Health System Development Research Articles

Bystander defibrillation for out-of-hospital cardiac arrest in Ireland

AimsTo describe and explore predictors of bystander defibrillation in Ireland during the period 2012 to 2020. To examine the relationship between bystander defibrillation and health system developments. MethodsNational level Out of Hospital Cardiac Arrest (OHCA) registry data were interrogated, focusing on patients who had defibrillation performed. Bystander defibrillation (as compared to EMS initiated defibrillation) was the key outcome of concern. Logistic regression models were built and refined by fitting predictors, performing stepwise variable selection and by adding pairwise interactions that improved fit. ResultsThe data included 5,751 cases of OHCA where defibrillation was performed. Increasing year over time (OR 1.17, 95% CI 1.13, 1.21) was associated with increased adjusted odds of bystander defibrillation. Non-cardiac aetiology was associated with reduced adjusted odds of bystander defibrillation (OR 0.30, 95% CI 0.21, 0.42), as were increasing age in years (OR 0.99, 95% CI 0.987, 0.996) and night-time occurrence of OHCA (OR 0.67, 95% CI 0.53, 0.83). Six further variables in the final model (sex, call response interval, incident location (home or other), who witnessed collapse (bystander or not witnessed), urban or rural location, and the COVID period) were involved in significant interactions. Bystander defibrillation was in general less likely in urban settings and at home locations. Whilst women were less likely to receive bystander defibrillation overall, in witnessed OHCAs, occurring outside the home, in urban areas and outside of the COVID-19 period women were more likely, to receive bystander defibrillation. ConclusionsDefibrillation by bystanders has increased incrementally over time in Ireland. Interventions to address sex and age-based disparities, alongside interventions to increase bystander defibrillation at night, in urban settings and at home locations are required.

Development and validity testing of a matrix to evaluate maturity of clinical pathways: a case study in Saskatchewan, Canada

BackgroundHealthcare systems are transforming into learning health systems that use data-driven and research-informed approaches to achieve continuous improvement. One of these approaches is the use of clinical pathways, which are tools to standardize care for a specific population and improve healthcare quality. Evaluating the maturity of clinical pathways is necessary to inform pathway development teams and health system decision makers about required pathway revisions or implementation supports. In an effort to improve the development, implementation, and sustainability of provincial clinical pathways, we developed a clinical pathways maturity evaluation matrix. To explore the initial content and face validity of the matrix, we used it to evaluate a case pathway within a provincial health authority in Saskatchewan, Canada.MethodsBy using iterative consensus-based processes, we gathered feedback from stakeholders including patient and family partners, policy makers, clinicians, and quality improvement specialists, to rank, retain, or remove enablers and sub-enablers of the draft matrix. We tested the matrix on the Chronic Pain Pathway (CPP) for primary care in a local pilot area and revised the matrix based on feedback from the CPP development team leader.ResultsThe final matrix contains five enablers (i.e., Design, Ownership and Performer, Infrastructure, Performance Management, and Culture), 20 sub-enablers, and three trajectory definitions for each sub-enabler. Supplemental documents were created for six sub-enablers. The CPP scored 15 out of 40 possible points of maturity. Although the pathway scored highest in the Design enabler (10/12), it requires more attention in several areas, specifically the Ownership and Performer and the Performance Management enablers, each of which scored zero. Additionally, the Infrastructure and Culture enablers scored 2/4 and 3/8 points, respectively. These areas of the CPP are in need of improvement in order to enhance the overall maturity of the CPP.ConclusionsWe developed a clinical pathways maturity matrix to evaluate the various dimensions of clinical pathways’ development and implementation. The goals of this initial work were to develop and validate a tool to assess the maturity and readiness of new or existing pathways and to track pathways' revisions and improvements.

Lessons learned from a multi-site collaborative working toward a digital health use screening tool.

Digital health has the potential to expand health care and improve outcomes for patients-particularly for those with challenges to accessing in-person care. The acceleration of digital health (and particularly telemedicine) prompted by the Coronavirus-19 (COVID-19) pandemic facilitated continuity of care in some settings but left many health systems ill-prepared to address digital uptake among patients from underserved backgrounds, who already experience health disparities. As use of digital health grows and the digital divide threatens to widen, healthcare systems must develop approaches to evaluate patients' needs for digital health inclusion, and consequentially equip patients with the resources needed to access the benefits of digital health. However, this is particularly challenging given the absence of any standardized, validated multilingual screening instrument to assess patients' readiness for digital healthcare that is feasible to administer in already under-resourced health systems. This perspective is structured as follows: (1) the need for digital health exclusion risk screening, (2) our convening as a group of stakeholders, (3) our review of the known digital health screening tools and our assessment, (4) formative work with patients regarding their perceptions on language and concepts in the digital health screening tools, and (5) conclusion with recommendations for digital health advocates generated by this collaborative of digital health researchers and operations leaders. There is a need to develop a brief, effective tool to screen for digital health use that can be widely implemented in diverse populations. We include lessons learned from our experiences in developing and testing risk of digital health exclusion screening questions in our respective health systems (e.g., patient perception of questions and response options). Because we recognize that health systems across the country may be facing similar challenges and questions, this perspective aims to inform ongoing efforts in developing health system digital exclusion screening tools and advocate for their role in advancing digital health equity.

Implementation of Quality Improvement System in a National Health System.

There is a continued need to improve the quality of health care services and the health outcomes associated with that care. Quality improvement model and the Learning Health System framework have emerged as potential methods to achieve the goals of better care and enhanced outcomes. Few practical tools and approaches have been developed to assist with the initiation of quality improvement and development of a Learning Health System. The Department of Veterans Affairs developed and deployed a national system to assist and organize improvement projects and serve as a database for learning. During its first 5 years of use, 7397 quality improvement projects were completed using the electronic tool. National implementation of a structured tool for quality improvement is possible.

The Complete Inpatient Record Using Comprehensive Electronic Data (CIRCE) project: A team‐based approach to clinically validated, research‐ready electronic health record data

AbstractIntroductionThe rapid adoption of electronic health record (EHR) systems has resulted in extensive archives of data relevant to clinical research, hospital operations, and the development of learning health systems. However, EHR data are not frequently available, cleaned, standardized, validated, and ready for use by stakeholders. We describe an in‐progress effort to overcome these challenges with cooperative, systematic data extraction and validation.MethodsA multi‐disciplinary team of investigators collaborated to create the Complete Inpatient Record Using Comprehensive Electronic Data (CIRCE) Project dataset, which captures EHR data from six hospitals within the University of Pennsylvania Health System. Analysts and clinical researchers jointly iteratively reviewed SQL queries and their output to validate desired data elements. Data from patients aged ≥18 years with at least one encounter at an acute care hospital or hospice occurring since 7/1/2017 were included. The CIRCE Project includes three layers: (1) raw data comprised of direct SQL query output, (2) cleaned data with errors removed, and (3) transformed data with standardized implementations of commonly used case definitions and clinical scores.ResultsBetween July 1, 2017 and December 31, 2023, the dataset captured 1 629 920 encounters from 740 035 patients. Most encounters were emergency department only visits (n = 965 834, 59.3%), followed by inpatient admissions without an intensive care unit admission (n = 518 367, 23.7%). The median age was 46.9 years (25th–75th percentiles = 31.1–64.7) at the time of the first encounter. Most patients were female (n = 418 303, 56.5%), a significant proportion were of non‐White race (n = 272 018, 36.8%), and 54 625 (7.4%) were of Hispanic/Latino ethnicity.ConclusionsThe CIRCE Project represents a novel cooperative research model to capture clinically validated EHR data from a large diverse academic health system in the greater Philadelphia region and is designed to facilitate collaboration and data sharing to support learning health system activities. Ultimately, these data will be de‐identified and converted to a publicly available resource.

A tabletop exercise approach to global disaster preparedness: insights from Nepal's first international conference on disaster preparedness and management.

Considering recent earthquakes and the COVID-19 pandemic, disaster preparedness has come to the forefront of the public health agenda in Nepal. To strengthen the developing health system, many initiatives are being implemented at different levels of society to build resiliency, one of which is through training and education. The first International Conference on Disaster Preparedness and Management convened in Dhulikhel, Nepal on December 1-3, 2023. It brought together international teaching faculty to help deliver didactic and simulation-based sessions on various topics pertaining to disaster preparedness and management for over 140 Nepali healthcare professionals. This paper focuses on the tabletop exercise-based longitudinal workshop portion of the conference on disaster leadership and communication, delivered by United States-based faculty. It delves into the educational program and curriculum, delivery method, Nepali organizer and US facilitator reflections, and provides recommendations for such future conferences, and adaptation to other settings.

Social and Economic Determinants of Life Expectancy at Birth in Eastern Europe.

Life expectancy at birth is considered a parameter of the social development, health system, or economic development of a country. We aimed to investigate the effects of GDP per capita (as the economic factor), health care expenditure, the number of medical doctors (as social factors), and CO2 emissions (as the environmental factor) on life expectancy. We used panel data analysis for 13 Eastern European countries over the 2000-2020 period. After performing the analysis, we used a cross-country fixed-effects panel (GLS with SUR weights). According to our model, a one percent increase in health expenditure (as % of GDP) increases life expectancy at birth by 0.376 years, whereas each additional medical doctor per 10,000 inhabitants increases life expectancy at birth by 0.088 years on average. At the same time, each additional 10,000 USD per capita each year would increase life expectancy at birth by 1.8 years on average. If CO2 emissions increase by 1 metric ton per capita, life expectancy at birth would decrease by 0.24 years, suggesting that higher carbon emissions are capable of reducing longevity. Every European country has to make special efforts to increase the life expectancy of its inhabitants by applying economic and health policies focused on the well-being of the population.

Beyond Shared Decision-Making: Integrating Coproduction, Learning Health Systems, Artificial Intelligence, and Workforce Development for Patient-Centered Care.

Beyond Shared Decision-Making: Integrating Coproduction, Learning Health Systems, Artificial Intelligence, and Workforce Development for Patient-Centered Care.

Mechanism of synergy between public health, food safety and consumer behavior: the role of neuromarketing

Methods. The results of the study were obtained by using the following methods: comparison – when studying the dynamics of the global hunger index and the GTI in Ukraine to determine Ukraine's place in the world food security ranking; general and specific – when establishing the relationship between food security and the public health system; standard methods of sociological research – when studying the behavior of food consumers as a result of the use of various neuromarketing methods; structural and logical analysis – when justifying the use of neuromarketing methods to improve the country's food security and directly affect the development of the public health system. Results. The role of positive changes in the regulatory and legal support for the functioning of the integrated public health system in Ukraine in the context of European integration processes is shown. The position of Ukraine in the world food security ranking among the indicators of 125 countries is investigated. The dynamics of the factors influencing the formation of the GHI is analyzed. It is proved that food security is one of the components of the public health system. The reasons for the food problem in the world and in Ukraine in particular are considered. Examples of the application of neuromarketing methods as a tool for influencing food security and the public health system in general are given. Positive and negative factors of influence of neuromarketing methods on the public health system are systematized. The necessity of further scientific research on the synergy of neuromarketing, food security and the public health system as factors influencing the overall well-being of the population is emphasized. Novelty. The article is the first to investigate the aspects of synergy between public health, food security and neuromarketing in Ukraine in the current conditions of ecosystem disruption during the period of military aggression. Practical value. The application of neuromarketing methods to improve the promotion of food products on the market aimed at ensuring food security of the country, improving public welfare and further development of the public health system is proposed.

Assessment of the occupational health and safety management system by qualimetric methods

Abstract Requirements of the international standard ISO 45001:2018 were analysed to identify the need for monitoring, measuring and analysing the functioning of the occupational health and safety management system. This analysis has made it clear that the effectiveness of the development and implementation of the occupational health and safety management system depends on the assessment methodology. The study focused on existing studies and publications on the assessment of processes, including those related to occupational safety, assessment methods or qualitative methods, and statistical methods used for assessment. As a result, the topic has been proven relevant, and the goal of the article was determined: to study the possibility of using qualimetric methods for evaluating the labour safety management system. A survey was conducted among workers at a machine-building enterprise to evaluate the occupational health and safety management system. Verbal scales were proposed to process the study results as they allow quantitative ratings to be obtained on the coded scale of the desirability function. The study result is a technique for obtaining a quantitative assessment of the occupational health and safety management system. This technique is universal and can be applied to any enterprise. It can also be used to make managerial decisions regarding the improvement of the occupational health and safety management system.

PQCAIE: Post quantum cryptographic authentication scheme for IoT-based e-health systems

The increasing integration of Internet of Things (IoT) technologies in consumer electronics has revolutionized various sectors, including healthcare. This evolution has led to the development of IoT-enabled consumer health devices and systems, offering benefits such as enhanced remote health monitoring and more efficient health data management. However, these advancements also pose significant security challenges, especially regarding data privacy and secure access. A critical concern is the vulnerability of current cryptographic methods to potential future quantum computing capabilities. This paper focuses on addressing these challenges by exploring the implementation of Post-Quantum Cryptography (PQC) in IoT-based consumer health electronics. Specifically, it evaluates the application of PQC methods in conjunction with Transport Layer Security 1.3 (TLS 1.3) for robust authentication in these systems. The study analyzes the performance and security efficacy of these schemes, comparing them to existing cryptographic approaches. Additionally, it delves into the practical hurdles and prospective solutions related to the deployment of post-quantum cryptographic techniques in the context of consumer health electronics, paving the way for more secure and reliable healthcare technology in the era of advanced consumer electronics.

Trust in healthcare: methodological and conceptual insights from mixed-method research in Lao People’s Democratic Republic

BackgroundGlobal health foregrounds trust as a key requirement for the achievement of international health initiatives, but it remains an elusive concept that is often mobilised without consideration of its dimensions,...

Resuscitation for out-of-hospital cardiac arrest in Ireland 2012–2020: Modelling national temporal developments and survival predictors

AimTo explore potential predictors of national out-of-hospital cardiac arrest (OHCA) survival, including health system developments and the COVID pandemic in Ireland. MethodsNational level OHCA registry data from 2012 through to 2020, relating to unwitnessed, and bystander witnessed OHCA were interrogated. Logistic regression models were built by including predictors through stepwise variable selection and enhancing the models by adding pairwise interactions that improved fit. Missing data sensitivity analyses were conducted using multiple imputation. ResultsThe data included 18,177 cases. The final model included seventeen variables. Of these nine variables were involved in pairwise interactions. The COVID-19 period was associated with reduced survival (OR 0.61, 95%CI 0.43, 0.87), as were increasing age in years (OR 0.96, 95% CI 0.96, 0.97) and call response interval in minutes (OR 0.97, 95% CI 0.96, 0.99). Amiodarone administration (OR 3.91, 95% CI 2.80, 5.48), urban location (OR 1.40, 95% CI 1.12, 1.77), and chronological year over time (OR 1.14, 95% CI 1.08, 1.20) were associated with increased survival. ConclusionsNational survival from OHCA has significantly increased incrementally over time in Ireland. The COVID-19 pandemic was associated with decreased survival even after accounting for potential disruption to key elements of bystander and EMS care. Further research is needed to understand and address the discrepancy between urban and rural OHCA survival. Information concerning pre-event patient health status and inpatient care process may yield important additional insights in future.

Reducing the burden of preventable deaths from sepsis in Canada: A need for a national sepsis action plan.

Sepsis is a global health threat with significant morbidity and mortality. Despite clinical practice guidelines and developed health systems, sepsis is often unrecognized or misdiagnosed, leading to preventable harm. In Canada, sepsis is responsible for 1 in 20 deaths and is a significant driver of health system costs. Despite being a signatory to the World Health Organization's Resolution WHA 70.7, adopted in 2017, Canada has not lived up to its commitment. Many existing sepsis policies were developed in response to a specific tragedy, and there is no national sepsis action plan. In this article, we describe the burden of sepsis, provide examples of existing, context-specific, reactionary sepsis policies, and urge a coordinated, proactive Canadian sepsis action plan to reduce the burden of sepsis.

The Vaccine-Education Paradox in a Cross-Country Analysis: Education Predicts Higher and Lower Vaccination Rates

Research has shown a mixed relationship between education and vaccination rates. In the current analysis, we aimed to determine the relationship between educational level and coronavirus disease 2019 (COVID-19) vaccination rates. We performed a cross-country analysis on data from 133 countries. Correlation analyses showed that higher and better education was associated with higher COVID-19 vaccination rates. When we performed the regression analysis including the education, health system, and economic development variables, education-COVID-19 vaccination relationships were mostly reversed. In particular, in wealthy countries, as the mean years of schooling decreased and the pupil-teacher ratio increased, COVID-19 vaccination rates increased. In less affluent countries, with greater education expenditures, COVID-19 vaccination rates decreased. We explain these contradictions by describing links between vaccination rates, life expectancy, and education-related variables. Our findings may aid in promoting more effective uptake of COVID-19 vaccination.

Construction and application case study of a “Primary Care-focused” county health system development index

Background“Focusing on primary care” is the primary principle guiding health system in China. However, there is a lack of effective measurement tools in practice. ObjectiveThe study sought to construct an index of "primary care-focused" county health system development index and perform empirical case analysis with two counties. MethodsThe study was conducted from 2021 to 2022. The index (including its sub-indicators, scoring methods and weights) was constructed based on a literature review and experts’ consensus (via a Delphi technique). Then, it was applied in 2 counties in Guangxi Zhuang Autonomous Region, based on data collected from a range of sources from 2020 to 2022, including surveys for community residents, patients and health professionals survey, institutional survey, medical insurance claims data, as well as data of key informant interviews. ResultsThe results of Delphi method showed that the authority coefficient of experts was 0.91, the coefficients of variation of two rounds of consultation were 0.14 and 0.13, respectively. The constructed index system contains 3 domains, 15 dimensions, and 36 indicators, with a comprehensive index calculation method. The results showed that the overall scores for the two counties in Guangxi Zhuang Autonomous Region were 58.62 and 52.57, respectively. The scores of both counties were below the current national benchmark (60.00 points). ConclusionWithin the constraint of data availability, the index system constructed in this study could be applied to monitor and evaluate the extent that county health systems have achieved “primary care focus”. Its application may improve visibility and priority of primary care development, facilitate the development and implementation policies to strengthen primary care.

Is India ready for fundamental right to health?

The right to health, a vital indicator of human development and thus, the economic and social development, has been an age-old phenomenon in India. Although, no explicit recognition to the right to health or healthcare has been given under the Indian constitution, the hon’ble supreme court, through various judicial interpretations, has repeatedly observed that right to health is a part of fundamental right to life and personal liberty enshrined under article 21. However, the fundamental policy question being raised in recent years is whether to guarantee health as a separate fundamental right in India. The issues for consideration are multifarious, the most important being- whether we have reached the level of economic and health systems development so as to make this a justiciable right-implying that its denial is an offense.

Impact of Covid-19 Pandemic on HIV/AIDS Testing and Treatment

Objective: This study aimed to assess the impact of the COVID-19 pandemic on HIV testing, diagnosis, treatment, and care in Nagpur, India by analyzing trends across patient data from 2017-2021. The goal was to outline challenges and future policy measures to mitigate disruptions and improve engagement of individuals living with HIV/AIDS. Materials and Methods: Data were analyzed for 971 diagnosed HIV/AIDS patients undergoing antiretroviral therapy at the Government Medical College's Integrated Counseling and Testing Centre and Antiretroviral Therapy Centre in Nagpur, spanning 2017-2021. Descriptive statistics were used to evaluate trends in key parameters - HIV screening, positivity rates, patient characteristics, ICTC-ART linkages, treatment outcomes. Appropriate ethical guidelines were adhered to. Results: Notable declines in HIV testing and positivity rates were observed during the COVID-19 period. Changes in patient demographic distribution and service gaps (drop in eligible spouse testing; ICTC-ART linkage gaps) indicated likely challenges in care access and engagement during the pandemic. Issues also emerged in critical areas including ART adherence, loss to follow-ups, and cessation of treatment over 2019-2021. Discussion: The results underscore pandemic-related disruptions faced by HIV care systems, potentially stemming from lockdowns, restrictions, and healthcare service limitations. Addressing detriments through multi-faceted approaches is imperative - improved ICTC-ART linkages, adoption of telemedicine/multi-month ART models and decentralized care can aid optimization of HIV care delivery during outbreaks. The learnings can inform the development of resilient health systems equipped to support vulnerable groups through co-occurring epidemics. Keywords: COVID-19, healthcare utilization, ICTCs (Integrated counseling and testing centers), linkage, pandemic, patient retention, service gaps, HIV/AIDS, vulnerable populations.

Финансирование национальной системы здравоохранения с учетом тенденций развития медицинской помощи и социально-экономических реалий

The effectiveness of the functioning of the health care system consists in achieving high indicators of the quality of life of the population, which is achieved through the use of various regulatory and self-regulation tools in the health care system, which are always based on the need for financial support, which is the cornerstone of solving problems related to the need to increase the effectiveness of the health protection system. The financing of the healthcare system is considered from the point of view of its compliance with modern socio-economic realities. The optimal model of financing the domestic healthcare system is being investigated in terms of the relationship between the life expectancy of the population, the amount of financing for the health protection system, the number of medical institutions and the availability of medical personnel. The priority directions of the development of the national health financing system are substantiated. It is concluded that the national model for financing the health protection system should be a model based on the allocation of funds from the federal budget, which are directed to ensuring the financing of programs for the development of the national health system, as well as based on the creation of institutional, legislative and mental conditions for attracting public funds to the insurance industry medicine. It is confirmed that there is a close relationship between the effective indicator of life expectancy and public spending on health, which corresponds to WHO statistics. Other factors do not have such a strong impact on the national health system. It is recommended to further develop the healthcare financing system based on foreign experience, on the development of insurance and paid medicine.

Evaluation and associated factors of public health emergency management among medical college students in a city in Southwest China: a cross-sectional study

BackgroundColleges and universities face an increased risk of public health emergencies. Among them, medical colleges and universities deserve more attention as they serve as the play a fundamental role in providing public health emergency services and in cultivating medical professionals. Effectively managing infectious disease prevention and control, as well as responding to public health emergencies in medical colleges and universities, is of great importance for enhancing the capacity of social emergency governance and improving the completeness of the public health system. This study aims to understand the management of public health emergencies in medical colleges in a city in southwest China, explore the factors associated with medical college students’ evaluations, and provide recommendations for emergency management mechanisms in colleges and universities.MethodsIn total, 781 medical college students were selected through stratified random sampling and surveyed using a questionnaire. The main factors affecting students’ evaluation of emergency management were analyzed using multiple linear regression and structural equation modeling.ResultsThe overall emergency management situation in medical colleges was relatively complete, with satisfactory results. Medical college students’ satisfaction with the timeliness of prevention measures was the highest, while the publicity and education were the lowest. Multiple linear regression analysis showed that grades, emergency education, -simulation training, -information reporting, and dynamic adjustment measures were associated with the evaluation of emergency management by medical students.ConclusionsAlthough the evaluation of emergency management in medical colleges was generally positive, certain limitations still existed. To improve the development of the public health system, colleges and universities should constantly reform and innovate emergency management mechanisms according to the important links in the prevention and control processes.