Improve Health Care Delivery Systems Research Articles

Implementing Innovative Approaches to Improve Health Care Delivery Systems for Integrating Communicable and Non-Communicable Diseases Using Tuberculosis and Diabetes as a Model in Tanzania.

Background: Many evidence-based health interventions, particularly in low-income settings, have failed to deliver the expected impact. We designed an Adaptive Diseases Control Expert Programme in Tanzania (ADEPT) to address systemic challenges in health care delivery and examined the feasibility, acceptability and effectiveness of the model using tuberculosis (TB) and diabetes mellitus (DM) as a prototype. Methods: This was an effectiveness-implementation hybrid type-3 design that was implemented in Dar es Salaam, Iringa and Kilimanjaro regions. The strategy included a stepwise training approach with web-based platforms adapting the Gibbs' reflective cycle. Health facilities with TB services were supplemented with DM diagnostics, including glycated haemoglobin A1c (HbA1c). The clinical audit was deployed as a measure of fidelity. Retrospective and cross-sectional designs were used to assess the fidelity, acceptability and feasibility of the model. Results: From 2019-2021, the clinical audit showed that ADEPT intervention health facilities more often identified median 8 (IQR 6-19) individuals with dual TB and DM, compared with control health facilities, median of 1 (IQR 0-3) (p = 0.02). Likewise, the clinical utility of HbA1c on intervention sites was 63% (IQR:35-75%) in TB/DM individuals compared to none in the control sites at all levels, whereas other components of the standard of clinical management of patients with dual TB and DM did not significantly differ. The health facilities showed no difference in screening for additional comorbidities such as hypertension and malnutrition. The stepwise training enrolled a total of 46 nurse officers and medical doctors/specialists for web-based training and 40 (87%) attended the workshop. Thirty-one (67%), 18 nurse officers and 13 medical doctors/specialists, implemented the second step of training others and yielded a total of 519 additional front-line health care workers trained: 371 nurses and 148 clinicians. Overall, the ADEPT model was scored as feasible by metrics applied to both front-line health care providers and health facilities. Conclusions: It was feasible to use a stepwise training and clinical audit to support the integration of TB and DM management and it was largely acceptable and effective in differing regions within Tanzania. When adapted in the Tanzania health system context, the model will likely improve quality of services.

The future of health systems to 2030: a roadmap for global progress and sustainability.

Most research on health systems examines contemporary problems within one, or at most a few, countries. Breaking with this tradition, we present a series of case studies in a book written by key policymakers, scholars and experts, looking at health systems and their projected successes to 2030. Healthcare Systems: Future Predictions for Global Care includes chapters on 52 individual countries and five regions, covering a total of 152 countries. Synthesised, two key contributions are made in this compendium. First, five trends shaping the future healthcare landscape are analysed: sustainable health systems; the genomics revolution; emerging technologies; global demographics dynamics; and new models of care. Second, nine main themes arise from the chapters: integration of healthcare services; financing, economics and insurance; patient-based care and empowering the patient; universal healthcare; technology and information technology; aging populations; preventative care; accreditation, standards, and policy; and human development, education and training. These five trends and nine themes can be used as a blueprint for change. They can help strengthen the efforts of stakeholders interested in reform, ranging from international bodies such as the World Health Organization, the International Society for Quality in Health Care and the World Bank, through to national bodies such as health departments, quality and safety agencies, non-government organisations (NGO) and other groups with an interest in improving healthcare delivery systems. This compendium offers more than a glimpse into the future of healthcare-it provides a roadmap to help shape thinking about the next generation of caring systems, extrapolated over the next 15 years.

Modeling Physicianss Dynamic Behaviors in an Online Healthcare Community: An Empirical Study Using a Vector Autoregression Approach

Physicians’ participation in online healthcare platforms serves to integrate online healthcare resources with the offline medical system. This integration brings opportunities for reshaping healthcare delivery systems. Although, in the field of telemedicine, there has been extensive discussion about physician participation, little is known about how physicians actually participate in online healthcare platforms and offline medical systems. Understanding physicians’ participation dynamics between online and offline channels is of great importance to academic researchers, practitioners, and policymakers. Such an understanding can reveal insights into how healthcare is actually delivered to patients through both channels, how to contribute to quantifying the social impacts of online healthcare services, and how to improve healthcare delivery systems. Thus, in this study, we investigate physicians’ online-offline behavior dynamics. We collected data from both online and offline channels to conduct our analysis. As physicians’ online and offline activities are highly endogenous, we deploy a time-series technique and develop a structural vector autoregression (SVAR) model to examine such behavior dynamics. We find that physicians’ online activities can lead to a higher service quantity in offline channels, whereas offline activities may reduce physicians’ online services due to resource constraints. Our results also show that the more offline patients physicians serve, the more articles the physicians will likely share online. These findings are robust to various econometric specifications and estimation methods. Our paper contributes to the advocacy of Health 2.0 and provides evidence of the value of online healthcare communities and the policies that support them.

Risk factors for metastatic prostate cancer: A sentinel event case series.

Root cause analysis is a technique used to assess systems factors related to "sentinel events"-serious adverse events within healthcare systems. This technique is commonly used to identify factors, which allowed these adverse events to occur, to target areas for improvement and to improve health care delivery systems. We sought to apply this technique to men presenting with metastatic prostate cancer (PCa). We performed an in-depth case series analysis of 15 patients, who presented with metastatic disease at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center using root cause analysis to refine a list of health system factors that lead to late stage presentation in the current era. Key factors in late diagnosis of PCa included lack of insurance, lack of routine PSA testing, comorbidities, reticence of patients to follow up actionable PSA, and aggressive disease. Three patients had aggressive disease that would not have been discovered at an early stage in the disease process, despite routine screening. However, analysis of the remaining 12 patients illuminated health system factors led to missing important diagnostic information, which might have led to diagnosis of PCa at a curable stage. The cases help highlight the need for systems based approaches to early diagnosis of PCa. A heterogeneous group of barriers to early diagnosis were identified in our series of patients including economic, health systems, and cultural factors. These findings underscore the need for individualized approaches to preventing delayed diagnosis of PCa. While limited by our single-institution scope, this approach provides a model for research and quality improvement initiatives to identify modifiable systems factors impeding appropriate diagnoses of PCa.

Assessment of patient's satisfaction regarding the service quality of a rural hospital of Burdwan district, West Bengal, India

Background: Patients satisfaction is the basis of quality healthcare services. To improve quality of healthcare it is most important to obtain feedback from patients. Patients’ satisfaction or service quality mostly depends on patients’ expectation. This study was conducted to identify some important areas where improvement can be done by knowing patients expectation, perception and their gaps. Methods: A cross-sectional study was conducted among patients aged >18 years. Total 350 patients from OPD by consecutive sampling and 309 patients from IPD by complete enumeration was taken from a rural hospital of Burdwan district. A modified form of SERVQUAL questionnaires was used. Results: Service quality gaps were identified across all the five dimensions as well as all the 22 items of the survey instrument (except one item). All those gaps were statistically significant (Except two items). It was identified that highest service quality gap exist against the item no. 8 (Provide its services at the time) for OPD and item no. 20 (Readiness for personal attention) for IPD services. Conclusions: This study measured service quality of a hospital in the context of patients’ perceptions and expectations and identified some areas of improvement while catering health services. The findings can help the healthcare provider to plan conceptually in improving health care delivery systems.

A collaborative case study: The Office of Native Medicine.

National concerns about reducing the persistent health disparities found among varying racial and ethnic populations have led to initiatives to improve health care delivery systems. Many of these initiatives also promote the cultural competence of health care providers as a way to meet unique patient needs that go beyond immediate health problems, and to account for other critical components of patient care, such as health literacy, health beliefs and behaviors, and cultural practices. This case study describes a patient-centered care model developed by the Chinle Comprehensive Health Care Facility on the Navajo Reservation in Arizona, a model that has added a cadre of traditional tribal practitioners as part of its hospital and other clinical service resources.

Can Simulation and Human Factors Improve Systems and Safety?

Program Description: Our expertise and skill are essential, but not sufficient, for optimal patient outcomes. We work with teams and we work within systems with variable functionality. How can we make sure our team works together effectively? How can we improve the systems within which we work? An expert panel will describe how we can use simulation and the science of human factors to improve the processes, the equipment, and even the spaces in which we work. Examples address emergency response teams, airway carts, and electronic health records. Our keynote speaker, F. Jacob Seagull, PhD, is an expert in human factors applications in health care. Educational Objectives: (1) Understand how simulation can be used to improve health care delivery systems and safety. (2) Understand how human factors principles can be applied to improve health care delivery systems and safety.

Case study

Objective To emphasize the added value of 3-dimensional (3D) in the prenatal assessment of agenesis of the corpus callosum (ACC). Methods Volume data sets of the brain of a fetus with ACC, as suspected previously by 2D-US, were stored. A retrospective offline analysis of the stored volume was performed. Results From the stored volume, complete ACC was diagnosed, and it was confirmed by a postnatal computed tomographic scan. Conclusion A combination of 2Dand 3D-US has considerable advantage over 2D-US in the diagnosis of fetal ACC. 3D-US provides an invaluable tool for the prenatal diagnosis and management of ACC, and its offline networking capabilities may improve healthcare delivery systems by extending the benefits of prenatal diagnosis of cerebral malformations to poorly served areas where an MRI is not available.

Development and Preliminary Validation of the Patient Perceptions of Integrated Care Survey

Valid measures of the integration of patient care could provide rapid and accurate feedback on the successfulness of current efforts to improve health care delivery systems. This article describes the development and pilot testing of a new survey, based on a novel conceptual model, which measures the integration of patient care as experienced by patients. We administered the survey to 1,289 patients with multiple chronic conditions from one health system and received responses from 527 patients (43%). Psychometric analysis of responses supported a six-dimension model of integration with satisfactory internal consistency, discriminant validity, and goodness of fit. The Patient Perceptions of Integrated Care survey can be used to measure the integration of care received by chronically ill patients for two main purposes: as a research tool to compare interventions intended to improve the integration of care and as a quality improvement tool intended to guide the refinement of delivery system innovations.

Health care services quality at private hospitals, from patients’ perspective: A comparative study between Jordan and Saudi Arabia

The purpose of this study was to compare health care services quality of private hospitals in Jordan and Saudi Arabia. The data for the study was collected through a questionnaire comprising 28 items mainly related to tangible, reliability, responsiveness, assurance, empathy and accessibility. The instrument was validated through pilot testing, Pearson correlation analysis, and using exploratory factor analysis. The internal consistency of the instrument was found to be 0.75. A sample of 606 respondents completed the questionnaire, 327 from the private hospitals in Jordan and 279 from the private hospitals in Saudi Arabia that were selected randomly from six private hospitals. The collected data were analyzed by applying descriptive and inferential statistical techniques such as means and independent sample t-tests. The results obtained show that there was a significant difference in health care services quality between Jordan and Saudi Arabia. Tangibles and accessibility were better in the Saudi Arabia’s private hospitals. However, tangibles were found better in the private hospitals in Jordan. Recommendations were made for the health care providers and administrators to improve health care delivery systems. Continuous monitoring of patient perceptions to improve the quality of health care and patient satisfaction for the overall quality evaluations from patients on the private hospital services is recommended. Key words: Health care quality, private hospital, Jordan, Saudi Arabia.

Advancing Primary Care in France and the United States

Primary care has been identified as key to improving health care delivery systems across the globe. France and the United States have been ranked low on scales of primary care orientation. However, each nation has developed significant approaches to structuring primary care and organizing primary care-focused systems. This article reviews those efforts and finds that both nations face similar barriers to implementing many primary care initiatives.

Leadership: a central tenet for postgraduate dementia services curricula development in Australia

In the next decades of the twenty-first century, the global aging of populations will challenge every nation's ability to provide leadership by qualified health professionals to reshape and improve health care delivery systems. The challenge for educators is to design and deliver courses that will give students the knowledge and skills they need to fill that leadership role confidently in dementia care services. This paper explores the ways in which a curriculum can develop graduates who are ready to become leaders in shaping their industry. The Master of Health Science-Aged Services (MHSAS) program at Victoria University, Melbourne, Australia is applied as a case study to describe the process by which the concept of leadership is applied as the key driver in curriculum development, teaching practices and learning outcomes. Evaluation instruments employed in a variety of purposes including teaching, curriculum planning and unit appraisal are discussed. Challenges for the future are proposed including the need for postgraduate programs in dementia to seek stronger national and international benchmarks and associations with other educational institutions to promote leadership and a vision of what is possible and desirable in dementia care provision. In the twenty-first century, effective service provision in the aged health care sector will require postgraduate curricula that equip students for dementia care leadership. The MHSAS program provides an established template for such curricula.

Priorities and Strategies for the Implementation of Integrated Informatics and Communications Technology to Improve Evidence-Based Practice

The U.S. health care system is one of the world's most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.

Priorities and strategies for the implementation of integrated informatics and communications technology to improve evidence-based practice

The U.S. health care system is one of the world’s most advanced systems. Yet, the health care system suffers from unexplained practice variations, major gaps between evidence and practice, and suboptimal quality. Although information processing, communication, and management are key to health care delivery and considerable evidence links information/communication technology (IT) to improvements in patient safety and quality of care, the health care system has a longstanding gap in its investment. In the Crossing the Quality Chasm and Building a Better Delivery System reports, The Institute of Medicine and National Academy of Engineering identified IT integration as critical to improving health care delivery systems. This paper reviews the state of IT use in the U.S. health care system, its role in facilitating evidence-based practices, and identifies key attributes of an ideal IT infrastructure and issues surrounding IT implementation. We also examine structural, financial, policy-related, cultural, and organizational barriers to IT implementation for evidence-based practice and strategies to overcome them.