Healthcare Policy Planning Research Articles

Seizing pandemic lessons: a call to reinvent public health and healthcare policy planning in post-COVID-19 Hong Kong.

Seizing pandemic lessons: a call to reinvent public health and healthcare policy planning in post-COVID-19 Hong Kong.

Temporal trend, spatial analysis and spatiotemporal clusters of infant mortality associated with congenital toxoplasmosis in Brazil: Time series from 2000 to 2020.

To analyse the spatial, temporal and spatial-temporal patterns of infant mortality associated with congenital toxoplasmosis in Brazil between the years 2000 and 2020. Ecological study of time series, with spatial analysis and spatiotemporal scan of infant mortality associated with congenital toxoplasmosis from the records of deaths of the Mortality Information System of the Brazilian Ministry of Health. The rates were smoothed by the Local Empirical Bayesian model. The Global Moran Index, Global Geary's Contiguity and Getis-Ord General statistics were calculated for spatial autocorrelation assessment. The trends were evaluated by the Joinpoint method. We identified 1183 infant deaths associated with congenital toxoplasmosis in Brazil between 2000 and 2020. The predominant characteristics were male sex (52.1%), post-neonatal age group (51.9%), white race/colour (45.7%), and Southeast region of residence (40.0%). The infant mortality rate associated with congenital toxoplasmosis showed an increasing trend in the country in the years analysed. The spatial analysis showed heterogeneous distribution of mortality in the Brazilian territory and found no evidence of spatial autocorrelation; but spatial-temporal analysis identified three risk clusters involving 703 municipalities. Infant mortality associated with congenital toxoplasmosis is a persistent public health problem in Brazil. The risk factors male sex, indigenous race/colour, early neonatal age, North and Northeast regions and risk clusters mapped in this study should be observed for future analysis and planning of health care policies in the control of infant deaths associated with congenital toxoplasmosis. Health surveillance strategies and public health policies need to be strengthened.

Clinical characteristics of COVID-19 in older adults. A retrospective study in long-term nursing homes in Catalonia.

The natural history of COVID-19 and predictors of mortality in older adults need to be investigated to inform clinical operations and healthcare policy planning. A retrospective study took place in 80 long-term nursing homes in Catalonia, Spain collecting data from March 1st to May 31st, 2020. Demographic and clinical data from 2,092 RT-PCR confirmed cases of SARS-CoV-2 infection were registered, including structural characteristics of the facilities. Descriptive statistics to describe the demographic, clinical, and molecular characteristics of our sample were prepared, both overall and by their symptomatology was performed and an analysis of statistically significant bivariate differences and constructions of a logistic regression model were carried out to assess the relationship between variables. The incidence of the infection was 28%. 71% of the residents showed symptoms. Five major symptoms included: fever, dyspnea, dry cough, asthenia and diarrhea. Fever and dyspnea were by far the most frequent (50% and 28%, respectively). The presentation was predominantly acute and symptomatology persisted from days to weeks (mean 9.1 days, SD = 10,9). 16% of residents had confirmed pneumonia and 22% required hospitalization. The accumulated mortality rate was 21.75% (86% concentrated during the first 28 days at onset). A multivariate logistic regression analysis showed a positive predictive value for mortality for some variables such as age, pneumonia, fever, dyspnea, stupor refusal to oral intake and dementia (p<0.01 for all variables). Results suggest that density in the nursing homes did not account for differences in the incidence of the infection within the facilities. This study provides insights into the natural history of the disease in older adults with high dependency living in long-term nursing homes during the first pandemic wave of March-May 2020 in the region of Catalonia, and suggests that some comorbidities and symptoms have a strong predictive value for mortality.

Decision Support Software for Forecasting Patient’s Length of Stay

Length of stay of hospitalized patients is generally considered to be a significant and critical factor for healthcare policy planning which consequently affects the hospital management plan and resources. Its reliable prediction in the preadmission stage could further assist in identifying abnormality or potential medical risks to trigger additional attention for individual cases. Recently, data mining and machine learning constitute significant tools in the healthcare domain. In this work, we introduce a new decision support software for the accurate prediction of hospitalized patients’ length of stay which incorporates a novel two-level classification algorithm. Our numerical experiments indicate that the proposed algorithm exhibits better classification performance than any examined single learning algorithm. The proposed software was developed to provide assistance to the hospital management and strengthen the service system by offering customized assistance according to patients’ predicted hospitalization time.

Caregivers needing care: the unmet needs of the family caregivers of end-of-life cancer patients.

Family caregivers play a significant role in the care of cancer patients, especially in their end of life. Identifying and meeting the needs of these caregivers is essential to improving their quality of patient care. This study was conducted to identify the unmet needs of the caregivers of end-of-life cancer patients. A total of 18 semi-structured interviews were held with the family caregivers of end-of-life cancer patients using purposive sampling. The interviews were recorded, transcribed, and analyzed using qualitative content analysis. The analysis of the data led to the formation of three main categories, including social needs, cognitive needs, and psychological needs. The social needs category comprised of the subcategories of support for care, effective communication and financial support. The cognitive needs category comprised of educational support and support in decision-making. The psychological needs category comprised of support for psychological trauma, preparation to confront the reality of the death of a loved one, and support for mourning. The family caregivers of end-of-life cancer patients take on the responsibility of many aspects of care for their patient, but many of their own needs remain unmet. The findings of this study can be used for healthcare policy planning and the development of palliative interventions, particularly for the family caregivers of end-of-life cancer patients.

Coding accuracy for Parkinson's disease hospital admissions: implications for healthcare planning in the UK

ObjectivesHospital Episode Statistics data are used for healthcare planning and hospital reimbursements. Reliability of these data is dependent on the accuracy of individual hospitals reporting Secondary Uses Service (SUS) which includes hospitalisation. The number and coding accuracy for Parkinson's disease hospital admissions at a tertiary centre in Birmingham was assessed. Study designRetrospective, routine-data–based study. MethodsA retrospective electronic database search for all Parkinson's disease patients admitted to the tertiary hospital over a 4-year period (2009–2013) was performed on the SUS database using International Classification of Disease codes, and on the local inpatient electronic prescription database, Prescription and Information Communications System, using medication prescriptions. Capture-recapture methods were used to estimate the number of patients and admissions missed by both databases. ResultsFrom the two databases, between July 2009 and June 2013, 1068 patients with Parkinson's disease accounted for 1999 admissions. During these admissions, the Parkinson's disease was coded as a primary or secondary diagnosis. Ninety-one percent of these admissions were recorded on the SUS database. Capture-recapture methods estimated that the number of Parkinson's disease patients admitted during this period was 1127 patients (95% confidence interval: 1107–1146). A supplementary search of both SUS and Prescription and Information Communications System was undertaken using the hospital numbers of these 1068 patients. This identified another 479 admissions. SUS database under-estimated Parkinson's disease admissions by 27% during the study period. ConclusionThe accuracy of disease coding is critical for healthcare policy planning and must be improved. If the under-reporting of Parkinson's disease admissions on the SUS database is repeated nationally, expenditure on Parkinson's disease admissions in England is under-estimated by approximately £61 million per year.

Cancer Incidence in Patients Diagnosed with Acquired Immunodeficiency Syndrome (AIDS) in Colombia

Background: AIDS is associated with a number of malignancies, which in turn carry a high burden of mortality and morbidity in affected patients. This article was developed as an initiative of the High-Cost Diseases Office (CAC in Spanish) to provide the Colombian health system with evidence on the incidence of Cancer in patients diagnosed with AIDS in the country. Methods: The CAC compiled the National Cancer and Human Immunodeficiency Virus (HIV) administrative registries, which identify unique patients diagnosed with both Cancer and AIDS from 1983 to 2015. For the 736 cases found, we considered only those diagnosed with Cancer five years before a diagnosis of AIDS and all cases after the diagnosis. A final sample of 238 individuals, with age ranging from 17 to 84 years, diagnosed with AIDS between 1998 and 2015, was analyzed using Stata Software to compute Standardized Incidence Ratio (SIR) of cancers. Results: Results show that patients with AIDS display an elevated risk of developing the following specific types of cancer: Kaposi’s sarcoma’s (male SIR 301.12; female SIR 252.67) Invasive cervical cancer (female SIR 5.09); Non- Hodgkin Lymphoma (male SIR 20.65; female SIR 9.10). The following non-AIDS-defining cancers were also more common in patients with the disease: in men, anal cancer (SIR 51.52), eye and related malignancies (SIR 27.24), and Hodgkin’s Lymphoma (SIR 20.96); in women: anal (SIR 24.82); vaginal and vulvar (SIR 10.36); and in situ cervical cancer (SIR 5.83). Conclusion: There is an increased incidence of specific types of cancers in a population of patients diagnosed with AIDS in Colombia, in accordance with data from other regions of the world. The National Cancer and AIDS registries provide local information, which can be used for health care policy planning.

Age, Period, and Cohort Effects on Gastric Cancer Mortality

The incidence of gastric cancer varies both within and among populations and can change rapidly without a corresponding decline in Helicobacter pylori prevalence. Here, we describe the changes in gastric cancer mortality in Japan in relation to age-period-cohort effects as well as the decline in H. pylori prevalence. We used data from Japanese for men and women aged 30-94 for birth years 1875-1970 (calendar time 1950-2000) to observe the age, period and cohort effects on gastric cancer mortality rates. Additionally, we used Poisson regression to simultaneously adjust for concurrent age, period and cohort effects as well as for declining H. pylori prevalence in the Japanese population. There was an approximate 60 % decline in gastric cancer mortality between 1965 and 1995. Detailed age, period and cohort analyses and Poisson regression analysis showed these factors interact in complex ways, analyses focused on one or two of these effects, such as birth cohort without considering concurrent age and period would obscure important interactions that affected different age groups at different times to produce this composite effect. The underlying complexity in population-disease dynamics requires population-specific descriptions of trends using multiple methods to provide an in-depth analysis while simultaneously allowing for necessary statistical adjustments as well as identification of interactions. More thorough descriptions of the population-specific general trends in relation to changes in the population structure (age-period-cohort) enable better prevention and health care policy planning, and further, the descriptions enable hypothesis generation regarding causes of population-specific disease patterns.

A real-life snapshot of the current trends of urinary diversion

Continent bladder substitution has substantially developed since its introduction nearly three decades ago. Although the ideal bladder substitute is yet to be developed, it has been well established that all patients undergoing radical cystectomy should be considered at least potential candidates for orthotopic urinary diversion 1. Notably, in many bladder cancer referral centres, including ours, orthotopic substitution has replaced ileal conduit as the primary form of reconstruction 2-4. However, this dissemination has not been noticed at the community level. The authors 5 provide a real-life snapshot of the current trends of urinary diversion on the nationwide level. Using the nationwide inpatient sample, they report significant underutilisation of continent urinary diversion after radical cystectomy; 92% of patients undergoing radical cystectomy received incontinent reconstruction. Nonetheless, they noticed a modest trend towards increased continent diversion in the later years of the study; however, the percentage is still far from expected. Moreover, the study reinforces previous findings of significant demographic disparities in receiving continent diversion. These disparities have become a persistent theme and have also been demonstrated in resource utilisation, oncological outcomes and access to minimally invasive surgery 6. Is it surgeons' bias or patients' choice? This issue is far from resolved. Undoubtedly, these disparities are to be addressed in healthcare policy planning, more research is also needed to investigate factors influencing the surgeon's decision-making process.

Incidence of end-stage renal disease in the Turkish-Cypriot population of Northern Cyprus: a population based study.

BackgroundThis is the first report of the incidence and causes of end-stage renal disease (ESRD) of the Turkish-Cypriot population in Northern Cyprus.MethodsData were collected over eight consecutive years (2004–2011) from all those starting renal replacement therapy (RRT) in this population. Crude and age-standardised incidence at 90 days was calculated and comparisons made with other national registries. We collected DNA from the entire prevalent population. As an initial experiment we looked for two genetic causes of ESRD that have been reported in Greek Cypriots.ResultsCrude and age-standardised incidence at 90 days was 234 and 327 per million population (pmp) per year, respectively. The mean age was 63, and 62% were male. The age-adjusted prevalence of RRT in Turkish-Cypriots was 1543 pmp on 01/01/2011. The incidence of RRT is higher than other countries reporting to the European Renal Association – European Dialysis and Transplant Association, with the exception of Turkey. Diabetes is a major cause of ESRD in those under 65, accounting for 36% of incident cases followed by 30% with uncertain aetiology. 18% of the incident population had a family history of ESRD. We identified two families with thin basement membrane nephropathy caused by a mutation in COL4A3, but no new cases of CFHR5 nephropathy.ConclusionsThis study provides the first estimate of RRT incidence in the Turkish-Cypriot population, describes the contribution of different underlying diagnoses to ESRD, and provides a basis for healthcare policy planning.

Prevalência de Diabetes Mellitus em Pelotas, RS: um estudo de base populacional

To compare the prevalence of Diabetes Mellitus among the adult population of an urban area, according to self-reported diabetes and fasting glucose test results. We carried out a population-based cross-sectional study of 1,968 subjects aged 20-69 years, living in the urban area of the city of Pelotas, Southern Brazil, in the year 2000. Sample size was calculated at 1,800 subjects. We visited the households of 40 randomly selected census sectors. We administered a standardized questionnaire to all subjects, which included questions on the presence of "blood sugar" and on medical confirmation in case of positive responses. A subsample of 367 participants was selected to donate blood samples for laboratory tests, including fasting blood glucose. We adopted as cutoff points for the detection of diabetes levels of 126 mg/dl and 140 mg/dl. Results are shown as frequencies and their respective 95% confidence intervals. Of the subjects interviewed, 110 (5.6%; 95% CI: 4.6-6.6) referred the presence of Diabetes Mellitus diagnosed by a physician. In the subsample of 367 subjects who underwent blood testing, the prevalence of self-referred, physician-confirmed diabetes mellitus was 7.1% (95% CI: 4.5-9.7). The prevalence estimates found in the present study are compatible with those obtained in other national surveys. Population-based studies are rare Brazil, and may contribute to the planning of health care policies.