Improve Population Health Outcomes Research Articles

Colorectal cancer prevention inCentral, Eastern European andSouth Caucasus countries: areview of policy approaches.

This study aims to examine the availability and comprehensiveness of policies pertaining to colorectal cancer (CRC) in Central, Eastern European and South Caucasus countries, as it is a major public health concern in these regions and the second most common cause of cancer deaths among women. We performed a scoping review using the Arksey and O'Malley methodology, searching for publicly available policy documents from 18 countries. We described the prevention methods and activities in each country based on the World Health Organization guidelines for CRC screening. Our research found that most countries had at least five policies related to CRC prevention, which most commonly included primary, secondary and tertiary prevention measures. Elements such as promoting healthy lifestyle choices and implementing screening methods such as fecal occult blood tests, fecal immunochemical tests or colonoscopy were frequently mentioned in these policies. However, target age ranges varied among countries. Our analysis revealed a pressing need to increase the availability and utilization of CRC screening in these countries. One of the main limitations of this study is that it is a desk review conducted using internet-based resources, which may have missed important sources or recent policy documents that are not yet available online. Despite our efforts to include all relevant policies, it is possible that we overlooked other policies that contain relevant information, such as those that cover cancer treatment methods. Additionally, our search excluded primary healthcare and universal healthcare coverage policies, which could include important information on CRC prevention and control activities. Additionally, as a scoping review approach was used, no critical assessment of the included studies or literature was conducted. Furthermore, due to the limited number of countries included, the comparability of the findings is limited. In future research, it would be beneficial to expand the study and collect new data from decision-makers and stakeholders to further investigate these hypotheses. It is also important to note that the presence of a policy document is not the end goal, as it is simply a step toward better outcomes. In summary, our research highlights the need for improved and unified efforts toward preventing and detecting CRC in Central, Eastern European and South Caucasus countries. This knowledge can be used to focus efforts on developing a standardized policy document and national screening program that can be adapted to meet the unique needs of each country. The importance of CRC screening, regardless of need, must be emphasized in order to aid in the transition from curative to preventive cancer care. Our study highlights the need for more detailed and science-based policies for CRC prevention and screening in Central, Eastern European and South Caucasus countries. While many countries have policies in place, they often lack key components and do not fully reflect current evidence-based guidelines. To improve population health outcomes, further research is needed to understand the implementation and enforcement of these policies as well as their impact on cancer incidence and survival. As the screening landscape evolves, countries may learn from each other and a better understanding of the complex policy frameworks that impact CRC screening is needed so that countries can update and tailor policy documents to their specific situations. In conclusion, policymakers in Central, Eastern European and South Caucasus countries have implemented various policy approaches to prevent and control the CRC. The effectiveness of these approaches varies across countries and depends on several factors, including the availability of resources, the level of public awareness and the political will to implement effective policies. Further research is needed to determine the most effective policy approaches for CRC prevention in these regions and to ensure that the right policies are in place to reduce the incidence and impact of this disease. The study aimed to identify gaps in existing research and areas for future work by mapping, categorizing and organizing existing evidence on CRC policies in Central, Eastern European and South Caucasus countries. Additional research is necessary to understand the implementation and enforcement of these policies and how they impact health outcomes such as cancer incidence and survival. CRC policy is heterogeneous in Central and Eastern Europe and the South Caucasus region.There are particularly important differences regarding the implementation of CRC screening.Cancer screening and palliative care approaches were less frequently included.Variations exist in the comprehensiveness of policy by prevention level and country.

The Effect of Interprofessional Education on Student Readiness for Collaborative Practice.

Health care reform promotes interprofessional patient-centric health care models associated with improved population health outcomes. Interprofessional education (IPE) programs are necessary to cultivate collaborative care, yet little evidence exists to support IPE pedagogy within nursing and other health science academia. This quasiexperimental study examined differences in pre- and posttest Readiness for Interprofessional Learning Scale (RIPLS) scores following an IPE intervention. The IPE intervention consisted of a video presentation and a debriefing session after a simulated interprofessional collaborative patient care conference that introduced baccalaureate nursing and health science students to the roles and responsibilities of clinicians in team-based primary care. Pre- and postintervention RIPLS scores were analyzed. Pre- and postintervention RIPLS scores increased across all subscales, with distinct variation between nursing and health science student subscales. This IPE intervention had positive effects on students' readiness for interprofessional learning. Additional research is warranted to support health science pedagogy. [J Nurs Educ. 2024;63(5):304-311.].

Cost-effectiveness of population-based screening for chronic obstructive pulmonary disease in China: a simulation modeling study

China has the highest disease burden of chronic obstructive pulmonary disease (COPD) in the world; however, the diagnosis rate remains low. Screening for COPD in the population may improve early diagnosis and long-term health outcomes for patients with COPD. In this study, we aimed to evaluate the cost-effectiveness of population-based COPD screening policies in China. We developed a microsimulation model that simulated incidence, natural history, and clinical management of COPD over a lifetime horizon among the general population aged 35-80 years in China. We evaluated population-based screening policies with different screening methods (one-step with COPD Screening Questionnaire or two-step with additional portable spirometer test) and frequencies (one-time or every 1-10 years). We calculated the incremental cost-effectiveness ratio (ICER) of the screening policies compared with the status quo (without screening) and identified the most cost-effective screening policy. Scenario and sensitivity analyses were performed to assess the impact of key parameters and the robustness of model results. Compared with the status quo, all population-based COPD screening policies were cost-effective with estimated ICERs ranging between $8034 and $13,209 per quality-adjusted-life-year (QALY), all under the willingness-to-pay value of $38,441/QALY (three times China's gross domestic product per capita). A total of 0.39%-8.10% of COPD-related deaths and 0.58%-2.70% of COPD exacerbations were projected to be averted by COPD screening. Among all screening policies, annual two-step screening was the most cost-effective. Improving the linkage from screening to diagnosis and treatment could further increase population health benefits and the cost-effectiveness of COPD screening. Population-based screening for COPD could be cost-effective in China. Offering public programs for COPD screening similar to existing preventive health services for other chronic diseases could be a promising strategy to improve population health outcomes and mitigate the disease burden of COPD in China. Alexander von Humboldt Foundation, National Natural Science Foundation of China, CAMS Innovation Fund for Medical Science, Chinese Academy of Engineering project, and Horizon Europe.

“We’re sinking”: a qualitative interview-based study on stakeholder perceptions of structural and process limitations to the Canadian healthcare system

BackgroundDespite longstanding efforts and calls for reform, Canada’s incremental approach to healthcare changes has left the country lagging behind other OECD nations. Reform to the Canadian healthcare system is essential to develop a higher performing system. This study sought to gain a deeper understanding of the views of Canadian stakeholders on structural and process deficiencies and strategies to improve the Canadian healthcare system substantially and meaningfully.MethodsWe conducted individual, ~ 45-minute, semi-structured virtual interviews from May 2022 to August 2022. Using existing contacts and snowball sampling, we targeted one man and one woman from five regions in Canada across four stakeholder groups: (1) public citizens; (2) healthcare leaders; (3) academics; and (4) political decision makers. Interviews centered on participants’ perceptions of the state of the current healthcare system, including areas where major improvements are required, and strategies to achieve suggested enhancements; Donabedian’s Model (i.e., structure, process, outcomes) was the guiding conceptual framework. Interviews were audio-recorded, transcribed verbatim, and de-identified, and inductive thematic analysis was performed independently and in duplicate according to published methods.ResultsThe data from 31 interviews with 13 (41.9%) public citizens, 10 (32.3%) healthcare leaders, 4 (12.9%) academics, and 4 (12.9%) political decision makers resulted in three themes related to the structure of the healthcare system (1. system reactivity; 2. linkage with the Canadian identity; and 3. political and funding structures), three themes related to healthcare processes (1. staffing shortages; 2. inefficient care; and 3. inconsistent care), and three strategies to improve short- and long-term population health outcomes (1. delineating roles and revising incentives; 2. enhanced health literacy; 3. interdisciplinary and patient-centred care).ConclusionCanadians in our sample identified important structural and process limitations to the Canadian healthcare system. Meaningful reforms are needed and will require addressing the link between the Canadian identity and our healthcare system to facilitate effective development and implementation of strategies to improve population health outcomes.

Artificial Intelligence in Health Care – A Study on Perceptions of and Readiness for Artificial Intelligence in Health-care Professionals

Abstract Background: With a call to action from the health-care industry and the Indian government, there are significant gaps in health-care professionals’ uptake and utilization of artificial intelligence (AI)-based tools. This study attempts to explore the current perceptions and readiness for AI among health-care workers. Methods: A web-based questionnaire comprising seven sections on descriptive educational and occupational data, AI familiarity level, role-specific training benefits, training advantages, implementation issues, driving factors, and perceived risks was designed from a literature search. Two additional domains of perception on professional impact and preparedness for AI in health care were estimated using a prevalidated Shinners AI Perception tool. Results: Of the 402 study participants, 192 (47.9%) were doctors from diverse specializations, and the remaining 209 (52.1%) were undergraduate medical and nursing students and affiliated health professionals. Although 79.8% of participants had never attended a course on AI, 82% agreed on the need for training in AI to explore new opportunities in their respective fields. 72.1% of participants agreed that data privacy and confidentiality posed the most significant challenge to AI implementation among the studied factors. Conclusion: This survey reveals awareness regarding AI, which is attributable to a lack of formal training received by health-care professionals. Most participants believed that AI could improve population health outcomes, and collective efforts are needed to make this belief a reality.

Unveiling the Impact of Demographic Factors on Disease Survival: A Multifaceted Examination across Diverse Medical Conditions

Purpose: In this research, we studied the intricate interplay between demographic indicators and survival rates across various diseases, aiming to address the gap in comprehensive analyses across multiple conditions.
 Methodology: Drawing from a dataset encompassing 9105 critically ill patients from five medical centers in the United States [1], admitted between1989-1991 and 1992-1994, our analysis spans eight disease categories. Leveraging techniques such as Cox-proportional hazard models and machine learning algorithms, we explore the influence of socio-economic status, gender, race, and education on survival outcomes.
 Findings: Our findings underscore significant demographic disparities in disease survivability, with ethnicity, gender, and education level showing varying impacts across different medical conditions. Notably, Asians exhibit lower hazards for certain diseases but higher hazards for others, while females demonstrate better survival probabilities compared to males. Moreover, individuals with higher education levels tend to have slightly increased hazards for certain conditions.
 Unique Contribution to Theory, Practice, and Policy: The call for comparative analyses across multiple diseases using comprehensive datasets marks a pivotal shift in research strategy. It aims to highlight the interplays and shared risk factors across diseases, contributing significantly to the advancement of theoretical frameworks, the refinement of healthcare practices, and the shaping of informed public health policies. This approach seeks to bridge a critical gap in the literature, offering a foundation for interventions designed to enhance disease management and improve population health outcomes comprehensively.

Measuring regularity of human physical activities with entropy models

Regularity is an important aspect of physical activity that can provide valuable insights into how individuals engage in physical activity over time. Accurate measurement of regularity not only advances our understanding of physical activity behavior but also facilitates the development of human activity modeling and forecasting. Furthermore, it can inform the design and implementation of tailored interventions to improve population health outcomes. In this paper, we aim to assess the regularity of physical activities through longitudinal sensor data, which reflects individuals’ all physical activities over an extended period. We explore three entropy models, including entropy rate, approximate entropy, and sample entropy, which can potentially offer a more comprehensive evaluation of physical activity regularity compared to metrics based solely on periodicity or stability. We propose a framework to validate the performance of entropy models on both synthesized and real-world physical activity data. The results indicate entropy rate is able to identify not only the magnitude and amount of noise but also macroscopic variations of physical activities, such as differences on duration and occurrence time. Simultaneously, entropy rate is highly correlated with the predictability of real-world samples, further highlighting its applicability in measuring human physical activity regularity. Leveraging entropy rate, we further investigate the regularity for 686 individuals. We find the composition of physical activities can partially explain the difference in regularity among individuals, and the majority of individuals exhibit temporal stability of regularity.

Public health spending in Sub-Saharan Africa: exploring transmission mechanisms using the latent growth curve mediation model

In response to the imperatives of universal health coverage, structural factors that may hinder the effectiveness of increased spending in sub-Saharan Africa (SSA) need attention. This study assessed the mediating role of these factors in domestic general government health expenditure (DGGHE) effects to propose solutions for improving population health outcomes (PHO). The analysis used the Latent Growth Curve Mediation Model (LGCMM) approach within the structural equation model (SEM) framework for panel data from 42 SSA countries from 2015 to 2018. The findings were that malaria and female education formed a channel through which DGGHE imparted its effects on DALY in SSA, and these effects were achieved via the specific path from the DGGHE slope to the DALY slope, via malaria and female education slopes. However, the paper found no evidence of immunization coverage mediating the relationship between DGGHE and DALY in SSA. The paper concludes that structural factors affect the effectiveness of DGGHE on PHO, implying that governments should emphasize existing programs to fight against malaria and increase immunization coverage.

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.
 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.
 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. 
 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<0.05). Residents with presence of mental health and social issues had significantly higher risk of healthcare utilization and cost.
 
 Discussion & 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. 
 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. 
 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.

Collaboration with Indigenous communities in an integrated care learning health system in Ontario, Canada: a case study of the Frontenac, Lennox & Addington Ontario Health Team

Context: Health systems in the province of Ontario in Canada have been restructured into Ontario Health Teams (OHTs). OHTs seek to provide integrated care through improving patient experience, improving care provider experience, improving population health outcomes, reducing costs, and addressing health equity - per the Quintuple Aim framework. The Frontenac, Lennox & Addington (FLA) OHT was created in bringing together numerous clinical and community partners, including local Indigenous health groups. Indigenous peoples face health inequities driven by colonization and systematic racism; improving accessibility, cultural appropriateness, and cultural safety of health systems are essential. To ensure that unique needs of Indigenous peoples are met, there should be a collaborative, participatory approach to planning and executing Indigenous-specific evaluation activities, with Indigenous-specific performance indicators.
 Objectives: 1) To co-design, implement, and evaluate a governance process for collaboration with Indigenous communities, for Indigenous-focussed evaluation of FLA OHT activities. 2) To nest the above into a case study of the FLA OHT, examining processes for centering Indigenous perspectives and priorities in systems evaluation. 
 Study Design: Case study method involving community-based participatory research (CBPR), and using principles of Ownership, Control, Access, Possession (OCAP) in ethical Indigenous health research. The research team involves Indigenous members of FLA OHT working groups and tables, other partners and stakeholders from the broader Indigenous communities of the region, Queen’s University (Kingston, Ontario) researchers on the FLA OHT’s evaluation support structure, and other FLA OHT team members. Data used for the case study include focus groups and interviews with Indigenous members, analysis of meeting minutes and other relevant organizational documents, and surveys on team function and Indigenous-specific evaluation activities. Indigenous-specific indicators have been identified through rapid literature reviews and are being incorporated into logic models for evaluation of FLA OHT projects.
 Expected Outcomes: 1) A framework to operationalize collaboration between Indigenous stakeholders and mainstream health systems, in the co-design and co-execution of health system evaluation approaches that reflect Indigenous perspectives and priorities. 2) Incorporation of Indigenous-specific evaluation activities for FLA OHT projects.
 Results: Work in progress at time of abstract submission.
 Conclusions: The framework produced will serve as a practical, operationalized guide to other mainstream health systems and Indigenous groups seeking to collaborate together. The Indigenous-specific evaluation activities will enable thoughtful and rigorous consideration of whether the needs of Indigenous patients and communities are met, and allow for modification of programs and services – per the “learning health system” goal of iterative knowledge production and action to drive continuous improvement. Additionally, this project will strengthen relationships between the region’s mainstream service organizations, policymakers, Queen’s University academic researchers, and local Indigenous peoples. Strengthened relationships will facilitate current and future collaborative work to improve systems, as a step towards addressing health inequities facing Indigenous peoples.

A Framework for the Fair Pricing of Medicines.

As high-cost medicines put increasing pressure on public health care budgets, the need to identify 'fair' prices for medicines has never been greater. This paper proposes a framework, built upon fundamental economic principles, that allows for the consideration of 'fair' prices for medicines. The framework incorporates key considerations from conventional supply-side and demand-side approaches for specifying a cost-effectiveness 'threshold', including the health opportunity cost borne by other patients ([Formula: see text]) and society's willingness to pay for marginal improvements in population health ([Formula: see text]). The costs incurred by manufacturers in developing and supplying new medicines are also considered, as are the incentives for manufacturers to strategically price up to any common price per unit of benefit (cost-effectiveness 'threshold') specified by the payer. The framework finds that, at any 'fair' price, a medicine's dynamically calculated incremental cost-effectiveness ratio (ICER) lies below [Formula: see text]. When pricing medicines collectively, the framework finds that a common price below [Formula: see text] is required to maximize population health (consumer surplus) or to maximize total welfare (consumer and producer surplus). This framework has important policy implications for payers who wish to improve population health outcomes from constrained health care budgets. In particular, existing approaches to 'value-based pricing' should be reconsidered to ensure that patients receive a 'fair' share of the resulting economic surplus.

Government, governance, and place-based approaches: lessons from and for public policy

BackgroundPlace-based approaches are increasingly applied to address the determinants of health, many of which are complex problems, to ultimately improve population health outcomes. Through public policy, government actions can affect the effectiveness of place-based approaches by influencing the conceptualisation, development, implementation, governance, and/or evaluation of place-based approaches. Despite the important role of public policy, there has been limited examination of public policy related to place-based approaches. We add to the limited knowledge base by analysing Australian national public policy, to explore: (1) the definitions, conceptualisations, and characteristics of place-based approaches in public policy; (2) the government’s perception and communication of its role in place-based approaches; and (3) the extent to which government policy reflects the necessary conditions for successful place-based governance developed by Marsh and colleagues, namely localised context, embedded learning, and reciprocal accountability.MethodsThis research was underpinned by the Theory of Systems Change and methodologically informed by the READ approach to document analysis. Ritchie and Spencer’s framework method was utilised to analyse the data.ResultsWe identified and reviewed 67 policy documents. In terms of conceptualisation, common characteristics of place-based approaches related to collaboration, including community in decision-making, responsiveness to community needs, and suitability of place-based approaches to address complex problems and socio-economic determinants of health. Three roles of government were identified: funder, partner, and creator of a supportive policy environment. From the three criteria for successful place-based governance, localisedcontext was the most dominant across the documents and reciprocalaccountability the least.ConclusionsBased on our findings, we drew key implications for public policy and research. There was a disproportionate emphasis on the bottom-up approach across the documents, which presents the risk of diminishing government interest in place-based approaches, potentially burdening communities experiencing disadvantage beyond their capacities. Governments engaged in place-based approaches should work towards a more balanced hybrid approach to place-based approaches that maintain the central functions of government while allowing for successful place-based governance. This could be achieved by promoting consistency in conceptualisations of ‘place-based’, employing an active role in trust building, advancing the creation of a supportive policy environment, and embedding ‘learning’ across place-based approaches.

Abstract 19042: Statewide Burden of Ischemic Heart Disease Attributable to Dietary Risk Factors From 1990-2019 in United States: A Systematic and Comparative Benchmarking Study

Introduction: Ischemic Heart Disease (IHD) is the 1 st leading cause of deaths among all causalities in United states (US). However, there is a large statewide variation within the US due to IHD attributable to dietary risk factors. Comparable and consistent state-level burden of total IHD attributable to dietary risk factors have not been produced previously. Methods: Using Global Burden of Disease methodology, deaths, and disability adjusted life years (DALYs) due to IHD attributable to dietary risk factors were analyzed by age group, sex, year, and location across the US from 1990-2019. Results were presented in all age counts and age standardized rate per 100,000 person years. Results: The annual percentage of change (APC) in total DALYs increased by 32% for IHD attributable to a high sodium diet, followed by a 10% increase for a diet high in sugar-sweetened beverages and a 2% increase for a diet low in vegetables. In terms of total deaths, the highest APC increase was observed in Nevada (142%), followed by Alaska (98%) and Arizona (65%). Conversely, the District of Columbia and Nebraska had the lowest APC increases in total DALYs and deaths. Regarding age groups, the highest APC increase in the total number of deaths was seen in the 95+ year group (97%), followed by the 90-94 age (44%), 55-59 age (10%), and 50-54 age (3%). Conclusions: Statewide disparities of IHD attributable to dietary risk factors in the US is significant and calls for comprehensive public health strategies. By addressing the root causes and promoting healthier dietary habits, it is possible to reduce the burden of IHD, improve population health outcomes, and alleviate the strain on healthcare systems and the economy.

Theory of systems change: An initial, middle-range theory of public health research impact

Abstract There is increasing attention on evidencing research impact and applying a systems thinking perspective in public health. However, there is limited understanding of the extent to which and how public health research that applies a systems thinking perspective contributes to changes in system behaviour and improved population health outcomes. This paper addresses the theoretical limitations of research impact, theory-based evaluation and systems thinking, by drawing on their respective literature to develop an initial, middle-range Theory of Systems Change, focused on the contribution of public health research that takes a systems perspective on population health outcomes. The Theory of Systems Change was developed through four phases: (1) Preliminary activities, (2) Theory development, (3) Scripting into images, and (4) Examining against Merton’s criteria. The primary propositions are: that well-functioning systems create the conditions for improved population health outcomes; the inter-related properties of, and practices within, well-functioning systems include adaptation, alignment, collaboration and evidence-driven action and learning; and public health research contributes to population health outcomes by embedding capacity in the system. The Theory of Systems Change can guide researchers in developing project-specific theories of change and creates the theoretical architecture for the accumulation of learning. The Theory of Systems Change is necessarily incomplete and an initial attempt to develop a theory to be scrutinized and tested. Ultimately, it seeks to advance theory and provide evidence-based guidance to maximize the contribution of research. We provide examples of how we have applied the Theory of Systems Change to Pathways in Place.

Implementing e-procurement at the Zimbabwe’s National Pharmaceutical Company (NatPharm): Challenges and Prospects

This study explores the challenges and benefits of adopting electronic procurement (e-procurement) technologies to facilitate anti-corruption mechanisms, accountability and transparency in the procurement of pharmaceuticals at the National Pharmaceutical (NatPharm) Company in Zimbabwe. Pharmaceutical corruption is a serious threat to the attainment of Universal Health Coverage. It is imperative for the Government of Zimbabwe to adopt Information Communication Technologies (ICTs) to detect and prevent corruption and fraud, thereby, addressing leakages, mismanagement and theft of medicines, thereby, improving population health outcomes. The study used a qualitative exploratory case study approach and data was gathered through documentary review. The study findings reveal that, pharmaceutical procurement is highly vulnerable to corruption at NatPharm. Bid rigging, procurement-related corruption, bribery and nepotism characterise pharmaceutical procurement at NatPharm. The study recommends the adoption of a transparent e-procurement system with open contracting and integrity pacts to reduce corruption, increase transparency and accountability at NatPharm.

Centering Communities of Color in the Modernization of a Public Health Survey System: Lessons from Oregon.

Public health survey systems are tools for informing public health programming and policy at the national, state, and local levels. Among the challenges states face with these kinds of surveys include concerns about the representativeness of communities of color and lack of community engagement in survey design, analysis, and interpretation of results or dissemination, which raises questions about their integrity and relevance. Using a data equity framework (rooted in antiracism and intersectionality), the purpose of this project was to describe a formative participatory assessment approach to address challenges in Oregon Behavioral Risk Factor Surveillance System (BRFSS) and Student Health Survey (SHS) data system by centering community partnership and leadership in (1) understanding and interpreting data; (2) identifying strengths, gaps, and limitations of data and methodologies; (3) facilitating community-led data collection on community-identified gaps in the data; and (4) developing recommendations. Project team members' concerns, observations, and critiques are organized into six themes. Throughout this engagement process, community partners, including members of the project teams, shared a common concern: that these surveys reproduced the assumptions, norms, and methodologies of the dominant (White, individual centered) scientific approach and, in so doing, created further harm by excluding community knowledges and misrepresenting communities of color. Meaningful community leadership is needed for public health survey systems to provide more actionable pathways toward improving population health outcomes. A data equity approach means centering communities of color throughout survey cycles, which can strengthen the scientific integrity and relevance of these data to inform community health efforts.

Assessment and Documentation of Social Determinants of Health Among Health Care Providers: Qualitative Study

Background Research clearly demonstrates social determinants of health (SDOH) impact health outcomes. Provider consideration of patient SDOH in prevention and treatment planning is critical for improved health care quality and health equity. Despite awareness of the connections between SDOH and improved population health, research demonstrates few providers document patient SDOH. Objective This qualitative study aimed to better understand the barriers and facilitators of SDOH assessment, documentation, and referral in different health care settings and roles. Methods Individual semistructured interviews were conducted with practicing health care providers in South Carolina between August 25, 2022, and September 2, 2022. Participants were recruited via community partners’ web-based newsletters or listservs using a purposive sampling design. An interview guide with 19 questions was used to explore the following research question: How do SDOH impact patient health and what are the facilitators and barriers experienced by multidisciplinary health care providers assessing and documenting patient SDOH? Results Participants (N=5) included a neonatal intensive care unit registered nurse, a nurse practitioner, a certified nurse midwife, a family and preventive medicine physician, and a counselor (licensed clinical social worker) with careers spanning 12 to 32 years. Participant responses are presented according to the following 5 themes: participants’ understanding of SDOH for the patient population, assessment and documentation practices, referrals to other providers and community-based resources, barriers and facilitators of SDOH assessment and documentation, and SDOH assessment and documentation training preferences. Overall, participants were aware of the importance of including patient SDOH in assessment and intervention but noted a variety of institutional and interpersonal barriers to assessment and documentation, including time constraints, perceptions of stigma around discussion of SDOH, and limited referral protocols. Conclusions Incentivizing inclusion of patient SDOH in health care must be facilitated from the top down, so assessment and documentation can be universally implemented in a pragmatic way that works for providers in a variety of roles and settings for the betterment of health care quality, health equity, and improved population health outcomes. Partnering with community organizations can serve to augment health care organizations’ resource and referral availability for addressing patients’ social needs.

Scaling-up Evidence-based Interventions for Communities of Color With Marked Health Disparities: Lessons Learned From COVID-19 Can Be Applied to Reduce Morbidity and Mortality and Achieve Health Equity.

Scaling-up Evidence-based Interventions for Communities of Color With Marked Health Disparities: Lessons Learned From COVID-19 Can Be Applied to Reduce Morbidity and Mortality and Achieve Health Equity.

Estimation of health literacy levels in patients with cardiovascular diseases in a Gulf country

IntroductionCardiovascular diseases (CVDs) are the leading cause of mortality worldwide. In the United Arab Emirates (UAE), the prevalence of deaths associated with CVD is higher than the global average, and the incidence of premature coronary heart disease is 10–15 years earlier than in Western nations. In patients with CVD, inadequate health literacy (HL) is significantly associated with poor health outcomes. The goal of this study is to assess HL levels among patients with CVD in the UAE to develop effective health system strategies for disease prevention and management.MethodsA nationwide cross-sectional survey to assess HL levels in patients with CVD was conducted between January 2019 and May 2020 in the UAE. The association between health literacy level with patient age, gender, nationality, and education was determined using the Chi-Square test. The significant variables were further analyzed by ordinal regression.ResultsOf 336 participants (86.5% response rate), approximately half 51.5% (173/336) of the respondents were women, and 46% (146/336) of them attained high school level of education. More than 75% (268/336) of the participants were above the age of 50 years. Overall, 39.3% (132/336) of respondents possessed inadequate HL, and 46.4% (156/336) and 14.3% (48/336) demonstrated marginal and adequate HL, respectively. Inadequate health literacy was more prevalent among women, as compared to men. Age was significantly associated with HL levels. Participants under age 50 had higher adequate HL levels 45.6% (31/68), (95% CI (3.8–57.4), P < 0.001). There was no correlation between education and health literacy levels.ConclusionThe inadequate HL levels found in outpatients with CVD is a major health concern in the UAE. To improve population health outcomes, health system interventions, including targeted educational and behavioral programs for the older population are necessary.

Opportunistic Screening: Radiology Scientific Expert Panel.

Radiologic tests often contain rich imaging data not relevant to the clinical indication. Opportunistic screening refers to the practice of systematically leveraging these incidental imaging findings. Although opportunistic screening can apply to imaging modalities such as conventional radiography, US, and MRI, most attention to date has focused on body CT by using artificial intelligence (AI)-assisted methods. Body CT represents an ideal high-volume modality whereby a quantitative assessment of tissue composition (eg, bone, muscle, fat, and vascular calcium) can provide valuable risk stratification and help detect unsuspected presymptomatic disease. The emergence of "explainable" AI algorithms that fully automate these measurements could eventually lead to their routine clinical use. Potential barriers to widespread implementation of opportunistic CT screening include the need for buy-in from radiologists, referring providers, and patients. Standardization of acquiring and reporting measures is needed, in addition to expanded normative data according to age, sex, and race and ethnicity. Regulatory and reimbursement hurdles are not insurmountable but pose substantial challenges to commercialization and clinical use. Through demonstration of improved population health outcomes and cost-effectiveness, these opportunistic CT-based measures should be attractive to both payers and health care systems as value-based reimbursement models mature. If highly successful, opportunistic screening could eventually justify a practice of standalone "intended" CT screening.