Provincial Health Services Research Articles

Prevalence of atherosclerotic cardiovascular disease and subsequent major adverse cardiovascular events in Alberta, Canada: A real-world evidence study.

BackgroundAtherosclerotic cardiovascular disease (ASCVD) is a leading cause of morbidity and mortality worldwide. Data from Canadian populations regarding the burden of ASCVD are limited. Therefore, we describe the 5‐year period prevalence of ASCVD and subsequent major adverse cardiovascular event (MACE) outcomes among patients with ASCVD in Alberta, Canada.MethodsA retrospective, observational study was conducted by linking provincial health services data, vital statistics, and pharmaceutical dispenses data. Five‐year period prevalence of clinical ASCVD was captured between 2011 and 2016, and a cohort of adult patients with an initial clinical ASCVD event were identified between 2012 and 2016. One‐year incidence rates (IRs) of subsequent MACE outcomes were calculated as composite and individual measures. A subgroup of patients with acute myocardial infarction (AMI) as their index event was examined.ResultsThere were 198 573 patients (mean [standard deviation] age: 63.9 [15.6] years; 56.6% males) identified with clinical ASCVD between 2012 and 2016. Overall, the 5‐year period prevalence of ASCVD in Alberta was 89.9 per 1000 persons and the 1‐year IR for a primary MACE outcome was 6.15 (95% confidence interval [CI]: 6.03–6.26) per 100 person‐years. Among the ASCVD cohort, 9465 had an AMI as their index event and the IR for a primary MACE outcome was 14.30 (95% CI: 13.45–15.20) per 100 person‐years.ConclusionsThis study found that the prevalence of ASCVD and the rate of subsequent MACE outcomes 1 year following the initial ASCVD event are substantial, particularly among patients with an AMI. Secondary prevention strategies aimed at lowering this risk are needed for patients with ASCVD.

Implementing a Suicide Audit in Montreal: Taking Suicide Review Further to Make Concrete Recommendations for Suicide Prevention

Objective A suicide audit was pilot implemented in order to generate recommendations on how to improve suicide prevention. Methods Thirty-nine consecutive suicides that occurred in Montreal, Canada from January to October 2016 were audited. A retrospective analysis of their life trajectory and service utilization was conducted using the psychological autopsy method, which included interviewing suicide-bereaved survivors and examining health and social services records and the coroner’s investigation file. A psychosocial and service utilization profile was drawn for each decedent. A multidisciplinary panel reviewed each case summary to identify gaps in terms of individual intervention, provincial public health and social services, and regional programs. Results Five main suicide prevention recommendations were made to prevent similar suicides: (1) deploy mobile crisis intervention teams (short-term, high-intensity, home-based treatment) in hospital emergency departments; (2) train primary and specialized mental health care professionals to screen for and manage substance use disorders; and (3) implement public awareness campaigns to encourage help seeking for depression and substance use disorders; (4) access for all, regardless of age, to an effective psychosis treatment program; and (5) provide universal access to a general practitioner, especially for men. Conclusions The suicide audit procedure was implemented effectively and targeted recommendations were generated to prevent similar suicides. However, resistance from medical and hospital quality boards arose during the process, though these could be allayed if regional and provincial authorities actively endorsed the multidisciplinary and multi stakeholders suicide audit process. Highlights A bottom-up approach to generate recommendations for suicide prevention. Implementation was challenging with resistance to our interdisciplinary approach. The audit needs the support of the regional health department to lift barriers.

Pregnancy outcomes in women affected by fetal alpha-thalassemia: a case control study

To evaluate the possible associations between fetal α-thalassemia and risk of adverse pregnancy outcomes using a provincial woman-child health service information database in China. This was a case control study (N = 438,747) in which we compared all singleton pregnancies of women with or without the α-thalassemia trait from May 2016 to May 2020, and where women with the trait were further allocated to a normal fetal group, a group of fetuses with the α-thalassemia trait, and a fetal group with hemoglobin H (HbH) disease according to the results of fetal DNA analysis. With thalassemic women whose fetuses were normal as the reference, fetuses in the HbH disease group showed a higher increase in the odds of Apgar scores being < 7 at 1 min (adjusted odds ratio [aOR], 2.79; 1.03–7.59) and 5 min (aOR, 4.56; 1.07–19.40). With non-thalassemic women as the reference, these trends were more obvious (aOR, 4.83; 2.55–9.16; aOR, 6.24; 2.75–14.18, respectively); whereas the normal fetal group was more likely to be diagnosed with postpartum hemorrhage (aOR, 1.66; 1.10–2.50). In addition, fetal HbH disease and gestational age were two independent factors influencing low Apgar scores, and their combination reflected medium accuracy in Apgar predictions.

Proposing an Effective Model for Improving Integration the Medical Education System with Health Services at Iran's Ministry of Health and Medical Education

Background: In Iran, the medical education system was integrated with the healthcare provision system in 1985 and finally, it led to the creation of a new ministry titled �Ministry of Health and Medical Education�. Regarding this integration has created some problems, the current study intended to provide an effective pattern for improvement of this integration. Methods: The present study is both fundamental and applied in terms of objective. The statistical population of the client study included all of the managers, faculty members and experts in the universities of medical sciences in Khuzestan Province, in southwestern Iran, who were chosen by the use of full census sampling. Finally, 103 people filled in the questionnaires. The data collection instrument was a researcher-devised questionnaire. The data analysis was done by SPSS Ver.24, the descriptive statistics (percentage, mean, and standard deviation), and the inferential statistics (Pearson Correlation Test). Results: In order to increase the effectiveness of this integration, four scenarios were suggested among which, finally �the separation of the medical education from the medical sciences universities and placing under direct supervision of the Minister of Health and Medical Education� with 3.84 (based on a maximum score of 4) achieved the highest score. Based on this score, a model based on the upstream laws of Iran was designed and suggested and in each province, instead of having a unit and independent institution under the title of the university of medical sciences and healthcare services, two separate institutions as �The Provincial University of Medical Sciences� and �The Provincial Health Service Organization� would be created and would work under the supervision of Minister of Health and Medical Education. Conclusion: The results of this study showed that medical education in the health ministry supervised universities is affected by the discussions of the provision of the health and medical care provision. Therefore, to realize it and improve the educational tasks, production of knowledge, and conducting of research in the universities, and protecting it from other departments, an effective pattern has been suggested.

IMPLEMENTASI UPAYA KESEHATAN MASYARAKAT (UKM) SEKUNDER DI BALKESMAS WILAYAH MAGELANG

The establishment of Public Health Center (Balkesmas) organization in Central Java is based on Central Java Governor Regulation Number. 99 of 2016. The Public Health Center (Balkesmas) provides public health services in the form of second-tier Public Health Efforts (UKM). In the implementation, a record related to the referral of UKM secondary was not recorded well and the regency/city has less involvement as a referral of UKM secondary in Public Health Center (Balkesmas) of Magelang region. Therefore, in an effort to implement referral of UKM secondary effectively and efficiently, Balkesmas of Magelang region need to pay attention of availability of resources in the organization, interpretation and application. This study aims to analyze the implementation referral of UKM secondary in Balkesmas of Magelang region based on Charles O Jones theory which consists of organization, interpretation and application. The research used a descriptive qualitative method with indepth interview and literature study toward selected informants based on purposive sampling criteria. The results of this study indicate that the Implementation Referral of UKM Secondary In Balkesmas of Magelang region has not run optimally yet due to several obstacles. Human resources are not placed according to their competence, Lack of understood about referral of UKM and the underlying guidelines, the implementation was not based on guidelines and technical instructions. Thus, it is recommended for the Central Java Provincial Health Service to carry out the fulfillment of human resources according to the required competencies and provide socialization to implementor about referral of UKM, and for Balkesmas of Magelang region to implement referral of UKM based on guidelines and technical instructions and provide socialization about referral of UKM to the regency / city of Balkesmas of Magelang region.

Systematic Suicide Audit: An Enhanced Method to Assess System Gaps and Mobilize Leaders for Prevention.

In Quebec, Canada, several independent processes are in place to investigate cases of death by suicide. An enhanced multidisciplinary audit process was developed to analyze these cases more thoroughly, with the aim of generating recommendations for suicide prevention. A study was undertaken to evaluate the feasibility and implementability of this process. The life trajectories of 14 people who died by suicide in Montreal, Canada, in 2016 were reconstructed on the basis of information retrieved by interviewing bereaved relatives and examining coroner investigation files and other records. A multidisciplinary panel that included a representative of families bereaved by suicide then reviewed case summaries to determine unmet needs and service gaps at 3 levels: individual intervention, regional programs, and the provincial health and social services system. The feasibility of the audit process was demonstrated in the context of a public health care system. Thirty-one distinct recommendations were made variably across 13 of the 14 cases reviewed, whereas none had originally been made by the coroner. The recommendations that recurred most often were (1) improve training for professionals and educate the general public regarding depression and substance-related disorders; (2) deploy mobile crisis intervention teams from emergency departments; and (3) provide access to a family physician to all, especially men. Although the audit produced novel recommendations and is implementable, there was resistance from physicians and their hospital mortality review committee against this multidisciplinary audit involving families. These concerns could be alleviated by having the process endorsed by provincial authorities.

Prevalence and risk factors for cisplatin-induced hearing loss in children, adolescents, and young adults: a multi-institutional North American cohort study

Cisplatin is used to treat a wide range of childhood cancers and cisplatin-induced hearing loss (CIHL) is a common and debilitating toxicity. We aimed to address persistent knowledge gaps in CIHL by establishing benchmarks for the prevalence of and risk factors for CIHL. In this multi-institutional cohort study, children (age 0-14 years), adolescents, and young adults (age 15-39 years) diagnosed with a cisplatin-treated tumour from paediatric cancer centres, who had available cisplatin dosing information, and primary audiology data for central review from consortia located in Canada and the USA were eligible for inclusion. Audiology was centrally reviewed and CIHL graded using the consensus International Society of Pediatric Oncology (SIOP) Boston Ototoxicity Scale. We assessed the prevalence of moderate or severe CIHL (SIOP grade ≥2) at latest follow-up and end of therapy, in each demographic, diagnosis, and treatment group and their relative contributions to risk for CIHL. Secondary endpoints explored associations of cisplatin dose reductions and CIHL with survival. We also examined whether cisplatin dose reductions and CIHL were associated with survival outcomes. We included 1481 patients who received cisplatin. Of the 1414 (95·5%) participants who had audiometry at latest follow-up (mean 3·9 years [SD 4·2] since diagnosis), 620 (43·8%) patients developed moderate or severe CIHL. The highest prevalence of CIHL was seen in the youngest patients (aged <5 years; 360 [59·4%] of 606 patients) and those with a CNS tumour (221 [50·9%] of 434 patients), hepatoblastoma (110 [65·9%] of 167 patients), or neuroblastoma (154 [62·1%] of 248 patients). After accounting for cumulative cisplatin dose, higher fractionated doses were associated with risk for CIHL (for each 10mg/m2 increase per day, adjusted odds ratio [aOR] 1·15 [95% CI 1·07-1·25]; for each 50 mg/m2 increase per cycle aOR 2·16 [1·37-3·51]). Vincristine exposure was newly identified as a risk factor for CIHL (aOR 3·55 [2·19-5·84]). Dose reductions and moderate or severe CIHL were not significantly associated with survival differences. Using this large, multicentre cohort, benchmarks were established for the prevalence of CIHL in patients treated with cisplatin. Variations in cisplatin dosing confer additive risk for developing CIHL and warrant investigation as a potential approach to decrease the burden of therapy. US National Institutes of Health and National Institute on Deafness and Other Communication Disorders, US National Institutes of Health and National Cancer institute, St Baldrick's Foundation, Genome Canada, Genome British Columbia, Canadian Institutes of Health Research, the Canada Foundation for Innovation, University of British Columbia, British Columbia Children's Hospital Research Institute, British Columbia Provincial Health Services Authority, Health Canada, and C17 Research Network.

The AED Project: Multiorganization Collaboration to Streamline Automatic External Defibrillator Data in Out-of-Hospital Cardiac Arrests

BackgroundIn patients with out-of-hospital cardiac arrest (OHCA), automated external defibrillator (AED) devices contain valuable data about the patient’s initial rhythm. The retrieval process was previously without protocol, despite its critical role in the patient journey. MethodsThrough a Plan-Do-Study-Act model, the cardiology department at Royal Jubilee Hospital (Victoria, British Columbia, Canada) collaborated with provincial emergency health services (British Columbia Emergency Health Services) to cocreate a request process for data from AEDs used by first responders. British Columbia Fire Departments, which are under municipal oversight, required an alternate strategy. Educational presentations allowed for feedback and spread. Patients surviving OHCA and transfer to the regional cardiac centre were consecutively enrolled from November 2018 to April 2020. We evaluated the timeliness of AED information retrieval, and tracked the process to admission. A retrospective chart review informed specifics after admission. A survey to the Coronary Intensive Care Unit staff was used to assess clinical utility. ResultsSeventy-one consecutive patients were enrolled during the study period. Seven rhythm strips arrived with the patient, thus not affected by the initiative. From the remaining 64 cases, 80% (n = 51/64) were received within 48 hours, and 88% (n = 45/51) were received within 24 hours with a median of 1 hour. Eighteen Coronary Intensive Care Unit staff completed the survey; 81% reported AED data as “very useful” to clinical decision-making (n = 13/16). The AED rhythm strips provided insight into OHCA etiology (100%; n = 11/11), supported evidence for diagnoses (100%; n = 11/11), and reduced unnecessary testing (64%; n = 7/11). ConclusionsImplementing an organized protocol allowed for timely access to AED data, which was directly integrated into clinical decision-making and positively affected hospital stay.

Does Fiscal Transfer Improve the Equalization of Regional Public Health Service Evidence from a Spatial Panel-Data Analysis in China

Public health service is regarded a key social resource contributing to the national health and sustainable development. Its development gap, however, exists among regions in China due to the unbalanced regional economy, and is also affected by financial distribution. With the effect of tax reform, central fiscal transfer has become a strategic approach to narrow the regional gap of public health service and improve the regional development. This paper aims to evaluate provincial public health service levels in China by applying entropy method and shows that obvious spatial imbalance of public health service level exists in Chinese provinces and such imbalance is also consistent with that of average fiscal transfer from the central government to the regional ones. The current research also looks at, by adopting spatial panel model, a model developed from economic convergence model, whether central fiscal transfer effectively helps to lower the level of public health service difference in regions and the outcome depicts that central fiscal transfer, particularly fiscal transfer for specific purposes, accelerates Chinese public health service development especially in eastern, middle and western regions. From the perspective of spatial effect, neighborhood imitation effect exists to allow completion among neighboring regional governments and therefore more investment to public health service. Compared with the pace of economic development, central fiscal transfer’s limited effect is still seen in less developed regions particularly some midland and western areas, due to the inadequate investment rooted in government’s structured expenditure plan. The implication of this research is that, apart from the attention to economic growth, the government should, with the effort of fiscal transfer, financially focus more on the area of public health service.

Antenatal Screening for Syphilis: Ten Years of Observation Amongst Pregnant Women Receiving Care at the Maternity Units of the Province of Trento in Northern Italy

<i>Introduction</i>. Serology screening for syphilis infection in pregnancy is an internationally recommended practice. For some time, in the province of Trento (northern Italy), data regarding antenatal serology screening for syphilis have been acquired through the birth assistance certificate, whose completion by the healthcare professionals providing assistance at birth is mandatory in Italy. This study describes the coverage of serology screening and the seroprevalence of syphilis infection amongst pregnant women receiving care in the maternity facilities of the province of Trento between 2008 and 2017. <i>Materials and methods</i>. The results of serological screening are recorded in the electronic birth assistance certificate as: test not performed; negative test, positive test, or results pending. In cases of a positive test or results pending, the Authors consulted the hospital information system (SIO), an electronic repository containing data regarding all services provided to users of the Provincial Health Service. This operation also made it possible to recover full data regarding the serological profile, any treatments administered and the obstetric/neonatal outcomes. The Authors calculated screening coverage, the seroprevalence of the infection and the occurrence of cases of congenital syphilis, by analysing the neonates’ health status for the first two years of life. <i>Results</i>. Between 01.01.2008 and 31.12.2017, 46,627 pregnant women received care at maternity units of the province of Trento. Screening coverage was found to be higher than 99%. A total of 95 pregnant women were found to be true positives at serology screening for syphilis (15 Italian nationals and 80 foreign women). Seroprevalence for all pregnant women was 2/1000 (0.4/1000 amongst Italian women and 6.8/1000 amongst foreign women). Amongst the latter, the highest value was observed amongst women originating from Eastern European countries (9.3/1000). 62% of positive cases were identified as prior, already treated syphilis and 38% were identified as an early or late latent infection. Antibiotic therapy with penicillin was prescribed in all cases for which it was indicated. No considerable differences were observed with regard to the obstetric/neonatal outcomes between seropositive ad seronegative women. No cases of congenital syphilis were observed. <i>Conclusions</i>. Screening coverage concerned almost all the pregnant women who received care. The seroprevalence calculated in this study was consistent with the available Italian and European data. Our findings confirmed that there is a higher proportion of cases amongst the foreign population, especially amongst women from Eastern European countries, who nevertheless have an antenatal care profile not unlike that of seronegative women.

Child health services during a COVID-19 outbreak in KwaZulu-Natal Province, South Africa

Background. Current evidence indicates that children are relatively spared from direct COVID-19-related morbidity and mortality, but that the indirect effects of the pandemic pose significant risks to their health and wellbeing. Objectives. To assess the impact of the local COVID-19 outbreak on routine child health services. Methods. The District Health Information System data set for KwaZulu-Natal (KZN) provincial health services was accessed, and monthly child health-related data were extracted for the period January 2018 - June 2020. Chronological and geographical variations in sentinel indicators for service access, service delivery and the wellbeing of children were assessed. Results. During April - June 2020, following the start of the COVID-19 outbreak in KZN, significant declines were seen for clinic attendance (36%; p =0.001) and hospital admissions (50%; p =0.005) of children aged &lt;5 years, with a modest recovery in clinic attendance only. Among service delivery indicators, immunisation coverage recovered most rapidly, with vitamin A supplementation, deworming and food supplementation remaining low. Changes were less pronounced for in- and out-of-hospital births and uptake rates of infant polymerase chain reaction testing for HIV at birth, albeit with wide interdistrict variations, indicating inequalities in access to and provision of maternal and neonatal care. A temporary 47% increase in neonatal facility deaths was reported in May 2020 that could potentially be attributed to COVID-19-related disruption and diversion of health resources. Conclusions. Multiple indicators demonstrated disruption in service access, service delivery and child wellbeing. Further studies are needed to establish the intermediate- and long-term impacts of the COVID-19 outbreak on child health, as well as strategies to mitigate these.

Child health services during a COVID-19 outbreak in KwaZulu-Natal Province, South Africa.

Current evidence indicates that children are relatively spared from direct COVID-19-related morbidity and mortality, but that the indirect effects of the pandemic pose significant risks to their health and wellbeing. To assess the impact of the local COVID-19 outbreak on routine child health services. The District Health Information System data set for KwaZulu-Natal (KZN) provincial health services was accessed, and monthly child health-related data were extracted for the period January 2018 - June 2020. Chronological and geographical variations in sentinel indicators for service access, service delivery and the wellbeing of children were assessed. During April - June 2020, following the start of the COVID-19 outbreak in KZN, significant declines were seen for clinic attendance (36%; p=0.001) and hospital admissions (50%; p=0.005) of children aged &lt;5 years, with a modest recovery in clinic attendance only. Among service delivery indicators, immunisation coverage recovered most rapidly, with vitamin A supplementation, deworming and food supplementation remaining low. Changes were less pronounced for in- and out-of-hospital births and uptake rates of infant polymerase chain reaction testing for HIV at birth, albeit with wide interdistrict variations, indicating inequalities in access to and provision of maternal and neonatal care. A temporary 47% increase in neonatal facility deaths was reported in May 2020 that could potentially be attributed to COVID-19-related disruption and diversion of health resources. Multiple indicators demonstrated disruption in service access, service delivery and child wellbeing. Further studies are needed to establish the intermediate- and long-term impacts of the COVID-19 outbreak on child health, as well as strategies to mitigate these.

OCCUPATIONAL ACCIDENTS ENCOUNTERED PRE-HOSPITAL BY EMERGENCY MEDICAL SERVICES PERSONNEL AND EVALUATION OF FEEDBACK

This study aims to investigate occupational accidents and their contributing factors encountered by emergency medical services professionals. Workplace incident report forms submitted between January 2017 and November 2019 and determined by the Ankara provincial health directorate emergency health services have been evaluated. Evaluation of workplace accidents according to contributing factors has shown that most accidents occur due to mechanical (41.3%) and psychosocial (19.7%) factors. In this study, musculoskeletal system injuries were found to be the most observed result of occupational accidents (57.8%). While males encountered workplace accidents mostly due to ergonomic reasons, female personnel suffered accidents mainly due to biological factors. Thus, while female workers were more likely to be exposed to blood and bodily fluids, male workers were at risk to face accidents due to transportation. Further analysis showed that biological accidents were mostly seen in interns (50.0%), whereas the highest rates of ergonomic (29.1%) and psychosocial (22.5%) workplace accidents were seen among drivers. Pre-hospital emergency health care workers have a high risk of exposure to workplace accidents. It will be beneficial to develop strategies in order to decrease the risk of occupational incidents.

Proposed Implementation of Blockchain in British Columbia's Health Care Data Management.

BackgroundThere are several challenges such as information silos and lack of interoperability with the current electronic medical record (EMR) infrastructure in the Canadian health care system. These challenges can be alleviated by implementing a blockchain-based health care data management solution.ObjectiveThis study aims to provide a detailed overview of the current health data management infrastructure in British Columbia for identifying some of the gaps and inefficiencies in the Canadian health care data management system. We explored whether blockchain is a viable option for bridging the existing gaps in EMR solutions in British Columbia’s health care system.MethodsWe constructed the British Columbia health care data infrastructure and health information flow based on publicly available information and in partnership with an industry expert familiar with the health systems information technology network of British Columbia’s Provincial Health Services Authorities. Information flow gaps, inconsistencies, and inefficiencies were the target of our analyses.ResultsWe found that hospitals and clinics have several choices for managing electronic records of health care information, such as different EMR software or cloud-based data management, and that the system development, implementation, and operations for EMRs are carried out by the private sector. As of 2013, EMR adoption in British Columbia was at 80% across all hospitals and the process of entering medical information into EMR systems in British Columbia could have a lag of up to 1 month. During this lag period, disease progression updates are continually written on physical paper charts and not immediately updated in the system, creating a continuous lag period and increasing the probability of errors and disjointed notes. The current major stumbling block for health care data management is interoperability resulting from the use of a wide range of unique information systems by different health care facilities.ConclusionsOur analysis of British Columbia’s health care data management revealed several challenges, including information silos, the potential for medical errors, the general unwillingness of parties within the health care system to trust and share data, and the potential for security breaches and operational issues in the current EMR infrastructure. A blockchain-based solution has the highest potential in solving most of the challenges in managing health care data in British Columbia and other Canadian provinces.

Survey of Drug Information Database Preferences among Staff from Selected British Columbia Health Authorities

With the increasing use of electronic point-of-care resources, it is imperative to clearly understand what health professionals consider valuable when selecting a drug information database. A current analysis of the preferences of staff in selected British Columbia health authorities was deemed helpful for determining which electronic drug information database should be purchased. To determine the factors that BC hospital pharmacists, nurses, and other health professionals value in an electronic drug information database and to better understand the general preferences of staff in choosing between the Lexicomp and Micromedex databases. An electronic survey was created for data collection. The survey was open from August 10 to September 15, 2018, and again from November 11 to December 7, 2018. The survey link was sent by e-mail to staff in the following health authorities: Fraser Health, Providence Health Care, Provincial Health Services Authority, and Vancouver Coastal Health. Qualitative and quantitative methods were used to analyze the survey data. A total of 247 responses were received, of which 145 (58.7%) were complete. Completed surveys were received from 77 pharmacists, 52 nurses, and 16 other health professionals. Participants ranked dosing information and ease of use as the most important factors that they considered when choosing a drug information database. There were no significant differences between the Lexicomp and Micromedex resources in terms of usability, quality, and preference. This survey provided insights into what BC health authority staff perceive as important when utilizing a drug information database. Those considering either renewing or initiating a subscription to an online drug information database can use these results to better understand the preferences of health care professionals. Survey respondents ranked dosing information and ease of use as the 2 most important factors in selecting a drug information database. Pharmacists were more particular about using their preferred database than were other health professionals.

Contracting-out care: The socio-spatial politics of nursing home care at the intersection of British Columbia’s labor, land, and capital markets

The provincial health services labor market was fundamentally altered in 2002 with the introduction of a series of legislative and policy changes enabling the contracting-out, or subcontracting, of care workers in nursing home facilities in order to encourage private sector investment in nursing home infrastructure and provision. This legislation was intended to shrink provincial expenses and replace aging facilities through partnerships with the private sector that would keep debt off provincial books. Through in-depth interviews with front-line workers and provincial and Health Authority administrators, this research foregrounds care as a political relationship by mapping how these legislative changes related to provincial budget concerns splintered a specialized labor market, eroding both working and caring conditions, and exposing eldercare in British Columbia, Canada to the speculative dynamics of finance.

PEMODELAN KASUS PNEUMONIA PADA BALITA DI PROVINSI BALI MENGGUNAKAN METODE REGRESI NONPARAMETRIK B-SPLINE

Pneumonia is an inflammatory lung disease caused by bacterium Streptococcus pneumonia, Chlamydophila pneumonia bacteria, influenza virus, and fungi. Bali Provincial Health Service data in 2018 shows that one of the diseases that causes many deaths in children under five is pneumonia. This study aims to model the number of pneumonia cases in children under five in Bali Province in 2018 with six research variables, namely percentage of low birth weight, percentage of coverage of infants who receive vitamin A, percentage of infants who receive exclusive breastfeeding, percentage of under-five health services, percentage of villages that implement community-based total sanitation, and percentage of neonatal complications management. In the B-Spline function there are connecting points called knots. The best estimation of the B-Spline regression model is obtained from selecting the optimum knot point with the criteria for the value of generalized cross validation (GCV) and the selected mean square error (MSE) having the minimum value. The B-Spline regression model that is formed is the quadratic B-Spline model (order 3) with five knots resulting in an value of 87.79%.

Improving Care at Correctional Facilities: Listening, Learning and Creating Change from a Patient Care Quality Office.

Correctional Health Services (CHS) became part of the Provincial Health Services Authority in British Columbia (BC) in October, 2017. There are 2,700 clients in BC in 10 facilities, and approximately 60% of these clients have mental health issues and/or substance use issues. To address healthcare quality complaints and queries for this unique setting, in keeping with provincial legislation, nursing role of the patient care quality specialist was created in 2018. Challenges, particularly related to direct communication limitations due to the security of incarcerated persons, have led to adapted processes, tools and approaches. Numerous collaborations have been established within and external to the CHS in BC, including the Federal Correctional Services and Accreditation Canada, which have resulted in new relationships to better understand client issues, develop policies and support continuity of care between the community and the correctional facility.

Data Centre Profile: The Provincial Health Data Centre of the Western Cape Province, South Africa.

IntroductionThe Western Cape Provincial Health Data Centre (PHDC) consolidates person-level clinical data across government services, leveraging sustained investments in patient registration systems, a unique identifier, and maturation of administrative and clinical digital health systems.ObjectivesThe PHDC supports clinical care directly through tools for clinicians which integrate patient data or identify patients in need of interventions, and indirectly through supporting operational and epidemiological analyses.MethodsThe PHDC is housed entirely within government. Data are processed from a range of source systems, usually daily, through distinct harmonisation and curation, beneficiation, and reporting processes. Linkage is predominantly through the unique identifier which doubles as a pervasive folder number, augmented by other identifiers. Further data processing includes triangulation of multiple data sources for enumerating health conditions, with assignment of certainty levels for each enumeration. Outputs include patient-specific email alerts, a web-based consolidated patient clinical viewing platform, filterable line-listings of patients with specific conditions and associated characteristics and outcomes, management reports and dashboards, and data releases in response to operational and research data requests. Strict architectural, administrative and governance processes ensure privacy protection.ResultsIn the past decade 8 million unique people are recorded as having sought healthcare in the provincial public sector health services, with current utilisation at 15 million attendances or admissions a year. Cross-sectional enumeration of health conditions includes over 430 000 people with HIV, 500 000 with hypertension, 235 000 with diabetes. Annually 110 000 pregnancies and 54 000 patients with tuberculosis are enumerated. Over 50 data requests are processed each year for internal and external requesters in accordance with data request and release governance processes.ConclusionsThe single consolidated environment for person-level health data in the Western Cape has created new opportunities for supporting patient care, while improving the governance around access to and release of sensitive patient data.

Development of a Food Security Indicator Framework in British Columbia

Food security is complex in both content and governance, making it difficult to measure and monitor. In 2016, the Population and Public Health Program of the British Columbia Centre for Disease Control, Provincial Health Services Authority, sought to identify or construct an evidence-based conceptual frame­work to guide the systematic selection of food security indicators for British Columbia (BC), Canada. A systemized scan of the literature found no existing conceptual frameworks specific to food security indica­tors appropriate to the Global North. The most relevant indicator frameworks for food security in the litera­ture were environmental health indicator frameworks. These formed the foundation for the conceptual framework for food security indicators in BC. The framework is a matrix that combines an adaptation of the environmental health casual network (i.e., determinants–current state–impact–response) with food security elements (i.e., (i) individual and household food insecurity; (ii) food systems, and (iii) capacity). Use of this framework can enable program planners and policy-makers to be clear about where and how they are attempting to assess, influence, and monitor food security. It also illustrates interconnectedness between indicators. The creation of this framework has laid the foundation for the development of a set of indicators for BC Public Health. Its wide scope allows for the potential of various sectors to populate the framework with indicators and thus create a comprehensive assessment of food security in BC.