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Escobar MF, Echavarría MP, Carvajal JA, Lesmes MC, Porras AM, Mesa V, Ávila-Sánchez FA, Gallego JC, Riascos NC, Hurtado D, Fernández PA, Posada L, Hernández AM, Ramos I, Irurita MI, Loaiza JS, Echeverri D, Gonzalez L, Peña-Zárate EE, Libreros-Peña L, Galindo JS, Granados M. Hospital padrino: a collaborative strategy model to tackle maternal mortality: a mixed methods study in a middle-income region. Lancet Reg Health Am 2024; 31:100705. [PMID: 38445021 PMCID: PMC10912672 DOI: 10.1016/j.lana.2024.100705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
Background Reducing maternal mortality ratio (MMR) remains a paramount goal for low- and middle-income countries (LMICs), especially after COVID-19's devastating impact on maternal health indicators. We describe our experience implementing the Hospital Padrino Strategy (HPS), a collaborative model between a high-complexity hospital (Fundación Valle del Lili) and 43 medium- and low-complexity hospitals in one Colombian department (an administrative and territorial division) from 2021 to 2022, to sustain the trend towards reducing MMR. The study aimed to assess the effects of implementing HPS on both hospital performance and maternal health indicators in Valle del Cauca department (VCD). Methods A mixed-methods study was conducted, comprising two phases. In the first phase, we investigated a cohort of hospitals through prospective follow-up to assess the outcomes of HPS implementation on hospital performance and maternal health indicators in VCD. In the second phase, qualitative data were collected through focus groups with 131 health workers from 33 hospitals to explore the implications of the HPS implementation on healthcare personnel. All data were obtained from records within the HPS implementation and from the Health Secretary of VCD. Findings Evidence shows that in the context of HPS, 51 workshops involved 980 healthcare workers, covering the entire territory. Substantial improvements were observed in hospital conditions and healthcare personnel's technical competencies when providing obstetric care. Seven hundred eighty-five pregnant women with obstetric or perinatal emergencies received care through telehealth systems, with a progressive increase in technology adoption. Nine percent required Intensive Care Unit (ICU) admission, and none died. The MMR decreased from 78.8 in 2021 to 12.0 cases per 100,000 live births by 2022. Improvements in indicators and conducted training sessions instilled confidence and empowerment among the healthcare teams in the sponsored hospitals, as evidenced in focus groups derived from a sample of 131 healthcare workers from 33 hospitals. Interpretation Implementing the Hospital Padrino Strategy led to a significant MMR reduction, and consolidated a model of social healthcare innovation replicable in LMICs. Funding The Hospital Padrino Strategy was funded by the Fundación Valle del Lili and the Health Secretary of Valle del Cauca. Furthermore, this study received funding from a general grant for research from Tecnoquimicas S.A.
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Affiliation(s)
- María Fernanda Escobar
- Unidad de Equidad Global en Salud, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - María Paula Echavarría
- Unidad de Equidad Global en Salud, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Javier Andrés Carvajal
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
| | | | | | - Viviana Mesa
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Fernando A Ávila-Sánchez
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Juan Carlos Gallego
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Natalia C Riascos
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - David Hurtado
- Departamento de Ginecología y Obstetricia, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Paula A Fernández
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | - Leandro Posada
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | | | - Isabella Ramos
- Facultad de Ciencias de la Salud, Universidad Icesi, Calle 18 No. 122-135, Cali, Colombia
| | | | | | - Daniel Echeverri
- Fundación para el Desarrollo Integral del Pacífico - Propacífico, Cali, Colombia
| | - Luisa Gonzalez
- Unidad de Responsabilidad Social, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
| | - Evelyn Elena Peña-Zárate
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
| | - Laura Libreros-Peña
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
| | - Juan Sebastián Galindo
- Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
| | - Marcela Granados
- Subdirección General, Fundación Valle del Lili, Cra. 98 no. 18-49, Cali 760032, Colombia
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Boujelben A, Amous I. Strategy maintenance in smart healthcare systems. BMC Med Inform Decis Mak 2023; 23:272. [PMID: 38017472 PMCID: PMC10683088 DOI: 10.1186/s12911-023-02291-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/05/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUNDS The size of medical strategies is expected to grow in conjunction with the expansion of modern diseases' complexity. When a strategy includes more than ten statements, its manual management becomes very challenging, and in some cases, impossible. As a result, the updates they get may result in the unavoidable appearance of anomalies. This causes an interruption in the outflow of imperfect knowledge. METHODS In this paper, we propose an approach called TAnom-HS to verify healthcare strategies. We focus on the management and maintenance, in a convenient and automatic way, of a large strategy to guarantee knowledge accuracy and enhance the efficiency of the inference process in healthcare systems. RESULTS We developed a prototype of our proposal and we applied it on some cases from the BioPortal repository. The evaluation of both steps of TAnom-HS proved the efficiency of our proposal. CONCLUSION To increase ontologies expressiveness, a set of rules called strategy is added to it. TAnom-HS is a two-step approach that treats anomalies in healthcare strategies. Such a task helps to take automatic and efficient healthcare decisions.
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Affiliation(s)
| | - Ikram Amous
- MIRACL laboratory, University of Sfax, Sfax, Tunisia
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Miller T, Reihlen M. Assessing the impact of patient-involvement healthcare strategies on patients, providers, and the healthcare system: A systematic review. Patient Educ Couns 2023; 110:107652. [PMID: 36804578 DOI: 10.1016/j.pec.2023.107652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Patient involvement has become an important and lively field of research, yet existing findings are fragmented and often contested. Without a synthesis of the research field, these findings are of limited use to scholars, healthcare providers, or policy-makers. OBJECTIVE Examine the body of knowledge on patient involvement to determine what is known, contested, and unknown about benefits, risks, and effective implementation strategies. PATIENT INVOLVEMENT Patients were not involved. METHODS Systematic literature review of 99 journal articles using a conceptual model integrating three levels: health systems, health providers, and patients. We extracted individual research findings and organized them into the structure of our model to provide a holistic picture of patient involvement. RESULTS The review highlights overlaps and conflicts between various patient involvement approaches. Our results show benefits for individual patients and the health system as a whole. At the provider level, however, we identified clear barriers to patient involvement. DISCUSSION Patient involvement requires collaboration among health systems, healthcare providers, and patients. We showed that increasing patient responsibility and health literacy requires policy-maker interventions. This includes incentives for patient education by providers, adapting medical education curricula, and building a database of reliable health information and decision support for patients. Furthermore, policies supporting a common infrastructure for digital health data and managed patient data exchange will foster provider collaboration. PRACTICAL VALUE Our review shows how an approach integrating health systems, healthcare providers, and patients can make patient involvement more effective than isolated interventions. Such systematic patient involvement is likely to improve population health literacy and healthcare quality.
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Affiliation(s)
- Thomas Miller
- Institute of Management and Organization, Leuphana University Lüneburg, Lüneburg, Germany.
| | - Markus Reihlen
- Institute of Management and Organization, Leuphana University Lüneburg, Lüneburg, Germany.
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Abstract
Background Healthcare providers operate in a unique industry characterized by pursuit of perhaps the most noble of missions: the delivery of vital health and medical services to those in need. Distinguishing features abound, differentiating the healthcare industry from others, with such facets having the potential to compel those serving in health and medical establishments to focus exclusively on their selected industry. But directing attention solely within can result in missed opportunities, especially regarding innovation. Many innovations which are well suited for healthcare establishments emerge externally, making at least some exposure beyond the healthcare industry essential for institutions desirous of operating on the innovation frontier. Discussion True innovation emerges from broad worldviews, allowing healthcare providers to comprehensively understand the current state of the art. With such an understanding, novel tools, techniques, and approaches, regardless of industry of origin, can be examined for their potential to elevate the status and stature of efforts within health and medical establishments. It is this very open, inquisitive mindset that permitted Willis-Knighton Health System to identify and incorporate a range of innovations which originated outside of the healthcare industry. Its embracement of and associated successes with the repurposing approach known as adaptive reuse, the delivery of complex medical services via centers of excellence, and the structuring of operations using the hub-and-spoke organization design, for example, would never have occurred had executives not directed attention externally in search of innovations that could be used within. Conclusions Innovations offer key pathways for healthcare providers to enhance the depth and breadth of health and medical services offered in their establishments and communities. By peering beyond the walls of healthcare institutions, providers amplify opportunities to discover novel methods and approaches that potentially can be transferred into their own organizations, benefiting themselves and their patient populations.
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Affiliation(s)
- James K Elrod
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA
| | - John L Fortenberry
- Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA. .,LSU Shreveport, 1 University Place, Shreveport, LA, 71115, USA.
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Abstract
BACKGROUND African Americans (AAs) are disproportionately affected by acute heart failure (AHF) compared with other racial/ethnic groups. Disparities in AHF risk factors among AAs are attributed to higher rates of hypertension and diabetes mellitus, lower socioeconomic status, higher dietary caloric and salt intake, and biologic/genetic differences. However, AAs are frequently underrepresented in AHF clinical trials, and race-related differences in risks and clinical outcomes are not well understood. OBJECTIVE The aim of this work was to review published data on AHF in the AA population, including management strategies that may differ based on race and common barriers to optimal care. METHODS Publications were identified in Pubmed (through June 10, 2013) with the use of the search strategy terms (acute heart failure) AND (black OR African American OR racial). RESULTS Racial disparities in the quality of AHF care are relatively uncommon; however, racial differences in pathophysiology have resulted in differing pharmacologic recommendations (eg, isosorbide dinitrate plus hydralazine is indicated only in AAs). Various socioeconomic factors influence disease progression, treatment compliance, and hospitalization/rehospitalization rates. CONCLUSIONS Further research would enhance understanding of pathophysiologic heart failure differences between racial groups. Programs are needed that incorporate known clinical and cultural differences to improve quality of care and reduce the disease burden of AHF for all patients.
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Affiliation(s)
| | - Ola Akinboboye
- Association of Black Cardiologists, Washington DC Heart House, Washington, DC; Weill Medical College of Cornell University, New York, New York; Laurelton Heart Specialists P.C., Rosedale, New York
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