Health System Improvement Research Articles

A PROSPECTIVE DESCRIPTIVE STUDY OF TRAUMA REGISTRY IN NETAJI SUBHASH CHANDRA BOSE MEDICAL COLLEGE, JABALPUR

Background: Trauma registries are databases of information regarding patients who have been came and treated in hospital for injuries caused by trauma. Aim: The objectives of this study to collect data related to trauma registry presenting to our center, as well as to analyze the demographic characteristics and other relevant data of patients admitted in our center. Methods: A Prospective descriptive demographic study was conducted in Tertiary care center Netaji Subhash Chandra Bose Medical College and Hospital Jabalpur from 1st January 2020 to 30th June 2021. In our study included patients who present at our center with history of recent Orthopaedic trauma and sustained fracture within 48 hours. In our study excluded isolated head injuries. The data collected was analyzed. Results: Out of 10241 patients, 7271(71%) were male and 2970(29%) were female with 2253(22%) in the 21-30 age group. Road traffic accident was the major cause of trauma (56%)followed by fall and slips (22%) and assaults(18%).The majority of these patients were brought by their family members (68%).Close to half of patients had upper extremity injury (48%) followed by lower extremity injury (45%) followed by Spinal injury (4%) and Pelvis injury(3%). Conclusion: Trauma registry is complex database of demographic, injuries and outcomes of trauma patients. This study can help to decreasing the burden of trauma and improve health system.

Community Mobility and COVID-19 Dynamics in Jakarta, Indonesia.

In response to the COVID-19 pandemic, mobile-phone data on population movement became publicly available, including Google Community Mobility Reports (CMR). This study explored the utilization of mobility data to predict COVID-19 dynamics in Jakarta, Indonesia. We acquired aggregated and anonymized mobility data sets from 15 February to 31 December 2020. Three statistical models were explored: Poisson Regression Generalized Linear Model (GLM), Negative Binomial Regression GLM, and Multiple Linear Regression (MLR). Due to multicollinearity, three categories were reduced into one single index using Principal Component Analysis (PCA). Multiple Linear Regression with variable adjustments using PCA was the best-fit model, explaining 52% of COVID-19 cases in Jakarta (R-Square: 0.52; p < 0.05). This study found that different types of mobility were significant predictors for COVID-19 cases and have different levels of impact on COVID-19 dynamics in Jakarta, with the highest observed in “grocery and pharmacy” (4.12%). This study demonstrates the practicality of using CMR data to help policymakers in decision making and policy formulation, especially when there are limited data available, and can be used to improve health system readiness by anticipating case surge, such as in the places with a high potential for transmission risk and during seasonal events.

Implementing and Sustaining Brief Addiction Medicine Interventions with the Support of a Quality Improvement Blended-eLearning Course: Learner Experiences and Meaningful Outcomes in Kenya

Quality improvement methods could assist in achieving needed health systems improvements to address mental health and substance use, especially in low-middle-income countries (LMICs). Online learning is a promising avenue to deliver quality improvement training. This Computer-based Drug and Alcohol Training Assessment in Kenya (eDATA-K) study assessed users’ experience and outcome of a blended-eLearning quality improvement course and collaborative learning sessions. A theory of change, developed with decision-makers, identified relevant indicators of success. Data, analyzed using descriptive statistics and thematic analysis, were collected through extensive field observations, the eLearning platform, focus group discussions, and key informant interviews. The results showed that 22 community health workers and clinicians in five facilities developed competencies enabling them to form quality improvement teams and sustain the new substance-use services for the 8 months of the study, resulting in 4591 people screened, of which 575 received a brief intervention. Factors promoting course completion included personal motivation, prior positive experience with NextGenU.org’s courses, and a certificate. Significant challenges included workload and network issues. The findings support the effectiveness of the blended-eLearning model to assist health workers in sustaining new services, in a supportive environment, even in a LMIC peri-urban and rural settings.

Competency in Nursing Informatics of Health Educators

Introduction: The purpose of this study was to identify career preparation activities among nursing students. Methods: The study was designed as a descriptive study. Typically, 132 middle and high school health educators worked in areas of Chungcheong Province and Seoul. Results: Nursing informatics competencies in accordance with the age, education level and type of business of the subject did not show a significant difference. It showed a positive correlation between NEIS utilization, satisfaction and nursing informatics competencies. Conclusion: This study suggests standardization of duties of health educators and system improvement and education.

The Bayelsa Health Summit: strategizing for health at a subnational level in Nigeria

Nigeria is falling short of global targets for universal health coverage (UHC) and the country's journey toward the accelerated achievement of UHC is dependent on progress made by all its subnational governments. The Bayelsa State Health Summit (BSHS) was organized by a subnational government in the Niger Delta region of Nigeria to deepen the understanding of the state's health system and to strategize for improved health outcomes. In this article we share our experience with the planning, organization and outcomes of the BSHS. The BSHS titled 'Achieving Improved Health Systems Performance through Strategic Planning and Stakeholder Engagement' was held for 3d in April 2021. More than 1800 participants across diverse national and international organizations deliberated and made recommendations across the summit theme and subthemes. At the end of the summit, the state government and summit participants resolved to enact a state health law, to develop and adopt a state 10-y health system improvement plan and to establish a Bayelsa Centre for Disease Control. The BSHS exposed the context-specific needs, challenges and expectations of the Bayelsa health system. It served as a platform for extensive stakeholder engagement and buy-in and fostered high-level political commitment for the transformation of the Bayelsa health system.

The role of quality improvement collaboratives in general practice: a qualitative systematic review

BackgroundThis systematic review used qualitative methodologies to examine the role of quality improvement collaboratives (QICs) in general practice. The aim was to inform implementers and participants about the utility of...

A Serious Game Employed to Introduce Principles of Interprofessional Collaboration to Students of Multiple Health Professions

Background Serious games may be beneficial to student learning and skill development when deployed within the context of interprofessional education (IPE). The purpose of this study was to describe the development, implementation, and evaluation of a serious game to introduce foundational knowledge and skills related to interprofessional collaboration in health professions education. Methods A commercially available board game simulation product was purchased by the university and was central to this learning experience. Participants included students from 13 professional programs. During each session, students were organized into teams of four, engaged in an open discussion with their team, played the game and participated in debriefing. At the conclusion, students completed an 11-item program evaluation. Frequencies for each forced-rating question were reported in aggerate and analyzed by profession. A thematic analysis was conducted for open-ended questions. Results A total of 229 students participated and completed the program evaluation. Greater than 88% of respondents either “Agree” or “Strongly Agree” that after participating they were able to communicate and collaborate with students from other health professions programs; discuss the roles of collaboration, innovation, and being data-driven for health-systems improvement; and discuss the importance of teamwork in healthcare provision. Respondents reported this experience contributed to their competence as an interprofessional team member in the areas of teamwork, communication, and creative problem solving. Conclusions An interprofessional serious game was well-rated by a diverse group of health professions students. Students reported a high level of agreement with being able to discuss concepts important to interprofessional collaboration.

Priorities of China\u2019s participation in global malaria elimination: the perspective of malaria endemic countries

BackgroundMalaria is one of the major diseases affecting global health, while progress in malaria control and elimination has stagnated in some endemic countries. China has been certificated malaria free by World Health Organization in 2021, and will get more involved on global malaria elimination. Further discussion is needed on how to collaborate with the malaria endemic countries and provide effective help. This study was to investigate the perceptions of malaria endemic countries on China’s contribution to global malaria elimination and to lay a foundation for further action.MethodsSemi-structured interviews were conducted with key informants including national malaria project managers and technicians from malaria endemic countries. Thematic framework approach was used to analyze the data.ResultsMalaria endemic countries now face challenges in insufficient funds, technique, products, public health systems and inadequacy of international assistance. They hold a positive attitude towards cooperation with China and identified experience and technique exchange, personnel training, system building and scientific research cooperation as prioritized areas.ConclusionsChina could make full use of its own advantages in technique transfer, health system improvement, information system construction, and health human resource training and take an active part in global malaria elimination.

Explaining the declining utilization of village clinics in rural China over time: A decomposition approach

With a goal of improving health system quality and efficiency, reforms of China's health system over the past decade have sought to strengthen primary healthcare in lower-level clinics and health centers. Despite these wide-ranging reforms and initiatives, population-based studies have documented dramatic declines in patients' use of primary care facilities during this period. In this paper, we explore the determinants of this trend in China's rural areas using detailed longitudinal data following a nationally-representative sample of rural households and village clinics from 2011 to 2018. We estimate that between 2011 and 2018, the probability that individuals sought care at village clinics when ill dropped by 44%. At the same time, the utilization of outpatient services in county hospitals increased by 56% and patient self-treatment increased by 20%. Detailed Kitagawa-Oaxaca-Blinder decompositions suggest four primary drivers of this trend: the shifting burden of disease in rural areas, changes in how patients choose to seek care given different disease conditions, declining drug inventory in village clinics, and the decreasing importance of remoteness as a determinant of healthcare seeking behavior. Our results highlight the deteriorating role of village clinics in the rural healthcare system and the increasing importance of self-treatment and higher-tier primary care services.

A socio-technical systems analysis of the application of RFID-enabled technology to the transport of precious laboratory samples in a large acute teaching hospital

The scale and pace of improvement in patient safety in healthcare has been unacceptably slow. A paucity of research into the application of systems-thinking concepts and a failure to appreciate health systems complexity are cited as barriers to sustainable health systems improvement. This study reports on a socio-technical systems analysis, called the CUBE, of the characteristics of a large acute teaching hospital's system for the transport of precious specimens, a system enabled by radio-frequency identification tracking technology. The CUBE proved itself to be an effective analytic tool. The analysis provided a constructive framework to link diverse data and documentation; explicitly inviting consideration of the roles and understandings of different stakeholders; as well as broader cultural factors that could influence current or future activity. The analysis also supported recommendations to improve and extend operations. This study supports the argument for systems understanding and systems thinking being at the core of new approaches to patient safety.

Bridging medical education goals and health system outcomes: An instrumental case study of pre-clerkship students' improvement projects.

IntroductionMany medical schools engage students in health system improvement (HSI) efforts. Evaluation of these efforts often focuses on students’ learning outcomes and rarely considers the impact on health systems, despite the significant commitment health systems make to these efforts. Our study identified and evaluated system-level outcomes of pre-clerkship medical students’ engagement in HSI efforts.MethodsWe used an instrumental case study approach to examine the effects of pre-clerkship medical students’ engagement in HSI projects as part of a 15-month experiential curriculum. We extracted data from 53 project summaries and posters completed during the 2017–18 academic year and follow-up survey data collected in May 2019 from physician coaches and health system professionals who mentored students, contributed to these projects, and worked in the clinical microsystems where the projects occurred.ResultsWe identified three categories and ten indicators of health system outcomes relevant to medical student engagement in HSI. Using these indicators, our evaluation found multiple benefits to the microsystems in which projects occurred. These included achievement of project aims, perceived immediate and sustained project impact on the health system, and development and implementation of projects with aims that aligned with national and health system priorities.ConclusionEvaluation of HSI curricula needs to include effects on health systems so that program design can optimize the experience for all involved. Our study offers a framework others can use to evaluate system-level effects of project-based HSI curricula and shows several ways in which students’ engagement can add value to health systems.Supplementary InformationThe online version of this article (10.1007/s40037-022-00711-1) contains supplementary material, which is available to authorized users.

The WHO Prison Health Framework: a framework for assessment of prison health system performance.

BackgroundThe Health in Prisons European Database (HIPED) aims to periodically collect data on prison health systems, services and health outcomes to inform equivalence of care for people living in prison. Recognized as the United Nations hub for health data in prisons, HIPED lacked an established framework to define its domains and indicators to measure progress. Therefore, the objectives of developing this framework were to inform surveillance systems at prison, local, regional, national and international level and to use it to guide improvement of prison health systems and cross-country comparison.MethodsThe framework was conceptualized through identification of policy priorities and existing frameworks, notably the WHO Health System Framework. A consultation with a range of WHO stakeholders was conducted evaluating the components of existing frameworks and their relevance to the prison health context, as well as identifying areas needing further emphasis. The final stage identified the structure of the framework.ResultsThe framework consists of three main building blocks. The first captures the system-level aspects of prison health care (or inputs) whilst the second captures delivery aspects of prison health care (or outputs). These building blocks are in turn modified by two influencing factors. Ultimately, all these elements impact on the third building block, health outcomes. In addition, two cross-cutting principles associated with all these building blocks and influencing factors are included.ConclusionsA new framework for assessing prison health system performance is now available, crucial to support informed decision-making for policy design and implementation for prisons and other places of detention.

Site Readiness Framework to Improve Health System Preparedness for a Potential New Alzheimer’s Disease Treatment Paradigm

New therapies that address the underlying pathophysiology of Alzheimer’s Disease (AD), coupled with the growth of the AD population, will transform the AD care pathway and present significant challenges to health systems. We explored real-world challenges health systems may face in delivering potential new AD therapies with diverse stakeholders. Key challenges in care included integrating primary care providers into assessment and management, availability of memory care specialists, understanding payment and coverage issues and training mid-level providers to help coordinate care and serve as a shared resource across the system. This input informed a novel Site Readiness Framework for AD, comprising self-assessment exercises to identify health system capabilities and gaps and a framework of core strategies and responsive tools to help prepare to integrate new AD therapies. These resources may help health systems improve readiness to modify care pathways to integrate new therapies for AD.

Leveraging COVID-19 pandemic response for improved health system financing: Lessons from Ghana.

The COVID‐19 pandemic has exposed health system funding challenges across many developing countries. The needed infrastructure to effectively respond to the pandemic was absent in many developing countries. This has resulted in policymakers resorting to various strategies to mobilise sufficient resources in response to the pandemic, especially in the early stages. This paper reviewed Ghana's efforts to mobilise domestic and external resources for the health sector in response to the pandemic. The paper also assessed lessons from these strategies and highlights how these lessons could be leveraged to sustain financing for the health sector. Using evidence from desk reviews, we demonstrate the existence of fiscal space through external sources, partnership with non‐state actors, and effective public financial management (budget space). We also show that the COVID‐19 pandemic presents an important momentum to drive future investment in health infrastructure across developing countries.

Perceptions of the impact of COVID-19 on healthcare communication in a nationally representative cross-sectional survey of family caregivers

ObjectiveTo understand the perceptions of the impact of the COVID-19 pandemic on healthcare communication with family caregivers.DesignNationally representative survey.SettingUSA (national).Participants340 family caregivers, demographically representative of the US population by race/ethnicity.Primary...

The Devil Is in the Data: Can Regional Variation in Amenable Mortality Help to Understand Changes in Health System Performance in Poland?

The contribution of health systems to health is commonly assessed using levels of amenable mortality. Few such studies exist for Poland, with analyses of within-the-country patterns being particularly scarce. The aim of this paper is to analyse differences in amenable mortality levels and trends across Poland’s regions using the most recent data and to gain a more nuanced understanding of these differences and possible reasons behind them. This can inform future health policy decisions, particularly when it comes to efforts to improve health system performance. We used national and regional mortality data to construct amenable mortality rates between 2002 and 2019. We found that the initially observed decline in amenable mortality stagnated between 2014 and 2019, something not seen elsewhere in Europe. The main driver behind this trend is the change in ischemic heart disease (IHD) mortality. However, we also found that there is a systematic underreporting of IHD as a cause of death in Poland in favour of heart failure, which makes analysis of health system performance using amenable mortality as an indicator less reliable. We also found substantial geographical differences in amenable mortality levels and trends across Poland, which ranged from −3.3% to +8.1% across the regions in 2014–2019. These are much bigger than variations in total mortality trends, ranging from −1.5% to −0.2% in the same period, which suggests that quality of care across regions varies substantially, although some of this effect is also a coding artefact. This means that interpretation of health system performance indicators is not straightforward and may prevent implementation of policies that are needed to improve population health.

The COVID-19 pandemic and disruptions in a district quality improvement initiative: Experiences from the CLEVER Maternity Care programme.

BackgroundMany health systems were poorly prepared for the coronavirus disease 2019 (COVID-19) pandemic and found it difficult to protect maternity and reproductive health services. The aim of the study was to explore the influence of the COVID-19 pandemic on the ability of maternity healthcare providers to maintain the positive practices introduced by the CLEVER Maternity Care programme and to elicit information on their support needs.MethodsThis multimethod study was conducted in midwife-led obstetric units (MOUs) and district hospitals in Tshwane District, South Africa and included a survey questionnaire and qualitative reports and reflections by the CLEVER implementation team. Two five-point Likert-scale items were supplemented by open-ended questions to provide suggestions on improving health systems and supporting healthcare workers.ResultsMost of the 114 respondents were advanced midwives or registered nurses (86%). Participants from MOUs rated the maintenance of quality care practices significantly higher than those from district hospitals (p = 0.0130). There was a significant difference in perceptions of support from the district management between designations (p = 0.0037), with managers having the most positive perception compared with advanced midwives (p = 0.0018) and registered nurses (p = 0.0115). The interpretation framework had three main themes: working environment and health-system readiness; quality of patient care and service provision; and healthcare workers’ response to the pandemic. Health-facility readiness is described as proactive, reactive or lagging.ConclusionLessons learned from this pandemic should be used to build responsive health systems that will enable primary healthcare workers to maintain quality patient care, services and communication.

Migrants’ Health Policies and Access to Health Care in Portugal within the European Framework

Migratory flows have a specific influence in the European and Portuguese demographic context. Societies’ commitment to ensure fundamental rights of all citizens and migrants includes the promotion of health. This study aims to describe migrants’ health policies and access to the health system in Portugal within the European framework. We carried out a mixed methods approach, analyzing health policies in European Union countries and public health key indicators from statistical secondary data collected from Eurostat and Migrant Integration Policy Index. This data was complemented with a survey applied to immigrants living in Portugal. Portugal is a European country known for its favorable immigrant integration policies and has developed access to the health care system. However, our study has shown that greater investment is needed to overcome limitations or social inequalities which inhibit migrants’ access. Additionally, we sought to present a comparative analysis between Portugal and European Union countries, which can contribute to improve health systems within the current crisis.

Application Effect Analysis of Operating Room Detailed Nursing Based on Medical Big Data in Patients Undergoing Gastrointestinal Tumor Surgery.

With the continuous development of internet information computing, the continuous improvement of medical and health systems, and the continuous increase of medical big data, traditional operating room care also needs to be further optimized. Medical big data is a forum data set for medical industry healthcare, electronic medical record information, clinical case record information, medical financial data, remote patient monitoring data, clinical decision support data, medical insurance data set, online consulting platform, and so on. Gastrointestinal tumors are currently one of the largest malignant tumors. Compared with ordinary patients, the presence of fear, depression, irritability, and other unhealthy emotions in patients with gastrointestinal tumors will reduce the therapeutic effect. Without careful care, the use of chemotherapy and other treatments makes patients vulnerable to various side effects. This article aims to study the use of medical big data intelligent algorithms to perform detailed care for patients during gastrointestinal tumor surgery and analyze the effects of care. This paper proposes an improved DNN algorithm; the DNN algorithm is to use several weight coefficient matrices and bias vectors to perform a series of linear operations and activation operations with the input value vector, starting from the input layer, backward calculation layer by layer, until the operation reaches the output layer, and the output result is obtained. This algorithm is used to study the theory, use mathematical formulas for method calculation and model design, and use the model to carry out detailed nursing experiments in the relevant operating room. The results of the experiment show that patients who have performed detailed care have a 27.2% improvement in treatment and rehabilitation effects than those who have not, and the level of detailed care has an obvious positive relationship with the rate of condition conversion. In the end, the hospital's detailed care quality evaluation index, which is QEI, increases by 1 point, which can increase the rate of condition conversion by 0.4.

The diagonal approach: A theoretic framework for the economic evaluation of vertical and horizontal interventions in healthcare

The diagonal approach is a health system funding concept wherein vertical approaches targeting specific diseases are combined with horizontal approaches intended to strengthen health systems broadly. This taxonomy can also be used to classify health system interventions as either vertical or horizontal. Previous studies have used mathematical programming to evaluate horizontal interventions, but these models have not allowed concurrent evaluation of different types of horizontal interventions or captured spillovers and intertemporal effects. This paper aims to develop a theoretic framework for the diagonal approach. The framework is articulated through integer programming, maximizing health benefits given constraints by identifying the optimal set of both vertical and horizontal interventions to fund.The theoretic framework for the diagonal approach is developed by synthesizing and expanding three prior works. The decision problem is synthesised to allow concurrent evaluation of three different types of horizontal interventions, those: (i) improving health system efficiency, (ii) improving capacity, and (iii) investing in new platforms. Linear programs are converted to integer form, relaxing previous assumptions related to constant returns to scale and divisibility of interventions. The framework is expanded to evaluate multiple budget constraints and options for new platforms. A new form for the value function is used to estimate the benefits of intervention combinations, capturing spillovers between vertical and horizontal interventions and dynamic returns to scale. The decision problem is specified inferotemporally, explicitly capturing the impact of the time horizon on the optimal choice set. Dynamic examples are provided to demonstrate the advantages of the diagonal approach over prior frameworks.This framework extends existing works, enabling simultaneous comparison of various combinations of both vertical and horizontal interventions, capturing spillovers and intertemporal effects. The diagonal approach framework defines decision problems flexibly and realistically, forming the basis for future applied work. Implementation would improve resource allocation and patient health outcomes.