The Basic Commissioning Cycle

Author(s):  
Julie Sin

In this chapter, the core purpose of commissioning is presented and there is an orientation to the key stages of the commissioning cycle. These ‘stages’ or key parts of the cycle are those of problem definition and needs assessment, prioritization and planning, procurement and contracting, and monitoring and evaluation. There is an overview of how each contributes to commissioning with a practical emphasis throughout. It is noted that commissioning at its best is a multidisciplinary effort. The chapter also notes that in systems with separate commissioning and provider functions, the onus of population health gain through health services is placed primarily on the commissioner. If commissioner and provider functions become more closely aligned, then hypothetically at least the provider arena would also become increasingly aligned to the work of whole population planning.

Author(s):  
Julie Sin

This introductory chapter sets out the book’s practical purpose to be a useful and salient guide in the real life arena of commissioning and health services decision-making for better population health outcomes. The book is grounded in the experience of health services in England where the intention is to provide a comprehensive range of services on a whole population basis. The reader will be taken through the book using the main anchoring point of commissioning, the process of securing services for populations within finite resources. The book is structured in two parts. The first half (Part I) contains core topics to help build confidence about commissioning for health gain. It covers the purpose of commissioning, its health service context, and offers concepts that tangibly link commissioning actions with a population approach. Part II builds on that to cover more applied topics that commissioners will need to navigate in practice.


2021 ◽  
Vol 13 (6) ◽  
pp. 3320
Author(s):  
Amy R. Villarosa ◽  
Lucie M. Ramjan ◽  
Della Maneze ◽  
Ajesh George

The COVID-19 pandemic has resulted in many changes, including restrictions on indoor gatherings and visitation to residential aged care facilities, hospitals and certain communities. Coupled with potential restrictions imposed by health services and academic institutions, these changes may significantly impact the conduct of population health research. However, the continuance of population health research is beneficial for the provision of health services and sometimes imperative. This paper discusses the impact of COVID-19 restrictions on the conduct of population health research. This discussion unveils important ethical considerations, as well as potential impacts on recruitment methods, face-to-face data collection, data quality and validity. In addition, this paper explores potential recruitment and data collection methods that could replace face-to-face methods. The discussion is accompanied by reflections on the challenges experienced by the authors in their own research at an oral health service during the COVID-19 pandemic and alternative methods that were utilised in place of face-to-face methods. This paper concludes that, although COVID-19 presents challenges to the conduct of population health research, there is a range of alternative methods to face-to-face recruitment and data collection. These alternative methods should be considered in light of project aims to ensure data quality is not compromised.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jannike Karlstad ◽  
Cathrine Fredriksen Moe ◽  
Mari Wattum ◽  
Berit Støre Brinchmann

Abstract Background Caring for an individual with an eating disorder involves guilt, distress and many extra burdens and unmet needs. This qualitative study explored the experiences of parents with adult daughters suffering from anorexia nervosa or bulimia nervosa and the strategies they adopted. A subsidiary aim of the study was to explore the relationship between the caregivers’ perceived need for professional support and the support they reported receiving in practice from the health services. Methods Semi-structured interviews were conducted with 11 mothers and fathers from across Norway. Data collection, coding and analysis was conducted using the principles of constructivist grounded theory in an iterative process. The main concern shared by participants was identified by this process and their “solution” to the main concern then formed the content of the core category. Results ″Wearing all the hats″ emerged as the core category, indicating that the parents have to fulfil several roles to compensate the lack of help from health services. The three subcategories: “adapting to the illness”, “struggling for understanding and help” and “continuing to stay strong” described how the participants handled their situation as parents of adult daughters with eating disorders. Conclusions In daily life, the parents of adults with eating disorders have to attend to a wide range of caregiver tasks to help their ill daughters. This study suggests that the health services that treat adults with eating disorders should be coordinated, with a professional carer in charge. The parents need easy access to information about the illness and its treatment. They also need professional support for themselves in a demanding situation.


Author(s):  
Andres Alban ◽  
Philippe Blaettchen ◽  
Harwin de Vries ◽  
Luk N. Van Wassenhove

Problem definition: Achieving broad access to health services (a target within the sustainable development goals) requires reaching rural populations. Mobile healthcare units (MHUs) visit remote sites to offer health services to these populations. However, limited exposure, health literacy, and trust can lead to sigmoidal (S-shaped) adoption dynamics, presenting a difficult obstacle in allocating limited MHU resources. It is tempting to allocate resources in line with current demand, as seen in practice. However, to maximize access in the long term, this may be far from optimal, and insights into allocation decisions are limited. Academic/practical relevance: We present a formal model of the long-term allocation of MHU resources as the optimization of a sum of sigmoidal functions. We develop insights into optimal allocation decisions and propose pragmatic methods for estimating our model’s parameters from data available in practice. We demonstrate the potential of our approach by applying our methods to family planning MHUs in Uganda. Methodology: Nonlinear optimization of sigmoidal functions and machine learning, especially gradient boosting, are used. Results: Although the problem is NP-hard, we provide closed form solutions to particular cases of the model that elucidate insights into the optimal allocation. Operationalizable heuristic allocations, grounded in these insights, outperform allocations based on current demand. Our estimation approach, designed for interpretability, achieves better predictions than standard methods in the application. Managerial implications: Incorporating the future evolution of demand, driven by community interaction and saturation effects, is key to maximizing access with limited resources. Instead of proportionally assigning more visits to sites with high current demand, a group of sites should be prioritized. Optimal allocation among prioritized sites aims at equalizing demand at the end of the planning horizon. Therefore, more visits should generally be allocated to sites where the cumulative demand potential is higher and counterintuitively, often those where demand is currently lower.


2020 ◽  
Vol 35 (3) ◽  
pp. 199-203
Author(s):  
Emilaine Ferreira dos Santos ◽  
Estela Iraci Rabito ◽  
Caryna Eurich Mazur ◽  
Rubia Daniela Thieme ◽  
Maria Eliana Madalozzo Schieferdecker

Home enteral nutrition (HEN) provides care for the special need for food at home. Although the majority of patients in HEN is clinically stable, support from health professionals, and monitoring and evaluation for maintenance or evolution of therapy are necessary. However, the current pandemic situation of COVID-19 and the lack of specific treatment for coronavirus infection have led to changes in the health services work routine. The social distance recommendation to contain the progress of COVID-19 interferes with the home care service. Thus, in order to provide assistance effectively and safely to the patient, family members and health professionals, adaptations can be made. Therefore, the objective of this manuscript is to discuss elements and recommendations that contribute to HEN care during the COVID-19 pandemic.


2018 ◽  
Vol 212 ◽  
pp. 136-144 ◽  
Author(s):  
P. Sandiford ◽  
D. Vivas Consuelo ◽  
P. Rouse ◽  
D. Bramley

2021 ◽  
Author(s):  
Jawad Chishtie ◽  
Iwona Anna Bielska ◽  
Aldo Barrera ◽  
Jean-Sebastien Marchand ◽  
Muhammad Imran ◽  
...  

BACKGROUND Simple visualizations in health research data, such as scatter plots, heat maps and bar charts typically present relationships between two variables. Interactive visualization methods allow for multiple related facets, such as multiple risk factors, to be studied simultaneously, leading to data insights through exploring trends and patterns from complex big healthcare data. The technique presents a powerful tool that can be used in combination with statistical analysis for knowledge discovery, hypothesis generation and testing, and decision support. OBJECTIVE The primary objective of this scoping review is to describe and summarize the evidence of interactive visualization applications, methods and tools being employed in population health and HSR, and their sub-domains in the last 15 years, from 1 January 2005 to 30 March 2019. Our secondary objective is to describe the use cases, metrics, frameworks used, settings, target audience, goals and co-design of applications. METHODS We adapted standard scoping review guidelines, with a peer reviewed search strategy, two independent researchers at each stage of screening and abstraction, with a third independent researcher to arbitrate conflicts and validate findings. A comprehensive abstraction platform was built to capture the data from diverse bodies of literature, primarily from the computer science and health care sector. After screening 11,310 articles, we present findings from 56 applications from interrelated areas of population health and health services research, and their sub-domains such as epidemiologic surveillance, health resource planning, access, utilization and costs, among diverse clinical and demographic populations. RESULTS As a companion review to our earlier systematic synthesis of literature on visual analytic applications, we present findings in six major themes of interactive visualization applications developed for eight major problem categories. We found a wide application of interactive visualization methods, the major being epidemiologic surveillance for infectious disease, resource planning, health service monitoring and quality and studying medication use patterns. Data sources included mostly secondary administrative and electronic medical record data. Additionally, at least two-third applications involved participatory co-design approaches, while introducing a distinct category ‘embedded research’ within co-design initiatives. These applications were in response to an identified need for data-driven insights towards knowledge generation and decision support. We further discuss the opportunities from the use of interactive visualization methods towards studying global health, inequities including social determinants of health, and other related areas. We also allude to the challenges in the uptake of these methods. CONCLUSIONS Visualization in health has strong historical roots, with an upward trend in the use of these methods in population health and health services research. Such applications are being fast utilized by academic and health care agencies for knowledge discovery, hypotheses generation and decision support. CLINICALTRIAL Protocol registration: RR1-10.2196/14019 Related first review: RR2-10.2196/14019 INTERNATIONAL REGISTERED REPORT RR2-10.2196/14019


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