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Chiarelli AM, Walker MJ, Espino-Hernandez G, Gray N, Salleh A, Adhihetty C, Gao J, Fienberg S, Rey MA, Rabeneck L. Adherence to guidance for prioritizing higher risk groups for breast cancer screening during the COVID-19 pandemic in the Ontario Breast Screening Program: a descriptive study. CMAJ Open 2021; 9:E1205-E1212. [PMID: 34933878 PMCID: PMC8695571 DOI: 10.9778/cmajo.20200285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer screening in Ontario, Canada, was deferred during the first wave of the COVID-19 pandemic, and a prioritization framework to resume services according to breast cancer risk was developed. The purpose of this study was to assess the impact of the pandemic within the Ontario Breast Screening Program (OBSP) by comparing total volumes of screening mammographic examinations and volumes of screening mammographic examinations with abnormal results before and during the pandemic, and to assess backlogs on the basis of adherence to the prioritization framework. METHODS A descriptive study was conducted among women aged 50 to 74 years at average risk and women aged 30 to 69 years at high risk, who participated in the OBSP. Percentage change was calculated by comparing observed monthly volumes of mammographic examinations from March 2020 to March 2021 with 2019 volumes and proportions by risk group. We plotted estimates of backlog volumes of mammographic examinations by risk group, comparing pandemic with prepandemic screening practices. Volumes of mammographic examinations with abnormal results were plotted by risk group. RESULTS Volumes of mammographic examinations in the OBSP showed the largest declines in April and May 2020 (> 99% decrease) and returned to prepandemic levels as of March 2021, with an accumulated backlog of 340 876 examinations. As of March 2021, prioritization had reduced the backlog volumes of screens for participants at high risk for breast cancer by 96.5% (186 v. 5469 expected) and annual rescreens for participants at average risk for breast cancer by 13.5% (62 432 v. 72 202 expected); there was a minimal decline for initial screens. Conversely, the backlog increased by 7.6% for biennial rescreens (221 674 v. 206 079 expected). More than half (59.4%) of mammographic examinations with abnormal results were for participants in the higher risk groups. INTERPRETATION Prioritizing screening for those at higher risk for breast cancer may increase diagnostic yield and redirect resources to minimize potential long-term harms caused by the pandemic. This further supports the clinical utility of risk-stratified cancer screening.
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Affiliation(s)
- Anna M Chiarelli
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont.
| | - Meghan J Walker
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
| | - Gabriela Espino-Hernandez
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
| | - Natasha Gray
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
| | - Ayesha Salleh
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
| | - Chamila Adhihetty
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
| | - Julia Gao
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
| | - Samantha Fienberg
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
| | - Michelle A Rey
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
| | - Linda Rabeneck
- Cancer Care Ontario (Chiarelli, Walker, Espino-Hernandez, Gray, Salleh, Adhihetty, Gao, Fienberg, Rey, Rabeneck), Ontario Health, Toronto, Ont.; Dalla Lana School of Public Health (Chiarelli, Walker, Rabeneck), University of Toronto, Toronto, Ont.; Department of Radiology (Fienberg), Grand River Hospital, Kitchener, Ont
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Ayman G, Strachan JA, McLennan N, Malouf R, Lowe‐Zinola J, Magdi F, Roberts N, Alderdice F, Berneantu I, Breslin N, Byrne C, Carnell S, Churchill D, Grisoni J, Hirst JE, Morris A, Murphy HR, O’Brien J, Schmutz C, Shah K, Singal AS, Strachan MWJ, Cowan K, Knight M. The top 10 research priorities in diabetes and pregnancy according to women, support networks and healthcare professionals. Diabet Med 2021; 38:e14588. [PMID: 33949704 PMCID: PMC8359941 DOI: 10.1111/dme.14588] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 04/19/2021] [Indexed: 12/21/2022]
Abstract
AIMS To undertake a Priority Setting Partnership (PSP) to establish priorities for future research in diabetes and pregnancy, according to women with experience of pregnancy, and planning pregnancy, with any type of diabetes, their support networks and healthcare professionals. METHODS The PSP used established James Lind Alliance (JLA) methodology working with women and their support networks and healthcare professionals UK-wide. Unanswered questions about the time before, during or after pregnancy with any type of diabetes were identified using an online survey and broad-level literature search. A second survey identified a shortlist of questions for final prioritisation at an online consensus development workshop. RESULTS There were 466 responses (32% healthcare professionals) to the initial survey, with 1161 questions, which were aggregated into 60 unanswered questions. There were 614 responses (20% healthcare professionals) to the second survey and 18 questions shortlisted for ranking at the workshop. The top 10 questions were: diabetes technology, the best test for diabetes during pregnancy, diet and lifestyle interventions for diabetes management during pregnancy, emotional and well-being needs of women with diabetes pre- to post-pregnancy, safe full-term birth, post-natal care and support needs of women, diagnosis and management late in pregnancy, prevention of other types of diabetes in women with gestational diabetes, women's labour and birth experiences and choices and improving planning pregnancy. CONCLUSIONS These research priorities provide guidance for research funders and researchers to target research in diabetes and pregnancy that will achieve greatest value and impact.
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Affiliation(s)
- Göher Ayman
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - James A. Strachan
- Medical Sciences DivisionUniversity of OxfordJohn Radcliffe HospitalOxfordUK
| | - Niamh McLennan
- MRC Centre for Reproductive HealthUniversity of EdinburghQueen's Medical Research InstituteEdinburghUK
| | - Reem Malouf
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Jack Lowe‐Zinola
- The Royal Wolverhampton Hospital NHS TrustNew Cross HospitalWolverhamptonUK
| | - Fida Magdi
- The Royal Wolverhampton Hospital NHS TrustNew Cross HospitalWolverhamptonUK
| | - Nia Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | - Fiona Alderdice
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
- School of Nursing and MidwiferyQueen’s University BelfastBelfastUK
| | - Iuliana Berneantu
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Niki Breslin
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Caroline Byrne
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Sonya Carnell
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - David Churchill
- The Royal Wolverhampton Hospital NHS TrustNew Cross HospitalWolverhamptonUK
- University of WolverhamptonWolverhamptonUK
| | - Jeannie Grisoni
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Jane E. Hirst
- Nuffield Department of Women’s and Reproductive HealthUniversity of OxfordOxfordUK
- John Radcliffe HospitalOxford University Hospitals NHS Foundation TrustOxfordUK
| | | | - Helen R. Murphy
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Division of Women's HealthSt Thomas’ CampusKing's College LondonLondonUK
- Elsie Bertram Diabetes CentreNorfolk and Norwich University HospitalNorwichUK
| | - Jane O’Brien
- Stockport NHS Foundation TrustStepping Hill HospitalStockportUK
| | | | | | - Ankita S. Singal
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | | | - Katherine Cowan
- James Lind AllianceNational Institute for Health Research EvaluationTrials and Studies Coordinating CentreUniversity of SouthamptonSouthamptonUK
| | - Marian Knight
- National Perinatal Epidemiology UnitNuffield Department of Population HealthUniversity of OxfordOxfordUK
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Palladino R, Migliatico I, Sgariglia R, Nacchio M, Iaccarino A, Malapelle U, Vigliar E, Salvatore D, Troncone G, Bellevicine C. Thyroid fine-needle aspiration trends before, during, and after the lockdown: what we have learned so far from the COVID-19 pandemic. Endocrine 2021; 71:20-25. [PMID: 33284396 PMCID: PMC7719849 DOI: 10.1007/s12020-020-02559-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Nowadays, the clinical management of thyroid nodules needs to be multi-disciplinary. In particular, the crosstalk between endocrinologists and cytopathologists is key. When FNAs are properly requested by endocrinologists for nodules characterised by relevant clinical and ultrasound features, cytopathologists play a pivotal role in the diagnostic work-up. Conversely, improper FNA requests can lead to questionable diagnostic efficiency. Recently, recommendations to delay all non-urgent diagnostic procedures, such as thyroid FNAs, to contain the spread of COVID-19 infection, have made the interplay between endocrinologists and cytopathologists even more essential. The objective of this study was to assess the impact of COVID-19 pandemic on our practice by evaluating the total number of FNAs performed and the distribution of the Bethesda Categories before, during, and after the lockdown. METHODS We analysed the FNA trends before (1st January 2019 to March 13th 2020), during (March 14th to May 15th), and after (May 16th to July 7th) the lockdown. RESULTS Although the total number of weekly FNAs dropped from 62.1 to 23.1, our referring endocrinologists managed to prioritise patients with high-risk nodules. In fact, in the post-lockdown, the weekly proportion of benign diagnoses dropped on average by 12% and that of high-risk diagnoses increased by 6%. CONCLUSIONS The lesson we have learned so far from this pandemic is that by applying safety protocols to avoid contagion and by increasing the threshold for FNA requests for thyroid nodules, we can continue to guarantee our services to high-risk patients even in times of a health crisis.
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Affiliation(s)
- Raffaele Palladino
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Ilaria Migliatico
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Roberta Sgariglia
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Mariantonia Nacchio
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Antonino Iaccarino
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Umberto Malapelle
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Elena Vigliar
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Domenico Salvatore
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
| | - Giancarlo Troncone
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy.
| | - Claudio Bellevicine
- Department of Public Health, University of Naples Federico II, Via S. Pansini 5, 80131, Naples, Italy
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Hatakeyama Y, Fujita S, Iida S, Nagai Y, Shimamori Y, Ayuzawa J, Hirao T, Onishi R, Seto K, Matsumoto K, Hasegawa T. Prioritization of patient safety health policies: Delphi survey using patient safety experts in Japan. PLoS One 2020; 15:e0239179. [PMID: 32941481 PMCID: PMC7497979 DOI: 10.1371/journal.pone.0239179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 09/01/2020] [Indexed: 11/19/2022] Open
Abstract
Various patient safety interventions have been implemented since the late 1990s, but their evaluation has been lacking. To obtain basic information for prioritizing patient safety interventions, this study aimed to extract high-priority interventions in Japan and to identify the factors that influence the setting of priority. Six perspectives (contribution, dissemination, impact, cost, urgency, and priority) on 42 patient safety interventions classified into 3 levels (system, organizational, and clinical) were evaluated by Japanese experts using the Delphi technique. We examined the relationships of the levels and the perspectives on interventions with the transition of the consensus state in rounds 1 and 3. After extracting the high-priority interventions, a chi-squared test was used to examine the relationship of the levels and the impact/cost ratio with high priority. Regression models were used to examine the influence of each perspective on priority. There was a significant relationship between the level of interventions and the transition of the consensus state (p = 0.033). System-level interventions had a low probability of achieving consensus. “Human resources interventions,” “professional education and training,” “medication management/reconciliation protocols,” “pay-for performance (P4P) schemes and financing for safety,” “digital technology solutions to improve safety,” and “hand hygiene initiatives” were extracted as high-priority interventions. The level and the impact/cost ratio of interventions had no significant relationships with high priority. In the regression model, dissemination and impact had an influence on priority (β = -0.628 and 0.941, respectively; adjusted R-squared = 0.646). The influence of impact and dissemination on the priority of interventions suggests that it is important to examine the dissemination degree and impact of interventions in each country for prioritizing interventions.
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Affiliation(s)
| | | | - Shuhei Iida
- All Japan Hospital Association, Tokyo, Japan
- Nerima General Hospital, Tokyo, Japan
- Institute for Healthcare Quality Improvement, Tokyo Healthcare Foundation, Tokyo, Japan
| | - Yoji Nagai
- All Japan Hospital Association, Tokyo, Japan
- Hitachinaka General Hospital, Hitachinaka, Ibaraki, Japan
| | | | - Junko Ayuzawa
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Hirao
- Faculty of Medicine, Kagawa University, Takamatsu, Kagawa, Japan
| | - Ryo Onishi
- Toho University School of Medicine, Tokyo, Japan
| | - Kanako Seto
- Toho University School of Medicine, Tokyo, Japan
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Abstract
The UK's National Institute for Health and Care Excellence (NICE) is responsible for conducting health technology assessment (HTA) on behalf of the National Health Service (NHS). In seeking to justify its recommendations to the NHS about which technologies to fund, NICE claims to adopt two complementary ethical frameworks, one procedural-accountability for reasonableness (AfR)-and one substantive-an 'ethics of opportunity costs' (EOC) that rests primarily on the notion of allocative efficiency. This study is the first to empirically examine normative changes to NICE's approach and to analyse whether these enhance or diminish the fairness of its decision-making, as judged against these frameworks. It finds that increasing formalisation of NICE's approach and a weakening of the burden of proof laid on technologies undergoing HTA have together undermined its commitment to EOC. This implies a loss of allocative efficiency and a shift in the balance of how the interests of different NHS users are served, in favour of those who benefit directly from NICE's recommendations. These changes also weaken NICE's commitment to AfR by diminishing the publicity of its decision-making and by encouraging the adoption of rationales that cannot easily be shown to meet the relevance condition. This signals a need for either substantial reform of NICE's approach, or more accurate communication of the ethical reasoning on which it is based. The study also highlights the need for further empirical work to explore the impact of these policy changes on NICE's practice of HTA and to better understand how and why they have come about.
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Affiliation(s)
- Victoria Charlton
- Department of Global Health and Social Medicine, King's College London, 40 Aldwych, London, WC2B 4BG, UK.
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Qoronfleh MW. Health is a political choice: why conduct healthcare research? Value, importance and outcomes to policy makers. Life Sci Soc Policy 2020; 16:5. [PMID: 32715382 PMCID: PMC7382967 DOI: 10.1186/s40504-020-00100-8] [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: 05/03/2020] [Accepted: 06/11/2020] [Indexed: 06/11/2023]
Abstract
This paper offers the Eastern Mediterranean Region (EMR) viewpoint with Qatar as a case for lasting transformation of health systems. The Qatar case study illustrates the importance of research in the development of health policy. It provides description of a series of projects that have been undertaken in relevant national areas such as autism, dementia, genomics, palliative care and patient safety. The paper discourse draws attention to investment requirement in health research systems to respond to country national health priorities and to strengthen public health policies for improving health and social outcomes by narrowing the gap between research and politics. In short, the discussion highlights the following: i) health is a human right marching towards universal health care, with research underpinning every advance in health care and quality medical services; ii) evidence-based research is emerging as a critical tool to aid policy- and decision-makers; iii) investment necessity in healthcare research/systems to enable responding to a country's national health priorities and to strengthen public health policies; and iv) need for multi-sectoral involvement of stakeholders to bridge the gap between research and politics. Finally, atypical stakeholders' engagement and bond to politics is a prerequisite to achieve healthcare objectives and policy success so as to reap the benefits of public health results.
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Affiliation(s)
- M Walid Qoronfleh
- Research & Policy Department, World Innovation Summit for Health (WISH), Qatar Foundation, P.O. Box 5825, Doha, Qatar.
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Abstract
IMPORTANCE Primary care physicians have limited time to discuss preventive care, but it is unknown how they prioritize recommended services. OBJECTIVE To understand primary care physicians' prioritization of preventive services. DESIGN, SETTING, AND PARTICIPANTS This online survey was administered to primary care physicians in a large health care system from March 17 to May 12, 2017. Physicians were asked whether they prioritize preventive services and which factors contribute to their choice (5-point Likert scale). Results were analyzed from July 8, 2017, to September 19, 2019. EXPOSURES A 2 × 2 factorial design of 2 hypothetical patients: (1) a 50-year-old white woman with hypertension, type 2 diabetes, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of breast cancer; and (2) a 45-year-old black man with hypertension, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of colorectal cancer. Two visit lengths (40 minutes vs 20 minutes) were given. Each patient was eligible for at least 11 preventive services. MAIN OUTCOMES AND MEASURES Physicians rated their likelihood of discussing each service during the visit and reported their top 3 priorities for patients 1 and 2. Physician choices were compared with the preventive services most likely to improve life expectancy, using a previously published mathematical model. RESULTS Of 241 physicians, 137 responded (57%), of whom 74 (54%) were female and 85 (62%) were younger than 50 years. Physicians agreed they prioritized preventive services (mean score, 4.27 [95% CI, 4.12-4.42] of 5.00), mostly by ability to improve quality (4.56 [95% CI, 4.44-4.68] of 5.00) or length (4.53 [95% CI, 4.40-4.66] of 5.00) of life. Physicians reported more prioritization in the 20- vs 40-minute visit, indicating that they were likely to discuss fewer services during the shorter visit (median, 5 [interquartile range {IQR}, 3-8] vs 11 [IQR, 9-13] preventive services for patient 1, and 4 [IQR, 3-6] vs 9 [IQR, 8-11] for patient 2). Physicians reported similar top 3 priorities for both patients: smoking cessation, hypertension control, and glycemic control for patient 1 and smoking cessation, hypertension control, and colorectal cancer screening for patient 2. Physicians' top 3 priorities did not usually include diet and exercise or weight loss (ranked in their top 3 recommendations for either patient by only 48 physicians [35%]), although these were among the 3 preventive services most likely to improve life expectancy based on the mathematical model. CONCLUSIONS AND RELEVANCE In this survey study, physicians prioritized preventive services under time constraints, but priorities did not vary across patients. Physicians did not prioritize lifestyle interventions despite large potential benefits. Future research should consider whether physicians and patients would benefit from guidance on preventive care priorities.
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Affiliation(s)
- Jessica J. Zhang
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Michael B. Rothberg
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Anita D. Misra-Hebert
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | | | - Glen B. Taksler
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
- Medicine Institute, Cleveland Clinic, Cleveland, Ohio
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
- Center for Health Care Research and Policy, Case Western Reserve University and MetroHealth Medical Center, Cleveland, Ohio
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Ceugnart L, Delaloge S, Balleyguier C, Deghaye M, Veron L, Kaufmanis A, Mailliez A, Poncelet E, Lenczner G, Verzaux L, Gligorov J, Thomassin-Naggara I. [Breast cancer screening and diagnosis at the end of the COVID-19 confinement period, practical aspects and prioritization rules: recommendations of 6 French health professionals societies]. Bull Cancer 2020; 107:623-628. [PMID: 32416925 PMCID: PMC7203044 DOI: 10.1016/j.bulcan.2020.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Luc Ceugnart
- Département d'imagerie médicale, centre Oscar-Lambret, Lille, France
| | - Suzette Delaloge
- Département de médecine oncologique et prévention des cancers, Gustave-Roussy, Villejuif, France.
| | | | - Michel Deghaye
- Centre régional de coordination des dépistages des cancers d'Ile de France, Paris, France
| | - Lucie Veron
- Département de médecine oncologique et prévention des cancers, Gustave-Roussy, Villejuif, France
| | - Aldis Kaufmanis
- Centre régional de coordination des dépistages des cancers d'Ile de France, Paris, France
| | - Audrey Mailliez
- Département d'oncologie médicale et génétique, centre Oscar-Lambret, Lille, France
| | - Edouard Poncelet
- Service d'imagerie de la femme, centre hospitalier de Valenciennes, Valenciennes, France
| | | | - Laurent Verzaux
- Service de radiologie clinique Les Ormeaux, Le Havre, France
| | - Joseph Gligorov
- Département d'oncologie médicale, hôpital Tenon, Paris, France
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Oliver N, Holt RIG. The James Lind Alliance Research Priorities for Diabetes revisited. Diabet Med 2020; 37:511-512. [PMID: 32181537 DOI: 10.1111/dme.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- N Oliver
- Invited Reviews Editor, Diabetic Medicine
- Division of Diabetes and Endocrinology, Imperial College, London, UK
| | - R I G Holt
- Editor-in-Chief, Diabetic Medicine
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
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Varghese L, Ezat Wan Puteh S, Schecroun N, Jahis R, Van Vlaenderen I, Standaert BA. Applying a Constrained Optimization Portfolio Model to Aid Prioritization of Public Health Interventions in Malaysia. Value Health Reg Issues 2020; 21:172-180. [PMID: 32044690 DOI: 10.1016/j.vhri.2019.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/28/2019] [Accepted: 11/17/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Countries have constrained healthcare budgets and must prioritize new interventions depending on health goals and time frame. This situation is relevant in the sphere of national immunization programs, for which many different vaccines are proposed, budgets are limited, and efficient choices must be made in the order of vaccine introduction. METHODS A constrained optimization (CO) model for infectious diseases was developed in which different intervention types (prophylaxis and treatment) were combined for consideration in Malaysia. Local experts defined their priority public health issues: pneumococcal disease, dengue, hepatitis B and C, rotavirus, neonatal pertussis, and cholera. Epidemiological, cost, and effectiveness data were informed from local or regionally published literature. The model aimed to maximize quality-adjusted life-year (QALY) gain through the reduction of events in each of the different diseases, under budget and intervention coverage constraints. The QALY impact of the interventions was assessed over 2 periods: lifetime and 20 years. The period of investment was limited to 15 years. RESULTS The assessment time horizon influenced the prioritization of interventions maximizing QALY gain. The incremental health gains compared with a uninformed prioritization were large for the first 8 years and declined thereafter. Rotaviral and pneumococcal vaccines were identified as key priorities irrespective of time horizon, hepatitis B immune prophylaxis and hepatitis C treatment were priorities with the lifetime horizon, and dengue vaccination replaced these with the 20-year horizon. CONCLUSIONS CO modeling is a useful tool for making economically efficient decisions within public health programs for the control of infectious diseases by helping prioritize the selection of interventions to maximize health gain under annual budget constraints.
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Affiliation(s)
| | | | - Nadia Schecroun
- Keyrus Biopharma c/o GSK, Health Economics Department, Wavre, Belgium
| | - Rohani Jahis
- Ministry of Health, Disease Control Division, Putrajaya, Malaysia
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Abstract
The purpose of patient positioning is to provide optimal surgical site exposure for surgical team members and prevent negative patient outcomes. This study explores perioperative nurses' experiences when positioning patients for surgery. We collected data using focus group interviews of 17 OR nurses in Norway and used qualitative content analysis to analyze the data. The study findings showed that perioperative nurses emphasized their most important priorities as concepts that can be categorized into three themes: leading and coordinating patient positioning, ensuring patient safety, and promoting efficient use of OR nurses' expertise. The study findings also identify a need to define formal responsibilities in patient positioning and processes for determining positioning outcomes. Perioperative leaders should verify OR nurse competence for patient positioning to help ensure continuity and safety in complex patient pathways.
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e Silva RT, Cristante AF, Marcon RM, de Barros-Filho TEP. Medical care for spinal diseases during the COVID-19 pandemic. Clinics (Sao Paulo) 2020; 75:e1954. [PMID: 32401963 PMCID: PMC7196724 DOI: 10.6061/clinics/2020/e1954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 01/18/2023] Open
Affiliation(s)
- Ricardo Teixeira e Silva
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| | - Alexandre Fogaça Cristante
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Raphael Martus Marcon
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tarcísio Eloy Pessoa de Barros-Filho
- Instituto de Ortopedia e Traumatologia (IOT), Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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King PR, Beehler GP, Buchholz LJ, Johnson EM, Wray LO. Functional concerns and treatment priorities among veterans receiving VHA Primary Care Behavioral Health services. Fam Syst Health 2019; 37:68-73. [PMID: 30614723 PMCID: PMC6748326 DOI: 10.1037/fsh0000393] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION The Primary Care-Mental Health Integration program is a component of the Veterans Health Administration's patient-centered medical home, which emphasizes comprehensive, patient-centered care. One model of primary care-mental health integration, known as Primary Care Behavioral Health (PCBH), positions trained behavioral health providers as members of the primary care team. Whereas patient perspectives are essential to effective patient-centered care, little empirical information exists regarding patients' goals and priorities for addressing their biopsychosocial concerns in PCBH. METHOD A regional mail survey of Veterans Health Administration patients was used. We collected data from 281 veterans (27% response rate) who received PCBH services in a northeastern region. RESULTS Respondents identified difficulty with sleep (80%), low energy/amotivation (78%), and managing stress (72%) as the most prevalent individual concerns, although the majority endorsed concerns in multiple domains of functioning. Overwhelmingly, patients who endorsed any biopsychosocial problem area reported that they did (53-93%) or would like to (56-81%) address that concern with a behavioral health provider. Respondents most frequently identified anger as a top priority for future care, followed by stress management, energy/motivation, and sleep disturbance. Whereas sample means signaled neutral or better quality of life in most individual domains, total Quality of Life Inventory scores suggested very low (32%) to average (30%) overall quality-of -life ratings for most participants. DISCUSSION In addition to symptom-focused PCBH assessments, providers should gather biopsychosocial data to identify and monitor functional and quality-of -life concerns and evaluate patient preferences in addressing these concerns over the course of clinical care. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Paul R. King
- VA Center for Integrated Healthcare, VA WNY Healthcare System, Buffalo, NY
- Department of Counseling, School, and Educational Psychology, University at Buffalo, Buffalo, NY
| | - Gregory P. Beehler
- VA Center for Integrated Healthcare, VA WNY Healthcare System, Buffalo, NY
- School of Public Health and Health Professions, University at Buffalo, Buffalo, NY
| | - Laura J. Buchholz
- VA Center for Integrated Healthcare, VA WNY Healthcare System, Buffalo, NY
- The University of Tampa, Tampa, FL
| | - Emily M. Johnson
- VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY
| | - Laura O. Wray
- VA Center for Integrated Healthcare, VA WNY Healthcare System, Buffalo, NY
- Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
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Falavigna G, Costantino G, Furlan R, Quinn JV, Ungar A, Ippoliti R. Artificial neural networks and risk stratification in emergency departments. Intern Emerg Med 2019; 14:291-299. [PMID: 30353271 DOI: 10.1007/s11739-018-1971-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/16/2018] [Indexed: 11/28/2022]
Abstract
Emergency departments are characterized by the need for quick diagnosis under pressure. To select the most appropriate treatment, a series of rules to support decision-making has been offered by scientific societies. The effectiveness of these rules affects the appropriateness of treatment and the hospitalization of patients. Analyzing a sample of 1844 patients and focusing on the decision to hospitalize a patient after a syncope event to prevent severe short-term outcomes, this work proposes a new algorithm based on neural networks. Artificial neural networks are a non-parametric technique with the well-known ability to generalize behaviors, and they can thus predict severe short-term outcomes with pre-selected levels of sensitivity and specificity. This innovative technique can outperform the traditional models, since it does not require a specific functional form, i.e., the data are not supposed to be distributed following a specific design. Based on our results, the innovative model can predict hospitalization with a sensitivity of 100% and a specificity of 79%, significantly increasing the appropriateness of medical treatment and, as a result, hospital efficiency. According to Garson's Indexes, the most significant variables are exertion, the absence of symptoms, and the patient's gender. On the contrary, cardio-vascular history, hypertension, and age have the lowest impact on the determination of the subject's health status. The main application of this new technology is the adoption of smart solutions (e.g., a mobile app) to customize the stratification of patients admitted to emergency departments (ED)s after a syncope event. Indeed, the adoption of these smart solutions gives the opportunity to customize risk stratification according to the specific clinical case (i.e., the patient's health status) and the physician's decision-making process (i.e., the desired levels of sensitivity and specificity). Moreover, a decision-making process based on these smart solutions might ensure a more effective use of available resources, improving the management of syncope patients and reducing the cost of inappropriate treatment and hospitalization.
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Affiliation(s)
- Greta Falavigna
- CNR-IRCrES, Research Institute on Sustainable Economic Growth, Moncalieri, Italy.
| | - Giorgio Costantino
- Clinical Medicine Department, Fondazione IRCCS, Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Humanitas Research Hospital, Rozzano, Italy
| | - James V Quinn
- Division of Emergency Medicine, Stanford University, Stanford, CA, USA
| | - Andrea Ungar
- Syncope Unit, Geriatric Medicine and Cardiology, Careggi University Hospital, Florence, Italy
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Tran BX, Dang KA, Le HT, Ha GH, Nguyen LH, Nguyen TH, Tran TH, Latkin CA, Ho CSH, Ho RCM. Global Evolution of Obesity Research in Children and Youths: Setting Priorities for Interventions and Policies. Obes Facts 2019; 12:137-149. [PMID: 30865948 PMCID: PMC6547288 DOI: 10.1159/000497121] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 01/21/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Childhood obesity has become a major global epidemic that causes substantial social and health burdens worldwide. The effectiveness of childhood obesity control and prevention depends largely on understanding the issue, including its current development and associated factors in a contextualized perspective. OBJECTIVES Our study aimed to gauge this kind of understanding. METHODS We systematically searched the Web of Science database for studies concerning child obesity published up to 2017 and analyzed the volume of publications, growth rates, impact scores, collaborations, authors, affiliations, and journals. A total of 57,444 research papers were included. RESULTS The three subject categories with the highest number of papers (over 3,000) were (1) nutrition and dietetics, (2) pediatrics, and (3) public, environmental, and occupational health. We found a dramatic increase in the amount of scientific literature on childhood obesity in the past one or two decades, led by scholars from the USA - ranking at the top regarding the total number of papers (23,965 papers; 30.8%) and total number of citations (859,793 citations) - and multiple Western countries where the obesity epidemic is prevalent. CONCLUSIONS The findings highlight the need for improving international and local research capacities and collaboration to accelerate knowledge production and translation into contextualized and effective childhood obesity prevention.
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Affiliation(s)
- Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam,
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA,
| | - Kim Anh Dang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Huong Thi Le
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tân University, Da Nang, Vietnam
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tu Huu Nguyen
- Anesthesia and Critical Care Department, Hanoi Medical University, Hanoi, Vietnam
| | - Tung Hoang Tran
- Department of Lower Limb Surgery, Vietnam - Germany Hospital, Hanoi, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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O’Neill B, Aversa V, Rouleau K, Lazare K, Sullivan F, Persaud N. Identifying top 10 primary care research priorities from international stakeholders using a modified Delphi method. PLoS One 2018; 13:e0206096. [PMID: 30359391 PMCID: PMC6201922 DOI: 10.1371/journal.pone.0206096] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High quality primary care is fundamental to achieving health for all. Research priority setting is a key facilitator of improving how research activity responds to concrete needs. There has never before been an attempt to identify international primary care research priorities, in order to guide resource allocation and to enhance global primary care. This study aimed to identify a list of top 10 primary care research priorities, as identified by members of the public, health professionals working in primary care, researchers, and policymakers. METHODS We adapted the James Lind Alliance Priority Setting Partnership process, to conduct multiple rounds of stakeholder recruitment and prioritization. The study included an online survey conducted in three languages, followed by an in-person priority setting exercise involving primary care stakeholders from 13 countries. FINDINGS Participants identified a list of top 10 international primary care research priorities. These were focused on diverse topics such as enhancing use of information and communication technology, and improving integration of indigenous communities' knowledge in the design of primary care services. The main limitations of the study related to challenges in engaging an adequate diversity and number of appropriate stakeholders, particularly members of the public, in aggregating the diverse set of responses into coherent categories representative of the participants' perspectives and in adequately representing the diversity of submitted responses while ensuring research priorities on the final list are sufficiently actionable to guide resource allocation. CONCLUSIONS The top 10 identified research priorities have the potential to guide research resource allocation, supporting funding agencies and initiatives to promote global primary care research and practice.
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Affiliation(s)
- Braden O’Neill
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Aversa
- Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Rouleau
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Kim Lazare
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Frank Sullivan
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
- School of Medicine, University of St. Andrews, St. Andrews, United Kingdom
| | - Nav Persaud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
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Abstract
Health care spending in the United States has increased to unprecedented levels, and these costs have broken medical providers' promise to do no harm. Medical debt is the leading contributor to U.S. personal bankruptcy, more than 50% of household foreclosures are secondary to medical debt and illness, and patients are choosing to avoid necessary care because of its cost. Evidence that the health care delivery model is contributing to patient hardship is a call to action for the profession to transition to a high-value model, one that delivers the highest health care quality and safety at the lowest personal and financial cost to patients. As such, value improvement work is being done at academic medical centers across the country. To promote measurable improvements in practice on a national scale, academic institutions need to align efforts and create a new model for collaboration, one that transcends cross-institutional competition, specialty divisions, and geographical constraints. Academic institutions are particularly accountable because of the importance of research and education in driving this transition. Investigations that elucidate effective implementation methodologies and evaluate safety outcomes data can facilitate transformation. Engaging trainees in quality improvement initiatives will instill high-value care into their practice. This article charges academic institutions to go beyond dissemination of best practice guidelines and demonstrate accountability for high-value quality improvement implementation. By effectively transitioning to a high-value health care system, medical providers will convincingly demonstrate that patients are their most important priority.
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Affiliation(s)
- Pamela T Johnson
- P.T. Johnson is director, Appropriate Imaging, physician lead, Johns Hopkins Health System High Value Care Committee, vice chair, Quality and Safety, program director, Radiology Residency, and associate professor, Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland. M.D. Alvin is a second-year diagnostic radiology resident, Department of Radiology, Johns Hopkins Medicine, Baltimore, Maryland. R.C. Ziegelstein is vice dean for education, Johns Hopkins University School of Medicine, and professor, Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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Newdick C. Can Judges Ration with Compassion? A Priority-Setting Rights Matrix. Health Hum Rights 2018; 20:107-120. [PMID: 30008556 PMCID: PMC6039723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
How should courts supervise health service resource allocation? Although practice varies widely, four broad approaches can be represented on a matrix comparing, on two axes, (a) individual-community rights and (b) substantive-procedural remedies. Examples from each compartment of the matrix are discussed and, although the community-procedural approach is recommended as a general rule, a range of other responses within the matrix may also be desirable.
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Abstract
INTRODUCTION Many countries have developed disease surveillance systems to deal with epidemics, but although health information systems have existed for more than two decades, constraints and biases in data collection limit the relevance of policy decisions and strategies in the field of health, as priority has been given to education and health in developing countries. Donor support has led to the development of systems for the production of statistics, designed, among other things, to more clearly target interventions in terms of educational objectives, action and credibility and enable health systems to continue to benefit from external funding. METHODS We used a classical anthropology approach based on observations and in-depth interviews with local and national health system actors. RESULTS The aim of this article is to analyse the real effects of the production of health statistics in health care systems and to determine the relevance of these figures in the context in which they apply. DISCUSSIONS Health priorities defined by international organizations and technical and financial partners focus on diseases considered to be ?priorities? to the detriment of neglected diseases, which are perceived as being more important at the local level due to their impact on the already limited health systems. We describe how health actors within healthcare structures adjust and adapt to public health requirements.
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Denham N, Matthews B. Nurses Underscore Value of Collaboration when Implementing Health Technology. Biomed Instrum Technol 2018; 52:32-36. [PMID: 29350978 DOI: 10.2345/0899-8205-52.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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23
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Remme M, Martinez-Alvarez M, Vassall A. Cost-Effectiveness Thresholds in Global Health: Taking a Multisectoral Perspective. Value Health 2017; 20:699-704. [PMID: 28408014 DOI: 10.1016/j.jval.2016.11.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [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: 07/27/2016] [Revised: 11/13/2016] [Accepted: 11/13/2016] [Indexed: 05/21/2023]
Abstract
Good health is a function of a range of biological, environmental, behavioral, and social factors. The consumption of quality health care services is therefore only a part of how good health is produced. Although few would argue with this, the economic framework used to allocate resources to optimize population health is applied in a way that constrains the analyst and the decision maker to health care services. This approach risks missing two critical issues: 1) multiple sectors contribute to health gain and 2) the goods and services produced by the health sector can have multiple benefits besides health. We illustrate how present cost-effectiveness thresholds could result in health losses, particularly when considering health-producing interventions in other sectors or public health interventions with multisectoral outcomes. We then propose a potentially more optimal second best approach, the so-called cofinancing approach, in which the health payer could redistribute part of its budget to other sectors, where specific nonhealth interventions achieved a health gain more efficiently than the health sector's marginal productivity (opportunity cost). Likewise, other sectors would determine how much to contribute toward such an intervention, given the current marginal productivity of their budgets. Further research is certainly required to test and validate different measurement approaches and to assess the efficiency gains from cofinancing after deducting the transaction costs that would come with such cross-sectoral coordination.
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Affiliation(s)
- Michelle Remme
- Social and Mathematical Epidemiology (SaME) Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
| | - Melisa Martinez-Alvarez
- Social and Mathematical Epidemiology (SaME) Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Anna Vassall
- Social and Mathematical Epidemiology (SaME) Group, Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Sousa FAMDR, Goulart MJG, Braga AMDS, Medeiros CMO, Rego DCM, Vieira FG, Pereira HJADR, Tavares HMCV, Loura MMP. Setting health priorities in a community: a case example. Rev Saude Publica 2017; 51:11. [PMID: 28273229 PMCID: PMC5336317 DOI: 10.1590/s1518-8787.2017051006460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/30/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the methodology used in the process of setting health priorities for community intervention in a community of older adults. METHODS Based on the results of a health diagnosis related to active aging, a prioritization process was conceived to select the priority intervention problem. The process comprised four successive phases of problem analysis and classification: (1) grouping by level of similarity, (2) classification according to epidemiological criteria, (3) ordering by experts, and (4) application of the Hanlon method. These stages combined, in an integrated manner, the views of health team professionals, community nursing and gerontology experts, and the actual community. RESULTS The first stage grouped the identified problems by level of similarity, comprising a body of 19 issues for analysis. In the second stage these problems were classified by the health team members by epidemiological criteria (size, vulnerability, and transcendence). The nine most relevant problems resulting from the second stage of the process were submitted to expert analysis and the five most pertinent problems were selected. The last step identified the priority issue for intervention in this specific community with the participation of formal and informal community leaders: Low Social Interaction in Community Participation. CONCLUSIONS The prioritization process is a key step in health planning, enabling the identification of priority problems to intervene in a given community at a given time. There are no default formulas for selecting priority issues. It is up to each community intervention team to define its own process with different methods/techniques that allow the identification of and intervention in needs classified as priority by the community. OBJETIVO Descrever a metodologia utilizada no processo de estabelecimento de prioridades em saúde para intervenção comunitária, numa comunidade idosa. MÉTODOS Partindo dos resultados de um diagnóstico de saúde no âmbito da promoção do envelhecimento ativo, concebeu-se um processo de estabelecimento de prioridades a fim de selecionar o problema prioritário para intervenção. O processo integrou quatro etapas sucessivas de análise e classificação dos problemas: (1) agrupamento por nível de similitude, (2) classificação de acordo com critérios epidemiológicos, (3) ordenação por peritos e (4) aplicação do método de Hanlon. No decurso destas etapas, combinaram-se, de forma integrada, as perspetivas dos profissionais da equipe de saúde, de peritos em enfermagem comunitária e gerontologia e da própria comunidade. RESULTADOS Na primeira etapa, agruparam-se por nível de similitude os problemas identificados, constituindo-se um corpo de 19 problemas para análise. Na segunda, esses problemas foram classificados pelos elementos da equipe de saúde, mediante a aplicação de critérios de cariz epidemiológico (magnitude, vulnerabilidade e transcendência). Os nove problemas mais relevantes resultantes da operacionalização da segunda etapa do processo foram submetidos a análise por peritos, e selecionados os cinco problemas com maior pertinência de atuação. Na última etapa, com recurso à participação de líderes formais e informais da comunidade, identificou-se o problema prioritário para intervenção nessa comunidade específica: a Baixa Interação Social na Participação Comunitária. CONCLUSÕES O processo de estabelecimento de prioridades é uma etapa fundamental do planejamento em saúde, permitindo identificar os problemas prioritários a intervir numa determinada comunidade e num determinado momento. Não existem fórmulas predeterminadas para a seleção de problemas prioritários. Cabe a cada equipe de intervenção comunitária a definição de um processo próprio com diferentes métodos/técnicas que possibilitem a identificação e intervenção em necessidades classificadas como prioritárias pela comunidade.
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Affiliation(s)
| | - Maria José Garcia Goulart
- Centro de Saúde de Ponta Delgada. Unidade de Saúde de Ilha de São Miguel. Ponta Delgada, Açores, Portugal
| | | | | | | | - Flávio Garcia Vieira
- Unidade de Saúde Pública. Unidade de Saúde de Ilha de São Miguel. Ponta Delgada, Açores, Portugal
| | - Helder José Alves da Rocha Pereira
- Departamento de Enfermagem, Saúde da Família e Comunidade. Escola Superior de Saúde. Universidade dos Açores. Ponta Delgada, Açores, Portugal
| | | | - Marta Maria Puim Loura
- Serviço de Saúde Ocupacional. Hospital do Divino Espírito Santo, EPE. Ponta Delgada, Açores, Portugal
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Le Lain R, Ignaszewski C, Klingmann I, Cesario A, de Boer WI. SPRINTT and the involvement of stakeholders: strategy and structure. Aging Clin Exp Res 2017; 29:65-67. [PMID: 28144912 DOI: 10.1007/s40520-016-0706-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/11/2016] [Accepted: 10/10/2016] [Indexed: 11/30/2022]
Abstract
The current healthcare systems are built around the traditional paradigm of patients suffering from a single acute illness. They are, therefore, largely unprepared to face the increasing demands for health services arising from the expansion of an older population with specific medical needs related to multiple chronic disorders. As a consequence, the medical conditions of a large and growing segment of the older European population are not efficiently managed by the available healthcare services. In the context of an aging population, policy makers such as the European Commission and European Institutions, such as the European Medicines Agency (EMA), devote time and resources to study and accompany the need of the aging population. The EMA recognizes the importance of making sure that the needs of the Elderly are considered during development, approval, and use of new medicines, and, therefore, engages with healthcare professional organisations. The Sarcopenia and Physical Frailty in Older People: Multicomponent Intervention Strategies (SPRINTT) is the obvious result of these strategies. The present article describes the SPRINTT workpackage activities aimed at engaging the scientific discussion on the physical frailty and sarcopenia with the EMA as one of its interlocutor, acknowledging the need to collaborate on this topic to foster a productive dialogue.
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Affiliation(s)
- Régis Le Lain
- Global Regulatory Affairs, Sanofi R&D, 1 Avenue Pierre Brossolette, 91380, Chilly-Mazarin, France.
| | | | | | - Alfredo Cesario
- EU-Open SrL, Venetia, Italy
- Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Willem Ivo de Boer
- EU-Open SrL, Venetia, Italy
- Department of Pulmonology, Leiden University Medical Center, Leiden, The Netherlands
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Berglund M. [Follow-up of schizophrenia drugs should be discontinued immediately]. Lakartidningen 2017; 114:EEI4. [PMID: 28045469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Rumbold B, Weale A, Rid A, Wilson J, Littlejohns P. Public Reasoning and Health-Care Priority Setting: The Case of NICE. Kennedy Inst Ethics J 2017; 27:107-134. [PMID: 28366905 PMCID: PMC6728154 DOI: 10.1353/ken.2017.0005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Health systems that aim to secure universal patient access through a scheme of prepayments-whether through taxes, social insurance, or a combination of the two-need to make decisions on the scope of coverage that they guarantee: such tasks often falling to a priority-setting agency. This article analyzes the decision-making processes at one such agency in particular-the UK's National Institute for Health and Care Excellence (NICE)-and appraises their ethical justifiability. In particular, we consider the extent to which NICE's model can be justified on the basis of Rawls's conception of "reasonableness." This test shares certain features with the well-known Accountability for Reasonableness (AfR) model but also offers an alternative to it, being concerned with how far the values used by priority-setting agencies such as NICE meet substantive conditions of reasonableness irrespective of their procedural virtues. We find that while there are areas in which NICE's processes may be improved, NICE's overall approach to evaluating health technologies and setting priorities for health-care coverage is a reasonable one, making it an exemplar for other health-care systems facing similar coverage dilemmas. In so doing we offer both a framework for analysing the ethical justifiability of NICE's processes and one that might be used to evaluate others.
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Gagné C, Roberge S, Harvey B. [Not Available]. Perspect Infirm 2016; 13:29-31. [PMID: 29381277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Claire Gagné
- CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Québec, Canada
| | - Sylvie Roberge
- Centre hospitalier universitaire Sainte-Justine, Montréal, Québec, Canada
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Abstract
This article provides a brief account of the historical background to the Gender Symmetry Workshop and describes its major goals. The Workshop is a successor to an earlier workshop co-sponsored by the Centers for Disease Control and Prevention and the National Institute of Justice in 1998, namely the Workshop on Building Data Systems for Monitoring and Responding to Violence Against Women. Some key issues that were left unresolved in that workshop provided the rationale for holding the Gender Symmetry Workshop. The Workshop was designed to cover three topic areas: (1) a typology of violence, (2) measurement issues, and (3) women’s use of violence.
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Arnesen T, Trommald M. Roughly right or precisely wrong? Systematic review of quality-of-life weights elicited with the time trade-off method. J Health Serv Res Policy 2016; 9:43-50. [PMID: 15006240 DOI: 10.1258/135581904322716111] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective: Cost-utility analysis is gaining importance as a tool for setting priorities in health care. The approach requires quality-of-life weights on a scale from 0.00 (corresponding to death) to 1.00 (corresponding to perfect health). Different methods and perspectives of the evaluators tend to give different results. Time trade-off (TTO) is the most commonly used method to elicit quality-of-life weights for quality-adjusted life-years (QALYs). How reliable are the results of this method, when limited to one specific perspective, as input for cost-utility analysis? Method: Systematic literature review of empirical studies in which the TTO is elicited by the respondent on their own behalf. Results: In 56 papers, quality-of-life weights for 102 diagnostic groups were given. Ranking of the diagnostic groups according to their quality-of-life weights had no apparent relation to severity. One specific diagnostic group was assigned quality-of-life weights ranging from 0.39 to 0.84. Altogether, 57% of respondents did not trade any life-time at all in exchange for health improvements. The distributions studied were skewed towards 1.00 and were bimodal without a central tendency. The correlation between the TTO and related methods was generally weak. Possible explanations for the poor empirical properties of the TTO are inappropriate use of the method, lack of representative samples, or that the TTO does not measure what it claims to measure. Conclusion: In the light of these findings, the TTO elicited from the patient perspective, as currently practised, should not be used as an input for QALYs or for comparisons of diagnostic groups.
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Affiliation(s)
- Trude Arnesen
- Institute for Applied International Studies, Borggt. 2B, Pb. 2947 Toyen, N-0608 Oslo, Norway
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Smith N, Mitton C, Hall W, Bryan S, Donaldson C, Peacock S, Gibson JL, Urquhart B. High performance in healthcare priority setting and resource allocation: A literature- and case study-based framework in the Canadian context. Soc Sci Med 2016; 162:185-92. [PMID: 27367899 DOI: 10.1016/j.socscimed.2016.06.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 03/04/2016] [Accepted: 06/15/2016] [Indexed: 11/18/2022]
Abstract
Priority setting and resource allocation, or PSRA, are key functions of executive teams in healthcare organizations. Yet decision-makers often base their choices on historical patterns of resource distribution or political pressures. Our aim was to provide leaders with guidance on how to improve PSRA practice, by creating organizational contexts which enable high performance. We carried out in-depth case studies of six Canadian healthcare organizations to obtain from healthcare leaders their understanding of the concept of high performance in PSRA and the factors which contribute to its achievement. Individual and group interviews were carried out (n = 62) with senior managers, middle managers and Board members. Site observations and document review were used to assist researchers in interpreting the interview data. Qualitative data were analyzed iteratively with the literature on empirical examples of PSRA practice, in order to develop a framework of high performance in PSRA. The framework consists of four domains - structures, processes, attitudes and behaviours, and outcomes - within which are 19 specific elements. The emergent themes derive from case studies in different kinds of health organizations (urban/rural, small/large) across Canada. The elements can serve as a checklist for 'high performance' in PSRA. This framework provides a means by which decision-makers in healthcare might assess their practice and identify key areas for improvement. The findings are likely generalizable, certainly within Canada but also across countries. This work constitutes, to our knowledge, the first attempt to present a full package of elements comprising high performance in health care PSRA.
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Affiliation(s)
- Neale Smith
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, 7th floor, 828 W 10th Avenue Vancouver, BC V5Z1M9, Canada.
| | - Craig Mitton
- Centre for Clinical Epidemiology & Evaluation, UBC, Canada; School of Population and Public Health, UBC, Canada
| | - William Hall
- School of Population and Public Health, UBC, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology & Evaluation, UBC, Canada; School of Population and Public Health, UBC, Canada
| | - Cam Donaldson
- Yunus Centre for Social & Business Health, Glasgow Caledonian University, United Kingdom
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control (ARCC), Canada; BC Cancer Agency, Canada
| | - Jennifer L Gibson
- Joint Centre for Bioethics, Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
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Stone A. Pain Management Becomes a Priority for U.S. Health Care. ONS Connect 2016; 31:24. [PMID: 27305741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Pratt B, Merritt M, Hyder AA. Towards deep inclusion for equity-oriented health research priority-setting: A working model. Soc Sci Med 2016; 151:215-24. [PMID: 26812416 DOI: 10.1016/j.socscimed.2016.01.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 02/25/2015] [Revised: 10/12/2015] [Accepted: 01/11/2016] [Indexed: 11/19/2022]
Abstract
Growing consensus that health research funders should align their investments with national research priorities presupposes that such national priorities exist and are just. Arguably, justice requires national health research priority-setting to promote health equity. Such a position is consistent with recommendations made by the World Health Organization and at global ministerial summits that health research should serve to reduce health inequalities between and within countries. Thus far, no specific requirements for equity-oriented research priority-setting have been described to guide policymakers. As a step towards the explication and defence of such requirements, we propose that deep inclusion is a key procedural component of equity-oriented research priority-setting. We offer a model of deep inclusion that was developed by applying concepts from work on deliberative democracy and development ethics. This model consists of three dimensions--breadth, qualitative equality, and high-quality non-elite participation. Deep inclusion is captured not only by who is invited to join a decision-making process but also by how they are involved and by when non-elite stakeholders are involved. To clarify and illustrate the proposed dimensions, we use the sustained example of health systems research. We conclude by reviewing practical challenges to achieving deep inclusion. Despite the existence of barriers to implementation, our model can help policymakers and other stakeholders design more inclusive national health research priority-setting processes and assess these processes' depth of inclusion.
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Affiliation(s)
- Bridget Pratt
- Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins Berman Institute of Bioethics, USA; Nossal Institute of Global Health, University of Melbourne, Australia.
| | - Maria Merritt
- Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins Berman Institute of Bioethics, USA
| | - Adnan A Hyder
- Johns Hopkins Bloomberg School of Public Health, USA; Johns Hopkins Berman Institute of Bioethics, USA
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Halliday JA, Hendrieckx C, Beeney L, Speight J. Prioritization of psychological well-being in the care of diabetes: moving beyond excuses, bringing solutions. Diabet Med 2015; 32:1393-4. [PMID: 25819747 DOI: 10.1111/dme.12768] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J A Halliday
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia, Melbourne
- School of Psychology, Deakin University, Burwood, Victoria
| | - C Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia, Melbourne
- Centre for Mental Health and Wellbeing Research, Deakin University, Burwood, Victoria
| | - L Beeney
- Diabetes and Medical Psychology Services, Newtown, New South Wales, Australia
| | - J Speight
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia, Melbourne
- Centre for Mental Health and Wellbeing Research, Deakin University, Burwood, Victoria
- AHP Research, Hornchurch, UK
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Abstract
Recent scholarship has considered what, if anything, rich people owe to poor people to achieve justice in global health and the implications of this for international research. Yet this work has primarily focused on international clinical research. Health systems research is increasingly being performed in low and middle income countries and is essential to reducing global health disparities. This paper provides an initial description of the ethical issues related to priority setting, capacity-building, and the provision of post-study benefits that arise during the conduct of such research. It presents a selection of issues discussed in the health systems research literature and argues that they constitute ethical concerns based on their being inconsistent with a particular theory of global justice (the health capability paradigm). Issues identified include the fact that priority setting for health systems research at the global level is often not driven by national priorities and that capacity-building efforts frequently utilize one-size-fits-all approaches.
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Abstract
The use of cost-effectiveness modeling to prioritize healthcare spending has become a key foundation of UK government policy. Although the preferred method of evaluation-cost-utility analysis-is not without its critics, it represents a standard approach that can arguably be used to assess relative value for money across a range of disease types and interventions. A key limitation of economic modeling, however, is that its conclusions hinge on the input assumptions, many of which are derived from randomized controlled trials or meta-analyses that cannot be reliably linked to real-world performance of treatments in a broader clinical context. This means that spending decisions are frequently based on artificial constructs that may project costs and benefits that are significantly at odds with those that are achievable in reality. There is a clear agenda to carry out some form of predictive validation for the model claims, in order to assess not only whether the spending decisions made can be justified post hoc, but also to ensure that budgetary expenditure continues to be allocated in the most rational way. To date, however, no timely, effective system to carry out this testing has been implemented, with the consequence that there is little objective evidence as to whether the prioritization decisions made are actually living up to expectations. This article reviews two unfulfilled initiatives that have been carried out in the UK over the past 20 years, each of which had the potential to address this objective, and considers why they failed to deliver the expected outcomes.
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Regional committee decisions. East Mediterr Health J 2014; 20:745-9. [PMID: 25601814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Negrini S, Padua L, Kiekens C, Michail X, Boldrini P. Current research funding methods dumb down health care and rehabilitation for disabled people and aging population: a call for a change. Eur J Phys Rehabil Med 2014; 50:601-608. [PMID: 25521703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Health care systems in Western societies are faced with two major challenges: aging populations and the growing burden of chronic conditions. This translates into more persons with disabilities and the need for more Physical and Rehabilitation Medicine (PRM) services. We raise the point of how these emerging needs are faced by the actual research funding. We briefly present the results of an analysis we made about research funding by the Italian National Health Service as an interesting case study, since it relates to Italy (the financer) and the United States, where National Institutes of Health (NIH) reviewers were identified according to their classification of research topics. The topics of potentially greatest interest for aging Western societies, like chronicity, disability and rehabilitation, were among those least often funded and considered in the traditional method of financing research projects. These results could be based on those PRM peculiarities that make the specialty different from all other classical biomedical specialties, namely the bio-psycho-social approach and its specific research methodologies. Moreover, PRM researchers are spread among the different topics as usually classified, and it is probable that PRM projects are judged by non-PRM reviewers. There are at least two possible ways in which research can be better placed to meet the emerging needs of Western societies (chronicity, disability and consequently also rehabilitation). One is to create specific keywords on these topics so as to improve the match between researchers and reviewers; the second is to allocate specific funds to research in these areas. In fact, the not coherence between emerging needs and research priorities have already been periodically addressed in the past with specific "political" and/or "social" initiatives, when researchers were forced to respond to new emergencies: some historical examples include cancer or HIV and viral diseases or the recent Ebola outbreak.
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Affiliation(s)
- S Negrini
- Department of Clinical and Experimental Sciences University of Brescia, Brescia, Italy -
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Morton A. Aversion to health inequalities in healthcare prioritisation: a multicriteria optimisation perspective. J Health Econ 2014; 36:164-173. [PMID: 24831800 DOI: 10.1016/j.jhealeco.2014.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [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: 02/01/2012] [Revised: 03/26/2014] [Accepted: 04/02/2014] [Indexed: 06/03/2023]
Abstract
In this paper we discuss the prioritisation of healthcare projects where there is a concern about health inequalities, but the decision maker is reluctant to make explicit quantitative value judgements and the data systems only allow the measurement of health at an aggregate level. Our analysis begins with a standard welfare economic model of healthcare resource allocation. We show how - under the assumption that the healthcare projects under consideration have a small impact on individual health--the problem can be reformulated as one of finding a particular subset of the class of efficient solutions to an implied multicriteria optimisation problem. Algorithms for finding such solutions are readily available, and we demonstrate our approach through a worked example of treatment for clinical depression.
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Affiliation(s)
- Alec Morton
- Department of Management Science, Strathclyde Business School, University of Strathclyde, 16 Richmond Street, Glasgow G1 1XQ, United Kingdom.
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Abstract
PURPOSE To evaluate waiting times for first-eye cataract surgery in Sweden following widespread adoption of the Nationell Indikationsmodell for Kataraktextraktion (NIKE) tool for prioritizing patients for cataract surgery. METHODS Waiting times for all first-eye cataract surgeries in Sweden in 2009-2011 were identified from the Swedish National Cataract Register. Waiting times were compared according to demographic, clinical and NIKE indication group for surgery. Multivariate logistic regression modelling was used to determine factors associated with waiting times less than the 3-month Government guarantee period. RESULTS There were 141,070 first-eye cataract surgeries in 2009 to 2011; an annual increase of around 6%. Over the study period, mean waiting times decreased across all NIKE groups. The proportion waiting <3 months for surgery also increased across all NIKE groups. Surgery within 3 months of waitlisting was more likely for patients with a NIKE 1 indication classification (most need for surgery), in later years, male patients, younger patients and patients with a preoperative visual acuity in the better eye worse than 6/24. CONCLUSIONS Prioritizing patients for cataract surgery using NIKE reduces waiting times for those with the greatest need.
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Affiliation(s)
- Jonathon Q Ng
- Eye and Vision Epidemiology Research Group, Centre for Health Services Research, School of Population Health, The University of Western Australia, Perth, WA, AustraliaEyeNet Sweden, Blekinge Hospital, Karlskrona, SwedenDepartment of Clinical Sciences and Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden
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Hammonds R, Ooms G. The emergence of a global right to health norm--the unresolved case of universal access to quality emergency obstetric care. BMC Int Health Hum Rights 2014; 14:4. [PMID: 24576008 PMCID: PMC3974068 DOI: 10.1186/1472-698x-14-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/19/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The global response to HIV suggests the potential of an emergent global right to health norm, embracing shared global responsibility for health, to assist policy communities in framing the obligations of the domestic state and the international community. Our research explores the extent to which this global right to health norm has influenced the global policy process around maternal health rights, with a focus on universal access to emergency obstetric care. METHODS In examining the extent to which arguments stemming from a global right to health norm have been successful in advancing international policy on universal access to emergency obstetric care, we looked at the period from 1985 to 2013 period. We adopted a qualitative case study approach applying a process-tracing methodology using multiple data sources, including an extensive literature review and limited key informant interviews to analyse the international policy agenda setting process surrounding maternal health rights, focusing on emergency obstetric care. We applied John Kingdon's public policy agenda setting streams model to analyse our data. RESULTS Kingdon's model suggests that to succeed as a mobilising norm, the right to health could work if it can help bring the problem, policy and political streams together, as it did with access to AIDS treatment. Our analysis suggests that despite a normative grounding in the right to health, prioritisation of the specific maternal health entitlements remains fragmented. CONCLUSIONS Despite United Nations recognition of maternal mortality as a human rights issue, the relevant policy communities have not yet managed to shift the policy agenda to prioritise the global right to health norm of shared responsibility for realising access to emergency obstetric care. The experience of HIV advocates in pushing for global solutions based on right to health principles, including participation, solidarity and accountability; suggest potential avenues for utilising right to health based arguments to push for policy priority for universal access to emergency obstetric care in the post-2015 global agenda.
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Affiliation(s)
- Rachel Hammonds
- Department of Public Health, Institute of Tropical Medicine, 155 Nationalestraat, Antwerp 2000, Belgium
- Law and Development Research Group, University of Antwerp, Faculty of Law, Venusstraat 23, Antwerp 2000, Belgium
| | - Gorik Ooms
- Department of Public Health, Institute of Tropical Medicine, 155 Nationalestraat, Antwerp 2000, Belgium
- Law and Development Research Group, University of Antwerp, Faculty of Law, Venusstraat 23, Antwerp 2000, Belgium
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Abstract
The aim of this article is to analyze the different approaches of priority setting for health technology assessments (HTA). First, the paper identifies the reasons that make necessary to establish priorities and its importance for the success of the HTA models. Second, it studies the main stages that consider the determination of priorities based on the analysis of the models currently used by HTA agencies of developed countries. In the third place, the article describes the different criteria, methods of scoring and deliberation bodies included in the mechanism of priority setting of those agencies. Finally, the paper concludes mentioning lessons from the international experience that potentially can be an input for the design of a model of priority setting for HTA in our country.
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Trueland J. Older people: an index of frailty. Health Serv J 2013; 123:6-7. [PMID: 24416971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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46
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Moore A. Procurement. Good buy to all that. Health Serv J 2013; 123:22. [PMID: 24416975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Duggan S. Is an apolitical NHS what we really want? Health Serv J 2013; 123:18-19. [PMID: 24383182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Roberts DC, Schoelles K. AHRQ's free research can help plans anticipate coverage issues. Manag Care 2013; 22:41-44. [PMID: 24344527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Schwarz P. [Like a developing country when it comes to medicine and prioritization]. Ugeskr Laeger 2013; 175:2359. [PMID: 26495466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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50
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Cox R, Sanchez J, Revie CW. Multi-criteria decision analysis tools for prioritising emerging or re-emerging infectious diseases associated with climate change in Canada. PLoS One 2013; 8:e68338. [PMID: 23950868 PMCID: PMC3737372 DOI: 10.1371/journal.pone.0068338] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/28/2013] [Indexed: 11/18/2022] Open
Abstract
Global climate change is known to result in the emergence or re-emergence of some infectious diseases. Reliable methods to identify the infectious diseases of humans and animals and that are most likely to be influenced by climate are therefore required. Since different priorities will affect the decision to address a particular pathogen threat, decision makers need a standardised method of prioritisation. Ranking methods and Multi-Criteria Decision approaches provide such a standardised method and were employed here to design two different pathogen prioritisation tools. The opinion of 64 experts was elicited to assess the importance of 40 criteria that could be used to prioritise emerging infectious diseases of humans and animals in Canada. A weight was calculated for each criterion according to the expert opinion. Attributes were defined for each criterion as a transparent and repeatable method of measurement. Two different Multi-Criteria Decision Analysis tools were tested, both of which used an additive aggregation approach. These were an Excel spreadsheet tool and a tool developed in software 'M-MACBETH'. The tools were trialed on nine 'test' pathogens. Two different methods of criteria weighting were compared, one using fixed weighting values, the other using probability distributions to account for uncertainty and variation in expert opinion. The ranking of the nine pathogens varied according to the weighting method that was used. In both tools, using both weighting methods, the diseases that tended to rank the highest were West Nile virus, Giardiasis and Chagas, while Coccidioidomycosis tended to rank the lowest. Both tools are a simple and user friendly approach to prioritising pathogens according to climate change by including explicit scoring of 40 criteria and incorporating weighting methods based on expert opinion. They provide a dynamic interactive method that can help to identify pathogens for which a full risk assessment should be pursued.
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Affiliation(s)
- Ruth Cox
- Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada.
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