scholarly journals Decentralized facility financing versus performance-based payments in primary health care: a large-scale randomized controlled trial in Nigeria

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Madhulika Khanna ◽  
Benjamin Loevinsohn ◽  
Elina Pradhan ◽  
Opeyemi Fadeyibi ◽  
Kevin McGee ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Fixed Effects ◽  
Large Scale ◽  
Controlled Trial ◽  
Modern Contraceptive ◽  
Institutional Deliveries ◽  
Itn Use ◽  
Business As Usual ◽  
The Impact

Abstract Background Health system financing presents a challenge in many developing countries. We assessed two reform packages, performance-based financing (PBF) and direct facility financing (DFF), against each other and business-as-usual for maternal and child healthcare (MCH) provision in Nigeria. Methods We sampled 571 facilities (269 in PBF; 302 in DFF) in 52 districts randomly assigned to PBF or DFF, and 215 facilities in 25 observable-matched control districts. PBF facilities received $2 ($1 for operating grants plus $1 for bonuses) for every $1 received by DFF facilities (operating grants alone). Both received autonomy, supervision, and enhanced community engagement, isolating the impact of additional performance-linked facility and health worker payments. Facilities and households with recent pregnancies in facility catchments were surveyed at baseline (2014) and endline (2017). Outcomes were Penta3 immunization, institutional deliveries, modern contraceptive prevalence rate (mCPR), four-plus antenatal care (ANC) visits, insecticide-treated mosquito net (ITN) use by under-fives, and directly observed quality of care (QOC). We estimated difference-in-differences with state fixed effects and clustered standard errors. Results PBF increased institutional deliveries by 10% points over DFF and 7% over business-as-usual (p<0.01). PBF and DFF were more effective than business-as-usual for Penta3 (p<0.05 and p<0.01, respectively); PBF also for mCPR (p<0.05). Twenty-one of 26 QOC indicators improved in both PBF and DFF relative to business-as-usual (p<0.05). However, except for deliveries, PBF was as or less effective than DFF: Penta3 immunization and ITN use were each 6% less than DFF (p<0.1 for both) and QOC gains were also comparable. Utilization gains come from the middle of the rural wealth distribution (p<0.05). Conclusions Our findings show that both PBF and DFF represent significant improvements over business-as-usual for service provision and quality of care. However, except for institutional delivery, PBF and DFF do not differ from each other despite PBF disbursing $2 for every dollar disbursed by DFF. These findings highlight the importance of direct facility financing and decentralization in improving PHC and suggest potential complementarities between the two approaches in strengthening MCH service delivery. Trial registration ClinicalTrials.gov NCT03890653; May 8, 2017. Retrospectively registered.

scholarly journals The Impact of Regulations on the Supply and Quality of Care in Child Care Markets

2011 ◽  
Vol 101 (5) ◽  
pp. 1775-1805 ◽  
Author(s):  
V. Joseph Hotz ◽  
Mo Xiao
Keyword(s):  
Quality Of Care ◽  
Child Care ◽  
Fixed Effects ◽  
Quality Of Services ◽  
Lower Income ◽  
Care Services ◽  
State Child ◽  
The Impact ◽  
Child Care Regulations

We examine the impact of state child care regulations on the supply and quality of care in child care markets. We exploit panel data on both individual establishments and local markets to control for state, time, and, where possible, establishment-specific fixed effects to mitigate the potential bias due to policy endogeneity. We find that the imposition of regulations reduces the number of center-based child care establishments, especially in lower income markets. However, such regulations increase the quality of services provided, especially in higher income areas. Thus, there are winners and losers from the regulation of child care services. (JEL H75, J13, L51, L84)

scholarly journals Barriers and Facilitators To Implementation and Sustainment of 17 New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol

2020 ◽  
Author(s):  
Sarah L. Goff ◽  
Deborah Gurewich ◽  
Matthew Alcusky ◽  
Aparna G. Kachoria ◽  
Joanne Nicholson ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Large Scale ◽  
Healthcare Delivery ◽  
Accountable Care Organizations ◽  
Barriers And Facilitators ◽  
Accountable Care ◽  
Community Partner ◽  
Number Of Patients ◽  
The Impact

Abstract Background: Accountable care organizations (ACOs) utilize value-based payment models, which incentivize quality of care and cost reduction through shared financial risk contracts for payers and providers. The impact of ACOs on cost and quality has been mixed for Medicare and commercial insurers, but the model has yet to be extensively tested in the Medicaid system, which insures a large number of patients in socioeconomically disadvantaged populations. Additionally, despite substantial heterogeneity in ACO models, the majority of ACO studies have examined ACO outcomes without exploring the potential impact of implementation and sustainment on these outcomes. Understanding barriers and facilitators to implementation and sustainment of Medicaid ACOs will help to better understand their impact on patient care, outcomes and costs for a vulnerable population.Methods and Design: The state of Massachusetts (MA) approved 17 new Medicaid ACOs and associated Community Partner (CP) organizations in 2018 as part of a large-scale pragmatic experiment in healthcare reform. The new ACOs will receive $1.8 billion dollars in state and federal funds over five years aimed at supporting implementation and sustainment the new model. This study aims to identify barriers and facilitators to implementation and sustainment of activities supported by these funds using the Consolidated Framework for Implementation Science (CFIR) as a guiding framework through: (1) review of administrative documents classify organizational characteristics of the ACOs and CPs including plans for innovation; (2) key informant interviews (KII) with ACO and CP leaders, governmental administrative leaders, and patients; (3) case studies of ACOs and CPs; and (4) a survey of front-line providers and staff in the ACOs and CPs. Descriptive quantitative statistics will be used to analyze document and survey data and framework analysis will be used to analyze KII and site visit data.Discussion: The new Medicaid ACOs in MA aim to improve care integration, quality of care, and patient experience while reducing costs through innovations in healthcare delivery and payment. Understanding the barriers and facilitators to implementing and sustaining the ACO model will provide critical context for understanding the overall impact of the Medicaid ACO experiment in MA.

scholarly journals Modeling the impact of hospital logistics on quality of care and patient satisfaction: Results of a survey in three public healthcare facilities in Fez, Morocco

2020 ◽  
Vol 13 (2) ◽  
pp. 296
Author(s):  
Youness Frichi ◽  
Fouad Jawab ◽  
Said Boutahari
Keyword(s):  
Patient Satisfaction ◽  
Quality Of Care ◽  
Large Scale ◽  
Scale Validation ◽  
Healthcare Facility ◽  
Public Healthcare ◽  
Healthcare Facilities ◽  
The Impact ◽  
Physical Accessibility

Purpose: The objective of this research is to examine the role of hospital logistics in improving quality of care and patient satisfaction. Thus, the paper focuses on modeling and evaluating the relationship between these three constructs.Design/methodology/approach: In the present study, hospital logistics was specified as a second-order construct composed of five first-order constructs: physical accessibility, waiting time, consultation time, hospital hotel services, and administrative procedures. A questionnaire was developed and administered face-to-face to 384 hospitalized patients in three public healthcare facilities in Fez-Morocco. Collected data were processed and analyzed deploying the PLS-SEM method and using SmartPLS3 software. Data analysis was carried out by considering two types of patient circuits according to the admission modes in the healthcare facility: Urgent Patients Circuit and Scheduled Patients Circuit. Thus, two PLS-SEM models were evaluated and validated.Findings: Results highlighted the significant impact of hospital logistics on quality and satisfaction. In particular, the results of the two models showed that the most preponderant hospital logistics component is physical accessibility which consists of the availability and accessibility of ambulances, medical and nursing staff, support and guidance staff, technical facilities and equipment, etc. Thus, hospital managers and health system stakeholders should pay particular attention to hospital logistics activities in general and specifically to the physical accessibility to improve the quality of care and patient satisfaction.Research limitations/implications: This study only included patients from three public healthcare facilities in Fez-Morocco. Also, the model variables of hospital logistics construct are restricted and were applied in a specific context. Besides, the sample size was relatively reduced. Thus, results generalization might be limited. Further studies including more patients from other territories and including other logistics components are needed for large-scale validation of the proposed model. Originality/value: The results of this study contribute to the scientific literature on hospital logistics and its role as a lever for quality of care and patient satisfaction.

Reduced influence of affective disorders on perioperative complication rates, length of hospital stay, and healthcare costs following spinal fusion for adolescent idiopathic scoliosis

2019 ◽  
Vol 24 (6) ◽  
pp. 722-727
Author(s):  
Aladine A. Elsamadicy ◽  
Andrew B. Koo ◽  
Megan Lee ◽  
Adam J. Kundishora ◽  
Christopher S. Hong ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Idiopathic Scoliosis ◽  
Affective Disorder ◽  
Affective Disorders ◽  
Complication Rates ◽  
Total Cost ◽  
Adolescent Patients ◽  
Perioperative Complication ◽  
The Impact

OBJECTIVEIn the past decade, a gradual transition of health policy to value-based healthcare has brought increased attention to measuring the quality of care delivered. In spine surgery, adolescents with scoliosis are a population particularly at risk for depression, anxious feelings, and impaired quality of life related to back pain and cosmetic appearance of the deformity. With the rising prevalence of mental health ailments, it is necessary to evaluate the impact of concurrent affective disorders on patient care after spinal surgery in adolescents. The aim of this study was to investigate the impact that affective disorders have on perioperative complication rates, length of stay (LOS), and total costs in adolescents undergoing elective posterior spinal fusion (PSF) (≥ 4 levels) for idiopathic scoliosis.METHODSA retrospective study of the Kids’ Inpatient Database for the year 2012 was performed. Adolescent patients (age range 10–17 years old) with AIS undergoing elective PSF (≥ 4 levels) were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification coding system. Patients were categorized into 2 groups at discharge: affective disorder or no affective disorder. Patient demographics, comorbidities, complications, LOS, discharge disposition, and total cost were assessed. The primary outcomes were perioperative complication rates, LOS, total cost, and discharge dispositions.RESULTSThere were 3759 adolescents included in this study, of whom 164 (4.4%) were identified with an affective disorder (no affective disorder: n = 3595). Adolescents with affective disorders were significantly older than adolescents with no affective disorders (affective disorder: 14.4 ± 1.9 years vs no affective disorder: 13.9 ± 1.8 years, p = 0.001), and had significantly different proportions of race (p = 0.005). Aside from hospital region (p = 0.016), no other patient- or hospital-level factors differed between the cohorts. Patient comorbidities did not differ significantly between cohorts. The number of vertebral levels involved was similar between the cohorts, with the majority of patients having 9 or more levels involved (affective disorder: 76.8% vs no affective disorder: 79.5%, p = 0.403). Postoperative complications were similar between the cohorts, with no significant difference in the proportion of patients experiencing a postoperative complication (p = 0.079) or number of complications (p = 0.124). The mean length of stay and mean total cost were similar between the cohorts. Moreover, the routine and nonroutine discharge dispositions were also similar between the cohorts, with the majority of patients having routine discharges (affective disorder: 93.9% vs no affective disorder: 94.9%, p = 0.591).CONCLUSIONSThis study suggests that affective disorders may not have a significant impact on surgical outcomes in adolescent patients undergoing surgery for scoliosis in comparison with adults. Further studies are necessary to elucidate how affective disorders affect adolescent patients with idiopathic scoliosis, which may improve provider approach in managing these patients perioperatively and at follow-up in hopes to better the overall patient satisfaction and quality of care delivered.

Dietary Patterns: A New Therapeutic Approach for Depression?

2019 ◽  
Vol 20 (2) ◽  
pp. 123-129 ◽  
Author(s):  
Mariana Jesus ◽  
Tânia Silva ◽  
César Cagigal ◽  
Vera Martins ◽  
Carla Silva
Keyword(s):  
Depressive Symptoms ◽  
Dietary Patterns ◽  
Large Scale ◽  
Randomized Clinical Trials ◽  
Dietary Intervention ◽  
Common Mental Disorder ◽  
Controlled Trial ◽  
Statistical Significance ◽  
Inverse Association ◽  
The Impact

Introduction: The field of nutritional psychiatry is a fast-growing one. Although initially, it focused on the effects of vitamins and micronutrients in mental health, in the last decade, its focus also extended to the dietary patterns. The possibility of a dietary cost-effective intervention in the most common mental disorder, depression, cannot be overlooked due to its potential large-scale impact. Method: A classic review of the literature was conducted, and studies published between 2010 and 2018 focusing on the impact of dietary patterns in depression and depressive symptoms were included. Results: We found 10 studies that matched our criteria. Most studies showed an inverse association between healthy dietary patterns, rich in fruits, vegetables, lean meats, nuts and whole grains, and with low intake of processed and sugary foods, and depression and depressive symptoms throughout an array of age groups, although some authors reported statistical significance only in women. While most studies were of cross-sectional design, making it difficult to infer causality, a randomized controlled trial presented similar results. Discussion: he association between dietary patterns and depression is now well-established, although the exact etiological pathways are still unknown. Dietary intervention, with the implementation of healthier dietary patterns, closer to the traditional ones, can play an important role in the prevention and adjunctive therapy of depression and depressive symptoms. Conclusion: More large-scale randomized clinical trials need to be conducted, in order to confirm the association between high-quality dietary patterns and lower risk of depression and depressive symptoms.

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