Health Services Research Research Articles

Pandemic Preparedness - A Proposal for a Research Infrastructure and its Functionalities for a Resilient Health Research System.

Während einer Pandemie muss Resilienz nicht nur als Eigenschaft des Gesundheitssystems, sondern auch des umgebenden Forschungsumfelds betrachtet werden. Um verlässliche, evidenzbasierte Empfehlungen aus der Universitätsmedizin an die Gesundheitspolitik und die Entscheidungsträger bereitstellen zu können, müssen wissenschaftliche Erkenntnisse schnell, integrativ und multidisziplinär generiert, synthetisiert und kommuniziert werden. Die Resilienz der öffentlichen Gesundheitssysteme und der Gesundheitsforschungssysteme sind somit eng verknüpft. Die Reaktion auf die SARS-CoV-2-Pandemie in Deutschland wurde jedoch durch das Fehlen einer adäquat vernetzten Gesundheitsforschungsinfrastruktur erschwert. Das Netzwerk Universitätsmedizin (NUM) wurde zu Beginn der Pandemie mit dem Ziel gegründet, Deutschland auf zukünftige Pandemien vorzubereiten. Ziel des Projektes "PREparedness and PAndemic REsponse in Deutschland (PREPARED)" ist es, ein ganzheitliches Konzept für eine kooperative, adaptierbare und nachhaltige Gesundheitsforschungsinfrastruktur innerhalb des NUM zu entwickeln und damit einen Beitrag zu einer umfassenden Pandemiebereitschaft zu leisten. Das vorgeschlagene Konzept dieser Infrastruktur vereint vier Kern- und drei Unterstützungsfunktionalitäten in vier verschiedenen Handlungsfeldern. Die Funktionalitäten gewährleisten im Falle zukünftiger Gesundheitskrisen ein effizientes Funktionieren des Gesundheitsforschungssystems und eine rasche Übertragung entsprechender Implikationen in andere Systeme. Die vier Handlungsfelder sind (a) Monitoring und Surveillance, (b) Synthese und Transfer, (c) Koordination und Organisation sowie (d) Kapazitäten und Ressourcen. Die sieben Funktionalitäten umfassen 1) eine Monitoring- und Surveillance-Einheit, 2) eine Pathogenkompetenz-Plattform, 3) Evidenzsynthese und vertrauenswürdige Empfehlungen, 4) eine Einheit zur regionalen Vernetzung und Implementierung, 5) eine Strategische Kommunikationseinheit, 6) Human Resources Management und 7) ein Rapid Reaction & Response (R3)-Cockpit. Die Governance wird als Kontroll- und Regulierungssystem eingerichtet, wobei agile Management-Methoden in interpandemischen Phasen trainiert werden, um die Reaktionsfähigkeit zu verbessern sowie die Eignung agiler Methoden für die wissenschaftliche Infrastruktur für die Pandemiebereitschaft zu untersuchen. Der Aufbau der PREPARED-Forschungsinfrastruktur muss vor der nächsten Pandemie erfolgen, da Training und regelmäßige Stresstests grundlegende Voraussetzungen für deren Funktionieren sind.During a pandemic, resilience must be considered not only as an attribute of the health care system, but also of the surrounding research environment. To provide reliable evidence-based advice from university medicine to health policy and decision makers, scientific evidence must be generated, synthesized and communicated in a rapid, integrative and multidisciplinary manner. The resilience of public health systems and the health research systems are thus closely linked. However, the response to the SARS-CoV-2 pandemic in Germany was hampered by the lack of an adequate health research infrastructure. The Network University Medicine (NUM) was founded at the beginning of the pandemic with the aim of preparing Germany for future pandemics. The aim of the project "PREparedness and PAndemic REsponse in Deutschland (PREPARED)" is to develop a holistic concept for a cooperative, adaptable and sustainable health research infrastructure within the NUM and thus contribute to pandemic preparedness and rapid response. The proposed concept for a health research infrastructure includes four core and three supporting functionalities in four different fields of action. The functionalities aim to ensure efficient functioning within the health research system and a rapid translation to other systems in future health crises. The four fields of action are (a) monitoring and surveillance, (b) synthesis and transfer, (c) coordination and organization, and (d) capacities and resources. The seven functionalities include 1) a monitoring and surveillance unit, 2) a pathogen competence platform, 3) evidence synthesis and trustworthy recommendations, 4) a regional networking and implementation unit, 5) a strategic communication unit, 6) human resources management, and 7) a rapid reaction and the response (R3)-cockpit. A governance will be established as a control and regulatory system for all structures and processes, testing agile management in non-pandemic times to improve responsiveness and flexibility and to investigate the suitability of the methods for scientific pandemic preparedness. The establishment of the PREPARED health research infrastructure must take place before the next pandemic, as training and regular stress tests are its fundamental prerequisites.

Health literacy and COVID-19 pandemic impacts among adults in rural northern Arizona.

Limited health literacy - the ability to access, process, and use health information and services - contributes to persistent health inequities. Yet little is known about associations of limited health literacy with impacts from the COVID-19 pandemic, particularly for US adults in rural areas. This study sought to determine associations of limited health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in rural Northern Arizona. A cross-sectional, interviewer-administered survey was conducted with 119 adults from June 2020 to August 2021. Participants were recruited from two federally qualified health centers and by word of mouth. The Newest Vital Sign was used to measure health literacy, and the Epidemic-Pandemic Impacts Inventory was used to measure the effects of the COVID-19 pandemic on various aspects of personal and family life (eg spent more time on screens and devices, had family celebrations canceled or restricted). Descriptive, bivariate, and multivariable linear regression statistics were computed. Nineteen percent of participants had limited health literacy, and participants had an average of 22 individual impacts and 2 household impacts of the 92 COVID-19 impacts assessed. Multivariable regression model results showed that being male versus female or having public only versus any private insurance was significantly associated with fewer individual COVID-19 impacts on average. Being black, Indigenous, people of color versus White or being Hispanic, Latino, or Spanish versus not were each associated with significantly more individual COVID-19 impacts on average. Limited versus adequate health literacy was significantly associated with more household COVID-19 impacts on average. Sensitivity analysis results further showed that limited versus adequate health literacy was associated with significantly higher adjusted rates of household social, emotional, and infection COVID-19 impacts. This study's findings highlight the importance of assessing and accounting for health literacy in clinical practice and health services research addressing the impacts of the COVID-19 pandemic and future emergency events.

2.L. Round table: Monitoring health reforms to inform policy innovation: the Health Systems and Policies Monitor

Abstract Background The European Observatory on Health Systems and Policies’ (Observatory) Health Systems and Policy Monitor (HSPM) network convenes an international group of around 50 national health systems researchers from over 40 institutions across 31 high-income countries, including all EU countries, Canada, Israel, the UK and the US. In advance of the HSPM annual meeting, experts share the current year’s “top-three” health reforms in their countries via a standardized survey, soliciting details on content and general implementation processes. Reforms are iteratively organized into to 2 of 11 clusters, derived from the WHO health system building blocks. Experts then discuss background, status and content of national reforms in the year’s main clusters and initiate cross-country collaborations. A repository of over 650 reforms since 2018 has been created and is available online, showcasing reform patterns in HSPM countries. The collected data have informed studies on reform trends in HSPM countries from 2018-2019 and between 2020-2022, with work ongoing. Data are also consulted by researchers and policymakers wishing to learn about and from reforms in other countries. This workshop specifically aims to: • Inform participants about the methodologies used by the HSPM network to track reforms • Highlight common trends in major health reforms across countries since 2018 • Discuss national health reforms and the value of understanding and tracking these across countries • Identify research gaps in reform monitoring relevant to policy makers • Discuss how the health system research community can generate more relevant and actionable evidence Added-value The comparative analysis of reform trends provides insights into how systems operate and the types of reforms more likely to be implemented. The sharing of these insights also serves as a source of inspiration, allowing countries to learn from each other’s successes and failures and adopt proven best practices. This is relevant for policymakers and researchers striving to support health systems strengthening. Therefore, the workshop will support knowledge exchange between researchers and policymakers by (1) informing researchers and policymakers about similar ongoing reforms in other countries and (2) identifying areas where researchers can contribute to country reform agendas, and (3) stimulating interest in cross-country collaborative research on similar and topical reforms in different countries. Format This is a roundtable workshop chaired and moderated by the Observatory. An overview of reform trends and patterns since 2018 will set the scene, followed by an interactive discussion with policymakers and HSPM network members to (1) delve into trend dynamics and implications for health policy and research and (2) identify major (missing) research areas relevant to policymakers. In addition, we will leverage the geographic scope and expertise of the audience to reflect on the value of monitoring reforms. Key messages • Cross-country exchange of information on reform trends and implementation patterns can inspire future reforms and help policymakers identify promising policy approaches abroad. • Knowledge exchange between researchers and policymakers helps to determine evidence gaps and to generate relevant and actionable evidence that can drive policy innovation. Speakers/Panelists Reinhard Busse Berlin University of Technology, Berlin, Germany Ines Fronteira National School of Public Health - NOVA University of Lisbon, Lisbon, Portugal Iwona Kowalska-Bobko Jagiellonian University Medical College, Institute of Public Health, Cracow, Poland Isabel de La Mata DG SANTE, European Commission, Luxembourg, Luxembourg Vesna-Kestrin Petric Ministry of Health, Ljubljana, Slovenia

Governance and health system reform: a case study of new health regions in Ireland, 2018-2023

Abstract Background While the significance of good governance is recognised within health systems research, its role in health system reform is underexplored. This research focuses on the establishment of new decentralised regional health structures in Ireland in the period 2018-2023, examining how aspects of governance impacted the decentralisation reform process, from policy design through to implementation. Methods The research applied a qualitative, multi-method approach involving analysis of official documents relevant to the regional decentralisation process, and 12 semi-structured interviews with key informants from across the health sector. The research applies the TAPIC framework for health governance as its analytic framework and the data is analysed using thematic analysis. Results Deficiencies in accountability arrangements, poor transparency within the system and vis-à-vis external stakeholders, and a lack of clarity of roles and responsibilities for various process and key decisions related to the reform were identified as undermining progress at various stages of Ireland’s decentralisation reform process. An underlying distrust between key institutional actors was identified. These findings are grounded in complex social, cultural, and political and institutional developments in Ireland’s history. Also of note is the interwovenness of the five TAPIC domains and the importance of engaging with the complexity and relationality intrinsic to health system reform processes to achieve the aim(s) of the reform in question. Conclusions Large scale health system reform is a complex process and its governance presents distinct challenges and opportunities for stakeholders. To understand and address these, critical analysis of the historical context surrounding the policy reform and the institutional relationships at its core are needed. Key messages • Governance plays a crucial if overlooked role in health systems reform. Effective governance arrangements are central to the successful design and implementation of reform initiatives. • Ensuring a strong link between policy design and implementation processes is crucial to the success of health systems reform.

‘Positive disruption’: catalysing system-wide work on health inequalities through embedded research

Abstract Background This presentation explores embedded research as an innovative model for bridging system-level knowledge to action gaps in public health. Embedded researchers (ERers) are university-employed researchers co-located in public health organisations, who work to boost capacity in these organisations to tackle inequalities by better use of evidence in decision-making, evaluation and service improvement Methods Drawing on the initial phase of the role and wider literature, we qualitatively reflect on strengths and limits of a system-level ERer model. Most ERer evidence draws on a one-to-one organisational model. This presentation explores a different model of an ERer embedded in and working across a public health system (health services, municipality, third sector) in a large city in north England Results Our focus is on catalytic features of the ERer role (1) positionality: being embedded at system-level gives fuller understanding of inter-organisational connections and of the implications of emergent system changes; (2) convening: bringing together partners improves mutual awareness and builds interest in collectively pursuing research aligned to identified population health needs and public health priorities in the city; (3) co-production to build capacity: working with a new cross-organisational partnership to collectively address issues constraining opportunities to pursue system-level research; working with the municipality to explore the production/use of research to inform decisions on approaches towards health inequalities. This includes work on links between public health and other functions focused on social determinants of health Conclusions This presentation outlines distinctive consequences of system-level embedded research in a city-wide public health system. It critically appraises the transferability of this model of knowledge production and mobilisation at the intersection of system and cross-organisational action on health inequalities. Key messages • System-level embedded research is an innovative model for helping to bridge system-level knowledge to action gaps in public health. • The model has catalytic benefits and transferability potential, although this needs to be considered in relation to the specific context for proposed system-level embedded research.

Health economics and services research in symbiosis: STREAMLINEing mental health services in Austria

Abstract Objectives The cost of mental diseases exceeds 4% of GDP in Europe. In Austria, every 5th person lives with mental ill-health (MIH). Ongoing epidemiological, demographic and societal changes increase the need for easily accessible, better integrated and good value services. In STREAMLINE, we combine, harmonize and implement the latest methods in human service mapping and economic costing to optimize future service provision and financing for MIH in Austria. Methods We comprehensively assess the availability, activity and affordability of human services targeting MIH in Vienna within the health and social care, education, labour and justice sectors based on a conceptual mind map. We identify services through extensive literature, document and web searches plus expert consultations. Services are mapped and costed according to the European PECUNIA methods: classification of the main service types using the international DESDE taxonomy of human services; development of Reference Unit Costs using the PECUNIA RUC templates with primary data; validation of the results with secondary data; compilation of a comprehensive multi-sectoral service catalogue; and synthesis for spatial and policy analyses. Results We identified 756 sources, 75% individual organisations, 5% multi-organisations and 20% existing provider lists. 84% relate to health and social care, 10% labour, and 3% education and justice sectors each. 58% deliver care to adults, 37% to children & adolescents, and 5% support carers. Further service mapping and RUCs will be presented. Discussion STREAMLINE pioneers in coordinated public mental health services and economics research at scale. Assessed levels of fragmentation call for better integration, improved transition, reduced spatial inequity and increased support for carers. Results increase the feasibility of service evaluations from a societal perspective. Planned public service atlas facilitates information and access for service users and carers. Funding: WWTF Key messages • New methods for harmonized health services and economics research allow comprehensive information for optimized future mental health service planning and financing. • Assessed levels of fragmentation highlight the need for better integration, improved transition, reduced spatial inequity and increased support for carers.

2.G. Practice session: Africa and Europe: peer-to-peer HIS assessments for NCD, mental health and injuries surveillance

Abstract Public health surveillance is the basis for evidence-informed decision-making and health (systems) research, globally. Without robust data, public health challenges cannot be tackled. NCDs, mental health conditions and injuries (NCDI/MH) are among the biggest global public health challenges. Their risk and protective factors, including social, political and commercial determinants of health, transcend borders and require multi-disciplinary, multi-stakeholder and long-term responses. Since 2006, comparable national data on NCDI/MH are being collected in Europe on the basis of European Core Health Indicators (ECHI) and the European Health Interview Survey (EHIS). Currently, EU and WHO EURO are working together to set up a new Health Information Network. At EU level, a sustainable health information infrastructure is still lacking, despite extensive preparations in EU-funded projects. Part of these project activities were health information system (HIS) assessments, applying the WHO EURO Support tool to strengthen health information systems for peer-to-peer assessments. In the African region, the Africa Centres for Disease Control and Prevention (Africa CDC), founded in 2017, made NCDI/MH prevention and control a strategic priority. In 2021, it launched its first continental NCDs, Injuries Prevention and Control and Mental Health Promotion Strategy (2022-26) under which the organization supports its Member States. At the 3rd International Conference on Public Health in Africa (Zambia, Nov. 2023), Africa CDC presented a continental Guidance to strengthen NCDI/MH surveillance. The Guidance was developed in collaboration with Robert Koch Institute (RKI) and is based on desk reviews, surveys and national HIS assessments. Both Europe and Africa performed HIS assessments to strengthen NCDI/MH surveillance; standardized tools from WHO EURO and from the International Association of National Public Health Institutes (IANPHI) were used and adapted to fit peer-to-peer approaches and regional contexts. This workshop will present and discuss methodological approaches, experiences and lessons learned, thereby initiating knowledge exchange across continents. The presentations will address the following points: - From top-down to peer-to-peer: methods & tools used in HIS assessments - From paper to practice: the importance of site visits in HIS assessments - From educated guesses to evidence: outcomes of HIS assessments at country level - From evidence to action: translation of HIS assessment outcomes into HIS improvements - From pilot to scale-up: challenges, lessons learned, sustainability of HIS developments To our knowledge, this workshop is the first one at the EPH to bring together practitioners in HIS strengthening for NCDI/MH from Africa and Europe. The workshop offers a unique opportunity to engage with the audience and to explore options for international collaboration. Key messages • Interregional collaboration helps reduce health information inequalities, facilitating better global management of high burden health challenges, such as NCDs, mental health conditions and injuries. • Peer-to-peer HIS assessments in Africa and Europe strengthen NCDI/MH surveillance. They build evidence for policy advice, research and health education and add the benefit of forging expert networks.

Monitoring the digital healthcare transition in the Netherlands: Challenges, achievements and future

Abstract Since 2013, the Netherlands Institute of Health Service Research, along with other Dutch research institutes, has monitored the digital healthcare transition in The Netherlands. Through annual surveys of both healthcare professionals (from primary and secondary care) and users (patients as well as the general population) from 2013 to 2023, trends in digital health utilization and experiences have been tracked. Overall, there has been a steady increase in digital care adoption since 2013, but in 2023, growth among professionals stabilized while slightly rising among users. Some tools saw significant increases, like automatic medicine dispensers and home monitoring, freeing up nurses’ time. Utilization patterns differ among patients according to their educational attainment and age, showing lower usage rates among older individuals and those with lower levels of education. Most professionals, especially nurses, view digital care positively, but they recognize its limitations in solving healthcare challenges entirely. Healthcare professionals believe it offers only a limited contribution to cost management, workload reduction, and job satisfaction and emphasize the need for seamless integration into routine care. User opinions are divided, with those with chronic conditions often expressing skepticism. Both professionals and patients agree that personal experience is crucial in determining its value. Additionally, ensuring user-friendliness and clarifying reimbursement for digital healthcare are essential. This workshop provides an overview of developments in the Netherlands and a discussion of challenges, achievements, and prospects. Particular attention will be paid to the monitoring of digitalization progress and effects, and the use of digital solutions in primary and secondary care.

Substitution of care through the eyes of Dutch health insurers: a qualitative study

Abstract Objectives The objective of health policy measures in the Netherlands is to promote the substitution of care from hospitals to general practitioners (GPs), with reimbursement facilitating this shift. Given that health insurers are tasked with healthcare reimbursement in the Netherlands, understanding their experiences regarding care substitution is crucial. Methods First, informal interviews were held with employees from the Dutch Ministry of Health, Welfare and Sports, the National Health Care Institute and the Netherlands Institute of Health Services Research to construct the topic list. Then, we conducted semi-structured interviews with 15 employees from 7 health insurers, including healthcare purchasers, strategists, client relations executives, and business analysts, between February and April 2024. Transcripts were analyzed in MAXQDA by two researchers, after member checking. Results Insurers navigating substitution face a complex interplay of competition and collaboration, lacking a comprehensive framework. Long-term agreements with hospitals and GPs are seen as potential solutions, contingent on building trust. Diverse views on insurers’ roles emerge, from passive reimbursement to active infrastructure support. Budgetary constraints vary, with some insurers feeling constrained by national budgets for GPs and hospitals while others perceive more flexibility. Risks equalization and deductibles are identified as hindrances to substitution efforts, necessitating changes in financial incentives. Conclusions Overall, addressing these complexities requires aligning incentives and balancing collaboration and competition to optimize resource allocation to effectively meet evolving healthcare needs. A comprehensive framework to balance collaboration and competition might be helpful. Key messages • Understanding insurers’ views on care substitution is vital for healthcare policy in the Netherlands. • A comprehensive framework is needed to balance collaboration and competition, aligning incentives effectively.

Physical Activity-Related Health Services in Germany: Relevance and Necessary Framework Conditions - a Position Paper of the DNVF Working Group Physical Activity-Related Health Services Research

Based on the relevance of an established and broad foundation of physical activity in healthcare, this position paper of the DNVF working group Physical Activity-Related Health Services research presents current conceptual approaches to physical activity-related health services in Germany and highlights the need for interprofessional and interdisciplinary approaches. Three central positions are outlined and elaborated in order to integrate the evidence on health benefits of physical activity and exercise more strongly into healthcare and to show that, against the background of the challenges in the German healthcare system, physical activity-related health services can make a cost-effective and high-quality contribution to improve healthcare. These three positions include 1) the integration of all professional groups involved in healthcare into physical activity-related health services, 2) the greater integration of physical activity professions and physical activity interventions into all healthcare contexts and 3) the systematic consideration of physical activity- and exercise-related expertise in clinical guidelines.

A survey of availability and affordability of polypills for primary and secondary prevention of cardiovascular diseases in selected countries

Abstract Background/Introduction The recent inclusion of polypills—fixed-dose combinations of two or more antihypertensive drugs and statin with or without aspirin—in the World Health Organization’s Essential Medicines List (EML) reiterates the potential of this approach to improve global treatment coverage for primary or secondary prevention of cardiovascular diseases (CVDs). Although there exists extensive evidence on efficacy, safety, and acceptability of polypills, there is no research to-date assessing the "real world" availability and affordability of polypills globally. Purpose We conducted a cross-sectional survey of public and private sector facilities in 13 countries from around the world to evaluate the availability and affordability of polypills. Methods In the surveyed countries, we first ascertained whether any polypill was authorized for marketing and/or included in the national EMLs and clinical guidelines. The facility survey employed a modified WHO/Health Action International methodology. In each country, we collected retail and price data for polypills from at least one public sector facility and three private pharmacies using convenience sampling. Polypills were considered unaffordable in a given country if the lowest paid worker spends more than a days’ wage to purchase monthly supply. Results Polypills were approved for marketing in four of the 13 surveyed countries: Spain, India, Mauritius, and Argentina. None of these countries included polypills in national guidelines, formularies, or EMLs. Further, none of the surveyed public pharmacies in any of the four countries stocked any polypills. Among the surveyed private sector facilities, availability ranged from 0% in India (out-of-stock on the survey day but listed for sale) to 100% in Argentina and Spain. In the private sector, we identified seven unique polypill combinations, marketed by eight different companies. Although not in stock, India had a wider range of various combinations (n=5). Many combinations (63%) found in this survey were affordable in the local context, but these were limited to India and Spain. A lowest paid government worker would spend between 0.2 (India)–2.8 (Mauritius) days’ wages to pay the price for one month’s supply of the polypills. Polypills were likely to be affordable in countries that locally manufactured them. Further, two-pill combinations (one antihypertensive and a statin) were stocked by private pharmacies in Argentina, Bangladesh, Cameroon, India, Nepal, and Spain, with affordability ranging from 0.2 (India)–7.1 (Cameroon) days’ wages. Conclusion Low availability and affordability of polypills in both public and private sectors suggest that the implementation and overall uptake of polypills remains poor globally. Context-specific multi-disciplinary health system research is required to understand factors affecting polypill implementation and to design and evaluate appropriate implementation strategies.

Co-developing frameworks towards environmentally directed pharmaceutical prescribing in Scotland – A mixed methods study

The presence of human pharmaceuticals in the aquatic environment is recognised internationally as an important public health and environmental issue. In Scotland, healthcare sustainability targets call for improvements to medicine prescribing and use to reduce healthcare's impact on the environment. This proof-of-concept study aimed to develop a framework on the environmental impact of pharmaceuticals to use as a knowledge support tool for healthcare professionals, focussing on pharmaceutical pollution. Nominal Group Technique was applied to achieve consensus on pharmaceuticals and modelling factors for the framework, working with a panel of cross-sector stakeholders. Bayesian Belief Network modelling was applied to predict the environmental impact (calculated from hazard and exposure factors) of selected pharmaceuticals, with Scotland-wide mapping for visualisation in freshwater catchments. The model calculated the pollution risk score of the individual pharmaceuticals, using the ratio of prescribed mass vs. mass that would not exceed the predicted no-effect concentration in the freshwater environment. The pharmaceuticals exhibited different risk patterns, and spatial variation of risk was evident (generally related to population density), with the most catchments predicted to exceed the pollution risk score for clarithromycin (probability >80 % in 35 of 40 modelled catchments). Simulated risk scores were compared against observed risk calculated as the ratio of measured environmental concentrations from national regulatory and research monitoring and predicted no-effect concentrations. The model generally overpredicted risk, likely due to missing factors (e.g. solid-phase sorption, temporal variation), low spatial resolution, and low temporal resolution of the monitoring data. This work demonstrates a novel, trans-disciplinary approach to develop tools aiding collation and integration of environmental information into healthcare decision-making, through application of public health, environmental science, and health services research methods. Future work will refine the framework with additional clinical and environmental factors to improve model performance, and develop electronic interfaces to communicate environmental information to healthcare professionals.

Inpatient hospitalisations for patients with Prader-Willi syndrome: a 2019-2021 National Inpatient Sample analysis.

Prader-Willi syndrome (PWS) is a genetic disorder characterised by hyperphagia, intellectual disability and increased propensity to a range of medical disorders. To better characterise the clinical presentation of PWS across the lifespan, this study reports on the demographics and clinical diagnosis of individuals with PWS hospitalised in the United States. The National Inpatient Sample, an all-payor administrative claims database of hospitalisations in the United States, was queried for patients with a coded diagnosis of PWS from October 2019 through December 2021. Hospitalisations for patients with PWS were matched to five non-PWS hospitalisations based on age, sex, year and hospital characteristics. There were 4400 (95% CI: 3,885 to 4,915) PWS hospitalisations, with a median age of 24. Compared to controls, PWS hospitalisations had longer hospital stays (median 5 vs. 3days) and higher in-hospital mortality (2.2% vs. 1.3%). Infectious (19.0%) and respiratory (16.2%) diagnoses were most common for PWS patients. Codes for overweight or obesity were present in 38.1% of PWS hospitalisations, with Hispanic ethnicity was associated with a higher odds of overweight/obesity in PWS patients (aOR 1.73; 95% CI: 1.11-2.71). PWS hospitalisations are characterised by higher healthcare utilisation and complexity compared to matched controls. The high prevalence of obesity and significant rates of infectious and respiratory conditions highlight specific health challenges for PWS patients. Validation of the Q87.11 administrative claims code is an essential step for ongoing health services research in this condition.

Health Services Research

Health Services Research

What is health services research?

In health services research, the health care of the population is examined under everyday conditions. Scientific questions include medical, patient-oriented, system-, performance- and quality-related as well as health economics topics. In health services research, complex interventions, e.g., treatment concepts with multiple therapy components, and/or across multiple sectors, are often implemented. The design of studies in health services research is based on the research question, the setting, and the available data, which can come from avariety of sources.

SAHELI: Study and Action on Hysterectomy: Evidence on women’s health through the life course in India. Protocol for a mixed-methods study

Hysterectomy, removal of the uterus, is a commonly performed surgery for gynaecological morbidities. Emerging evidence indicates that hysterectomy performed before age 45 (early hysterectomy), is associated with considerable risks to women’s health. While most evidence on hysterectomy is from high-income settings, national surveys from India report high prevalence of early hysterectomy in specific regions, as well as higher prevalence amongst women in rural areas and with less education. The median age at hysterectomy in India is close to ten years before the onset of natural menopause. India has recently introduced national guidelines to address early hysterectomy, but large evidence gaps on the causes and consequences remain – which in turn limits the potential effectiveness of interventions at the clinical, health system and community level. Methods SAHELI is a Team Science study that will examine: (i) individual, social and health system determinants of early hysterectomy; (ii) women’s treatment pathways to hysterectomy and for gynaecological morbidity in general; and (iii) the consequences of undergoing hysterectomy on women’s physical, mental, economic and social well-being across the life course. This mixed-methods study includes population surveys amongst women in ages 25–49 in three high-prevalence states; qualitative health systems research to trace treatment journeys with women, health care providers and other stakeholders; evidence syntheses; and knowledge translation activities to ensure findings inform co-produced strategies and interventions. The study is grounded in a feminist epidemiology approach, aiming to examine individual and structural causes of vulnerability and prioritising the views of women, particularly in knowledge translation. Conclusions SAHELI, implemented by an all-women, multi-disciplinary team, is the first study in India to examine the causes and consequences of hysterectomy in a life course approach. We aim to influence interventions, policy and future research on women’s health, particularly access to quality gynaecological care and comprehensive health services through the life course.

Planning for and Assessing Rigor in Rapid Qualitative Analysis (PARRQA): a consensus-based framework for designing, conducting, and reporting

BackgroundThe use of rapid qualitative methods has increased substantially over the past decade in quality improvement and health services research. These methods have gained traction in implementation research and practice, wherein real-time adjustments are often made to optimize processes and outcomes. This brisk increase begs the questions: what does rigor entail in projects that use rapid qualitative analysis (RQA)? How do we define a pragmatic framework to help research teams design and conduct rigorous and valid rapid qualitative projects? How can authors articulate rigor in their methods descriptions? Lastly, how can reviewers evaluate the rigor of rapid qualitative projects?.MethodsA team of seven interdisciplinary qualitative methods experts developed a framework for ensuring rigor and validity in RQA and methods suitable for this analytic approach. We conducted a qualitative evidence synthesis to identify gaps in the literature and then drew upon literature, standard procedures within our teams, and a repository of rapid qualitative training materials to create a planning and reporting framework. We iteratively refined this framework through 11 group working meetings (60-90 minutes each) over the course of one year and invited feedback on items to ensure their completeness, clarity, and comprehensibility.ResultsThe Planning for and Assessing Rigor in Rapid Qualitative Analysis (PARRQA) framework is organized progressively across phases from design to dissemination, as follows: 1) rigorous design (rationale and staffing), 2) semi-structured data collection (pilot and planning), 3) RQA: summary template development (accuracy and calibration), 4) RQA: matrix analysis (matrices), and 5) rapid qualitative data synthesis. Eighteen recommendations across these sections specify best practices for rigor and validity.ConclusionsRapid qualitative methods play a central role in implementation evaluations, with the potential to yield prompt information and insights about context, processes, and relationships. However, guidance on how to assess rigor is nascent. The PARRQA framework enhances the literature by offering criteria to ensure appropriate planning for and assessment of rigor in projects that involve RQA. This framework provides a consensus-based resource to support high-level qualitative methodological rigor in implementation science.

SPINE20 Recommendations 2024 -Spinal Disability: Social Inclusion as a Key to Prevention and Management.

Spine disorders are the leading cause of disability worldwide. To promote social inclusion, it is essential to ensure that people can participate in their societies by improving their ability, opportunities, and dignity, through access to high-quality, evidence-based, and affordable spine services for all.To achieve this goal, SPINE20 recommends six actions.- SPINE20 recommends that G20 countries deliver evidence-based education to the community health workers and primary care clinicians to promote best practice for spine health, especially in underserved communities.- SPINE20 recommends that G20 countries deliver evidence-based, high-quality, cost-effective spine care interventions that are accessible, affordable and beneficial to patients.- SPINE20 recommends that G20 countries invest in Health Policy and System Research (HPSR) to generate evidence to develop and implement policies aimed at integrating rehabilitation in primary care to improve spine health.- SPINE20 recommends that G20 countries support ongoing research initiatives on digital technologies including artificial intelligence, regulate digital technologies, and promote evidence-based, ethical digital solutions in all aspects of spine care, to enrich patient care with high value and quality.- SPINE20 recommends that G20 countries prioritize social inclusion by promoting equitable access to comprehensive spine care through collaborations with healthcare providers, policymakers, and community organizations.- SPINE20 recommends that G20 countries prioritize spine health to improve the well-being and productivity of their populations. Government health systems are expected to create a healthier, more productive, and equitable society for all through collaborative efforts and sustained investment in evidence-based care and promotion of spine health.

Methodological path of an action research project in Brazil’s unified health system research program

ABSTRACT This paper analyzes the cyclical process of an action research project conducted by a group of academics, policy advocates, and humanization supporters under the aegis of Brazil’s Unified Health System Research Program. The project uses a qualitative approach, based on Institutional Analysis and Intervention Research principles. As nested cycles often pass through reflection-action moments, the findings are presented according to several such moments: method construction, participation type, search for theories, and cyclical action research process. They suggest that AR’s cyclical nature can enrich knowledge production and transform healthcare practices, and that well-qualified advocates and humanization supporters can contribute to this by understanding local health needs and providing valuable suggestions to enhance administrative and healthcare actions. These findings underscore the importance of the cyclical nature of action research, which constantly deepens and adds flexibility to participation, knowledge and data production, thereby providing a crucial element which enables research to continue, despite adverse conditions, such as the COVID-19 pandemic.

Matrix Support: interface between Specialty Dental Centers and primary oral health care in Brazil

BackgroundMatrix Support (MS) is a strategy that can be used to improve integration between Primary Health Care (PHC) and other levels of care.ObjectiveThe aim of this study was to investigate the association between MS carried out in Brazilian Dental Specialty Centers (CEOs) (secondary level of oral health care) and aspects of the integrated work process with PHC, as well as contextual variables.MethodsA quantitative cross-sectional study was conducted using data from the Program for Quality Improvement and Access to CEOs (PMAQ-CEO). Secondary data from the External Evaluation of the second cycle of PMAQ-CEO were analyzed, including contextual variables obtained from sources such as the Unified Health System (SUS) and official research institutions. Descriptive analyses were performed, and four multiple models were adjusted to investigate the association between the variables.ResultsThe results showed that about half of the CEOs did not carry out therapeutic projects developed with the oral health teams of PHC. It was found that the lack of therapeutic projects developed with the teams was associated with the lack of discussion of complex cases by the team, lack of discussion of individual therapeutic project, absence of joint continuing education activities, lack of construction and discussion of clinical protocols, and lack of belief in the importance of planning and periodic evaluation. The results suggest that the articulation between PHC and secondary oral health care still presents weaknesses within the scope of SUS. Comprehensive care needs to be strengthened, requiring greater intervention from management.ConclusionIt was concluded that the individual factors of CEOs, related to the work process, have a greater influence on the lack of integration with oral health teams of PHC, compared to the contextual variables of municipalities.