Health System Planning Research Articles

Getting the numbers right: Power, creativity and 'good' routine maternal and neonatal health data in Southern Tanzania.

What makes routine maternal and neonatal health data to be 'good quality'? That depends on whom you ask - the people collecting and reporting these data across health system levels have different priorities and face varying constraints. Data are constructed by people, about people, and they both reflect and impact human interactions. This study analyses the power dynamics shaping how routine health data are collected and reported in labour wards of two hospitals in Southern Tanzania. We draw from focused ethnographic observation at these two labour wards and 29 in-depth qualitative interviews with health care workers (HCWs), hospital leaders, and relevant district- and regional-level managers. We distinguish between two different types of power that shape how people engage with routine maternal and neonatal health data: authoritative and discretionary power. Authoritative power, or top-down power 'over', is reflected in how maternal and neonatal health targets and measurement demands are imposed on individuals lower in the power hierarchy. We show how this results in an environment where data are seen as 'political things' and where HCWs feel pressured and fear being blamed for poor health outcomes. Yet, data can also be a means for HCWs to exercise discretionary power - a type of bottom-up power to act creatively to deflect scrutiny and protect themselves and others. Strategically handling and manipulating data, HCWs 'get the numbers right' by balancing their own needs, top-down expectations, and structural challenges. HCWs may hereby compromise their own definitions of 'good' data, and as as consequence, limit the usefulness of routine data to inform clinical decision making and health system planning. We underline the importance of supportive supervision, feasibility and perceived relevance of routine health data for those tasked to collect and report it, in order to better navigate the blurry line between constructive accountability and counter-productive pressure.

Transitions to Nursing Homes Among Residents of Assisted Living and Community-Dwelling Home Care Recipients

To examine transitions to a nursing home among residents of assisted living relative to community-dwelling home care recipients. Population-based retrospective cohort study emulating a target trial. Linked, individual-level health system data were obtained from older adults (≥65years of age) who made an incident application for a bed in a nursing home in Ontario, Canada, between April 1, 2014, and March 31, 2019, and were followed until December 31,2019. Residency in assisted living was compared with only community-dwelling home care. Any long-stay (≥90days) and short-stay (<90days) transitions to a nursing home were examined. Inverse probability weighted pooled logistic regression models were used to generate marginal cumulative incidence curves under each exposure status that were standardized by the covariates. This study included 10,012 residents of assisted living (mean [SD] age 88.7 [6.26] years, 75% female) and 131,679 home care recipients (mean [SD] age 84.8 [7.43] years, 63% female) who applied for a bed in a nursing home (N= 141,691; 95,744.6 person-years). There were 6049 transitions among applicants from assisted living and 85,190 transitions among applicants who were home care recipients to a nursing home. The 5-year absolute risk reduction was 110 transitions to a nursing home per 1000 older adult applicants if all applicants resided in assisted living (95% CI, 71-148). Residency in assisted living resulted in a 12.7% relative decrease in the 5-year risk of any transition to a nursing home had all applicants resided in assisted living (95% CI, 8.3%-17.1%). Residents of assisted living were less likely to transition to a nursing home, despite equivalent clinical complexity and health care needs. The integration of assisted living into the continuum of care from the community to institutionalized nursing homes would better inform health system capacity and planning.

Distribution of The Health Workers in The Tuberculosis Sector, Mongolia: Assessment Results Using the Gini Index

Background: Mongolia was classified as one of the 30 countries with the highest tuberculosis burden by World Health Organization in 2021 and tuberculosis is the first leading cause of mortality among deaths from all communicable diseases in the country. The number and distribution of health workers to provide tuberculosis healthcare services will play an important role in the fight against tuberculosis. However, there has been no quantitative evaluation of the distribution of tuberculosis health workers in Mongolia. Therefore, this study aimed to examine the distribution of health workers in the tuberculosis sector using the Gini index. The results provide quantifiable information for monitoring resource distribution and serve as a basis for informed decision-making on resource allocation, facilitating targeted interventions and equitable healthcare distribution in Mongolia. Methods: Data from the National Center for Communicable Diseases and the National Statistical Information Service of Mongolia was obtained and analyzed. The Gini coefficients were calculated to reflect the inequality of distributions. Results: Total number of health workers in the tuberculosis sector was only 1.29 per 10,000 population. The Gini index values for the distribution of tuberculosis doctors, assistant workers, nurses, and laboratory technicians were at 0.61, 0.67, 0.43, and 0.33 respectively, all showing a range from severe to relative inequality. Conclusions: Findings showed the number and distribution of tuberculosis health workers were both inadequate and unequal and ring the need for proper health system planning. To plan the tuberculosis control and address the high burden of the disease in the country, the human resources situation should be analyzed and handled regularly. Keywords: Mongolia, Tuberculosis, Health workers, Distribution, Gini index

Prevalence of a dual diagnosis of mental illness and substance use disorder in Ontario, Canada: a retrospective cohort study using linked administrative data

ObjectivePopulation-based prevalence estimates of co-occurring mental illness and substance use disorder (herein dual diagnosis) are scarce and derived from a single source (e.g., survey data) which may lead to underestimation of prevalence. We linked administrative data to a representative mental health survey in Ontario, Canada to estimate dual diagnosis prevalence using a data triangulation method. Approach We retrospectively linked the 2002 and 2012 Canadian Community Health Survey on Mental Health (CCHS-MH) to emergency department, inpatient hospital, and outpatient physician records in Ontario, Canada. Mental illness and substance use disorder were ascertained though self-report, Composite International Diagnostic Interview screening, and linked administrative health records. We estimated 1-year, 5-year, and lifetime prevalence of dual diagnosis. ResultsOf the CCHS-MH survey participants, 14,790 (99.8%) were included in the study. The 1-year, 5-year, and lifetime prevalence of dual diagnosis was 2.3%, 4.8%, and 9.8%, respectively, which attenuated to 2.1%, 4.1%, and 8.4%, respectively, when tobacco use disorder was removed from substance use disorder ascertainment. ConclusionDual diagnosis is more common in the general population than previously estimated. Considering barriers to accessing care for both mental illness and substance use disorders among people with dual diagnosis annually, our 5-year prevalence estimate is likely most informative for health system planning. ImplicationsIn the context of increased health burden, barriers to care access, and challenges to effective treatment associated with dual diagnosis, our findings present a case for increased investment in integrated models of mental healthcare and addiction medicine.

An opportunity missed: Strengthening health system data on multisystem inflammatory syndrome in children from low- and middle-income countries in Asia

BackgroundMultisystem inflammatory syndrome in children (MIS-C) is a severe complication associated with SARS-CoV-2 infection. The clinical epidemiology of MIS-C is not completely understood in low- and middle-income countries (LMICs) due to limited reporting, including in Asia where there was a substantial burden of COVID-19. We aimed to discuss the challenges of diagnosing MIS-C and factors which may cause children from Asian LMICs to have an increased risk of MIS-C. MethodsNot applicable. ResultsThe burden of MIS-C in Asian LMICs may be disproportionately high due to underlying risk factors, resource-limited health systems, and the increased infectivity and transmissibility of recent SARS-CoV-2 variants. Complex clinical features of MIS-C contributed to missed or delayed diagnosis and treatment, while underlying risk factors including ethnicity, chronic health conditions, and socioeconomic factors may have predisposed children in Asian LMICs to MIS-C. ConclusionsThere was a lack of data on the clinical epidemiology of MIS-C in Asian LMICs during the COVID-19 pandemic, despite reports of higher paediatric mortality rates compared to high-income countries. This highlights the need for LMICs to have strong surveillance systems to collect high-quality and timely data on newly emerging complications associated with a pandemic, such as MIS-C. This will lead to rapid understanding of these emerging complications, and inform clinical management, disease prevention and health system planning.

The Health Impacts of Better Access to Axicabtagene Ciloleucel: The Case of Spain.

In this study, the health impacts of improving access to treatment with axicabtagene ciloleucel (axi-cel) was assessed in patients with relapsed/refractory diffuse large B-cell lymphoma after ≥2 lines of therapy in Spain. A partitioned survival mixture cure model was used to estimate the lifetime accumulated life years gained (LYG) and quality-adjusted life years (QALYs) per patient treated with axi-cel versus chemotherapy. Efficacy data were extracted from the ZUMA-1 trial for axi-cel and from the SCHOLAR-1 study for chemotherapy. In the base case, the incremental outcomes of axi-cel versus chemotherapy were evaluated in a cohort of 187 patients treated with CAR T-cell therapies, as reported by the "Spanish National Health System Plan for Advanced Therapies", and in the alternative scenario in the full eligible population based on epidemiological estimates (n = 490). Taking those currently treated with axi-cel, compared with chemotherapy, axi-cel provided an additional 1341 LYGs and 1053 QALYs. However, when all eligible patients (n = 490) were treated, axi-cel provided an additional 3515 LYs and 2759 QALYs. Therefore, if all eligible patients were treated with axi-cel rather than those currently treated as per the registry (n = 187), there would have been an additional 303 patients treated, resulting in an additional 2173 LYGs and 1706 QALYs in total. The lack of access in Spain has led to a loss of a substantial number of LYGs and QALYs, and efforts should be made to improve access for all eligible patients.

Engaging primary care professionals in OECD’s international PaRIS survey: a documentary analysis

Healthcare professionals have first-hand experience with patients in clinical practice and the dynamics in the healthcare system, which can be of great value in the design, implementation, data analysis and dissemination of research study results. Primary care professionals are particularly important as they provide first contact, accessible, coordinated, comprehensive and continuous people-focused care. However, in-depth examination of the engagement of health professionals in health system research and planning activities—how professionals are engaged and how this varies across national contexts- is limited, particularly in international initiatives. There is a need to identify gaps in the planning of engagement activities to inform the design and successful implementation of future international efforts to improve the responsiveness of health systems to the changing needs of patients and professionals. The aim of this study was to explore how primary care professionals were engaged in the design and implementation plans of an international health policy study led by the Organisation for Economic Co-operation and Development (OECD). The OECD’s international PaRIS survey measures and disseminates information on patient-reported outcome and experience measures (PROMs and PREMs) of people living with chronic conditions who are managed in primary care. A documentary analysis of 17 written national implementation plans (country roadmaps) was conducted between January and June 2023. Two reviewers independently performed the screening and data abstraction and resolved disagreements by discussion. We reported the intended target primary care professionals, phase of the study, channel of engagement, level of engagement, and purpose of engagement. All 17 countries aimed to engage primary care professionals in the execution plans for the international PaRIS survey. While organisations of primary care professionals, particularly of family doctors, were the most commonly targeted group, variation was found in the timing of engagement activities during the different phases of the study and in the level of engagement, ranging from co-development (half of the countries co-developed the survey together with primary care professionals) to one-off consultations with whom. International guidance facilitated the participation of primary care professionals. Continuous collaborative efforts at the international and national levels can foster a culture of engagement with primary care organisations and individual professionals and enhance meaningful engagement of primary care professionals.

Exploring the accessibility of primary health care data in Europe's COVID-19 response: developing key indicators for managing future pandemics (Eurodata study)

BackgroundPrimary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: (1) Describe PHC’s clinical pathways for acute COVID-19 cases, including long-term care facilities, (2) Describe PHC COVID-19 pandemic indicators, (3) Develop COVID-19 PHC activity indicators, (4) Explain PHC’s role in vaccination strategies, and (5) Create a PHC contingency plan for future pandemics.MethodsA mixed-method study will employ two online questionnaires to gather retrospective PHC data on COVID-19 management and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health (PH) experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and PH will be devised to address future pandemic scenarios. Analysis: Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving researchers from 28 European countries support the development.DiscussionWhile PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC’s role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants’ involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments’ daily dashboards in Europe, often overlooked in media and public debates.

High Uptake of Respiratory Syncitial Virus Prevention for Neonates in a Military Treatment Facility

We investigated the uptake of nirsevimab for infants and the bivalent respiratory syncytial virus prefusion F (RSVPreF) vaccine for pregnant persons as measures for RSV prevention during an infant's birth hospitalization in a military treatment facility. We found >85% uptake between October 2023 to February 2024. These data may aid health systems plan for future RSV seasons.

Health Disparities: Differences in Veteran and Non-Veteran Populations using Generative AI

Introduction: This study investigated self-reported health status, health screenings, vision problems, and vaccination rates among veteran and non-veteran groups to uncover health disparities that are critical for informed health system planning for veteran populations. Methods: Using public-use data from the National Health Interview Survey (2015-2018), this study adopts an ecologic cross-sectional approach to conduct an in-depth analysis and visualization of the data assisted by Generative AI, specifically ChatGPT-4. This integration of advanced AI tools with traditional epidemiological principles enables systematic data management, analysis, and visualization, offering a nuanced understanding of health dynamics across demographic segments and highlighting disparities essential for veteran health system planning. Findings: Disparities in self-reports of health outcomes, health screenings, vision problems, and vaccination rates were identified, emphasizing the need for targeted interventions and policy adjustments. Conclusion: Insights from this study could inform health system planning, using epidemiological data assessment to suggest enhancements for veteran healthcare delivery. These findings highlight the value of integrating Generative AI with epidemiological analysis in shaping public health policy and health planning.

A Comparative Study of Hospitals in Yasuj, Iran, in Terms of the Implementation of the Health System Planning and the Quality of Medical Services

Background: Today, the implementation of the health system plan has led to the reduction of people's payments and to equitable access to health services and the improvement of the quality of services. Objectives: The current research was conducted with the aim of a comparative study of hospitals in Yasuj, Iran, in terms of the implementation of the health system plan and the quality of medical service. Methods: The statistical population of the present descriptive study was 380 patients at Shahid Beheshti Hospital, Yasuj, 150 patients in Shahid Rajaei Hospital and 300 patients in Imam Sajjad Hospital, all located at Yasuj, Iran. According to Morgan's table, 181 patients at Shahid Beheshti Hospital, 108 patients at Shahid Rajaei Hospital and 169 patients at Imam Sajjad Hospital were included as the statistical sample. All the participants completed the questionnaire and the implementation status of the health system plan and the quality of medical services. One-way ANOVA was used to analyze the statistical findings. All statistical operations were performed using SPSS v.18 software Results: The results of the the present study indicated that the health system implementation status of Shahid Beheshti Hospital, Imam Sajjad Hospital and Shahid Rajaei Hospital in Yasuj was favorable. These findings indicated that the health system plan in Yasuj were properly and correctly implemented. Moreover, the quality of medical services at Shahid Beheshti Hospital, Imam Sajjad Hospital, and Shahid Rajaei Hospital in Yasuj were satisfactory. Also, the results showed that there is was no significant difference in the quality of medical services in Yasuj hospitals (P = 0.44 &amp; F = 0.81 &amp; 455 &amp; 2 F). Correspondingly, the results disclosed that there was no significant difference in the implementation status of the health system plan of hospitals in Yasuj city (P = 0.39 &amp; F = 0.93 &amp; 455 &amp; 2). Conclusions: Medical centers should continuously evaluate the quality of their services, since improving the quality of medical services encourages patients to follow their treatment instructions correctly and on time, and also accelerate the progress of treatments and achieves the main therapeutic goal of treating patients.

Determining the Optimal Methodology for Identifying Incident Stroke Deaths Using Administrative Datasets Within Australia

Quantifying stroke incidence and mortality is crucial for disease surveillance and health system planning. Administrative data offer a cost-effective alternative to "gold standard" population-based studies. However, the optimal methodology for establishing stroke deaths from administrative data remains unclear. We aimed to determine the optimal method for identifying stroke-related deaths in administrative datasets as the fatal component of stroke incidence, comparing counts derived using underlying and all causes of death (CoD). Using whole-population multijurisdictional person-level linked data from hospital and death datasets from South Australia, the Northern Territory, and Western Australia, we identified first-ever stroke events between 2012 and 2015, using underlying CoD and all CoD to identify fatal stroke counts. We determined the 28-day case fatality for both counts and compared results with gold standard Australian population-based stroke incidence studies. The total number of incident stroke events was 16,150 using underlying CoD and 18,074 using all CoD. Case fatality was 24.7% and 32.7% using underlying and all CoD, respectively. Case fatality using underlying CoD was similar to that observed in four Australian "gold standard" population-based studies (20%-24%). Underlying CoD generates fatal incident stroke estimates more consistent with population-based studies than estimates based on stroke deaths identified from all-cause fields in death registers.

Assessing the accuracy of health facility typology in representing the availability of health services: a case study in Mali

IntroductionUsing health facility types as a measure of service availability is a common approach in international standards for health system policy and planning. However, this proxy may not accurately reflect...

Examining the State of the Health System Plan from the Perspective of the Patients of Hospitals in Yasuj, Iran

Examining the State of the Health System Plan from the Perspective of the Patients of Hospitals in Yasuj, Iran

Global, regional, and national lifetime risks of developing and dying from gastrointestinal cancers in 185 countries: a population-based systematic analysis of GLOBOCAN

Gastrointestinal cancers account for a quarter of the global cancer incidence and a third of cancer-related deaths. We sought to estimate the lifetime risks of developing and dying from gastrointestinal cancers at the country, world region, and global levels in 2020. For this population-based systematic analysis, we obtained estimates of gastrointestinal cancer incidence and mortality rates from GLOBOCAN for 185 countries, alongside all-cause mortality and population data from the UN. Countries were categorised into quartiles of the Human Development Index (HDI). The lifetime risk of gastrointestinal cancers was estimated with a standard method that adjusts for multiple primaries, taking into account competing risks of death from causes other than cancer and life expectancy. The global lifetime risks of developing and dying from gastrointestinal cancers from birth to death was 8·20% (95% CI 8·18-8·21) and 6·17% (6·16-6·18) in 2020. For men, the risk of developing gastrointestinal cancers was 9·53% (95% CI 9·51-9·55) and of dying from them 7·23% (7·22-7·25); for women, the risk of developing gastrointestinal cancers was 6·84% (6·82-6·85) and of dying from them 5·09% (5·08-5·10). Colorectal cancer presented the highest risk, accounting for 38·5% of the total lifetime risk of developing, and 28·2% of dying from, gastrointestinal cancers, followed by cancers of the stomach, liver, oesophagus, pancreas, and gallbladder. Eastern Asia has the highest lifetime risks for cancers of the stomach, liver, oesophagus, and gallbladder, Australia and New Zealand for colorectal cancer, and Western Europe for pancreatic cancer. The lifetime risk of gastrointestinal cancers increased consistently with increasing level of HDI; however, high HDI countries (the third HDI quartile) had the highest death risk. The global lifetime risk of gastrointestinal cancers translates to one in 12 people developing, and one in 16 people dying from, gastrointestinal cancers. The identified high risk and observed disparities across countries warrants context-specific targeted gastrointestinal cancer control and health systems planning. Beijing Nova Program, CAMS Innovation Fund for Medical Sciences, and Talent Incentive Program of Cancer Hospital, CAMS (Hope Star).

Global Burden of Dementia Death from 1990 to 2019, with Projections to 2050: An Analysis of 2019 Global Burden of Disease Study.

Dementia is a growing global health challenge. Quantifying the current burden and predicting the future increases of dementia-related deaths are necessary to enhance effective policy decisions and health system planning. Data on dementia mortality was derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 study. The 2020-2050 dementia-related deaths were forecasted using the Bayesian age-period-cohort model. Globally, the number of dementia-related death increased from 0.56 million in 1990 to 1.62 million in 2019 and were estimated to increase to 4.91 million by the year 2050. Metabolic risk factors would become the most important modifiable risk factors affecting dementia death which account for 28.10% of dementia related death by the year 2050. For different Socio-demographic Index (SDI) regions, the low SDI region would have the highest age-standardized mortality rate (ASMR) (29.16 per 100,000) by 2050. Moreover, the number of dementia-related deaths under the age of 70 years was predicted to reach 0.18 million by 2050. Dementia related death remains a global health problem, and health policies targeting metabolic risk factors may be an important way to alleviate this problem.

Identifying and prioritising barriers to injury care in Northern Malawi, results of a multifacility multidisciplinary health facility staff survey.

The burden of injuries globally and in Malawi is substantial. Optimising both access to, and quality of, care in health systems requires attention. We aimed to establish how health facility staff in Karonga, Malawi, perceive barriers to seeking (delay 1), reaching (delay 2) and receiving (delay 3) injury care. We conducted a cross-sectional survey of health facility staff who treat patients with injuries in all health facilities serving the Karonga Demographic Surveillance Site population. The primary outcome was participant perceptions of the importance of delays 1 to 3 following injury. Secondary outcomes were the barriers within each of these delays considered most important and which were considered the most important across all delays stages. 228 staff completed the survey: 36.8% (84/228) were female and 61.4% (140/228) reported being involved in caring for an injured person at least weekly. Delay 3 was most frequently considered the most important delay 35.1% (80/228), with 19.3% (44/228) and 16.6% (38/228) reporting delays 1 and 2 as the most important respectively; 28.9% (66/228) of respondents either did not know or answer. For delay 1 the barrier, "the perceived financial costs associated with seeking care are too great", was considered most important. For delay 2, the barrier "lack of timely affordable emergency transport (formal or informal)" was considered most important. For delay 3, the barrier, "lack of reliably available necessary physical resources (infrastructure, equipment and consumable material)" was considered most important. When considering the most important overall barrier across all delays, the delay 3 barrier, "lack of reliably available necessary physical resources" received the most nominations (41.7% [95/228]). Given the awareness of health facility staff of the issues facing their patients, these findings should assist in informing health system planning.

All talk…only a little action: a reflection on embedding equity into integrated care models in Ontario, Canada

Background: Ontario Health Teams (OHTs) are a recently introduced model of delivery intended to integrate services to deliver connected care to defined populations in Ontario, Canada. The Quadruple Aim advocates for improving patient experience, reducing cost, advancing population health, and improving the provider experience; it is meant to be a guide for OHTs for performance outcomes and as a framework for evaluation and reporting. The Quintuple Aim, incorporating an added focus on health equity, has recently been introduced to OHTs, where equity is also built into continuous quality improvement requirements. As embedded OHT research fellows, we recognize our key role in supporting equity in healthcare delivery and programs. However, we also observe the challenges to generating actionable initiatives to integrate equity into OHTs.&#x0D; Objective: The objective of this presentation is to describe equity initiatives being incorporated in four OHTs in Ontario, Canada and to identify the barriers and facilitators at the micro, meso and macro levels. This presentation is aimed at those involved in integrated care research, policy, practice, and education.&#x0D; Methods: We will use a multiple case study design to describe the contexts of four integrated care models representing large, mid, and small urban regions of the province. This work is guided by the Rainbow Model for Integrated Care, which conceptualizes different domains of integrated care. We will include multiple data sources from each OHT, including key documents, formal and informal community partnerships, the level and nature of engagement with equity-deserving groups in governance processes, the extent to which equity is emphasized in strategic plans and other documents, and the resources available, we share insights gleaned on barriers and facilitators to applying an equity lens. &#x0D; Key Results: We identify challenges related to data availability for health equity decision making and health systems planning. Specifically, difficulties exist in accessing meaningful and linked data to understand OHT attributed populations; these difficulties are compounded when seeking data specific to equity deserving groups and when attempting to link equity relevant indicators to health system indicators. Furthermore, meaningful engagement with equity deserving groups in order to build relationships requires time and resources that are difficult to source; such engagement is particularly challenging in an environment of limited financial resources, where frequent reporting and pressure to quickly deliver outcomes is emphasized. OHTs are collaborative governance models composed of representation from member organizations, patients, and academics; this collaborative approach to governance can be a facilitator to embedding equity deserving groups into the structure of OHTs.&#x0D; Next Steps: Ontario Health Teams require support in creating comprehensive equity approaches that are specific to the needs of their communities and teams; further work is needed to better understand the needs of OHTs in this regard.

Development and Evaluation of a Novel Population Needs-Based Sub-Segmentation Model (NBSSM) in Singapore

Background: Population segmentation models are often used to stratify people into groups for care or services planning purposes. These are typically disease-specific or utilisation-based, and target high-risk patient groups. Singapore’s National Health Group (NHG) has developed a River of Life (RoL) segmentation approach stratifying its population into five segments, namely, Living Well, Living with Illness, Crisis and Complex Care, Living with Frailty and Leaving Well. Building on this approach, Yishun Health (YH), a Regional Population Health System under NHG caring for more than 300,000 residents in Northern Singapore, developed the Needs-Based Sub-Segmentation Model (NBSSM) to further stratify Yishun Zone residents who are living with illness and frailty using additional biological, psychological and social criteria. We evaluated the NBSSM’s ability to stratify residents into distinct risk-groups based on a set of person-centred outcomes.&#x0D; Methods: Yishun Zone residents with chronic illness and/or frailty were first identified to generate ‘Living with Illness’ and ‘Living with Frailty’ groups. These residents were further segmented into 10 sub-segments representing different needs and complexity levels, based on biological complexity i.e. number and severity of chronic diseases, as well as presence or absence of psychosocial criteria i.e. presence of mental illness and social issues.&#x0D; To evaluate the NBSSM, we studied its ability to stratify residents into distinct risk-groups using Charlson’s Comorbidity Index (CCI) scores as well as person-centred outcomes such as healthcare utilisation, and healthcare cost. Statistical distinction between NBSSM segments based on the above outcomes was also tested. Data from a Population Health Survey being conducted by YH, which included health behaviours and more detailed mental and social needs data, will next be integrated into the NBSSM to forecast the needs under each sub-segments to enable services planning for segment-specific interventions. &#x0D; Results: All 314,522 Yishun Zone residents were included for RoL segmentation, of which 53,653 residents known to YH were further sub-segmented by the NBSSM according to their biopsychosocial needs. CCI, healthcare utilisation (i.e. number of Emergency Department visits, Specialised Outpatient Clinic visits, admissions and annual bed-days), and annual total healthcare cost were found to be statistically different across the NBSSM segments (p&lt;0.05). Residents with presence of mental health and social issues had significantly higher risk of healthcare utilization and cost.&#x0D; &#x0D; Discussion &amp; Conclusion: Using only data that was readily available data in our electronic medical record system, the NBSSM was able to augment NHG RoL segmentation and effectively sub-segment the Yishun Zone resident population into mutually exclusive and collectively exhaustive groups with similar magnitude of risk of health needs and outcomes. &#x0D; NBSSM enables development of more targeted and aligned clinical governance and leadership of segment-specific interventions through clearer assignment of segment-specific accountability for population outcomes. Integrating comprehensive needs assessment data from the YH Population Health Survey will enable more coherent health system and services planning. &#x0D; In conclusion, needs-based segmentation models are more person-centred than disease-specified or utilization-only segmentation models. NBSSM enhances our health system’s system transformation and service planning capabilities to direct targeted interventions to meet needs and improve population health outcomes.&#x0D;

Clinical Features and Prognostic Factors in Multiple Myeloma Patients from Colombia. Real-World Data from Renehoc Registry

Background: The prognosis for patients with multiple myeloma (MM) has improved over time, but there is considerable heterogeneity in disease outcomes. Currently used risk models have been validated using data from patients in clinical trials, but their applicability to real-world populations may be limited. To provide clinicians with better tools for decision-making, it is essential to identify factors associated with overall survival (OS) in a local setting. This study aims to identify clinical factors associated with OS in a real-world cohort of Colombian patients with newly diagnosed multiple myeloma (NDMM) using data from the registry on hematologic diseases (RENEHOC). Methods: RENEHOC is an electronic healthcare record (EHR) system comprising data from 25 active centers in 6 Colombian cities as of July 2023. The study population was characterized using descriptive methodology. Two cohorts of patients were defined: Cohort A included patients who died within 5 years after diagnosis, and Cohort B included patients who were either alive or censored 5 years after diagnosis. Variables with a high proportion of missing information were evaluated in terms of magnitude and proportion. Univariate logistic regression was used to identify variables associated with OS, with those having a P value less than 0.2 considered for multivariate analysis. The results were presented as odds ratios (OR) with 95% confidence intervals (CI), and P values were calculated using the LR-test. Results: The analysis included 1579 patients with NDMM. The median age was 67 years (IQR 60-75), and 51.1% (n=808) of the patients were male. Most patients were insured through the contributory health system plan. At diagnosis, 36.9% (n=582) of patients had a bone fracture (n=425) and 26.9% (n=425) had renal insufficiency, with 9.8% requiring dialysis. Cytogenetic analysis was performed in 22.9% (n=361) of patients, and 24.1% (n=87) of them had high-risk features. Half of the patients were classified as ISS III at diagnosis. The median OS for the entire cohort was 98.4 months. According to the international staging system (ISS), OS varied significantly: 106.2 months for ISS I, and 79.1 and 63.1 months for ISS II and ISS III, respectively (p &amp;lt; 0.001). First-line treatment for 90% (n=1407) of patients included chemotherapy, with 70% of patients treated with Bortezomib-based triplets, with VCD (Bortezomib, Cyclophosphamide, and Dexamethasone) being the most frequently used of them (30.7%, n=486). Only 21.7% of patients were consolidated with autologous stem cell transplantation (ASCT) in the first line. Cohort A comprised 341 (21.6%) patients who died within 5 years after diagnosis. Univariate analysis showed a significantly higher proportion of patients ≥65 years, from the subsidized health plan, with renal insufficiency requiring dialysis, elevated B2-microglobulin levels at diagnosis, and who did not receive ASCT in this cohort. After multivariate logistic regression, four variables remained statistically significant predictors of OS: age ≥65 years, elevated B2-microglobulin levels, not receiving ASCT, and higher albumin values at diagnosis. These variables were associated with higher mortality risk, except for higher albumin values, which were associated with better survival (Table I). Conclusions: This study contributes to the growing body of evidence on multiple myeloma prognosis in the Colombian context. These findings provide valuable insights for clinicians in the local setting and may aid them in making informed decisions for individual patients. Nevertheless, future research and validation studies are warranted to confirm and build upon these findings.