Levels Of Health System Research Articles

Challenge of Absenteeism of Public Healthcare Center Workers in the Rural Area: A Study on Sylhet District, Bangladesh

Absenteeism has been linked to ineffective healthcare delivery in several studies. This research looks at absenteeism in Bangladesh's public healthcare centers (PHCs), a health system level recognized as vulnerable to absenteeism. Front-line health workers, administrators, service consumers, and health propensity committee chairpersons were interviewed in detail and participated in focus groups. Absenteeism was shown to be quite common among healthcare employees, and it is a big problem in PHCs in rural areas when lateness is included. Absenteeism influences the pair service consumers and associates, although it is not necessarily intentional. Even though there are measures to prevent absenteeism in PHCs, our results reveal that they are readily evaded and ineffectual due to utilization and formative difficulties. The Anti-Corruption Evidence (ACE) strategy, which aims to include and improve the stimulations of significant players in the system to support efficiency-renovating measures and, in turn, ensure efficient service delivery, might be relevant in this case. In this research, we evaluate the patient satisfaction and the quality of services at PHCs, and the effect of a lack of health workers in Bangladesh's rural public healthcare centers (PHCs).

Understanding Barriers and Facilitators of Pre-exposure Prophylaxis (PrEP) Among Transgender and Gender Diverse Adults in an Integrated Health Care System.

Transgender and gender diverse individuals face health disparities such as higher HIV prevalence, but limited studies have found low PrEP uptake among these populations. To understand both patient and provider perspectives regarding PrEP care for transgender and gender diverse individuals, we conducted a mixed-methods study at Kaiser Permanente Southern California from September 2020 to October 2021. Transgender and gender diverse adults (N = 396) participated in a web-based survey, and qualitative interviews were subsequently conducted with a subset of survey respondents (N = 32) and healthcare providers (N = 8). Among survey respondents, > 75% were familiar with PrEP, and > 40% reported at least one HIV risk factor, but < 5% had taken PrEP. Interview themes included increasing providers' inclusivity in primary care for transgender and gender diverse patients, and reducing logistical barriers and costs associated with PrEP-related visits. To improve PrEP uptake among transgender and gender diverse individuals, barriers across patient, provider, and health system levels must be addressed.

Optimizing the Use of Operating Rooms by Transitioning Common Hand Surgeries Into the Office Setting

The purpose of this study was to examine the true monetary implications, at the health system level, of moving simple hand procedures, performed with wide-awake local anesthesia no tourniquet surgery, from the ambulatory surgery center (ASC) to office setting. We analyzed the costs, revenues, case times, and patient demographics for 2 cohorts of patients who underwent hand and non-hand surgical procedures over a 2-year period. We calculated the mean margin per minute for the top 5 procedures in non-hand orthopedic surgery subgroups, complex plastics hand, and non-hand plastic surgery. We then calculated the following: (1) hours operating room or ASC time gained by moving hand procedures to the office, (2) additional subgroup patients theoretically treated by using the ASC hours gained, and (3) net margin (in dollars) because of additional procedures. Six board-certified hand surgeons performed 623 simple ASC and 808 in-office procedures, consisting of 795 carpal tunnel releases, 84 first dorsal compartment releases, and 446 trigger finger releases. The net margin per minute for simple ASC and in-office hand procedures was $25.01/min and $5.63/min, respectively. In the office setting, hand surgery freed up 821 hours of ASC time, which could be theoretically used to treat over 300 additional patients awaiting outpatient orthopedic hand or plastic surgery. Depending on the subspecialty and type of substituted cases, the theoretical net margin varied from-$150,413 to $3.9 million. Transitioning simple hand operations out of ASCs realized a mean cost savings of 82% per case ($1,137 vs $206) and effectively opened 821 additional hours of operating room time over a 2-year period. Transitioning simple hand operations out of the operating room setting and into the office setting reduces the cost of hand surgical care, improves operating room access for alternate procedures or patients, and validates the sustainability of safe and effective wide-awake local anesthesia no tourniquet surgery from a hospital system's financial standpoint.

Determinants Factors in Predicting Life Expectancy Using Machine Learning

Introduction. Life expectancy is, by definition, the average number of years a person can expect to live from birth to death. It is therefore the best indicator for assessing the health of human beings, but also a comprehensive index for assessing the level of economic development, education and health systems . From our extensive research, we have found that most existing studies contain qualitative analyses of one or a few factors. There is a lack of quantitative analyses of multiple factors, which leads to a situation where the predominant factor influencing life expectancy cannot be identified with precision. However, with the existence of various conditions and complications witnessed in society today, several factors need to be taken into consideration to predict life expectancy. Therefore, various machine learning models have been developed to predict life expectancy. The aim of this article is to identify the factors that determine life expectancy. Materials and Methods. Our research uses the Pearson correlation coefficient to assess correlations between indicators, and we use multiple linear regression models, Ridge regression, and Lasso regression to measure the impact of each indicator on life expectancy . For model selection, the Akaike information criterion, the coefficient of variation and the mean square error were used. R2 and the mean square error were used. Results. Based on these criteria, multiple linear regression was selected for the development of the life expectancy prediction model, as this model obtained the smallest Akaike information criterion of 6109.07, an adjusted coefficient of 85 % and an RMSE of 3.85. Conclusion and Discussion. At the end of our study, we concluded that the variables that best explain life expectancy are adult mortality, infant mortality, percentage of expenditure, measles, under-five mortality, polio, total expenditure, diphtheria, HIV / AIDS, GDP, longevity of 1.19 years, resource composition, and schooling. The results of this analysis can be used by the World Health Organization and the health sectors to improve society.

Seeking Racial Equity in Hematology and Oncology: a Fellow-Led Educational Series to Promote Reflection and Action.

The USA is experiencing a reckoning with racial injustice and graduate medical education programs are seeking ways to address this important topic in training. Fellows in hematology/oncology at the University of North Carolina recognized this important gap and adapted a curriculum for medical residents on racial equity to a subspecialty audience. Aims were (1) to improve knowledge and awareness about implicit bias and systemic racism and (2) introduce methods to address racial inequities. We used lived experiences and collated materials from scientific literature and lay media to illustrate key points. The course explored the effects of implicit bias on individual, clinical, and health system levels, anchored in Kahneman's two-system theory. Videos, journal articles, and group discussion were employed to appeal to many learning styles. A post-curriculum survey assessed perceptions of racial inequality in medicine and the series' effects using a Likert scale. Twenty-nine participants completed the survey (12 fellows), 71% reported improved awareness of racial inequities, and 61% reported improved comfort level in addressing racial inequities. All participants recognized at least "some" racial inequity in medicine, and over 75% of participants indicated interest in further sessions. Formulation of an educational curriculum by fellows and delivered in a division-wide setting was feasible and well received by participants, filling a key educational gap. We encourage other institutions to take similar steps to highlight issues of systemic racism and move our field in the right direction.

Massive Gastrointestinal Bleeding as a clinical manifestation of Miliary Tuberculosis

Tuberculosis is still a public health problem today and can have acute and chronic manifestations challenging clinics for various medical specialties. Because it’s a disease of multisystem potential, it is often overlooked when outside the respiratory clinical context. As a result, a clinical case report was carried out at the Hospital de Clínicas de Porto Alegre, in 2020, of a patient with voluminous gastrointestinal bleeding as severe acute clinical manifestation of Miliary and Intestinal Tuberculosis. Due to the potential severity of undiagnosed and untreated tuberculosis, high suspicion is suggested at all levels of health systems (whether public or private) with a view to early diagnosis, treatment and prevention of complications resulting from the disease.

Emergency obstetric referrals in public health facilities: A descriptive study from urban Maharashtra, India.

An effective referral system is key to access timely emergency obstetric care. The criticality of referrals makes it necessary to understand its pattern at the health system level. This study aims to document the patterns and primary reasons of obstetric case referral and the maternal and perinatal outcome of the cases in public health institutions in select areas of urban Maharashtra, India. The study is based on the health records of public health facilities in Mumbai and its adjoining three municipal corporations. The information on pregnant women referred for obstetric emergencies was collected from patient referral forms of municipal maternity homes and peripheral health facilities between 2016 and 2019. Maternal and child outcome data was obtained from "Received-In" peripheral and tertiary health facilities to track whether the referred woman reached the referral facility for delivery. Descriptive statistics were used to analyze demographic details, referral patterns, reasons of referrals, referral communication and documentation, time and mode of transfer and delivery outcomes. 14% (28,020) women were referred to higher health facilities. The most common reasons for referral were pregnancy-induced hypertension or eclampsia (17%), previous caesarean section (12%), fetal distress (11%) and Oligohydramnios (11%). 19% of all referrals were entirely due to unavailability of human resources or health infrastructure. Non-availability of emergency Operation Theatre (47%) and Neonatal Intensive Care Unit (45%) were the major non-medical reasons for referrals. Absence of health personnel such as anaesthetist (24%), paediatrician (22%), physician (20%) or obstetrician (12%) was another non-medical reason for referrals. Referring facility had a phone-based communication about the referral with the receiving facility in less than half of the cases (47%). 60% of the referred women could be tracked in higher health facilities. Of the tracked cases, 45% women delivered via caesarean section. Most of the deliveries (96%) resulted in live birth outcomes. 34% of the newborns weighed less than 2,500 grams. Improving referral processes are critical to enhance the overall performance of emergency obstetric care. Our findings emphasize the need for a formal communication and feedback system between referring and receiving facilities. Simultaneously, ensuring EmOC at different levels of health facilities by upgradation of health infrastructure is recommended.

Integrated Short-term Palliative Rehabilitation to improve quality of life and equitable care access in incurable cancer (INSPIRE): a multinational European research project.

Disability related to incurable cancer affects over a million Europeans each year and people with cancer rank loss of function among the most common unmet supportive care needs. To test the clinical and cost-effectiveness of an integrated short-term palliative rehabilitation intervention, to optimise function and quality of life in people affected by incurable cancer. This is a multinational, parallel group, randomised, controlled, assessor blind, superiority trial. The INSPIRE consortium brings together leaders in palliative care, oncology and rehabilitation from partner organisations across Europe, with complementary expertise in health service research, trials of complex interventions, mixed-method evaluations, statistics and economics. Partnership with leading European civil society organisations ensures citizen engagement and dissemination at the highest level. We will conduct a multinational randomised controlled trial across five European countries, recruiting participants to assess the effectiveness of palliative rehabilitation for people with incurable cancer on the primary outcome - quality of life - and secondary outcomes including disability, symptom burden and goal attainment. To support trial conduct and enhance analysis of trial data, we will also conduct: comparative analysis of current integration of rehabilitation across oncology and palliative care services; mixed-method evaluations of equity and inclusivity, processes and implementation for the intervention, at patient, health service and health system levels. Finally, we will conduct an evidence synthesis, incorporating INSPIRE findings, and a Delphi consensus to develop an international framework for palliative rehabilitation practice and policy, incorporating indicators, core interventions, outcomes and integration methods. If positive, the trial could produce a scalable and equitable intervention to improve function and quality of life in people with incurable cancer and reduce the burden of care for their families. It could also upskill the practitioners involved and motivate future research questions. The intervention could be adapted and integrated into different health systems using existing staff and services, with little or no additional cost.

Facilitators of improving the function of nongovernmental organizations (NGOs) in Iran's health system.

Iranian health nongovernmental organizations (NGOs) could play a variety of roles at many levels of Iran's health system, but their participation in the health sector is far from ideal. Therefore, this study was conducted to identify practical solutions for increasing the role and function of NGOs in the Iranian health system. This qualitative study was conducted between 2020 and 2021 in Tehran, Iran. The data for this study were gathered through 32 in-depth semi-structured interviews with 11 managers from the Ministry of Health as well as from Iran and Tehran universities of medical sciences and 21 Chief executive officers and directors of health NGOs. Data were analyzed by the content analysis approach using the MAXQDA 10 software. The facilitators for expanding the function and roles of NGOs in Iran's health system are classified into two groups of legal and structural mechanisms. "The existence of mandatory laws," "government support for NGOs," "the formulation of standard strategic planning and goals," "the establishment of a database and a network of NGOs," and "the establishment of independent organizational units as the connectors and coordinators of NGOs' affairs in the public sector" are the critical facilitators for the improvement of NGOs' roles in Iran's health system. According to the findings of this study, only limited measures and efforts have been made to improve NGOs' roles and participation in the Iranian health system; at the same time, NGOs' participation in the health sector is far from ideal. Iranian health NGOs are at the beginning of this route, and they would inevitably require various legislative and structural mechanisms to succeed.

Processo de trabalho para coordenação do cuidado na Estratégia de Saúde da Família

Abstract Objective To understand the work process of Family Health Strategy teams in the coordination of care, highlighting factors involved in this coordination. Method Qualitative study based on the attributes of care coordination, carried out with 18 care and management professionals between January and March 2020. Results Three final themes emerged: “Care plan”; “Standardization of practices”; and “Dialogical communication at different levels of care”. The pattern of responses points to the fragmentation of care and weakens coordination mechanisms. The exposure of restrictive factors related to the meso- and macro-organizational levels of the municipal health system reverberates in the ability of teams to coordinate care. Conclusion and implications for practice The coordination of care faces obstacles related to the work process of teams and structural issues in the organization of the health network. The contributions go beyond care and management, reaching education, research, and extension in professional training. Permanent education enables reorientations to guarantee the flow of users in the care network and provide comprehensive care to the population.

A Brief History of Public Health Informatics-Lessons for Leaders and a Look Into the Future.

A Brief History of Public Health Informatics-Lessons for Leaders and a Look Into the Future.

Enhancing healthcare services in an orthopaedic department utilising a system dynamics and participatory action research perspective to optimise patient flow

BACKGROUND: The high burden of trauma in Durban results in longer elective surgery waiting periods, which exacerbates the in-patient hospital days and increases the average length of stay. Quantitative analyses of the data clearly demonstrate a growing list of elective patients awaiting surgery while the rate of acute trauma admissions continues to escalate. It has been demonstrated that interactions of patients between the various stages of care should be carefully studied in order for policymakers to identify limiting factors and leverage points Many public health interventions run aground and fail to actualise their initial objectives since the system is deconstructed and reduced to simplified autonomous components. A restorative undertaking to remedy this syndrome is to reconstitute the normative conventions of framing, mapping out and scrutinising deficiencies within healthcare systems. This paper explores a model of total patient flow through the orthopaedic service to test alternative major new structural options for relieving pressure on health services. METHODS: Qualitative data was collected using purposeful sampling to conduct 20 semi-structured interviews as well as including discourse analysis and ethnographic research. Participatory action research (PAR) was the main epistemological method driving the study under the auspices of a system dynamics framework RESULTS: Areas of potential improvements have been identified which can ameliorate the flow of patients between the different departments together with the challenges and uncertainties that are present in achieving this CONCLUSION: Efficient patient flow management is a cornerstone in optimising healthcare services; the failure of such a system burdens the entire health system Level of evidence: Level 5

Exploring Bias in Restraint Use: Four Strategies to Mitigate Bias in Care of the Agitated Patient in the Emergency Department.

Agitation is a routine and increasingly common presentation to the emergency department (ED). In the wake of a national examination into racism and police use of force, this article aims to extend that reflection into emergency medicine in the management of patients presenting with acute agitation. Through an overview of ethicolegal considerations in restraint use and current literature on implicit bias in medicine, this article provides a discussion on how bias may impact care of the agitated patient. Concrete strategies are offered at an individual, institutional, and health system level to help mitigate bias and improve care. Reprinted from Acad Emerg Med 2021; 28:1061-1066, with permission from John Wiley & Sons. Copyright © 2021.

The Need for a Smoking Cessation “Care Package”

This Viewpoint from leadership at the US Food and Drug Administration (FDA) proposes the creation of a comprehensive “care package” framework of resources to help maximize cessation of tobacco use, including components focused on strategies at the individual, health system, and population levels.

Health Systems and Their Impact on Improving Health Services: A Simple Review

Introduction: The past decade has witnessed a renaissance of interest in health systems in academic discourse and policy dialogue, specially within the development community. It has been well known that level of health system affects the general health and outcome of the patients. The World Health Organization has described health systems as the totality of the individuals, organizations, and assets positioned together to uphold and enhance the health of the population they serve. Good health services are those which deliver effective, safe, high-quality interventions for both personal and non-personal health are provided when and when they are needed, with the least amount of resource waste. So, improving the health system including improving in all of this items. This study aims to evaluate the impact of health system level and health system development on improving health services.&#x0D; Conclusion: In conclusion, health system and health care levels depending on good management, planning, recording and behavior. All the workers should be highly trained and professional and updated to the recent ways in recording data and interacting with equipment and individuals to be able to sustain a developed recording system which makes it easier to get higher levels of safety and satisfactory outcomes with patients. Improving the health system is a continuous necessary needs updating to improve health services in general and patients’ health in particular.

The “Family Health = Family Wealth” intervention: study protocol for a pilot quasi-experimental controlled trial of a multi-level, community-based family planning intervention for couples in rural Uganda

BackgroundUganda has one of the highest fertility rates globally, but only 30% of women report using an effective method of contraception. Community-based, multi-level interventions are needed to help couples in rural Uganda overcome barriers to contraceptive use.MethodsThis study will pilot test the Family Health = Family Wealth intervention, a multi-level, community-based intervention employing transformative community dialogues, which use facilitated discussion to reshape community norms that influence family planning acceptance, to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4 sessions (two gender-segregated and two gender-mixed). Sessions simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services. At the health system level, a refresher training will be conducted with health workers in the intervention community’s health center to address gaps in contraceptive knowledge and skills as identified from a needs assessment.The intervention will be evaluated through a pilot quasi-experimental trial paired with a mixed methods process evaluation. Participants include 70 couples (N=140) randomized by community to the Family Health = Family Wealth intervention (n=35 couples) or to an attention-matched water, sanitation, and hygiene (WASH) intervention (n=35 couples). Participants include sexually active, married couples who are age 18 (or an emancipated minor) to 40 for women and age 18 (or an emancipated minor) to 50 for men, not pregnant, at least one person in the couple reports wanting to avoid pregnancy for at least a year, and not currently using a method of contraception or using a low-efficacy or ineffective method of contraception. The primary aims of the study are to (1) assess the feasibility of the intervention trial procedures, (2) the acceptability and feasibility of the intervention content and structure, and (3) explore the intervention’s preliminary effectiveness at increasing contraceptive use and affecting related outcomes among couples.DiscussionFilling the unmet need for family planning has important public health implications, including reductions in pregnancy-related health risks and deaths, and infant mortality. This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel, multi-level, community-based intervention to increase contraceptive use among couples with an unmet need for family planning in rural Uganda. We aim to use the findings of this pilot study to refine the trial procedures and intervention content for a future, larger cluster randomized controlled trial to establish the intervention’s efficacy.Trial registrationClinicalTrials.gov NCT04262882; registered on February 10, 2020.

A conceptual model of health insurance stability in the United States health care system.

In the U.S. health care system, people under age 65 are at risk of losing and regaining health insurance coverage over their lifetimes, which has important consequences for their physical and mental health. Despite the importance of insurance stability, we have an incomplete understanding about the complex factors influencing whether people lose and regain coverage. To advance our understanding of the dynamics of health insurance coverage and guide future research, our purpose is to present a new conceptual model of health insurance stability, where instability is defined as a person's loss or change of coverage, which can occur more than once in a lifetime. Drawing from theory and evidence in the literature, we posit that personal and plan characteristics, the health system, and the environmental context - economic, social/cultural, political/judicial, and geographic - drive health insurance stability over the life course and are understudied. Studies are needed to identify the populations most at risk of experiencing insurance instability and vulnerability in health outcomes that results from such insecurity, which may suggest reforms and health policies at the individual, health system, or environment levels to reduce those risks.

Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement

Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement

System and policy-level barriers and facilitators for timely and accurate diagnosis of young onset dementia.

The multiyear diagnostic journey for young onset dementia (YOD) is fraught with clinical and personal difficulties and poses significant uncertainty for people living with YOD and their families. Most existing research has examined the personal and/or clinical barriers to a timely diagnosis of YOD, but less evidence exists regarding system level factors. The aim of this study is to investigate health professionals' insights for a timely and accurate YOD diagnosis at the system level. Grounded theory qualitative study. Semi-structured in-depth interviews with 11 health professionals working across varied healthcare settings were conducted online via videoconference. Data were contrasted and compared within and between transcripts using the constant comparative method. Seven themes emerged about barriers and facilitators for timely and accurate diagnosis of YOD: (1) stigma and awareness of YOD; (2) mismatched policy; (3) fractured health system; (4) inadequate pathways for YOD diagnostic care; (5) effective use of General Practitioners; (6) inequitable access and fragmented service navigation; (7) diverse and marginalised groups. A complex web of systemic and system level barriers contributes to the delay of accurate and timely diagnosis for YOD. Diverse and marginalised groups experience greater inequitable disadvantage regarding YOD diagnostic care. There is an urgent need to focus on YOD diagnosis facilitators at the broader health system level.

Scaling up community-delivered mental health support and care: A landscape analysis.

The mental health crisis has caused widespread suffering and has been further exacerbated by the COVID-19 pandemic. Marginalized groups are especially affected, with many concerns rooted in social determinants of mental health. To stem this tide of suffering, consideration of approaches outside the traditional biomedical model will be necessary. Drawing from task-sharing models of mental health care that have been pioneered in low-resource settings, community-initiated care (CIC) represents a potentially promising collection of approaches. This landscape analysis seeks to identify examples of CIC that have been implemented outside of the research context, with the aim of identifying barriers and facilitators of scale up. A narrative review approach was used for this landscape analysis in which the PubMed database was searched and further supplemented with Google Scholar. Promising programs were then discussed over multiple rounds of meetings with the research team, consisting of collaborators with varied experiences in mental health. Using the selection criteria and feedback derived from group meetings, a final list of programs was identified and summarized according to common characteristics and features. The initial PubMed search yielded 16 results, supplemented by review of the first 100 entries in Google Scholar. Through 5 follow-up meetings among team members, consensus was reached on a final list of 9 programs, which were grouped into three categories based on similar themes and topics: (1) approaches for the delivery of psychosocial interventions; (2) public health and integrative approaches to mental health; and (3) approaches for addressing youth mental health. Key facilitators to scale up included the importance of sustainable financing and human resources, addressing social determinants and stigma, engaging diverse stakeholders, leveraging existing health infrastructure, using sustainable training models, ensuring cultural relevance and appropriateness, and leveraging digital technologies. This landscape analysis, though not an exhaustive summary of the literature, describes promising examples of efforts to scale up CIC outside of the research context. Going forward, it will be necessary to mobilize stakeholders at the community, health system, and government levels to effectively promote CIC.