Health System Network Research Articles

Survival, Chemotherapy Treatments, and Health Care Utilization Among Patients with Advanced Small Cell Lung Cancer: An Observational Study.

Most cases of small cell lung cancer (SCLC) are diagnosed at an advanced stage. The objective of this study was to investigate patient characteristics, survival, chemotherapy treatments, and health care use after a diagnosis of advanced SCLC in subjects enrolled in a health system network. This was a retrospective cohort study of patients aged ≥ 18years who either were diagnosed with stage III/IV SCLC or who progressed to advanced SCLC during the study period (2005-2015). Patients identified from the Indiana State Cancer Registry and the Indiana Network for Patient Care were followed from their advanced diagnosis index date until the earliest date of the last visit, death, or the end of the study period. Patient characteristics, survival, chemotherapy regimens, associated health care visits, and durations of treatment were reported. Time-to-event analyses were performed using the Kaplan-Meier method. A total of 498 patients with advanced SCLC were identified, of whom 429 were newly diagnosed with advanced disease and 69 progressed to advanced disease during the study period. Median survival from the index diagnosis date was 13.2months. First-line (1L) chemotherapy was received by 464 (93.2%) patients, most commonly carboplatin/etoposide, received by 213 (45.9%) patients, followed by cisplatin/etoposide (20.7%). Ninety-five (20.5%) patients progressed to second-line (2L) chemotherapy, where topotecan monotherapy (20.0%) was the most common regimen, followed by carboplatin/etoposide (14.7%). Median survival was 10.1months from 1L initiation and 7.7months from 2L initiation. Patients in a regional health system network diagnosed with advanced SCLC were treated with chemotherapy regimens similar to those in earlier reports based on SEER-Medicare data. Survival of patients with advanced SCLC was poor, illustrating the lack of progress over several decades in the treatment of this lethal disease and highlighting the need for improved treatments.

Measuring racial segregation in health system networks using the dissimilarity index

Racial disparities in the end-of-life treatment of patients are a well observed fact of the U.S. healthcare system. Less is known about how the physicians treating patients at the end-of-life influence the care received. Social networks have been widely used to study interactions with the healthcare system using physician patient-sharing networks. In this paper, we propose an extension of the dissimilarity index (DI), classically used to study geographic racial segregation, to study differences in patient care patterns in the healthcare system. Using the proposed measure, we quantify the unevenness of referrals (sharing) by physicians in a given region by their patients' race and how this relates to the treatments they receive at the end-of-life in a cohort of Medicare fee-for-service patients with Alzheimer's disease and related dementias. We apply the measure nationwide to physician patient-sharing networks, and in a sub-study comparing four regions with similar racial distribution, Washington, DC, Greenville, NC, Columbus, GA, and Meridian, MS. We show that among regions with similar racial distribution, a large dissimilarity index in a region (Washington, DC DI = 0.86 vs. Meridian, MS DI = 0.55), which corresponds to more distinct referral networks for black and white patients by the same physician, is correlated with black patients with Alzheimer's disease and related dementias receiving more aggressive care at the end-of-life (including ICU and ventilator use), and less aggressive quality care (early hospice care).

Experience and expectations of patients on weight loss: The Learning Health System Network Experience.

SummaryObjectiveWeight perception and degree of confidence in achieving healthy lifestyle can be determinants of engagement in obesity interventions. This study explored patients' perceived need for weight loss and the degree of self‐confidence in ability to lose weight and sought to identify factors associated with patients' self‐confidence in ability to lose weight.MethodsThe authors analysed data from a survey mailed to primary care patients within five sites of the Learning Health Systems Network that explored participants' prior experience with weight management.ResultsAmong the 2,263 participants who completed the survey section on ‘Patients’ Experience with Weight Management’, perceived need to lose 51 lb or more was statistically significant among those with class III obesity compared with other body mass index (BMI) groups (p value < 0.001). Reported desire to lose weight was also significantly higher among those with the highest BMI than those who were overweight (p value < 0.001). However, this same group had the lowest belief in ability to lose weight (p value < 0.001). In a multiple regression analysis, female gender, higher BMI and need to lose >10 lb were each independently associated with less belief in being able to lose weight.ConclusionsPatients had varying perceptions on weight loss; those with category III obesity had the highest desire to lose weight but had the least confidence in ability to lose weight. Higher BMI, female gender and need to lose >10 lb were associated with decreased self‐confidence in ability to lose weight.

The eradication of polio in Bhutan in the context of global polio eradication

Bhutan has made tremendous health gains in public health, particularly in vaccine-preventable diseases. Polio was eradicated two years ahead of the launch of the Global Polio Eradication Initiative and only 12 years after the introduction of oral polio vaccination nationwide. The last case of clinical poliomyelitis in Bhutan was reported in 1986. Bhutan maintains a very high coverage of polio immunisation coupled with a strong health system and surveillance network. The success story in the elimination of polio provides examples for other successful public health programmes now and in the future.

Delivering clinical preventive services in the Islamic Republic of Iran: A model for screening and behavior consultation practices.

Background: Screening and behavior consultation are considered to be limited, dispersed and expensive services across the country. To deliver efficient and equitable services current disordered practices need to be consolidated. Methods: An analysis of current situation, learned lessons and future scopes of country’s preventive care delivery, along with a review of international experience and generous participation of various stakeholders, led to proposing a model for screening and behavior consultation practices in IR. Iran. Results: Upon the results of the previous steps, the desired model was based on the network system and family physician. Comprehensive health centers and other centers affiliated to the network are the most appropriate service positions. However, private and academic preventive centers are playing their rules. Conclusion: The proposed model matches the overall pattern of service delivery in the health system (network system with the private sector and the educational sector).

Needs Assessment for Weight Management: The Learning Health System Network Experience.

ObjectiveTo assess patients’ weight management needs and experiences across multiple sites within the Learning Health System Network.Patients and MethodsA total of 19,964 surveys were sent to patients identified with overweight or obesity through medical record query at 5 health care systems throughout 11 states. The survey collected patients’ experiences with and opinions about weight management in clinical care from October 27, 2017, through March 1, 2018.ResultsAmong the 2380 responders, being younger, female, nonwhite, and single and having some college education or less were all significantly associated with higher body mass index (BMI). The most frequent weight loss barriers included food cravings (30.7%-49.9%) and having a medical condition limiting physical activity (17.7%-47.1%) (P<.001). Higher BMI was associated with a higher frequency of comorbidities and lower health status (P<.001). Higher BMI was also associated with a higher belief that primary care providers (PCPs) should be involved in weight loss management (P=.01) but lower belief that the PCP had the necessary skills and knowledge to help (P<.001). Responders with a higher BMI were more likely to feel judged (P<.001) and not always respected (P<.001) by their PCP. In addition, those with a higher BMI more frequently reported avoiding health care visits because of weight gain, not wanting to undress or be weighed, and not wanting to discuss their weight with their PCP (P<.001).ConclusionPhysician involvement in weight management is important to patients whose needs and experiences differ by BMI. These data may inform clinical weight management efforts and create greater alignment with patient expectations.

Evolving population data linkage services to transform large-scale biobanking services

IntroductionMany population data linkage centres have been established to provide a mechanism for making linked administrative data available to approved third parties within robust governance frameworks. While current models support a wide variety of research, modifications are required for linked administrative data to better position biobanking research infrastructure.&#x0D; Objectives and ApproachWe have sought to reconfigure population data linkage services to enhance the value of a newly established state-of-the art population and disease biobank embedded within a state based pathology network, equipped with robotic technology, with the capacity to store and process more than 3 million samples from participants consenting to data linkage and future unspecified research.&#x0D; ResultsThree data service streams have been developed: longitudinal data linkage, cohort management and targeted recruitment. Traditional infrastructure for population data linkage will support the longitudinal data linkage stream, making data and biospecimens available for research, without direct patient identifiers. Technical and governance changes are necessary to enable the rapid release of contemporaneous patient and health system data for cohort management and recruitment purposes. The cohort management stream seeks to significantly reduce the manual follow-up of administrative data. The newly developed targeted recruitment service will leverage on the jurisdictional data holdings and structure of the health system and pathology network, to identify optimal sites and service providers for patient recruitment at scale, in an expedited manner.&#x0D; Conclusion/ImplicationsModest changes to population data infrastructure have significant potential to enhance biobank research infrastructure. By fast tracking biospecimen accrual for diseases of population subgroups of strategic importance, this new service is intended to promote biobank viability, accelerate the pace of clinical trials recruitment and improve patient access to trials.

Supportive Care Nursing Clinical Protocol Incorporates Holism in a Public Acute Care Hospital.

The Supportive Care Nursing Clinical Protocol (SCNCP) was developed to guide holistic nursing care for seriously ill hospitalized patients. The SCNCP uses national guidelines and evidence-based interventions as its foundation. Seriously ill patients may require palliative care, which is synonymous with supportive care. Acute care nurses may not be proficient in providing holistic supportive care for patients with life-limiting illness. At a 670-bed public acute care hospital, palliative care consultation requires a physician order and palliation may arrive late in an illness. Independent nursing interventions can contribute to the alleviation of suffering. Evidence-based interventions used in the SCNCP include using computer applications for breathing exercise (relaxation and mindfulness), topical applications for alleviating thirst, and hand-held fans for dyspnea. The SCNCP is projected for implementation (Spring 2017). The SCNCP will be evaluated for effectiveness after 6 months of implementation. Key indicators for successful implementation include increased nursing knowledge of supportive care and the frequency of protocol implementation as evidenced in the electronic health record. Eventually, the SCNCP will be implemented as the standard for supportive care of the seriously ill for all hospitals in the health system network.

JUDICIALIZAÇÃO DA SAÚDE E INTERNAÇÕES COMPULSÓRIAS DE JOVENS USUÁRIOS DE DROGAS – UM ESTUDO EM ESPÍRITO SANTO DO PINHAL/SP

O artigo tem por objetivo analisar processos de internação compulsória de jovens e adultos usuários de drogas relativos aos anos de 2009 a 2014 na cidade de Espírito Santo do Pinhal (SP). Tratou-se de um estudo longitudinal retrospectivo, de caráter exploratório documental. O presente trabalho revelou que, em 99 processos, as famílias buscam na Justiça a internação compulsória de seus familiares. As internações de adolescentes via ação judicial são feitas em clínicas particulares pagas pelo município, enquanto os adultos são internados pelo Sistema Único de Saúde. Não há transferência de recursos estaduais, e os recursos federais não cobrem os gastos. Não há políticas públicas para esse fim, e há necessidade de fortalecimento dos Centros de Atenção Psicossocial para promoção da sustentabilidade e do equilíbrio social.

Spatial variation of pneumonia hospitalization risk in Twin Cities metro area, Minnesota.

Fine resolution spatial variability in pneumonia hospitalization may identify correlates with socioeconomic, demographic and environmental factors. We performed a retrospective study within the Fairview Health System network of Minnesota. Patients 2 months of age and older hospitalized with pneumonia between 2011 and 2015 were geocoded to their census block group, and pneumonia hospitalization risk was analyzed in relation to socioeconomic, demographic and environmental factors. Spatial analyses were performed using Esri's ArcGIS software, and multivariate Poisson regression was used. Hospital encounters of 17 840 patients were included in the analysis. Multivariate Poisson regression identified several significant associations, including a 40% increased risk of pneumonia hospitalization among census block groups with large, compared with small, populations of ⩾65 years, a 56% increased risk among census block groups in the bottom (first) quartile of median household income compared to the top (fourth) quartile, a 44% higher risk in the fourth quartile of average nitrogen dioxide emissions compared with the first quartile, and a 47% higher risk in the fourth quartile of average annual solar insolation compared to the first quartile. After adjusting for income, moving from the first to the second quartile of the race/ethnic diversity index resulted in a 21% significantly increased risk of pneumonia hospitalization. In conclusion, the risk of pneumonia hospitalization at the census-block level is associated with age, income, race/ethnic diversity index, air quality, and solar insolation, and varies by region-specific factors. Identifying correlates using fine spatial analysis provides opportunities for targeted prevention and control.

Status and Challenges of Medical Waste Management in Hospitals of Iran

Medical waste is of great importance due to its hazardous nature that can cause undesirable effects on humans and the environment. This study focuses on medical waste management in hospitals of Iran. Data were collected based on questionnaires and for self-report of medical waste management. The results along with other information were sent to the ministry of health network system. Results indicated that the mean generation rate of non-hazardous and sharp and infectious and total wastes in Iran were, respectively, 1.84, 1.09 (36.9% of total waste generated) and 2.98 kg/bed/day. Chemical waste generation rate in Iran is 0.02 kg/bed/day (0.68%) that relative to infectious waste and total waste generation rate is much lower which could be due to improper segregation of medical wastes. There is significant differences between private and governmental hospitals, in terms of infectious and sharp waste generation rates (P=0.027). Also there are significant differences between specialized and general hospitals in group of non-hazardous waste (P=0.039), infectious waste (P=0.001) and total waste generation rate (P=0.02). 65.41% of governmental hospitals used autoclave for infectious waste treatment. In the private and governmental hospitals 14.8% and 24.29%, respectively not have any treatment devices and hazardous waste was disposed without treatment.

Patient-Centered Network of Learning Health Systems: Developing a resource for clinical translational research.

The Learning Health System Network clinical data research network includes academic medical centers, health-care systems, public health departments, and health plans, and is designed to facilitate outcomes research, pragmatic trials, comparative effectiveness research, and evaluation of population health interventions. The Learning Health System Network is 1 of 13 clinical data research networks assembled to create, in partnership with 20 patient-powered research networks, a National Patient-Centered Clinical Research Network. Herein, we describe the Learning Health System Network as an emerging resource for translational research, providing details on the governance and organizational structure of the network, the key milestones of the current funding period, and challenges and opportunities for collaborative science leveraging the network.

Why service users do not complain or have \u2018voice\u2019: a mixed-methods study from Nepal\u2019s rural primary health care system

BackgroundDespite abundant literature on the different aspects of health care complaint management systems in high-income countries, little is known about this area in less developed health care systems and most research to date has been conducted in hospital settings. This article seeks to address this gap by reporting on research into complaint systems in primary health care (PHC) settings in Nepal.MethodsUsing a mixed-methods design, qualitative interviews were conducted with key informants (n = 39) and six community focus groups (n = 56), in the Dang District of Nepal. In addition, interviewer-administered structured questionnaire interviews were held with 400 service users, health facility operation and management committee (HFMC) members and service providers from 22 of the 39 public health facilities. Qualitative data were transcribed, organized and then analyzed using the framework method in QSR NVivo 10, while quantitative data were analyzed using IBM SPSS 22.ResultsDespite service users having grievances with the health system, they did not complain frequently: 9% (n = 20) reported ever making complaints about the PHC services. Complaints made were about medicines, health facility opening hours, health facility physical environment, and service providers, and were categorized into environment/equipment, accessibility/availability, level of empathy in the care process and care/safety. Generally, complaints were made verbally to health providers or to HFMC members or female community health volunteers. Use of formal channels such as suggestion boxes or written complaints was almost non-existent. Reasons reported for not complaining included: a lack of complaint channels; lack of knowledge of service entitlements; power asymmetry between service providers and service users; lack of opportunity to choose alternative providers, lack of an established culture of complaining, and a perceived lack of responsiveness to complaints.ConclusionVery few service users made complaints to PHC services in Nepal. Several contextual factors related to the community and the health system were identified as the reasons for not complaining. We recommend continuing efforts to establish proper complaints mechanisms with an increased emphasis on the existing community health system networks. Furthermore, awareness among service users about service entitlements and complaint mechanisms should be increased.

HBV and HCV serological markers in health professionals and users of the Brazilian Unified Health System network in the city of Resende, Rio de Janeiro, Brazil

ABSTRACT Introduction: Infections caused by the hepatitis B virus (HBV) and hepatitis C virus (HCV) are a major public health problem. Objectives: The study aimed to detect HBsAg, anti-HBc, anti-HBs and anti-HCV among health professionals and users of the Brazilian Unified Health System [Sistema Unico de Saude (SUS)] in the city of Resende, Rio de Janeiro, and to describe the sociodemographic profile and background of exposure. Methods: A total of 585 samples were collected between May and June 2014, obtained from the Brazilian Notifiable Diseases Surveillance System [Sistema de Informacao de Agravos de Notificacao (SINAN)] data, which were tested for HBsAg, anti-HBc, anti-HBs and anti-HCV. Results: The predominant age group observed was 30-44 years (n = 277; 47.3%), 54.87% (n = 321) were female and 271 (46.32%) self declared skin colour/ethnicity white. The married participants were 262 (44.78%), 42.22% graduated from high school (n = 247) and 174 were health professionals (29.74%). Four participants were anti-HCV reagents and 18 were anti-HBc reagents. From these, 15 participants were reactive for anti-HBs antibodies. Among health professionals, 68.8% were anti-HBs positive. And 63.9% of participants declared to be vaccinated against hepatitis B. Conclusion: The prevalence of 0.68% for HCV and 3.08% for anti-HBc are below that detected in the Southeast region from the last census in the capitals of Brazil. There is still a reduced acceptance among health professionals for HBV and HCV screening.

P2.06-045 Initiative for Early Lung Cancer Research on Treatment (IELCART): Topic: LAB, Other

Randomized controlled trial evidence to guide treatment of early stage lung cancer has been challenging for a variety of reasons. There is now increasing recognition of the power of large databases collected in the context of clinical care to provide important information and there are new statistical techniques for analysis to address unrecognized confounders. We have initiated a new multicenter, international collaborative network for this purpose. Based on an extensive literature review, scientific articles, and a series of focus sessions with a panel of expert surgeons, as well a panel of former patients, a series of critical questions regarding treatment of early lung cancer has been developed. Data forms of relevant data from both physicians and patients pre- and post-surgery to account for potential confounders have been developed, tested, and are being entered into a web-based data collection system that also includes relevant imaging data. Sites are being registered into this new network The four primary questions we found needing additional evidence that would be of most concern in regard to treatment of early lung cancer were the following•Under what circumstances should limited resection be performed?•How large should resection margins be when performing limited resection?•When should a watchful waiting approach be considered?•When should radiotherapy be considered an option for primary treatment The entire Mount Sinai Health System network which includes 5 hospitals has started enrollment. Treatment is according to usual care but documented in the IELCART registry. Four additional health systems are in the process of joining which requires completing the enrollment application and obtaining IRB approval to submit data to the IELCART registry. Since starting in March 2015, we have enrolled over 30 participants. Actual time required by the surgeon to complete the surgical data prior to surgery is a few minutes. Time to the patient and coordinator to complete the data forms prior to surgery requires between 30 and 60 minutes. We anticipate that approximately 10 health care systems will ultimately enroll in the IELCART. Within 2 years, we anticipate starting to have statistically meaningful results in answering the relevant questions. Beyond these, the IELCART registry by continuing to collect data as part of routine clinical practice will provide an important resource to answer future questions in a timely manner as they arise, including performing studies in the neo-adjuvant setting and companion diagnostics.

Factors associated with the lack of access to cervical cancer screening test results in the Brazilian unified health system network in the municipality of Rio de Janeiro.

Papanicolaou test screening remains an effective approach for the control of cervical cancer. However, for successful control of the disease, patients need to have access to the test results and complete the treatment. The aim of this study was to investigate the factors associated with lack of access to results from the most recent Papanicolaou test in women living in the municipality of Rio de Janeiro who used the Brazilian Unified Health System. Overall prevalence of lack of access to test results was 18.4%. Access to test results was lower for younger women of Black race/skin color origin, those who had difficulties in making an appointment, those who received no information about when to pick up the test results, and those who evaluated the assistance provided by the health professional who collected the Papanicolaou test. Issues related to the organization and infrastructure of the health unit were the most frequently reported cause by the interviewees. The Brazilian Unified Health Service should improve its knowledge of users and service conditions to prevent interruption of the screening flow.

After-effects and disabilities in traffic crash victims in northern Brazil

ABSTRACTObjectives: The objective of this study was to identify the characteristics related to crash and victim, as well as the after-effects/disabilities and consequences arising from traffic crashes occurring in the city of Rio Branco–Acre.Methods: This is an analytical descriptive cross-sectional study conducted in the City of Rio Branco–Acre. The study population consisted of 405 residents of the city who were victims of traffic crashes, of all age groups and genders, who were hospitalized for the first time as a result of the crash in public hospitals and the health system network, as recorded in the Hospital Information System, and who were discharged between January 1 and December 31, 2010. The data sources included hospital record consultations and active searches for the victims. Hierarchical logistic regression was performed to evaluate the factors associated with the after-effects.Results: The majority of the study population was motorcycle victims (68.6%), male, and young (20–39 years). Concerning the after-effects, the following were significantly associated: factors related to the presence of a postcrash activity limitation (odds ratio [OR] = 2.39; 95% confidence interval [CI], 2.39–6.76), length of hospital stay in days (OR = 1 03; 95% CI, 1.01–1.06), and surgical treatment (OR = 1.82; 95% CI, 1.03–3.21). Those who suffered damage to soft tissue and nerves or facial injury showed an odds ratio of 2 to 4 times of having an after-effect/disability, independent of the victim's personal attributes.Conclusion: The mechanism, such as the origin of the pattern of injuries, explains the exposure factors shown by each attribute of the victim and their characteristics. Many of the injuries were precursors to after-effects/disabilities, which, due to their nature and extent, result in the modification of the apparently healthy living standards of young victims who are routinely injured in traffic crashes. Therefore, public policies for prevention should be formulated, reformulated, and implemented, taking into account each attribute of the victims and their social conditions, because these are closely related to their habits and customs. This is a starting point for promoting changes to the current reality that traffic crashes present in the morbidity and mortality of the population.

Mapping the environmental and socioeconomic coverage of the INDEPTH international health and demographic surveillance system network

The International Network for the Demographic Evaluation of Populations and their Health (INDEPTH) has produced reliable longitudinal data about the lives of people in low- and middle-income countries (LMICs) through a global network of health and demographic surveillance system (HDSS) sites. Since reliable demographic data are scarce across many LMICs, we examine the environmental and socioeconomic (ES) similarities between existing HDSS sites and the rest of the LMICs. The HDSS sites were hierarchically grouped by the similarity of their ES conditions to quantify the ES variability between sites. The entire Africa and Asia region was classified to identify which regions were most similar to existing sites, based on available ES data. Results show that the current INDEPTH network architecture does a good job in representing ES conditions, but that great heterogeneities exist, even within individual countries. The results provide valuable information in determining the confidence with which relationships derived from present HDSS sites can be broadly extended to other areas, and to highlight areas where the new HDSS sites would improve significantly the ES coverage of the network.

Factors associated with chronic diseases among the elderly receiving treatment under the Family Health Strategy.

The profile of a sample population of elderly receiving treatment under the Family Health Strategy in the municipality of Teófilo Otoni, State of Minas Gerais, Brazil, is described, and the factors associated with diseases prevalence examined. Using simple random sampling, 385 elderly were interviewed using Form A and Elderly Form from the Primary Health Care Information System. The majority of the sample (83.1%) self-reported at least one disease, 69.9% had hypertension, and 17.7% had diabetes. Poisson regression analysis showed that the main factors associated with hypertension and other diseases were being non-white, having a low level of education, medication use, dental prosthesis use, and lack of a private health plan. The prevalence of diabetes was greater among women and individuals who depended on other people to live. It can be concluded that this sample population of elderly has a generally low socioeconomic status and are more susceptible to developing diseases, particularly hypertension. Diabetes should be controlled although had relatively low prevalence. It is suggested investments in structuring the health system network to provide adequate care for the elderly and in training health professionals to play an effective role in improving the quality of life of the elderly in Brazil.

Management shock: analysis of knowledge of professionals involved with the "viva vida" program

The Management Shock in Minas Gerais came to change the governmental model and boost more effective actions for the recovery and organization of the State. One of the structuring programs created in the health area was the “Viva Vida”, which aims to reduce maternal and child mortality. This study analyzes the knowledge of professionals involved with the program. This was a qualitative, exploratory, and explanatory study comprising five subjects involved with research and active in the Program’s coordination in the Secretary of Health of the State of Minas Gerais, Regional Health Management of Belo Horizonte, and in each level of health care: primary, secondary, and tertiary of the Unified Health System network. The data were obtained from interviews analyzed according to the method of Bardin. It was observed that respondents had experience in the practice related to the theme; however, not all demonstrated theoretical basis about the Viva Vida Program.