of climate change. The region also has high rates of poorly controlled chronic noncommunicable diseases (NCDs), which were responsible for at least 30 percent of deaths after two recent hurricanes. We conducted a scoping review of literature published between 1974 and 2020 to understand the burden and management of chronic NCDs in the Caribbean after natural disasters. Of the twenty-nine articles included in this review, most described experiences related to Hurricanes Dorian (2019) and Irma and Maria (2017) and the Haiti earthquake (2010). Challenges included access to medication, acute care services, and appropriate food, as well as communication difficulties and reliance on ad hoc volunteers and outside aid. Mitigating these challenges requires different approaches, including makeshift points of medication dispensing, disease surveillance systems, and chronic disease self-management education programs. Evidence is needed to inform policies to build resilient health systems and integrate NCD management into regional and national disaster preparedness and response plans.
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Affiliation(s)
- Saria Hassan
- Saria Hassan is an assistant professor at the Emory School of Medicine and Rollins School of Public Health, Emory University, in Atlanta, Georgia. At the time of manuscript submission, she was an instructor of internal medicine at the Yale School of Medicine, Yale University, in New Haven, Connecticut
| | - Mytien Nguyen
- Mytien Nguyen is a student in the MD/PhD program at the Yale School of Medicine
| | - Morgan Buchanan
- Morgan Buchanan is a student in the Department of Social and Behavioral Sciences at the Yale School of Public Health, Yale University
| | - Alyssa Grimshaw
- Alyssa Grimshaw is a clinical research and education librarian in Clinical Information Services at Yale University
| | - Oswald P Adams
- Oswald P. Adams is the dean of the Faculty of Medical Sciences at the University of the West Indies, Cave Hill, in Bridgetown, Barbados
| | - Trevor Hassell
- Trevor Hassell is the president of the Healthy Caribbean Coalition, in Bridgetown, Barbados
| | - LaVerne Ragster
- LaVerne Ragster is a retired professor and president emerita at the University of the Virgin Islands, in St. Thomas, US Virgin Islands
| | - Marcella Nunez-Smith
- Marcella Nunez-Smith is an associate professor of medicine in the Department of Internal Medicine and director of the Equity Research and Innovation Center, both at the Yale School of Medicine
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Werner EA, Aloisio CE, Butler AD, D'Antonio KM, Kenny JM, Mitchell A, Ona S, Monk C. Addressing mental health in patients and providers during the COVID-19 pandemic. Semin Perinatol 2020; 44:151279. [PMID: 32972778 PMCID: PMC7373005 DOI: 10.1016/j.semperi.2020.151279] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The pandemic, and the associated changes to pregnancy and postpartum experiences, can lead to profound psychological reactions including panic, hyperarousal, sleep disturbance, anxiety, depression, and traumatic stress disorders. Providers face compassion fatigue and shared trauma. In this article, we describe the mental health outcomes known to date in regard to the novel coronavirus disease 2019 pandemic for obstetric patients and their providers as well as therapeutic approaches, including our novel embedded mental health service, to address these mental health needs.
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Affiliation(s)
- Elizabeth A. Werner
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York,Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Cara E. Aloisio
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ashlie D. Butler
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Kristina M. D'Antonio
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Jennifer M. Kenny
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Anika Mitchell
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Samsiya Ona
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; New York State Psychiatric Institute, From Columbia University Irving Medical Center, New York, NY 10032.
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Papautsky EL, Hamlish T. Patient-reported treatment delays in breast cancer care during the COVID-19 pandemic. Breast Cancer Res Treat 2020; 184:249-254. [PMID: 32772225 PMCID: PMC7415197 DOI: 10.1007/s10549-020-05828-7] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 07/20/2020] [Indexed: 01/21/2023]
Abstract
Purpose The coronavirus disease (COVID-19) pandemic has had a profound impact on cancer care in the US Guidelines focused on the management of COVID-19, rather than healthcare needs of breast cancer patients requiring access to crucial services. This US survey of breast cancer survivors characterizes treatment delays early period in the pandemic. Methods We developed a survey and administered it to 609 adult breast cancer survivors in the US. We used snowball sampling with invitations distributed via social media. We used logistic regression to select a model of delay from a pool of independent variables including race, cancer stage, site of care, health insurance, and age. We used descriptive statistics to characterize delay types. Results Forty-four percent of participants reported cancer care treatment delays during the pandemic. Delays in all aspects of cancer care and treatment were reported. The only variable which had a significant effect was age (97 (.95, 99), p < 0.001) with younger respondents (M = 45.94, SD = 10.31) reporting a higher incidence of delays than older respondents (M = 48.98, SD = 11.10). There was no significant effect for race, insurance, site of care, or cancer stage. Conclusions Our findings reveal a pervasive impact of COVID-19 on breast cancer care and a gap in disaster preparedness that leaves cancer survivors at risk for poor outcomes. Delays are critical to capture and characterize to help cancer providers and healthcare systems develop effective and patient–tailored processes and strategies to manage cases during the current pandemic wave, subsequent waves, and future disasters.
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Affiliation(s)
- Elizabeth Lerner Papautsky
- Department of Biomedical & Health Information Sciences, University of Illinois at Chicago, 1919 W. Taylor St., Chicago, IL, 60612, USA.
| | - Tamara Hamlish
- University of Illinois Cancer Center, University of Illinois at Chicago, 818 S. Wolcott Ave., Chicago, IL, 60612, USA
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Miyatake H, Yamamoto K, Ozaki A, Kawada S, Nishikawa Y, Beniya H. Extreme snowfall and residential care: A case report of a 2-year-old girl with heart failure. Clin Case Rep 2020; 8:950-954. [PMID: 32577240 PMCID: PMC7303879 DOI: 10.1002/ccr3.2633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 11/29/2019] [Accepted: 12/08/2019] [Indexed: 11/16/2022] Open
Abstract
In residential care, the daily use of social networking services with patients (and patients' families) helps prepare for a potential disaster. This enables health workers to continue providing essential care even during disasters, while saving human and medical resources for those who need them the most.
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Affiliation(s)
| | | | | | - Shogo Kawada
- Department of Family MedicineFaculty of MedicineGeneral Practice and Community HealthUniversity of TsukubaIbarakiJapan
| | - Yoshitaka Nishikawa
- Department of Health InformaticsKyoto University School of Public HealthKyotoJapan
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Suneja A, Gakh M, Rutkow L. Burden and Management of Noncommunicable Diseases After Earthquakes and Tsunamis. Health Secur 2018; 16:30-47. [PMID: 29355393 DOI: 10.1089/hs.2017.0059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This integrative review examines extant literature assessing the burden and management of noncommunicable diseases 6 months or more after earthquakes and tsunamis. We conducted an integrative review to identify and characterize the strength of published studies about noncommunicable disease-specific outcomes and interventions at least 6 months after an earthquake and/or tsunami. We included disasters that occurred from 2004 to 2016. We focused primarily on the World Health Organization noncommunicable disease designations to define chronic disease, but we also included chronic renal disease, risk factors for noncommunicable diseases, and other chronic diseases or symptoms. After removing duplicates, our search yielded 6,188 articles. Twenty-five articles met our inclusion criteria, some discussing multiple noncommunicable diseases. Results demonstrate that existing medical conditions may worsen and subsequently improve, new diseases may develop, and risk factors, such as weight and cholesterol levels, may increase for several years after an earthquake and/or tsunami. We make 3 recommendations for practitioners and researchers: (1) plan for noncommunicable disease management further into the recovery period of disaster; (2) increase research on the burden of noncommunicable diseases, the treatment modalities employed, resulting population-level outcomes in the postdisaster setting, and existing models to improve stakeholder coordination and action regarding noncommunicable diseases after disasters; and (3) coordinate with preexisting provision networks, especially primary care.
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