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Machin H, Sutton G, Baird PN. Examining Corneal Tissue Exportation Fee and Its Impact on Equitable Allocation. Cornea 2022; 41:390-395. [PMID: 34483277 DOI: 10.1097/ico.0000000000002856] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
METHODS We conducted grounded theory semistructured interviews, purposively inviting participants until themed saturation was met. Sentiment analysis was used to determine opinion. RESULTS We interviewed n = 92 global eye tissue and eye bank professionals. We determined that corneal tissue, which is exported, costs between US $100 and US $6000 or is provided as gratis. Collectively, interviewees indicated that, globally, there were no fixed fee structures in place, and the fee was influenced by multiple factors on both export and import sides. They indicated that ultimately corneas were allocated based on the importers' ability to pay the price determined by the exporting eye bank. DISCUSSION Allocation of corneal tissue, which is exported, is influenced by the fees charged by the exporters to meet their bottom line and the funds available to importers. Therefore, export allocation is not equitable, with those who can pay a higher fee, prioritized. Steps to guide and support exporters with the development of fee structures that promote equitable allocation are essential. This will assist both export and import eye bank development, corneal tissue access development, and those awaiting a corneal transplant.
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Affiliation(s)
- Heather Machin
- Lions Eye Donation Service, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Victoria, Australia
| | - Gerard Sutton
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; and
- The University of Technology Sydney, Graduate School of Health, New South Wales, Australia
| | - Paul N Baird
- Department of Surgery, Ophthalmology, University of Melbourne, Victoria, Australia
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2
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Persad G, Pathak PA, Sönmez T, Ünver MU. Fair access to scarce medical capacity for non-covid-19 patients: a role for reserves. BMJ 2022; 376:o276. [PMID: 35105540 DOI: 10.1136/bmj.o276] [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: 11/04/2022]
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3
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Haywood N, Mehaffey JH, Kilbourne S, Mannem H, Weder M, Lau C, Krupnick AS, Agarwal A. Influence of broader geographic allograft sharing on outcomes and cost in smaller lung transplant centers. J Thorac Cardiovasc Surg 2022; 163:339-345. [PMID: 33008575 PMCID: PMC7474916 DOI: 10.1016/j.jtcvs.2020.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/06/2020] [Revised: 08/21/2020] [Accepted: 09/01/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation. METHODS Patients (47 pre and 54 post) undergoing lung transplantation were identified from institutional database from January 2016 to October 2019. Detailed chart review and analysis of institutional cost data was performed. Univariate analysis was performed to compare eras. RESULTS Similar short-term mortality and primary graft dysfunction were observed between groups. Decreased local donation (68% vs 6%; P < .001), increased travel distance (145 vs 235 miles; P = .004), travel cost ($8626 vs $14,482; P < .001), and total procurement cost ($60,852 vs $69,052; P = .001) were observed postimplementation. We also document an increase in waitlist mortality postimplementation (6.9 vs 31.6 per 100 patient-years; P < .001). CONCLUSIONS Following implementation of the new allocation policy in a small to medium size center, several changes were in accordance with policy intention. However, concerning shifts emerged, including increased waitlist mortality and resource utilization. Continued close monitoring of transplant centers stratified by size and location are paramount to maintaining global availability of lung transplantation to all Americans regardless of geographic residence or socioeconomic status.
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Affiliation(s)
- Nathan Haywood
- Division of Thoracic & Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Va
| | - J Hunter Mehaffey
- Division of Thoracic & Cardiovascular Surgery, University of Virginia Health System, Charlottesville, Va
| | - Sarah Kilbourne
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Hannah Mannem
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Max Weder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Va
| | - Christine Lau
- Division of Thoracic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Alexander S Krupnick
- Division of Thoracic Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Md
| | - Avinash Agarwal
- Division of Transplantation, Department of Surgery, University of Virginia Health System, Charlottesville, Va.
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4
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Abstract
The COVID-19 pandemic raised distinct challenges in the field of scarce resource allocation, a long-standing area of inquiry in the field of bioethics. Policymakers and states developed crisis guidelines for ventilator triage that incorporated such factors as immediate prognosis, long-term life expectancy, and current stage of life. Often these depend upon existing risk factors for severe illness, including diabetes. However, these algorithms generally failed to account for the underlying structural biases, including systematic racism and economic disparity, that rendered some patients more vulnerable to these conditions. This paper discusses this unique ethical challenge in resource allocation through the lens of care for patients with severe COVID-19 and diabetes.
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Affiliation(s)
- Jacob M. Appel
- Icahn School of Medicine at Mount
Sinai, NY, USA
- Jacob M. Appel, JD, MD, MPH,
Associate Professor of Psychiatry and Medical Education, Icahn School
of Medicine at Mount Sinai, 140 Claremont Ave #3D, New York, NY 10027,
USA.
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5
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Tran TNA, Wikle NB, Albert E, Inam H, Strong E, Brinda K, Leighow SM, Yang F, Hossain S, Pritchard JR, Chan P, Hanage WP, Hanks EM, Boni MF. Optimal SARS-CoV-2 vaccine allocation using real-time attack-rate estimates in Rhode Island and Massachusetts. BMC Med 2021; 19:162. [PMID: 34253200 PMCID: PMC8275456 DOI: 10.1186/s12916-021-02038-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 01/20/2021] [Accepted: 06/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND When three SARS-CoV-2 vaccines came to market in Europe and North America in the winter of 2020-2021, distribution networks were in a race against a major epidemiological wave of SARS-CoV-2 that began in autumn 2020. Rapid and optimized vaccine allocation was critical during this time. With 95% efficacy reported for two of the vaccines, near-term public health needs likely require that distribution is prioritized to the elderly, health care workers, teachers, essential workers, and individuals with comorbidities putting them at risk of severe clinical progression. METHODS We evaluate various age-based vaccine distributions using a validated mathematical model based on current epidemic trends in Rhode Island and Massachusetts. We allow for varying waning efficacy of vaccine-induced immunity, as this has not yet been measured. We account for the fact that known COVID-positive cases may not have been included in the first round of vaccination. And, we account for age-specific immune patterns in both states at the time of the start of the vaccination program. Our analysis assumes that health systems during winter 2020-2021 had equal staffing and capacity to previous phases of the SARS-CoV-2 epidemic; we do not consider the effects of understaffed hospitals or unvaccinated medical staff. RESULTS We find that allocating a substantial proportion (>75%) of vaccine supply to individuals over the age of 70 is optimal in terms of reducing total cumulative deaths through mid-2021. This result is robust to different profiles of waning vaccine efficacy and several different assumptions on age mixing during and after lockdown periods. As we do not explicitly model other high-mortality groups, our results on vaccine allocation apply to all groups at high risk of mortality if infected. A median of 327 to 340 deaths can be avoided in Rhode Island (3444 to 3647 in Massachusetts) by optimizing vaccine allocation and vaccinating the elderly first. The vaccination campaigns are expected to save a median of 639 to 664 lives in Rhode Island and 6278 to 6618 lives in Massachusetts in the first half of 2021 when compared to a scenario with no vaccine. A policy of vaccinating only seronegative individuals avoids redundancy in vaccine use on individuals that may already be immune, and would result in 0.5% to 1% reductions in cumulative hospitalizations and deaths by mid-2021. CONCLUSIONS Assuming high vaccination coverage (>28%) and no major changes in distancing, masking, gathering size, hygiene guidelines, and virus transmissibility between 1 January 2021 and 1 July 2021 a combination of vaccination and population immunity may lead to low or near-zero transmission levels by the second quarter of 2021.
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Affiliation(s)
- Thu Nguyen-Anh Tran
- Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA USA
| | - Nathan B. Wikle
- Center for Infectious Disease Dynamics, Department of Statistics, Pennsylvania State University, University Park, PA USA
| | - Emmy Albert
- Department of Physics, Pennsylvania State University, University Park, PA USA
| | - Haider Inam
- Center for Infectious Disease Dynamics, Department of Bioengineering, Pennsylvania State University, University Park, PA USA
| | - Emily Strong
- Center for Infectious Disease Dynamics, Department of Statistics, Pennsylvania State University, University Park, PA USA
| | - Karel Brinda
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA USA
| | - Scott M. Leighow
- Center for Infectious Disease Dynamics, Department of Bioengineering, Pennsylvania State University, University Park, PA USA
| | - Fuhan Yang
- Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA USA
| | - Sajid Hossain
- Yale School of Medicine, Yale University, New Haven, CT USA
| | - Justin R. Pritchard
- Center for Infectious Disease Dynamics, Department of Bioengineering, Pennsylvania State University, University Park, PA USA
| | - Philip Chan
- Department of Medicine, Brown University, Providence, RI USA
| | - William P. Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA USA
| | - Ephraim M. Hanks
- Center for Infectious Disease Dynamics, Department of Statistics, Pennsylvania State University, University Park, PA USA
| | - Maciej F. Boni
- Center for Infectious Disease Dynamics, Department of Biology, Pennsylvania State University, University Park, PA USA
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Morale W, Sessa C, Alessandrello I, Aprile G, Galeano D, Giglio E, Ficara V, Musumeci S, Scollo V, Zuppardo C, Baglieri A, Rizza G, Bonomo P, Modica S, Patriarca G, Elia R, Aliquò A, Musso S. [The management of nephropathic patients during the Covid-19 pandemic: the experience of Ragusa]. G Ital Nefrol 2021; 38:38-02-2021-05. [PMID: 33852221] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The public emergency caused by Covid-19 has forced health services to reorganize in order to separate positive patients from negative ones. In nephrology, this reorganization involves several levels of assistance concerning hospitalizations, ambulatory care and haemodialysis. Within the Complex Unit of Nephrology in Ragusa, the distribution of nephro-dialytic resources has involved four different hospitals, hence ensuring haemodialysis services for asymptomatic and pauci-symptomatic Covid-19 patients as well as for patients in Covid-Unit, Sub-Intensive Therapy and Intensive Care Unit. In this complex context, we had to create a common protocol involving all the professionals who provide assistance in our Unit, across the different structures. We also report some encouraging data that seem to indicate the effectiveness of the protocols put in place.
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Affiliation(s)
- Walter Morale
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Concetto Sessa
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Ivana Alessandrello
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Giorgio Aprile
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Dario Galeano
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Elisa Giglio
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Vincenzo Ficara
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Stella Musumeci
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Viviana Scollo
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Carmelo Zuppardo
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Andrea Baglieri
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Giovanni Rizza
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Pietro Bonomo
- Direzione Sanitaria Ospedale "Maggiore", Modica (RG), Italy
| | | | - Giuseppe Patriarca
- Direzione Generale Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Raffaele Elia
- Direzione Generale Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Angelo Aliquò
- Direzione Generale Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
| | - Salvatore Musso
- U.O.C Nefrologia e Dialisi, P.O. "Maggiore" di Modica. Azienda Sanitaria Provinciale di Ragusa, Ragusa, Italy
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7
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Machin H, Sutton G, Baird PN. Should Donors Consent to Export Their Corneas? Examination of Eye Tissue and Eye Care Sector Opinion. Cornea 2021; 40:398-403. [PMID: 33252381 DOI: 10.1097/ico.0000000000002559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/23/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Corneal tissue international activity is only possible because of the willingness of export populations to donate their corneas on their death. Current predonation public education campaigns and at-the-point-of-donation consent practice generally includes consent for transplantation, research, and/or training. It is unclear whether a consent-for-export step is universally included in the consent process or, indeed, whether it should. We interviewed eye tissue and eye care professionals from around the world, who exported, imported, or did neither to understand current consent-for-export awareness and determine opinion on future practice. METHOD During wider qualitative grounded-theory semistructured interviews with sector experts, to determine whether Australia should export, we captured sector opinion on consent-for-export. We used saturation and sentiment methods to determine opinion and χ2 correlation coefficients to examine association, using an α of P = 0.05. RESULTS We interviewed 92 individuals, 83 of whom discussed consent-for-export. Of those, 51% (42/83) demonstrated some awareness of the practice; however, there were contradictions between interviewees from the same location. Regardless of current awareness, 57% (41/72) believed donors should be informed or consented for export. Their approval did not extend to donor-directed decisions, which would allow donors to decide which nation their donation should be sent, with 62.5% (45/72) opposing that notion. CONCLUSIONS Our research indicates that the consent-for-export practice is not universally applied by exporting nations and that eye tissue and eye care professionals have limited awareness of the practice. Universally implementing a consent-for-export step within general consent practice would improve awareness, reduce confusion, and support donor wishes.
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Affiliation(s)
- Heather Machin
- Lions Eye Donation Service, Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
- Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia
| | - Gerard Sutton
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; and
- The University of Technology Sydney, Graduate School of Health, Sydney, New South Wales, Australia
| | - Paul N Baird
- Department of Surgery, Ophthalmology, University of Melbourne, Melbourne, Victoria, Australia
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Gershengorn HB, Holt GE, Rezk A, Delgado S, Shah N, Arora A, Colucci LB, Mora B, Iyengar RS, Lopez A, Martinez BM, West J, Goodman KW, Kett DH, Brosco JP. Assessment of Disparities Associated With a Crisis Standards of Care Resource Allocation Algorithm for Patients in 2 US Hospitals During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e214149. [PMID: 33739434 PMCID: PMC7980099 DOI: 10.1001/jamanetworkopen.2021.4149] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
IMPORTANCE Significant concern has been raised that crisis standards of care policies aimed at guiding resource allocation may be biased against people based on race/ethnicity. OBJECTIVE To evaluate whether unanticipated disparities by race or ethnicity arise from a single institution's resource allocation policy. DESIGN, SETTING, AND PARTICIPANTS This cohort study included adults (aged ≥18 years) who were cared for on a coronavirus disease 2019 (COVID-19) ward or in a monitored unit requiring invasive or noninvasive ventilation or high-flow nasal cannula between May 26 and July 14, 2020, at 2 academic hospitals in Miami, Florida. EXPOSURES Race (ie, White, Black, Asian, multiracial) and ethnicity (ie, non-Hispanic, Hispanic). MAIN OUTCOMES AND MEASURES The primary outcome was based on a resource allocation priority score (range, 1-8, with 1 indicating highest and 8 indicating lowest priority) that was assigned daily based on both estimated short-term (using Sequential Organ Failure Assessment score) and longer-term (using comorbidities) mortality. There were 2 coprimary outcomes: maximum and minimum score for each patient over all eligible patient-days. Standard summary statistics were used to describe the cohort, and multivariable Poisson regression was used to identify associations of race and ethnicity with each outcome. RESULTS The cohort consisted of 5613 patient-days of data from 1127 patients (median [interquartile range {IQR}] age, 62.7 [51.7-73.7]; 607 [53.9%] men). Of these, 711 (63.1%) were White patients, 323 (28.7%) were Black patients, 8 (0.7%) were Asian patients, and 31 (2.8%) were multiracial patients; 480 (42.6%) were non-Hispanic patients, and 611 (54.2%) were Hispanic patients. The median (IQR) maximum priority score for the cohort was 3 (1-4); the median (IQR) minimum score was 2 (1-3). After adjustment, there was no association of race with maximum priority score using White patients as the reference group (Black patients: incidence rate ratio [IRR], 1.00; 95% CI, 0.89-1.12; Asian patients: IRR, 0.95; 95% CI. 0.62-1.45; multiracial patients: IRR, 0.93; 95% CI, 0.72-1.19) or of ethnicity using non-Hispanic patients as the reference group (Hispanic patients: IRR, 0.98; 95% CI, 0.88-1.10); similarly, no association was found with minimum score for race, again with White patients as the reference group (Black patients: IRR, 1.01; 95% CI, 0.90-1.14; Asian patients: IRR, 0.96; 95% CI, 0.62-1.49; multiracial patients: IRR, 0.81; 95% CI, 0.61-1.07) or ethnicity, again with non-Hispanic patients as the reference group (Hispanic patients: IRR, 1.00; 95% CI, 0.89-1.13). CONCLUSIONS AND RELEVANCE In this cohort study of adult patients admitted to a COVID-19 unit at 2 US hospitals, there was no association of race or ethnicity with the priority score underpinning the resource allocation policy. Despite this finding, any policy to guide altered standards of care during a crisis should be monitored to ensure equitable distribution of resources.
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Affiliation(s)
- Hayley B. Gershengorn
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
- Division of Critical Care Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Gregory E. Holt
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Andrew Rezk
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Nayna Shah
- University of Miami Miller School of Medicine, Miami, Florida
| | - Arshia Arora
- University of Miami Miller School of Medicine, Miami, Florida
| | - Leah B. Colucci
- University of Miami Miller School of Medicine, Miami, Florida
| | - Belen Mora
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Andy Lopez
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Joseph West
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Kenneth W. Goodman
- Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel H. Kett
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
| | - Jeffrey P. Brosco
- Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine, Miami, Florida
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
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Agyepong IA, Godt S, Sombie I, Binka C, Okine V, Ingabire MG. Strengthening capacities and resource allocation for co-production of health research in low and middle income countries. BMJ 2021; 372:n166. [PMID: 33593725 PMCID: PMC7879269 DOI: 10.1136/bmj.n166] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Irene Akua Agyepong
- Ghana Health Service, Research and Development Division, Dodowa Health Research Center, Dodowa, Ghana
- Ghana College of Physicians and Surgeons, Accra, Ghana
| | | | | | | | - Vicky Okine
- Alliance for Reproductive Health Rights, Accra, Ghana
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Wetter S, Hodge JG, Carey E. Ethical Allocation of Scarce Food Resources During Public Health Emergencies. J Law Med Ethics 2021; 49:132-138. [PMID: 33966650 DOI: 10.1017/jme.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Escalating demands for limited food supplies at America's food banks and pantries during the COVID-19 pandemic have raised ethical concerns underlying "first-come, first-served" distributions strategies. A series of model ethical principles are designed to guide ethical allocations of these resources to assure greater access among persons facing food insecurity.
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Sentell T, Foss-Durant A, Patil U, Taira D, Paasche-Orlow MK, Trinacty CM. Organizational Health Literacy: Opportunities for Patient-Centered Care in the Wake of COVID-19. Qual Manag Health Care 2021; 30:49-60. [PMID: 33229999 DOI: 10.1097/qmh.0000000000000279] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES The coronavirus disease-2019 (COVID-19) pandemic is transforming the health care sector. As health care organizations move from crisis mobilization to a new landscape of health and social needs, organizational health literacy offers practical building blocks to provide high-quality, efficient, and meaningful care to patients and their families. Organizational health literacy is defined by the Institute of Medicine as "the degree to which an organization implements policies, practices, and systems that make it easier for people to navigate, understand, and use information and services to take care of their health." METHODS This article synthesizes insights from organizational health literacy in the context of current major health care challenges and toward the goal of innovation in patient-centered care. We first provide a brief overview of the origins and outlines of organizational health literacy research and practice. Second, using an established patient-centered innovation framework, we show how the existing work on organizational health literacy can offer a menu of effective, patient-centered innovative options for care delivery systems to improve systems and outcomes. Finally, we consider the high value of management focusing on organizational health literacy efforts, specifically for patients in health care transitions and in the rapid transformation of care into myriad distance modalities. RESULTS This article provides practical guidance for systems and informs decisions around resource allocation and organizational priorities to best meet the needs of patient populations even in the face of financial and workforce disruption. CONCLUSIONS Organizational health literacy principles and guidelines provide a road map for promoting patient-centered care even in this time of crisis, change, and transformation. Health system leaders seeking innovative approaches can have access to well-established tool kits, guiding models, and materials toward many organizational health literacy goals across treatment, diagnosis, prevention, education, research, and outreach.
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Affiliation(s)
- Tetine Sentell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawaii (Dr Sentell and Mr Patil); Arizona State University Edson College of Nursing and Healthcare Innovations, Phoenix (Ms Foss-Durant); The Daniel K. Inouye College of Pharmacy, Hilo, Hawaii (Dr Taira); Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts (Dr Paasche-Orlow); and Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Dr Trinacty)
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Nuñez JH, Porcel JA, Pijoan J, Batalla L, Teixidor J, Guerra-Farfan E, Minguell J. Rethinking Trauma Hospital Services in one of Spain's Largest University Hospitals during the COVID-19 pandemic. How can we organize and help? Our experience. Injury 2020; 51:2827-2833. [PMID: 33004206 PMCID: PMC7518794 DOI: 10.1016/j.injury.2020.09.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/19/2020] [Accepted: 09/24/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The severe disruptions caused by the SARS-CoV-2 coronavirus have necessitated a redistribution of resources to meet hospitals' current service needs during this pandemic. The aim is to share our experiences and outcomes during the first month of the Covid-19 pandemic, based on the strategies recommended and strategies we have implemented. METHODS Our experience comes from our work at a referral hospital within the Spanish National Health System. Changes to clinical practice have largely been guided by the current evidence and four main principles: (1) patient and health-care worker protection, (2) uninterrupted necessary care, (3) conservation of health-care resources, (4) uninterrupted formation for residents. Based on these principles, changes in the service organization, elective clinical visits, emergency visits, surgical procedures, and inpatient and outpatient care were made. RESULTS Using the guidance of experts, we were able to help the hospital address the demands of the Covid-19 outbreak. We reduced to a third of our orthopaedics and trauma hospital beds, provided coverage for general emergency services, and five ICUs, all continuing to provide care for our patients, in the form of 102 trauma surgeries, 6413 phone interviews and 520 emergency clinic visits. Also in the third week, we were able to restart morning meetings via telematics, and teaching sessions for our residents. On the other hand, eight of the healthcare personnel on our service (10.8%) became infected with Covid-19. CONCLUSIONS As priorities and resources increasingly shift towards the COVID-19 pandemic, it is possible to maintain the high standard and quality of care necessary for trauma and orthopaedics patients while the pandemic persists. We must be prepared to organize our healthcare workers in such a way that the needs of both inpatients and outpatients are met. It is still possible to operate on those patients who need it. Unfortunately, some healthcare workers will become infected. It is essential that we protect those most susceptible to severer consequences of Covid-19. Also crucial are optimized protective measures.
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Affiliation(s)
- Jorge H Nuñez
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain.
| | - Juan Antonio Porcel
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Pijoan
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Lledó Batalla
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Jordi Teixidor
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Ernesto Guerra-Farfan
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Joan Minguell
- Department of Traumatology and Orthopedic Surgery, University Hospital of Vall d'Hebron. 119-129, 08035, Barcelona, Spain; Universitat Autónoma de Barcelona, Barcelona, Spain
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Martínez García E, Del Rey de Diego P, Tormo de Las Heras C, Catalán Escudero P. Experience of a pediatric monographic hospital and strategies adopted for perioperative care during the SARS-CoV-2 epidemic and the reorganization of urgent pediatric care in the Community of Madrid. Spain. Rev Esp Anestesiol Reanim (Engl Ed) 2020; 67:527-528. [PMID: 32888715 PMCID: PMC7414315 DOI: 10.1016/j.redar.2020.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/06/2020] [Accepted: 07/20/2020] [Indexed: 11/22/2022]
Affiliation(s)
- E Martínez García
- Servicio de Anestesia y Reanimación, HIU Niño Jesús, Madrid, España.
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Knoper RC, John R. Commentary: The only constant is change: Understanding the changes in the new heart allocation system. J Thorac Cardiovasc Surg 2020; 161:1851-1852. [PMID: 33288240 DOI: 10.1016/j.jtcvs.2020.10.006] [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] [Received: 10/01/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Ryan C Knoper
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn.
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minn
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Affiliation(s)
- Adrian Brady
- European Society of Radiology, Vienna, Austria
- Mercy University Hospital, Cork, Ireland
| | - James Brink
- American College of Radiology, Reston, Virginia
- International Society for Strategic Studies in Radiology, Vienna, Austria
- Harvard Medical School, Boston, Massachusetts
| | - John Slavotinek
- Royal Australian and New Zealand College of Radiologists, Sydney, Australia
- Flinders Medical Centre and Flinders University, Adelaide, Australia
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16
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Barbosa-Breda J, Leal I, Sousa DC, Soares CA. Why Should SARS-CoV-2 Post-Pandemic Recovery Funding Be Used to Foster a Physician-Scientist Program? ACTA MEDICA PORT 2020; 33:628. [PMID: 32669183 DOI: 10.20344/amp.14421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/20/2022]
Affiliation(s)
- João Barbosa-Breda
- Cardiovascular Research & Development Center. Faculdade de Medicina. Universidade do Porto. Porto; Department of Ophthalmology. Centro Hospitalar Universitário São João. Porto; Research Group Ophthalmology. Department of Neurosciences. Katholieke Universiteit Leuven. Leuven. Belgium
| | - Inês Leal
- Department of Ophthalmology. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Centro de Estudos das Ciências da Visão. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - David Cordeiro Sousa
- Department of Ophthalmology. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Centro de Estudos das Ciências da Visão. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
| | - Célia Azevedo Soares
- Centro de Genética Médica Jacinto Magalhães. Centro Hospitalar Universitário do Porto. Porto. Unit for Multidisciplinary Research in Biomedicine. Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Portugal
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Benishek LE, Kachalia A, Daugherty Biddision L, Wu AW. Mitigating Health-Care Worker Distress From Scarce Medical Resource Allocation During a Public Health Crisis. Chest 2020; 158:2285-2287. [PMID: 32768457 PMCID: PMC7406428 DOI: 10.1016/j.chest.2020.07.073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/29/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lauren E Benishek
- Department of Anesthesiology & Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen Kachalia
- Department of Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lee Daugherty Biddision
- Department of Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD
| | - Albert W Wu
- Department of Health Policy and Management, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Chadha R, De Martin E, Kabacam G, Kirchner V, Kalisvaart M, Goldaracena N, Tanaka T, Spiro M, Sapisochin G, Vinaixa C, Hessheimer A, Campos Varela I, Rammohan A, Yoon YI, Victor D, Scalera I, Chan A, Bhangui P. Proceedings of the 25th Annual Congress of the International Liver Transplantation Society. Transplantation 2020; 104:1560-1565. [PMID: 32732832 DOI: 10.1097/tp.0000000000003160] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 25th Annual Congress of the International Liver Transplantation Society was held in Toronto, Canada, from May 15 to 18, 2019. Surgeons, hepatologists, anesthesiologists, critical care intensivists, radiologists, pathologists, and research scientists from all over the world came together with the common aim of improving care and outcomes for liver transplant recipients and living donors. Some of the featured topics at this year's conference included multidisciplinary perioperative care in liver transplantation, worldwide approaches to organ allocation, donor steatosis, and updates in pediatrics, immunology, and radiology. This report presents excerpts and highlights from invited lectures and select abstracts, reviewed and compiled by the Vanguard Committee of International Liver Transplantation Society. This will hopefully contribute to further advances in clinical practice and research in liver transplantation.
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Affiliation(s)
- Ryan Chadha
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Eleonora De Martin
- Department of Hepatology, AP-HP Hôpital Paul-Brousse, Centre Hépato-Biliaire, INSERM 1193, Villejuif, France
| | - Gokhan Kabacam
- Department of Gastroenterology, Ankara Guven Hospital, Ankara, Turkey
| | - Varvara Kirchner
- Department of Surgery, University of Minnesota Medical School and Masonic Children's Hospital, Minneapolis, MN
| | | | - Nicolas Goldaracena
- Department of Abdominal Organ Transplant and Hepatobiliary Surgery, University of Virginia Health System, Charlottesville, VA
| | - Tomohiro Tanaka
- Department of Hepatology, University of Iowa Hospitals and Clinics and Iowa City VA Medical Center, Iowa City, IA
| | - Michael Spiro
- Department of Anaesthesia and Intensive Care Medicine, Royal Free Hospital, London, United Kingdom
| | - Gonzalo Sapisochin
- Department of Abdominal Transplant and HPB Surgical Oncology, University Health Network, University of Toronto, Toronto, Canada
| | - Carmen Vinaixa
- Hepatology and Liver Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Amelia Hessheimer
- Hepatopancreatobiliary Surgery and Transplantation, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Isabel Campos Varela
- Liver Unit, Department of Internal Medicine, Hospital Universitario Vall D'Hebrón, Institut de Recerca, Barcelona, Spain
| | | | - Young-In Yoon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of South Korea
| | - David Victor
- Houston Methodist Hospital, Sherrie and Alan Conover Center for Liver Disease and Transplantation, Methodist University Hospital, Houston, TX
| | - Irene Scalera
- Hepatobiliary and Liver Transplant Unit, A. Cardarelli Hospital, Liver Unit, Cardarelli Hospital, Naples, Italy
| | - Albert Chan
- Division of Liver Transplantation, The University of Hong Kong, Hong-Kong
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurugram, Delhi NCR, India
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Rascado Sedes P, Ballesteros Sanz MA, Bodí Saera MA, Carrasco Rodríguez-Rey LF, Castellanos Ortega A, Catalán González M, López CDH, Díaz Santos E, Escriba Barcena A, Frade Mera MJ, Igeño Cano JC, Martín Delgado MC, Martínez Estalella G, Raimondi N, Roca I Gas O, Rodríguez Oviedo A, Romero San Pío E, Trenado Álvarez J. [Contingency plan for the intensive care services for the COVID-19 pandemic]. Med Intensiva 2020; 44:363-370. [PMID: 32336551 PMCID: PMC7180014 DOI: 10.1016/j.medin.2020.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [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: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 12/17/2022]
Abstract
In January 2020, the Chinese authorities identified a new virus of the Coronaviridae family as the cause of several cases of pneumonia of unknown aetiology. The outbreak was initially confined to Wuhan City, but then spread outside Chinese borders. On 31 January 2020, the first case was declared in Spain. On 11 March 2020, The World Health Organization (WHO) declared the coronavirus outbreak a pandemic. On 16 March 2020, there were 139 countries affected. In this situation, the Scientific Societies SEMICYUC and SEEIUC have decided to draw up this Contingency Plan to guide the response of the Intensive Care Services. The objectives of this plan are to estimate the magnitude of the problem and identify the necessary human and material resources. This is to provide the Spanish Intensive Medicine Services with a tool to programme optimal response strategies.
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Affiliation(s)
- P Rascado Sedes
- Servicio de Medicina Intensiva, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, España.
| | - M A Ballesteros Sanz
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - M A Bodí Saera
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona JoanXXIII, Tarragona, España
| | | | - A Castellanos Ortega
- Área de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Universidad de Valencia, Valencia, España
| | - M Catalán González
- Servicio de Medicina Intensiva, Hospital Universitario 12de Octubre, Madrid, España
| | - C de Haro López
- Área de Críticos, Corporación Sanitaria i Universitaria Parc Taulí. CIBER de Enfermedades Respiratorias, Sabadell, Barcelona, España
| | - E Díaz Santos
- Área de Críticos, Corporación Sanitaria i Universitaria Parc Taulí. CIBER de Enfermedades Respiratorias, Sabadell, Barcelona, España
| | - A Escriba Barcena
- Servicio de Medicina Intensiva, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
| | - M J Frade Mera
- Servicio de Medicina Intensiva, Hospital Universitario 12de Octubre, Madrid, España
| | - J C Igeño Cano
- Servicio de Medicina Intensiva y Urgencias, Hospital San Juan de Dios de Córdoba, Córdoba, España
| | - M C Martín Delgado
- Servicio de Medicina Intensiva, Hospital de Torrejón, Torrejón de Ardoz, Madrid, España
| | | | - N Raimondi
- División de Terapia Intensiva, Hospital Juan A. Fernández, Buenos Aires, Argentina
| | - O Roca I Gas
- Servicio de Medicina Intensiva, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - A Rodríguez Oviedo
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona JoanXXIII, Tarragona, España
| | | | - J Trenado Álvarez
- Servicio de Medicina Intensiva, Hospital Universitario Mútua Terrassa, Terrassa, Barcelona, España
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Mogul DB, Perito ER, Wood N, Mazariegos GV, VanDerwerken D, Ibrahim SH, Mohammad S, Valentino PL, Gentry S, Hsu E. Impact of Acuity Circles on Outcomes for Pediatric Liver Transplant Candidates. Transplantation 2020; 104:1627-1632. [PMID: 32732840 PMCID: PMC7319877 DOI: 10.1097/tp.0000000000003079] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In December 2018, United Network for Organ Sharing approved an allocation scheme based on recipients' geographic distance from a deceased donor (acuity circles [ACs]). Previous analyses suggested that ACs would reduce waitlist mortality overall, but their impact on pediatric subgroups was not considered. METHODS We applied Scientific Registry of Transplant Recipients data from 2011 to 2016 toward the Liver Simulated Allocation Model to compare outcomes by age and illness severity for the United Network for Organ Sharing-approved AC and the existing donor service area-/region-based allocation schemes. Means from each allocation scheme were compared using matched-pairs t tests. RESULTS During a 3-year period, AC allocation is projected to decrease waitlist deaths in infants (39 versus 55; P < 0.001), children (32 versus 50; P < 0.001), and teenagers (15 versus 25; P < 0.001). AC allocation would increase the number of transplants in infants (707 versus 560; P < 0.001), children (677 versus 547; P < 0.001), and teenagers (404 versus 248; P < 0.001). AC allocation led to decreased median pediatric end-stage liver disease/model for end-stage liver disease at transplant for infants (29 versus 30; P = 0.01), children (26 versus 29; P < 0.001), and teenagers (26 versus 31; P < 0.001). Additionally, AC allocation would lead to fewer transplants in status 1B in children (97 versus 103; P = 0.006) but not infants or teenagers. With AC allocation, 77% of pediatric donor organs would be allocated to pediatric candidates, compared to only 46% in donor service area-/region-based allocation (P < 0.001). CONCLUSIONS AC allocation will likely address disparities for pediatric liver transplant candidates and recipients by increasing transplants and decreasing waitlist mortality. It is more consistent with federally mandated requirements for organ allocation.
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Affiliation(s)
- Douglas B Mogul
- Department of Pediatrics, Johns Hopkins University, Baltimore, MD
| | - Emily R Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA
| | - Nicholas Wood
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | - George V Mazariegos
- Hillman Center for Pediatric Transplantation, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Samar H Ibrahim
- Division of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Saeed Mohammad
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Pamela L Valentino
- Section of Gastroenterology & Hepatology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Sommer Gentry
- Department of Mathematics, United States Naval Academy, Annapolis, MD
| | - Evelyn Hsu
- Department of Pediatrics, University of Washington, Seattle, WA
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Yemeke TT, Kiracho EE, Mutebi A, Apolot RR, Ssebagereka A, Evans DR, Ozawa S. Health versus other sectors: Multisectoral resource allocation preferences in Mukono district, Uganda. PLoS One 2020; 15:e0235250. [PMID: 32730256 PMCID: PMC7392331 DOI: 10.1371/journal.pone.0235250] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/22/2019] [Accepted: 06/11/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives To elicit citizen preferences for national budget resource allocation in Uganda, examine respondents’ preferences for health vis-à-vis other sectors, and compare these preferences with actual government budget allocations. Methods We surveyed 432 households in urban and rural areas of Mukono district in central Uganda.We elicited citizens’ preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey. The BWS survey consisted of 16 sectors corresponding to the Uganda national budget line items. Respondents chose, from a subset of four sectors across 16 choice tasks, which sectors they thought were most and least important to allocate resources to. We utilized the relative best-minus-worst score method and a conditional logistic regression to obtain ranked preferences for resource allocation across sectors. We then compared the respondents’ preferences with actual government budget allocations. Results The health sector was the top ranked sector where 82% of respondents selected health as the most important sector for the government to fund, but it was ranked sixth in national budget allocation, encompassing 6.4% of the total budget. Beyond health, water and environment, agriculture, and social development sectors were largely underfunded compared to respondents’ preferences. Works and transport, education, security, and justice, law and order received a larger share of the national budget compared to respondents’ preferences. Conclusions Among respondents from Mukono district in Uganda, we found that citizens’ preferences for resource allocation across sectors, including for the health sector, were fundamentally misaligned with current government budget allocations. Evidence of respondents’ strong preferences for allocating resources to the health sector could help stakeholders make the case for increased health sector allocations. Greater investment in health is not only essential to satisfy citizens’ needs and preferences, but also to meet the government’s health goals to improve health, strengthen health systems, and achieve universal health coverage.
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Affiliation(s)
- Tatenda T. Yemeke
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
| | - Elizabeth E. Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Aloysius Mutebi
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Rebecca R. Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Anthony Ssebagereka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Daniel R. Evans
- Duke University School of Medicine, Durham, NC, United States of America
| | - Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America
- * E-mail:
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22
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Brito Fernandes Ó, Péntek M, Kringos D, Klazinga N, Gulácsi L, Baji P. Eliciting preferences for outpatient care experiences in Hungary: A discrete choice experiment with a national representative sample. PLoS One 2020; 15:e0235165. [PMID: 32735588 PMCID: PMC7394384 DOI: 10.1371/journal.pone.0235165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/22/2019] [Accepted: 06/09/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Patient-reported experience measures (PREMs) are central to inform on the responsiveness of health systems to citizens’ health care needs and expectations. At their current form, PREMs do not reflect the weights that patients assign to varying aspects of the care experience. We aimed to investigate patients’ preferences and willingness to pay (WTP) for attributes of the care experience in outpatient settings. Methods A discrete choice experiment was conducted among a representative sample of the general adult population of Hungary (n = 1000). Choice set attributes and levels were defined based on OECD’s standardized PREMs (e.g. a doctor spending enough time in consultation, providing easy to understand explanations, giving opportunity to ask questions, and involving in decision making) and a price attribute. Conditional and mixed logit analyses were conducted. WTP estimates were computed in preference and WTP space. Results The respondents most preferred attribute was that of a doctor spending enough time in consultation, followed by involvement in decision making. Moreover, waiting times had a less important effect on respondents’ choice preference compared with aspects of the doctor-patient relationship. Estimates in the WTP space varied from €4.38 (2.85–5.90) for waiting an hour less at a doctor’s office to €36.13 (32.07–40.18) for a consultation where a doctor spends enough time with a patient relative to a consultation where a doctor does not. Conclusions A preference-based PREMs approach provide insight on the value patients assign to different aspects of their care experience. This can inform the decisions of policy-makers and other stakeholders to coordinate efforts and resource allocation in a more targeted manner, by acting on attributes of the care experience that have a greater impact on the implementation of patient-centered care.
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Affiliation(s)
- Óscar Brito Fernandes
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- * E-mail:
| | - Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Dionne Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Niek Klazinga
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
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Affiliation(s)
- Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Derek C Angus
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Associate Editor
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Maves RC, Downar J, Dichter JR, Hick JL, Devereaux A, Geiling JA, Kissoon N, Hupert N, Niven AS, King MA, Rubinson LL, Hanfling D, Hodge JG, Marshall MF, Fischkoff K, Evans LE, Tonelli MR, Wax RS, Seda G, Parrish JS, Truog RD, Sprung CL, Christian MD. Triage of Scarce Critical Care Resources in COVID-19 An Implementation Guide for Regional Allocation: An Expert Panel Report of the Task Force for Mass Critical Care and the American College of Chest Physicians. Chest 2020; 158:212-225. [PMID: 32289312 PMCID: PMC7151463 DOI: 10.1016/j.chest.2020.03.063] [Citation(s) in RCA: 181] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 02/01/2023] Open
Abstract
Public health emergencies have the potential to place enormous strain on health systems. The current pandemic of the novel 2019 coronavirus disease has required hospitals in numerous countries to expand their surge capacity to meet the needs of patients with critical illness. When even surge capacity is exceeded, however, principles of critical care triage may be needed as a means to allocate scarce resources, such as mechanical ventilators or key medications. The goal of a triage system is to direct limited resources towards patients most likely to benefit from them. Implementing a triage system requires careful coordination between clinicians, health systems, local and regional governments, and the public, with a goal of transparency to maintain trust. We discuss the principles of tertiary triage and methods for implementing such a system, emphasizing that these systems should serve only as a last resort. Even under triage, we must uphold our obligation to care for all patients as best possible under difficult circumstances.
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Affiliation(s)
| | | | | | - John L Hick
- Hennepin County Medical Center, Minneapolis, MN
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Charles L Sprung
- Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michael D Christian
- London's Air Ambulance, Royal London Hospital, Barts NHS Health Trust, London, England
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Baldotto C, Gelatti A, Accioly A, Mathias C, Mascarenhas E, Carvalho H, Faroni L, Araújo LH, Zukin M, Gadia R, Terra RM, Haddad R, de Lima VC, de Castro-Júnior G. Lung Cancer and the COVID-19 pandemic: Recommendations from the Brazilian Thoracic Oncology Group. Clinics (Sao Paulo) 2020; 75:e2060. [PMID: 32578829 PMCID: PMC7297526 DOI: 10.6061/clinics/2020/e2060] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/29/2020] [Indexed: 12/13/2022] Open
Abstract
New cases of the novel coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continue to rise worldwide following the declaration of a pandemic by the World Health Organization (WHO). The current pandemic has completely altered the workflow of health services worldwide. However, even during this critical period, patients with other diseases, like cancer, need to be properly treated. A few reports have shown that mortality due to SARS-CoV-2 is higher in elderly patients and those with other active comorbidities, including cancer. Patients with lung cancer are at risk of pulmonary complications from COVID-19, and as such, the risk/benefit ratio of local and systemic anticancer treatment has to be considered. For each patient, several factors, including age, comorbidities, and immunosuppression, as well as the number of hospital visits for treatment, can influence this risk. The number of cases is rising exponentially in Brazil, and it is important to consider the local characteristics when approaching the pandemic. In this regard, the Brazilian Thoracic Oncology Group has developed recommendations to guide decisions in lung cancer treatment during the SARS-CoV-2 pandemic. Due to the scarcity of relevant data, discussions based on disease stage, evaluation of surgical treatment, radiotherapy techniques, systemic therapy, follow-up, and supportive care were carried out, and specific suggestions issued. All recommendations seek to reduce contagion risk by decreasing the number of medical visits and hospitalization, and in the case of immunosuppression, by adapting treatment schemes when possible. This statement should be adjusted according to the reality of each service, and can be revised as new data become available.
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Affiliation(s)
- Clarissa Baldotto
- Oncologia, Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ, BR
| | - Ana Gelatti
- Grupo Brasileiro de Oncologia Toracica, Porto Alegre, RS, BR
| | | | | | - Eldsamira Mascarenhas
- Grupo Brasileiro de Oncologia Toracica, Porto Alegre, RS, BR
- Oncologia D’Or, Salvador, BA, BR
| | - Heloisa Carvalho
- Radioterapia, Instituto de Radiologia (INRAD), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Sao Paulo, SP, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
| | - Lilian Faroni
- Oncologia, Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ, BR
| | - Luiz Henrique Araújo
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, BR
- Instituto COI de Educacao e Pesquisa, Rio de Janeiro, RJ, BR
| | - Mauro Zukin
- Grupo Brasileiro de Oncologia Toracica, Porto Alegre, RS, BR
- Grupo de Oncologia D’Or, Rio de Janeiro, RJ, BR
| | - Rafael Gadia
- Sociedade Brasileira de Radioterapia, Sao Paulo, SP, BR
| | - Ricardo Mingarini Terra
- Sociedade Brasileira de Cirurgia Toracica, Sao Paulo, SP, BR
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Rui Haddad
- Grupo Brasileiro de Oncologia Toracica, Porto Alegre, RS, BR
- Sociedade Brasileira de Cirurgia Toracica, Sao Paulo, SP, BR
- Academia Nacional de Medicina, Rio de Janeiro, RJ, BR
| | - Vladmir Cordeiro de Lima
- Grupo Brasileiro de Oncologia Toracica, Porto Alegre, RS, BR
- Oncologia Medica, A.C. Camargo Cancer Center, Sao Paulo, SP, BR
| | - Gilberto de Castro-Júnior
- Grupo Brasileiro de Oncologia Toracica, Porto Alegre, RS, BR
- Hospital Sirio Libanes, Sao Paulo, SP, BR
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Al‐Shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, Wolff RA, Ibrahim NK, Chua ML, Hotte SJ, Meyers BM, Elfiki T, Curigliano G, Eng C, Grothey A, Xie C. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist 2020; 25:e936-e945. [PMID: 32243668 PMCID: PMC7288661 DOI: 10.1634/theoncologist.2020-0213] [Citation(s) in RCA: 431] [Impact Index Per Article: 107.8] [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] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 01/08/2023] Open
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread globally since being identified as a public health emergency of major international concern and has now been declared a pandemic by the World Health Organization (WHO). In December 2019, an outbreak of atypical pneumonia, known as COVID-19, was identified in Wuhan, China. The newly identified zoonotic coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is characterized by rapid human-to-human transmission. Many cancer patients frequently visit the hospital for treatment and disease surveillance. They may be immunocompromised due to the underlying malignancy or anticancer therapy and are at higher risk of developing infections. Several factors increase the risk of infection, and cancer patients commonly have multiple risk factors. Cancer patients appear to have an estimated twofold increased risk of contracting SARS-CoV-2 than the general population. With the WHO declaring the novel coronavirus outbreak a pandemic, there is an urgent need to address the impact of such a pandemic on cancer patients. This include changes to resource allocation, clinical care, and the consent process during a pandemic. Currently and due to limited data, there are no international guidelines to address the management of cancer patients in any infectious pandemic. In this review, the potential challenges associated with managing cancer patients during the COVID-19 infection pandemic will be addressed, with suggestions of some practical approaches. IMPLICATIONS FOR PRACTICE: The main management strategies for treating cancer patients during the COVID-19 epidemic include clear communication and education about hand hygiene, infection control measures, high-risk exposure, and the signs and symptoms of COVID-19. Consideration of risk and benefit for active intervention in the cancer population must be individualized. Postponing elective surgery or adjuvant chemotherapy for cancer patients with low risk of progression should be considered on a case-by-case basis. Minimizing outpatient visits can help to mitigate exposure and possible further transmission. Telemedicine may be used to support patients to minimize number of visits and risk of exposure. More research is needed to better understand SARS-CoV-2 virology and epidemiology.
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Affiliation(s)
- Humaid O. Al‐Shamsi
- Medical Oncology Department, Alzahra Hospital DubaiDubaiUnited Arab Emirates
- Department of Medicine, University of SharjahSharjahUnited Arab Emirates
- Emirates Oncology SocietyDubaiUnited Arab Emirates
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, Medicine, McMaster UniversityHamiltonOntarioCanada
- Medicine, McMaster UniversityHamiltonOntarioCanada
| | - Ahmad Alhuraiji
- Department of Hematology, Kuwait Cancer Control CenterKuwait
| | - Eric A. Coomes
- Division of Infectious Disease, Department of Medicine, University of TorontoTorontoOntarioCanada
| | - Roy F. Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | | | - Robert A. Wolff
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Nuhad K. Ibrahim
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer CenterHoustonTexasUSA
| | - Melvin L.K. Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Center SingaporeSingapore
- Oncology Academic Program, Duke‐NUS Medical SchoolSingapore
- Cong Hua's InstituteSingapore
| | - Sebastien J. Hotte
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Brandon M. Meyers
- Department of Oncology, Juravinski Cancer Centre, McMaster UniversityHamiltonOntarioCanada
| | - Tarek Elfiki
- Windsor Regional Cancer CenterWindsorOntarioCanada
- Department of Oncology, Schulich School of Medicine, University of Western OntarioLondonOntarioCanada
| | - Giuseppe Curigliano
- Department of Oncology and Hemato‐Oncology University of MilanMilanItaly
- Division of Early Drug Development for Innovative Therapy, University of MilanMilanItaly
- European Institute of OncologyMilanItaly
- IRCCS, University of MilanoMilanItaly
| | - Cathy Eng
- Vanderbilt‐Ingram Cancer CenterNashvilleTennesseeUSA
| | - Axel Grothey
- West Cancer Center, University of TennesseeMemphisTennesseeUSA
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan UniversityWuhanPeople's Republic of China
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DePeralta DK, Hong AR, Choy C, Wang J, Ricci JP, Marcano-Benfante BV, Lipskar AM. Primer for intensive care unit (ICU) redeployment of the noncritical care surgeon: Insights from the epicenter of the coronavirus disease 2019 (COVID-19) pandemic. Surgery 2020; 168:215-217. [PMID: 32532466 PMCID: PMC7245208 DOI: 10.1016/j.surg.2020.05.010] [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] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/13/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Danielle K DePeralta
- Department of Surgery, Northwell Health, New Hyde Park, NY; Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY.
| | - Andrew R Hong
- Department of Surgery, Northwell Health, New Hyde Park, NY; Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY; Department of Pediatrics, Northwell Health, New Hyde Park, NY
| | - Charles Choy
- Department of Surgery, Northwell Health, New Hyde Park, NY; Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY
| | - John Wang
- Department of Surgery, Northwell Health, New Hyde Park, NY; Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY
| | - John P Ricci
- Department of Surgery, Northwell Health, New Hyde Park, NY; Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY
| | - Brenda V Marcano-Benfante
- Department of Surgery, Northwell Health, New Hyde Park, NY; Department of Pediatrics, Northwell Health, New Hyde Park, NY
| | - Aaron M Lipskar
- Department of Surgery, Northwell Health, New Hyde Park, NY; Zucker School of Medicine at Hofstra/ Northwell, Hempstead, NY; Department of Pediatrics, Northwell Health, New Hyde Park, NY
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Taylor A, Taylor B, Parkes J, Fagan JJ. How should health resource allocation be applied during the COVID-19 pandemic in South Africa? S Afr Med J 2020; 110:12950. [PMID: 32880316] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 06/11/2023] Open
Affiliation(s)
- A Taylor
- Head of Clinical Unit, Division of Neurosurgery, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
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Singh JA, Moodley K. Critical care triaging in the shadow of COVID-19: Ethics considerations. S Afr Med J 2020; 110:355-359. [PMID: 32657716] [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] [Received: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023] Open
Abstract
Since the World Health Organization declared coronavirus disease 2019 (COVID-19) a Public Health Emergency of International Concern, COVID-19 infection and the associated mortality have increased exponentially, globally. South Africa (SA) is no exception. Concerns abound over whether SA's healthcare system can withstand a demand for care that is disproportionate to current resources, both in the state and private health sectors. While healthcare professionals in SA have become resilient and adept at making difficult decisions in the face of resource limitations, a surge in COVID-19 cases could place a severe strain on the country's critical care services and necessitate unprecedented rationing decisions. This could occur at two critical points: access to ventilation, and withdrawal of intensive care in non- responsive or deteriorating cases. The ethical dimensions of decision-making at both junctures merit urgent consideration.
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Affiliation(s)
- J A Singh
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
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Palmén R, Arroyo L, Müller J, Reidl S, Caprile M, Unger M. Integrating the gender dimension in teaching, research content & knowledge and technology transfer: Validating the EFFORTI evaluation framework through three case studies in Europe. Eval Program Plann 2020; 79:101751. [PMID: 31786403 DOI: 10.1016/j.evalprogplan.2019.101751] [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] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
Gender equality and gender mainstreaming in research is one of the six European Research Area (ERA) priorities. Integrating the gender dimension in research content and teaching is one of its three objectives. It is arguably the objective where least progress has been made. In this article we contribute to the evidence base by applying the EFFORTI evaluation framework to three empirical case study interventions that aim to integrate the gender dimension in tertiary education and research content. Comparison is based on an evaluation of the design of the intervention, those factors that have enabled/ hindered its implementation as well as an assessment of outcomes and impacts. The findings of the case studies highlight the importance of design, specifically regarding resources, legal status and the definition and operationalisation of the gender concept. Implementation hinges on top-level institutional commitment and mainstreaming gender studies with support of a central unit and crucially gender competence. A lack of recognition and status of gender studies and subsequent innovations was seen to hamper implementation. Outcomes and impacts included an increased awareness and interest in gender, increased gender competence, a push towards gender equality regarding representation and organisational change as well as an improved accreditation process and more and better research.
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Arias-López MDP, Mandich V, Mosciaro M, Ratto ME, Chaparro Fresco J, Boada N, Gallesio A, Gilardino R. [Recommendations for resource management in intensive care units during the COVID-19 pandemic]. Medicina (B Aires) 2020; 80 Suppl 3:67-76. [PMID: 32658850] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
This document aims to provide evidence-based recommendations to estimate the personal protective equipments (PPE), medical devices, and drugs commonly used in the Intensive Care Unit during the COVID-19 pandemic. A systematic literature review and gray literature assessment was performed, and the evidence was categorized using the GRADE methodology. Then a predictive model was built to support the estimation of resources needed during 30 days of the pandemic. In the development of these recommendations, 33 publications were included, with variable quality of evidence (low to very low quality). They refer to the use of PPE according to the risk of exposure; management and reuse of PPE, and the stock of drugs and medical devices needed for the care of patients with COVID-19. It is important to remark the difficult in estimating and managing the number of essential supplies and equipment required during a pandemic. The model allowed us to predict the resources required to provide critical care during 30 days of pandemic activity. Given the constant evolution of COVID-19, these recommendations might change as evidence evolves.
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Affiliation(s)
- María Del Pilar Arias-López
- División Terapia Intensiva, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
- Comité de Gestión, Calidad y Scores, Sociedad Argentina de Terapia Intensiva, Argentina
| | - Verónica Mandich
- Comité de Gestión, Calidad y Scores, Sociedad Argentina de Terapia Intensiva, Argentina
- Servicio de Terapia Intensiva, Hospital Donación Francisco Santojanni, Buenos Aires, Argentina
| | - Marta Mosciaro
- Comité de Gestión, Calidad y Scores, Sociedad Argentina de Terapia Intensiva, Argentina
- Servicio de Terapia Intensiva Infantil, Hospital Humberto Notti, Argentina
| | - María Elena Ratto
- Comité de Gestión, Calidad y Scores, Sociedad Argentina de Terapia Intensiva, Argentina
- Servicio de Terapia Intensiva, Hospital de Niños Sor María Ludovica, Argentina
| | - Jerónimo Chaparro Fresco
- Comité de Gestión, Calidad y Scores, Sociedad Argentina de Terapia Intensiva, Argentina
- Servicio de Terapia Intensiva, Hospital El Cruce Néstor Carlos Kirchner, Provincia de Buenos Aires, Argentina
| | - Nancy Boada
- Comité de Gestión, Calidad y Scores, Sociedad Argentina de Terapia Intensiva, Argentina
- Area de Cuidados Intensivos, Hospital Nacional de Pediatría Juan P. Garrahan, Argentina
| | - Antonio Gallesio
- Comité de Gestión, Calidad y Scores, Sociedad Argentina de Terapia Intensiva, Argentina
- Servicio de Terapia Intensiva, Hospital Italiano de Buenos Aires, Argentina
| | - Ramiro Gilardino
- Comité de Gestión, Calidad y Scores, Sociedad Argentina de Terapia Intensiva, Argentina. E-mail:
- London School of Hygiene and Tropical Medicine, University of London
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Chi PC, Bulage P, Østby G. Equity in aid allocation and distribution: A qualitative study of key stakeholders in Northern Uganda. PLoS One 2019; 14:e0226612. [PMID: 31841555 PMCID: PMC6913922 DOI: 10.1371/journal.pone.0226612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/02/2019] [Accepted: 12/02/2019] [Indexed: 11/18/2022] Open
Abstract
The Sustainable Development Goals have spurred a growing interest in and focus on equitable development. In theory, donors can play an important role in promoting equity within a country by providing services, influencing government policies and incorporating equity into decision-making. However, we know little about whether this actually happens on the ground. We conduct what we believe is the first study to explore the extent to which equity is prioritised in the allocation and distribution of aid, based on in-depth interviews with government officials, bilateral and international donors, and implementing partners operating in Northern Uganda. We find that a broad category of people are perceived to be marginalised/vulnerable, with a substantial segment largely untargeted by major donor programmes. Various stakeholders employ a wide range of strategies to identify the most vulnerable individuals and groups, including the use of available data and statistics, consultation and engagement with relevant stakeholders, and undertaking primary data collection. The strategies used to incorporate equity in aid allocation and distribution include: targeting the regions of Northern Uganda and Karamoja in particular, targeting both refugees and host populations in refugee-hosting districts, prioritising the critically vulnerable in any aid distribution process, and using specific tools and consultants to ensure that major equity issues are addressed in proposals. Challenges undermining the process include poor understanding of the concept of equity among some implementing partners, lack of comprehensively disaggregated data, corruption, and political interference in choice of aid location from government officials and donors.
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Affiliation(s)
- Primus Che Chi
- Department of Health Systems and Research Ethics, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Peace Research Institute Oslo (PRIO), Oslo, Norway
- * E-mail: ,
| | - Patience Bulage
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Gudrun Østby
- Peace Research Institute Oslo (PRIO), Oslo, Norway
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Wenner DM. The Social Value Requirement in Research: From the Transactional to the Basic Structure Model of Stakeholder Obligations. Hastings Cent Rep 2019; 48:25-32. [PMID: 30586181 DOI: 10.1002/hast.934] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The history of research ethics includes ethical norms that do not neatly fit into a rubric of "human subjects protections" but that are nevertheless seen as fundamental ethical dictates. Among these norms is the so-called social value requirement for clinical research. Recently, however, the ethical foundation for the social value requirement has come under criticism. I seek to clarify the terms of this foundational debate. I contend that much of this discussion-both critiques of the social value requirement as well as recent defenses-is predicated on a framework of research ethics that I refer to as the "transactional model of stakeholder obligations." I argue that this model does not fully capture the ethical considerations that ought to inform the design and conduct of clinical research, and I introduce and defend an alternative framework that I call the "basic structure model of stakeholder obligations." The basic structure model is grounded in a claim that clinical research plays a direct role in establishing the justice or injustice of our social organization and should therefore be governed more explicitly by justice-based considerations. As such, the model explicitly accounts for the fundamentally social nature of the research enterprise itself. In addition to defending the basic structure model, I show how it provides a more stable foundation for the social value requirement, and I consider some worries about whether the model may be too demanding in practice.
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Sim SY, Jit M, Constenla D, Peters DH, Hutubessy RCW. A Scoping Review of Investment Cases for Vaccines and Immunization Programs. Value Health 2019; 22:942-952. [PMID: 31426936 DOI: 10.1016/j.jval.2019.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 11/11/2018] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Many investment cases have recently been published intending to show the value of new health investments, but without consistent methodological approaches. OBJECTIVES To conduct a scoping review of existing investment cases (using vaccines and immunization programs as an example), identify common characteristics that define these investment cases, and examine their role within the broader context of the vaccine development and introduction. METHODS A systematic search was conducted from January 1980 to November 2017 to identify investment cases in the area of vaccines and immunization programs from gray literature and electronic bibliographic databases. Investment case outcomes, objectives, key variables, target audiences, and funding sources were extracted and analyzed according to their reporting frequency. RESULTS We found 24 investment cases, and most of them aim to provide information for decisions (12 cases) or advocate for a specific agenda (9 cases). Outcomes presented fell into 4 broad categories-burden of disease, cost of investment, impact of investment, and other considerations for implementation. Number of deaths averted (70%), incremental cost-effectiveness ratios (67%), and reduction in health and socioeconomic inequalities (54%) were the most frequently reported outcome measures for impact of investment. Health system capacity (79%) and vaccine financing landscape (75%) were the most common considerations for implementation. A sizable proportion (41.4%) of investment cases did not reveal their funding sources. CONCLUSIONS This review describes information that is critical to decision making about resource mobilization and allocation concerning vaccines. Global efforts to harmonize investment cases more broadly will increase transparency and comparability.
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Affiliation(s)
- So Yoon Sim
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Jit
- London School of Hygiene & Tropical Medicine, London, UK; Modelling and Economics Unit, Public Health England, London, UK
| | - Dagna Constenla
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David H Peters
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Raymond C W Hutubessy
- Initiative for Vaccine Research, Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland.
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Kuupiel D, Bawontuo V, Drain PK, Gwala N, Mashamba-Thompson TP. Supply chain management and accessibility to point-of-care testing in resource-limited settings: a systematic scoping review. BMC Health Serv Res 2019; 19:519. [PMID: 31340833 PMCID: PMC6657084 DOI: 10.1186/s12913-019-4351-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/16/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND World Health Organization (WHO) has created an essential list of in-vitro diagnostics. Supply chain management (SCM) is said to be the vehicle that ensures that developed point-of-care (POC) tests reach their targeted settings for use. We therefore, mapped evidence on SCM of and accessibility to POC testing (availability and use of POC tests) in low- and middle-income countries (LMICs). METHODS We conducted a systematic scoping review using Arksey and O'Malley's framework as a guide. We searched PubMed; CINAHL; MEDLINE; WEB of Science; Science Direct; and Google Scholar databases for studies that focused on POC diagnostic tests and SCM. The review included studies that were undertaken in 140 countries defined by the World Bank as LMICs published up to August 2017. Two reviewers independently screened the abstracts and full articles against the eligibility criteria. The study used the mixed methods appraisal tool version 2011 to assess the risk of bias for the included studies. NVivo version 11 was employed to extract themes from all included studies and results presented using a narrative approach. RESULTS Of 292 studies identified in this review, only 15 published between 2009 and 2017 included evidence on POC diagnostics and SCM. Of the 15 studies, three were conducted in Zambia, one each in Mozambique, Uganda, Guatemala; South Africa, one in Burkina Faso, Zimbabwe, and one multi-country study (Tanzania, Uganda, China, Peru and Zambia and Brazil). Six studies were not country specific since they were not primary studies. Majority of the studies reported stock-outs of HIV, syphilis, and malaria POC tests. There was a moderate to substantial level of agreement between the reviewers' responses at full article screening stage (Kappa statistic = 0.80, p < 0.01). Nine studies underwent methodological quality appraisal and all, scored between 90 and 100%. CONCLUSIONS The results demonstrated limited published research on SCM of and accessibility to POC testing in LMICs. Further studies aimed at investigating SCM of POC tests in resource-limited settings to identify the barriers/challenges and provide a context-specific evidence-based solutions for policy/decision makers, implementers, and POC developers, funders, and development partners would be essential. PROSPERO REGISTRATION NUMBER CRD42016043711.
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Affiliation(s)
- Desmond Kuupiel
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Vitalis Bawontuo
- Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Paul K. Drain
- International Clinical Research Center, Department of Global Health, University of Washington, Seattle, USA
- Division of Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA
- Department of Epidemiology, University of Washington, Seattle, USA
| | - Nonjabulo Gwala
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tivani P. Mashamba-Thompson
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Conway D, Albright P, Eliezer E, Haonga B, Morshed S, Shearer DW. The burden of femoral shaft fractures in Tanzania. Injury 2019; 50:1371-1375. [PMID: 31196597 DOI: 10.1016/j.injury.2019.06.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/07/2019] [Revised: 05/22/2019] [Accepted: 06/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Road traffic injuries disproportionately affect low- and middle-income countries (LMICs) and are associated with femur fractures that lead to long-term disability. Information about these injuries is crucial for appropriate healthcare resource allocation. The purpose of this study is to estimate the incidence of femoral shaft fractures in Tanzania and describe the unmet surgical burden. METHODS Study sites included six government hospitals across Tanzania. Investigators collected data from hospital admission and procedural logbooks to estimate femoral shaft fracture incidence and their treatment methods. Semi-quantitative interviews were conducted with relevant hospital personnel to validate estimates obtained from hospital records. Investigators gathered road traffic incident (RTI) statistics from national police reports and calculated femur fracture:RTI ratios. RESULTS Femoral shaft fracture annual incidence rate ranged from 2.1 to 18.4 per 100,000 people. Median low and high femur fracture:RTI ratio were 0.54 and 0.73, respectively. At smaller hospitals, many patients (5-25%) were treated with traction, and a majority (70-90%) are referred to other centers. Barriers to surgery at each hospital include a lack of surgical implants, equipment, and personnel. CONCLUSIONS The incidence rate is similar to previous estimations, and it is consistent with an increased femoral shaft fracture incidence in Tanzania when compared to higher income countries. The femur fracture:RTI ratio may be a valid tool for estimating femur fracture incidence rates. There is an unmet orthopaedic surgical burden for femur fractures treatment at rural hospitals in Tanzania, and the barriers to treatment could be targets for future interventions.
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Affiliation(s)
- Devin Conway
- Yale School of Medicine, Department of Orthopaedics & Rehabilitation, 800 Howard Avenue, New Haven, CT, USA.
| | - Patrick Albright
- Institute for Global Orthopaedics and Traumatology, University of California, San Francisco 2550 23rd Street, Building 9, 3rd Floor, San Francisco, CA, 94110, USA.
| | - Edmund Eliezer
- Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
| | - Billy Haonga
- Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania.
| | - Saam Morshed
- Institute for Global Orthopaedics and Traumatology, University of California, San Francisco 2550 23rd Street, Building 9, 3rd Floor, San Francisco, CA, 94110, USA.
| | - David W Shearer
- Institute for Global Orthopaedics and Traumatology, University of California, San Francisco 2550 23rd Street, Building 9, 3rd Floor, San Francisco, CA, 94110, USA.
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Öhler H, Negre M, Smets L, Massari R, Bogetić Ž. Putting your money where your mouth is: Geographic targeting of World Bank projects to the bottom 40 percent. PLoS One 2019; 14:e0218671. [PMID: 31226139 PMCID: PMC6588237 DOI: 10.1371/journal.pone.0218671] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 01/24/2019] [Accepted: 06/06/2019] [Indexed: 11/24/2022] Open
Abstract
The adoption of the shared prosperity goal by the World Bank in 2013 and Sustainable Development Goal 10, on inequality, by the United Nations in 2015 should strengthen the focus of development interventions and cooperation on the income growth of the bottom 40 percent of the income distribution. This paper contributes to the incipient literature on within-country allocations of development institutions and assesses the geographic targeting of World Bank projects to the bottom 40 percent. Bivariate correlations between the allocation of project funding approved over 2005–14 and the geographical distribution of the bottom 40 as measured by survey income or consumption data are complemented by regressions with population and other potential factors affecting the within-country allocations as controls. The correlation analysis shows that, of the 58 countries in the sample, 41 exhibit a positive correlation between the shares of the bottom 40 and World Bank funding, and, in almost half of these, the correlation is above 0.5. Slightly more than a quarter of the countries, mostly in Sub-Saharan Africa, exhibit a negative correlation. The regression analysis shows that, once one controls for population, the correlation between the bottom 40 and World Bank funding switches sign and becomes significant and negative on average. This is entirely driven by Sub-Saharan Africa and not observed in the other regions. Hence, the significant and positive correlation in the estimations without controlling for population suggests that World Bank project funding is concentrated in administrative areas in which more people live (including the bottom 40) rather than in poorer administrative areas. Furthermore, capital cities receive disproportionally high shares of World Bank funding on average.
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Affiliation(s)
- Hannes Öhler
- German Development Institute, Bonn, North Rhine-Westphalia, Germany
- * E-mail:
| | - Mario Negre
- German Development Institute, Bonn, North Rhine-Westphalia, Germany
- World Bank, Washington, D.C., United States of America
| | - Lodewijk Smets
- LICOS Centre for Institutions and Economic Performance, KU Leuven, Flemish Brabant, Belgium
| | - Renzo Massari
- Independent consultant, Washington, D.C., United States of America
| | - Željko Bogetić
- Independent Evaluation Group, World Bank, Washington, D.C., United States of America
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Abdolmanafi SE, Karamad S. A new approach for resource allocation for black spot treatment (case study: The road network of Iran). J Safety Res 2019; 69:95-100. [PMID: 31235240 DOI: 10.1016/j.jsr.2019.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/24/2018] [Revised: 01/05/2019] [Accepted: 03/02/2019] [Indexed: 06/09/2023]
Abstract
Currently, spatial and temporal distribution of safety resources in Iran is entirely based on expert opinions, regardless of network priorities. Considering the lack of resources for implementing safety treatments, prioritizing unsafe points is an important and complicated issue where the effectiveness of each safety treatment option should be thoroughly investigated. The political, social, and environmental aspects should also be taken into consideration, including social and political pressures and officials talks on less important topics. Obviously, this inappropriate resource allocation poses a serious challenge to the expected goals. In this study, a methodology based on economic and social issues is proposed to optimize the annual budget allocation for eliminating or reducing the risk of accident-prone points. In this methodology, the spatial and temporal distribution of budget is determined using a mathematical model aimed to maximize the benefits of reducing the accidents after deducting the costs of implementing the safety countermeasures. The outputs of this model include the safety countermeasure alternatives and a five-year time schedule for implementing them, or the alternative of no action with regard to budget, social, and judicial constraints. In order to evaluate the proposed method, it is applied to the road network of Iran and the results are compared with those of the conventional method that is currently used for resource allocation in this country. The results show that the proposed method leads to 15% higher benefits compared to the conventional method. Moreover, this method makes 641 safe points, which is about 17% more than the safe points resulted from the existing method. Therefore, the proposed method brings about a safer network as a result of the optimal allocation of available resources.
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Affiliation(s)
| | - Sina Karamad
- Dep. of Transportation Engineering, Islamic Azad University, Iran
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Krucien N, Pelletier-Fleury N, Gafni A. Measuring Public Preferences for Health Outcomes and Expenditures in a Context of Healthcare Resource Re-Allocation. Pharmacoeconomics 2019; 37:407-417. [PMID: 30499065 DOI: 10.1007/s40273-018-0751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The final outcome of any resource allocation decision in healthcare cannot be determined in advance. Thus, decision makers, in deciding which new program to implement (or not), need to accommodate the uncertainty of different potential outcomes (i.e., change in both health and costs) that can occur, the size and nature (i.e., 'bad' or 'good') of these outcomes, and how they are being valued. Using the decision-making plane, which explicitly incorporates opportunity costs and relaxes the assumptions of perfect divisibility and constant returns to scale of the cost-effectiveness plane, all the potential outcomes of each resource allocation decision can be described. OBJECTIVE In this study, we describe the development and testing of an instrument, using a discrete choice experiment methodology, allowing the measurement of public preferences for potential outcomes falling in different quadrants of the decision-making plane. METHOD In a sample of 200 participants providing 4200 observations, we compared four versions of the preference-elicitation instrument using a range of indicators. RESULTS We identified one version that was well accepted by the participants and with good measurement properties. CONCLUSION This validated instrument can now be used in a larger representative sample to study the preferences of the public for potential outcomes stemming from re-allocation of healthcare resources.
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Affiliation(s)
- Nicolas Krucien
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2QN, Scotland, UK.
| | - Nathalie Pelletier-Fleury
- Centre de Recherche en Epidémiologie et Santé des Populations, Université Paris-Sud, UVSQ, INSERM, Université Paris-Saclay, Villejuif, France
| | - Amiram Gafni
- Department of Health Research Methods, Evaluation and Impact, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Affiliation(s)
- Victor R Fuchs
- Stanford Institute for Economic Policy Research, Stanford University, Stanford, California
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Bowers J, Cheyne H, Mould G, Miller M, Page M, Harris F, Bick D. A multicriteria resource allocation model for the redesign of services following birth. BMC Health Serv Res 2018; 18:656. [PMID: 30134882 PMCID: PMC6106921 DOI: 10.1186/s12913-018-3430-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many healthcare services are under considerable pressure to reduce costs while improving quality. This is particularly true in the United Kingdom's National Health Service where postnatal care is sometimes viewed as having a low priority. There is much debate about the service's redesign and the reallocation of resources, both along care pathways and between groups of mothers and babies with different needs. The aim of this study was to develop a decision support tool that would encourage a systemic approach to service redesign and that could assess the various quality and financial implications of service change options making the consequent trade-offs explicit. The paper describes the development process and an initial implementation as a preliminary exploration of the possible merits of this approach. METHODS Other studies have suggested that combining multicriteria decision analysis with programme budgeting and marginal analysis might offer a suitable basis for resource allocation decisions in healthcare systems. The Postnatal care Resource Allocation Model incorporated this approach in a decision support tool to analyse the consequences of varying design parameters, notably staff contacts and time, on the various quality domains and costs. The initial phase of the study focussed on mapping postnatal care, involving interviews and workshops with a variety of stakeholders. This was supplemented with a literature review and the resultant knowledge base was encoded in the decision support tool. The model was then tested with various stakeholders before being used in an NHS Trust in England. RESULTS The model provides practical support, helping staff explore options and articulate their proposals for the redesign of postnatal care. The integration of cost and quality domains facilitates trade-offs, allowing staff to explore the benefits of reallocating resources between hospital and community-based care, and different patient-categories. CONCLUSIONS The main benefits of the model include its structure for assembling the key data, sharing evidence amongst multi-professional teams and encouraging constructive, systemic debate. Although the model was developed in the context of the routine maternity services for mothers and babies in the days following birth it could be adapted for use in other health care services.
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Affiliation(s)
- John Bowers
- Stirling Management School, University of Stirling, Stirling, FK9 4LA UK
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Gillian Mould
- Stirling Management School, University of Stirling, Stirling, FK9 4LA UK
| | - Martin Miller
- Stirling Management School, University of Stirling, Stirling, FK9 4LA UK
| | - Miranda Page
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Fiona Harris
- Nursing, Midwifery and Allied Health Professions Research Unit, Unit 13 Scion House, Stirling University Innovation Park, Stirling, FK9 4NF UK
| | - Debra Bick
- Florence Nightingale School of Nursing and Midwifery, King’s College London, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA UK
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Shah N, Abraham J, Goodwin W, Kahal H, Menon V, Lam FT, Barber TM. Effective Implementation of Peri-operative Local Guidelines for Metabolic Surgery in Patients with Diabetes Mellitus in a Tier 4 Setting Demonstrate Improved Work Efficiency and Resource Allocation. Obes Surg 2018; 28:3342-3347. [PMID: 30022426 DOI: 10.1007/s11695-018-3389-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND Dynamic changes in glycaemia predominate peri-operatively in patients with type 2 diabetes mellitus (T2DM) undergoing metabolic surgery. There is a lack of consensus and clear guidance on effective glycaemic management of such patients. The aim of this study was to design, pilot, and implement a proforma to improve consistency of glycaemic management and clarity of communication with healthcare professionals following metabolic surgery in patients with T2DM, thereby reducing unnecessary diabetes specialist nurse (DSN) referrals. METHODS A proforma was designed and piloted for 12 months to guide healthcare professionals on managing glycaemic therapies for T2DM patients undergoing metabolic surgery. Glycaemic control (HbA1c) and glycaemic therapies were reviewed 3 weeks pre-operatively and a proforma was completed accordingly. RESULTS Of the patients with T2DM (n = 34) who underwent metabolic surgery prior to the new proforma being implemented, 71% (n = 24) had a DSN referral. Half of these referrals were deemed unnecessary by the DSNs. Of the patients with T2DM (n = 33) who underwent metabolic surgery following implementation of the proforma, 21% (n = 7) had a DSN referral. Only 10% of these were deemed unnecessary. Despite the reduced DSN input, no diabetes-related complications were reported. CONCLUSION Implementation of our proforma effectively halved the proportion of patients with T2DM requiring a DSN referral. Additionally, there was a 40% absolute reduction in the proportion of unnecessary DSN referrals. The proforma improved clarity of communication and guidance for healthcare professionals in the glycaemic management of patients. This also facilitated improved work efficiency and resource allocation.
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Affiliation(s)
- Neha Shah
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
| | - Jenny Abraham
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Wendy Goodwin
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Hassan Kahal
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Vinod Menon
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - F T Lam
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - Thomas M Barber
- Dietetics, University Hospitals Coventry and Warwickshire, 2nd Floor Rotunda, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwickshire Institute for the Study of Diabetes Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
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Chen W, Zhai G, Ren C, Shi Y, Zhang J. Urban Resources Selection and Allocation for Emergency Shelters: In a Multi-Hazard Environment. Int J Environ Res Public Health 2018; 15:ijerph15061261. [PMID: 29903997 PMCID: PMC6025408 DOI: 10.3390/ijerph15061261] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 12/18/2022]
Abstract
This study explores how emergency shelters can adapt to a multi-hazard environment by geographic information system (GIS) and takes Guangzhou as a case for analysis. The physical suitability of the overall urban resources was first assessed by aiming to select the suitable resources and safe locations for emergency shelters in the context of multiple disasters. Afterward, by analyzing the scale and spatial distribution of affected areas and populations under different types of disaster scenarios, the demand for different kinds of shelters were predicted. Lastly, taking into account the coverage of the affected people, shelters were allocated according to different conditions in the districts. This work will hopefully provide a reference for the construction of emergency shelters and help form emergency operations in order to mitigate the impact of hazards. The issues identified in the study need to be further studied in medium or small-scale cities.
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Affiliation(s)
- Wei Chen
- School of Geographic and Oceanographic Sciences, Nanjing University, Nanjing 210046, China.
| | - Guofang Zhai
- School of Architecture and Urban Planning, Nanjing University, Nanjing 210093, China.
| | - Chongqiang Ren
- College of Economics, Northwest Minzu University, Lanzhou 730030, China.
| | - Yijun Shi
- School of Architecture and Urban Planning, Nanjing University, Nanjing 210093, China.
| | - Jianxin Zhang
- School of Geographic and Oceanographic Sciences, Nanjing University, Nanjing 210046, China.
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Schwarzman J, Bauman A, Gabbe B, Rissel C, Shilton T, Smith BJ. Organizational determinants of evaluation practice in Australian prevention agencies. Health Educ Res 2018; 33:243-255. [PMID: 29746649 DOI: 10.1093/her/cyy015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
Program evaluation is essential to inform decision making, contribute to the evidence base for strategies, and facilitate learning in health promotion and disease prevention organizations. Theoretical frameworks of organizational learning, and studies of evaluation capacity building describe the organization as central to evaluation capacity. Australian prevention organizations recognize limitations to current evaluation effectiveness and are seeking guidance to build evaluation capacity. This qualitative study identifies organizational facilitators and barriers to evaluation practice, and explores their interactions in Australian prevention organizations. We conducted semi-structured interviews with 40 experienced practitioners from government and non-government organizations. Using thematic analysis, we identified seven key themes that influence evaluation practice: leadership, organizational culture, organizational systems and structures, partnerships, resources, workforce development and training and recruitment and skills mix. We found organizational determinants of evaluation to have multi-level interactions. Leadership and organizational culture influenced organizational systems, resource allocation and support of staff. Partnerships were important to overcome resource deficits, and systems were critical to embed evaluation within the organization. Organizational factors also influenced the opportunities for staff to develop skills and confidence. We argue that investment to improve these factors would allow organizations to address evaluation capacity at multiple levels, and ultimately facilitate effective evaluation practice.
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Affiliation(s)
- J Schwarzman
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - A Bauman
- Prevention Research Collaboration, School of Public Health, L6 The Hub, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
| | - B Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - C Rissel
- NSW Office of Preventive Health, Don Everett Building, Level 1, Liverpool Hospital, Liverpool, NSW 2170, Australia
| | - T Shilton
- National Heart Foundation Western Australia, 334 Rokeby Road, Subiaco, WA 6008, Australia
| | - B J Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
- Prevention Research Collaboration, School of Public Health, L6 The Hub, Charles Perkins Centre, University of Sydney, Sydney, NSW 2006, Australia
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Bourgeois I, Whynot J. The influence of evaluation recommendations on instrumental and conceptual uses: A preliminary analysis. Eval Program Plann 2018; 68:13-18. [PMID: 29454262 DOI: 10.1016/j.evalprogplan.2018.02.008] [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: 09/01/2017] [Revised: 02/06/2018] [Accepted: 02/07/2018] [Indexed: 06/08/2023]
Abstract
Evaluation recommendations are sometimes included in evaluation reports to highlight specific actions to be taken to improve a program or to make other changes to its operational context. This preliminary study sought to examine evaluation recommendations drawn from 25 evaluation reports published by Canadian federal government departments and agencies, in order to examine the evaluation issues covered and the focus of the recommendations. Our results show that in keeping with policy requirements, the evaluation recommendations focused on program relevance, effectiveness and efficiency and economy. Furthermore, a significant number of recommendations also focused on the implementation of more rigorous performance measurement strategies. The focus of the recommendations did not vary by publication date, recommendation type, and organizational sector. The findings also show that for the most part, the management responses produced as part of the broader evaluation process support the recommendations included in the report and identify specific timelines for implementation.
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Affiliation(s)
- Isabelle Bourgeois
- École nationale d'administration publique, Université du Québec, 283 boul, Alexandre-Taché, Gatineau, QC, J8X 3X7, Canada.
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Dort T, Schecroun N, Standaert B. Improving the Hospital Quality of Care during Winter Periods by Optimizing Budget Allocation Between Rotavirus Vaccination and Bed Expansion. Appl Health Econ Health Policy 2018; 16:123-132. [PMID: 29159785 PMCID: PMC5797246 DOI: 10.1007/s40258-017-0362-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND During each winter the hospital quality of care (QoC) in pediatric wards decreases due to a surge in pediatric infectious diseases leading to overcrowded units. Bed occupancy rates often surpass the good hospital bed management threshold of 85%, which can result in poor conditions in the workplace. This study explores how QoC-scores could be improved by investing in additional beds and/or better vaccination programs against vaccine-preventable infectious diseases. METHODS The Cobb-Douglas model was selected to define the improvement in QoC (%) as a function of two strategies (rotavirus vaccination coverage [%] and addition of extra hospital beds [% of existing beds]), allowing improvement-isocurves to be produced. Subsequently, budget minimization was applied to determine the combination of the two strategies needed to reach a given QoC improvement at the lowest cost. Data from Jessa Hospital (Hasselt, Belgium) were chosen as an example. The annual population in the catchment area to be vaccinated was 7000 children; the winter period was 90 days with 34 pediatric beds available. Rotavirus vaccination cost per course was €118.26 and the daily cost of a pediatric bed was €436.53. The target QoC increase was fixed at 50%. The model was first built with baseline parameter values. RESULTS The model predicted that a combination of 64% vaccine coverage and 39% extra hospital beds (≈ 13 extra beds) in winter would improve QoC-scores by 50% for the minimum budget allocation. CONCLUSION The model allows determination of the most efficient allocation of the healthcare budget between rotavirus vaccination and bed expansion for improving QoC-scores during the annual epidemic winter seasons.
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Affiliation(s)
- Thibaut Dort
- Keyrus Management S.A.-N.V., Strombeek-Bever, Belgium C/O GSK, Wavre, Belgium
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Grépin KA, Pinkstaff CB, Hole AR, Henderson K, Norheim OF, Røttingen JA, Ottersen T. Allocating external financing for health: a discrete choice experiment of stakeholder preferences. Health Policy Plan 2018; 33:i24-i30. [PMID: 29415237 PMCID: PMC5886273 DOI: 10.1093/heapol/czx017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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] [Subscribe] [Scholar Register] [Accepted: 01/31/2017] [Indexed: 11/24/2022] Open
Abstract
Most donors of external financing for health use allocation policies to determine which countries are eligible to receive financial support and how much support each should receive. Currently, most of these policies place a great deal of weight on income per capita as a determinant of aid allocation but there is increasing interest in putting more weight on other country characteristics in the design of such policies. It is unclear, however, how much weight should be placed on other country characteristics. Using an online discrete choice experiment designed to elicit preferences over country characteristics to guide decisions about the allocation of external financing for health, we find that stakeholders assign a great deal of importance to health inequalities and the burden of disease but put very little weight on income per capita. We also find considerable variation in preferences across stakeholders, with people from low- and middle-income countries putting more weight on the burden of disease and people from high-income countries putting more weight on health inequalities. These findings suggest that stakeholders put more weight on burden of disease and health inequalities than on income per capita in evaluating which countries should received external financing for health and that that people living in aid recipient may have different preferences than people living in donor countries. Donors may wish to take these differences in preferences in mind if they are reconsidering their aid allocation policies.
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Affiliation(s)
- Karen A Grépin
- Department of Health Sciences, Wilfrid Laurier University, 75 University Ave, W. Waterloo, ON N2L3C5, Canada
| | - Crossley B Pinkstaff
- International Food Policy Research Institute, 2033 K Street, N.W. Washington, D.C. 20006, U.S.A
| | | | - Klara Henderson
- Independent Consultant, Warringah Street, North Balgowlah, NSW 2093, Australia
| | | | - John-Arne Røttingen
- Infectious Disease Control and Environmental Health, Norwegian Institute of Public Health, Lovisenberggata 8, 0456 Oslo, Norway, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, 655 Huntington Ave, Boston, MA 02115, USA, Department of Health Management and Health Economics, University of Oslo, Forskningsveien 3a/2b, 0373, Oslo, Norway and
| | - Trygve Ottersen
- Department of International Public Health, Norwegian Institute of Public Health, Norway, Marcus Thranes gate 2, 0473 Oslo, Norway, Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, University of Oslo, Kirkeveien 166, 0450 Oslo, Norway, Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018 Bergen, Norway
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Abstract
OBJECTIVE The objective of this research was to develop a computer simulation model that will provide the most optimal allocation of resources for a point of distribution (POD) site. DESIGN A baseline assessment was conducted by participants establishing POD sections with no guidance from the investigator. A computer model was built with four stations: triage, registration, screening, and dispensing. The information from the computer simulation was used to design the allocation of volunteers for the experimental group. Once the data were collected, a two-sample t test was used to determine the significance of the difference between the average times of the two groups to complete the POD. SETTING The POD site was conducted indoors with volunteers acting as patients, and volunteer nursing students, and pharmacy students acting as POD workers. Volunteers were divided into two groups, group B, experimental and group A, control. Time was recorded using a digital time-stamp at the beginning and at the end of the POD. INTERVENTIONS The researcher inputted the total number of volunteers into the model, and the model generated the most applicable ratio for distribution of human capital: a one-to-one ratio of screeners to dispensers. MAIN OUTCOME MEASURES The mean time for Group A was 4.55 minutes (95% CI: 4.27, 4.83). The mean time for group B was 3.05 minutes (95% CI: 2.79, 3.31). A two-sample t test and Analysis of Variance of these data show that the difference is meaningful (p < 0.001). RESULTS The results show that a discrete-event computer simulation can be used to identify the most efficient use of resources in order to decrease the amount of time that patients are required to participate. CONCLUSIONS The discrete-event computer simulation model was found to be effective at identifying ways to in-crease efficiency and reduce the overall time required by patients to complete the POD.
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Affiliation(s)
- Patrick Glass
- Formerly a Graduate Student at Purdue University Homeland Security Institute, Cameron, North Carolina; Major in the US Army, Fort Bragg, North Carolina
| | - Eric Dietz
- Professor of Computer and Information Technology and Director of the Purdue University Homeland Security Institute, West Lafayette, Indiana
| | - Pamela Aaltenon
- Professor Emerita, Purdue University, West Lafayette, Indiana
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MacQuilkan K, Baker P, Downey L, Ruiz F, Chalkidou K, Prinja S, Zhao K, Wilkinson T, Glassman A, Hofman K. Strengthening health technology assessment systems in the global south: a comparative analysis of the HTA journeys of China, India and South Africa. Glob Health Action 2018; 11:1527556. [PMID: 30326795 PMCID: PMC6197020 DOI: 10.1080/16549716.2018.1527556] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [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] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 09/19/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Resource allocation in health is universally challenging, but especially so in resource-constrained contexts in the Global South. Pursuing a strategy of evidence-based decision-making and using tools such as Health Technology Assessment (HTA), can help address issues relating to both affordability and equity when allocating resources. Three BRICS and Global South countries, China, India and South Africa have committed to strengthening HTA capacity and developing their domestic HTA systems, with the goal of getting evidence translated into policy. Through assessing and comparing the HTA journey of each country it may be possible to identify common problems and shareable insights. OBJECTIVES This collaborative paper aimed to share knowledge on strengthening HTA systems to enable enhanced evidence-based decision-making in the Global South by: Identifying common barriers and enablers in three BRICS countries in the Global South; and Exploring how South-South collaboration can strengthen HTA capacity and utilisation for better healthcare decision-making. METHODS A descriptive and explorative comparative analysis was conducted comprising a Within-Case analysis to produce a narrative of the HTA journey in each country and an Across-Case analysis to explore both knowledge that could be shared and any potential knowledge gaps. RESULTS Analyses revealed that China, India and South Africa share many barriers to strengthening and developing HTA systems such as: (1) Minimal HTA expertise; (2) Weak health data infrastructure; (3) Rising healthcare costs; (4) Fragmented healthcare systems; and (5) Significant growth in non-communicable diseases. Stakeholder engagement and institutionalisation of HTA were identified as two conducive factors for strengthening HTA systems. CONCLUSION China, India and South Africa have all committed to establishing robust HTA systems to inform evidence-based priority setting and have experienced similar challenges. Engagement among countries of the Global South can provide a supportive platform to share knowledge that is more applicable and pragmatic.
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Affiliation(s)
- Kim MacQuilkan
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Peter Baker
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Laura Downey
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Francis Ruiz
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Kalipso Chalkidou
- Global Health and Development Group, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Shankar Prinja
- School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kun Zhao
- Division of Health Technology Assessment and Policy Evaluation, China National Health Development Research Center (CHNHDR), Ministry of Health, Beijing, China
| | - Thomas Wilkinson
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | | | - Karen Hofman
- Priority Cost Effective Lessons for System Strengthening South Africa (PRICELESS SA), Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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