scholarly journals Implementing Technology That Disrupts Health Systems but not Quality of Care: The Pocket Colposcope in Lima, Peru

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 34-34
Author(s):  
Marlee Krieger ◽  
Nimmi Ramanujam ◽  
Mary Elizabeth Dotson Libby
Keyword(s):  
Quality Of Care ◽  
Low Income ◽  
Value Chain ◽  
Ease Of Use ◽  
Patient Acceptance ◽  
Disruptive Technology ◽  
Global Value Chain ◽  
High Quality ◽  
Iron Triangle

PURPOSE Innovative devices are often targeted at increasing access, improving quality, or reducing costs—the three axes of the infamous Iron Triangle of Health Care, which are notoriously difficult to simultaneously optimize. The main aim of this study was to demonstrate that disruptive technologies, if high quality and appropriately implemented, can result in improved access, cost, and quality of care, overcoming the conventional constraints of the Iron Triangle framework. METHODS Our team conducted a global value chain analysis of the Pocket Colposcope in Lima, Peru, and developed surveys and conducted in-depth interviews to evaluate Pocket Colposcope stakeholders. All surveys were developed with consultations from the Duke Evidence Lab and had institutional review board approval. RESULTS The global value chain identified 5 leverage points: regulatory approval, task shifting, collaboration, telemedicine, and patient acceptance. We also identified stakeholders and processes that affect the degree to which the Pocket Colposcope is successfully implemented. Of women surveyed, 39.4% answered that they had previously wanted a cervical cancer screening test, but had been unable to receive one as a result of some barrier. The most common responses were distance to clinics (31.0%), participants could not leave work (27.6%), and patients were afraid of receiving a cancer diagnosis (20.7%). All 4 midwives who participated in the focus group identified the portability of the Pocket Colposcope as the device’s most appealing feature. Providers identified the quality of the image, cost to patient, and ease of use as the 3 most important aspects of the Pocket Colposcope. CONCLUSION The Pocket Colposcope provides an opportunity to make high-quality diagnostic technology more accessible at a cheaper price for more people. Often, disruptive technology in low-income settings is expected to increase access at the cost of reducing quality. In the case of the Pocket Colposcope, the disruptive technology is significantly cheaper than existing technology, but quality is still high enough to succeed.

The Changing Patterns of North Korea’s International Film Co-Productions Since the 1980s: A Global Value Chain Approach

2020 ◽  
pp. 83-108
Author(s):  
Moon Hwy-Chang ◽  
Wenyang Yin
Keyword(s):  
Value Chain ◽  
North Korea ◽  
Film Industry ◽  
International Standards ◽  
The Political ◽  
Global Value Chain ◽  
Comprehensive Understanding ◽  
Changing Patterns ◽  
Film Productions

Although North Korea is one of the most closed countries in the world, it has long been pursuing international cooperation with other countries in order to upgrade the quality of its film industry to international standards. Preceding studies on this topic have mainly focused on the political influences behind filmmaking in general and very few studies have exclusively dealt with North Korea’s international co-productions. In this respect, in order to develop a comprehensive understanding of the internalization strategy of North Korea’s film productions, this paper uses the global value chain as a framework for analysis. This approach helps understand the internationalization pattern of each value chain activity of film co-productions in terms of the film location and the methods for collaborating with foreign partners. By dividing the evolution of North Korea’s international co-productions into three periods since the 1980s, this paper finds that although North Korea has shown mixed results with different aspects of the film value chain, it has generally improved its internationalization over the three periods. This paper further provides strategic directions for North Korea by learning some of the successful Chinese experiences in the film sector regarding collaboration with foreign partners—to foster a win-win situation for all involved parties.

scholarly journals Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hannah Maria Jennings ◽  
Joanna Morrison ◽  
Kohenour Akter ◽  
Hassan Haghparast-Bidgoli ◽  
Carina King ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health Care Providers ◽  
Low Income ◽  
Diabetes Management ◽  
Local Health ◽  
Care Seeking ◽  
Care Providers ◽  
Structured Interviews ◽  
Rural Bangladesh

Abstract Background Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered. Methods Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient. Results People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence. Conclusion People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care. Trial registration ISRCTN41083256. Registered on 30/03/2016.

scholarly journals A86 INFLAMMATORY BOWEL DISEASE PATIENTS’ SATISFACTION WITH TELEHEALTH: DURING THE COVID-19 PANDEMIC

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 56-57
Author(s):  
M Painchaud ◽  
S Singh ◽  
R M Penner
Keyword(s):  
Inflammatory Bowel Disease ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Bowel Disease ◽  
Online Survey ◽  
Ease Of Use ◽  
Term Care ◽  
Continuous Contact ◽  
Inflammatory Bowel

Abstract Background Due to the COVID-19 pandemic, clinics were forced to implement telehealth into clinical practice. Inflammatory bowel disease (IBD) patients are a unique population that require long-term care to achieve and maintain deep remission of disease. Thus, they require stable and continuous contact with healthcare providers, often with multiple appointments. We examined an IBD predominant practice, also providing care for general gastrointestinal (GI) conditions in Kelowna, British Columbia. As telehealth has the potential to become a standard of care for clinics, patient satisfaction must be considered. We hypothesize that with the efficacy and ease of remote appointments, there will be an increase in patient satisfaction, quality of care, and quality of communication. Aims We aim to compare the level of patient satisfaction between in-person appointments pre-pandemic, and current remote appointment telehealth practices. Methods An online survey was sent to the 608 patients who had participated in one or more remote appointment between March 15-June 15, 2020. The survey compared the level of patient satisfaction, quality of care, and quality of communication between patient and doctor before and during the pandemic. It was also determined if patients would elect to continue with remote appointments in the future due to ease of use, and time/financial resources saved. Results Of the 273 participants, 80% were IBD patients while 20% were treated for other GI conditions. A total of 78% reported that they would elect to continue with remote appointments as their primary point of care with their doctor. The remaining 22% reported that they prefer in-person visits due to the necessity of a physical exam, yet specified that communication by these remote means was still of good quality. Levels of patient satisfaction before and during the pandemic remained consistent, where 59% of patients assigned a satisfaction rating of 10 (highest) to their pre-pandemic in-person appointments, and 54% of patients assigned a rating of 10 to their remote appointments during the pandemic. Similar consistent results were found for quality of care and quality of communication. A total of 70% of patients reported that if this service had not been available, they would have sought out other forms of care; 18% of the total responses considering emergency care. Conclusions IBD patients at Kelowna Gastroenterology perceived similar levels of satisfaction, quality of care, and quality of communication with both in-person and telehealth appointments. This suggests that telehealth practices may be a cost-effective, sustainable appointment style that provides comparable quality to in-person appointments. Funding Agencies None

scholarly journals ISQUA17-2286IS HIGH QUALITY OF CARE ASSOCIATED WITH HIGHER COSTS? - A NATIONWIDE COHORT STUDY AMONG HIP FRACTURE PATIENTS

2017 ◽  
Vol 29 (suppl_1) ◽  
pp. 19-19
Author(s):  
P K Kristensen ◽  
R Søgaard ◽  
T M Thillemann ◽  
S P Johnsen
Keyword(s):  
Cohort Study ◽  
Quality Of Care ◽  
Hip Fracture ◽  
High Quality

‘It makes you someone who changes with the times’: health worker and client perspectives on a smartphone-based counselling application deployed in rural Tanzania

2019 ◽  
Vol 34 (4) ◽  
pp. 307-315 ◽  
Author(s):  
Kristy Hackett ◽  
Mina Kazemi ◽  
Curtis Lafleur ◽  
Peter Nyella ◽  
Lawelu Godfrey ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Health System ◽  
Data Management ◽  
Low Income ◽  
Community Intervention ◽  
Health Workers ◽  
Low Income Countries ◽  
Maternal And Newborn Health ◽  
Pregnancy And Childbirth

AbstractMobile health (mHealth) applications have been developed for community health workers (CHW) to help simplify tasks, enhance service delivery and promote healthy behaviours. These strategies hold promise, particularly for support of pregnancy and childbirth in low-income countries (LIC), but their design and implementation must incorporate CHW clients’ perspectives to be effective and sustainable. Few studies examine how mHealth influences client and supervisor perceptions of CHW performance and quality of care in LIC. This study was embedded within a larger cluster-randomized, community intervention trial in Singida, Tanzania. CHW in intervention areas were trained to use a smartphone application designed to improve data management, patient tracking and delivery of health messages during prenatal counselling visits with women clients. Qualitative data collected through focus groups and in-depth interviews illustrated mostly positive perceptions of smartphone-assisted counselling among clients and supervisors including: increased quality of care; and improved communication, efficiency and data management. Clients also associated smartphone-assisted counselling with overall health system improvements even though the functions of the smartphones were not well understood. Smartphones were thought to signify modern, up-to-date biomedical information deemed highly desirable during pregnancy and childbirth in this context. In this rural Tanzanian setting, mHealth tools positively influenced community perceptions of health system services and client expectations of health workers; policymakers and implementers must ensure these expectations are met. Such interventions must be deeply embedded into health systems to have long-term impacts on maternal and newborn health outcomes.

P3415Will less developed countries be capable of giving high-quality universal coverage to cardiovascular disease survivors? Results from a national health survey, Chile ENS 2016–2017

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Margozzini ◽  
A Passi ◽  
M Kruk ◽  
G Danaei
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Health Care ◽  
Quality Of Care ◽  
National Health ◽  
Health Survey ◽  
Universal Coverage ◽  
National Health Survey ◽  
High Quality

Abstract Background Chilean Health System has fully implemented Universal Health Coverage (UHC) for acute cardiovascular events since 2005. Age-adjusted cardiovascular mortality has decreased, but there is limited information about coverage and quality of chronic health care given to cardiovascular disease (CVD) survivors at the national level. Purpose To assess the prevalence and quality of care in Chilean adult CVD survivors. Methods Chilean National Health Survey 2016–2017 (ENS 2016–2017) is a random stratified multistage sample of non-institutionalized population over 14 years (n=6240). Age, education, gender, rural/urban and geographical area weighted prevalence of CVD survivors (self-reported medical diagnosis of myocardial infarction or cerebrovascular attack) were calculated. High quality of care was defined as meeting six criteria simultaneously: under 70mg% LDL- C level, statin use, aspirin use, blood pressure under 130/80 mmHg, HgA1C<7 or 8 (>74-year-old) and non-smoking. Quality of care was explored using multivariate linear and logistic regression adjusting by age, gender, education and year of diagnosis (before or after UHC). Results Weighted national prevalence of CVD survivors in over 20-year-old population was 6.1%. The sample size for the CVD survivor analyses was n=455. 28.7% of CVS had their first event before the year 2005 (n=141). Overall 27.9% had LDL-C under 70mg%, 37.8% used statins, 41.4% used aspirin, 37.8% had controlled blood pressure, 78.3% were non-smokers and 84.3% had good glycemic control. National “high quality of care” prevalence in CVD survivors was 0.3%, 0.4% and 0.1% for men and women respectively. LDL and Blood pressure control prevalence (meet both criteria simultaneously) was 4,4%. In the adjusted multivariate model age was associated to a higher number of quality criteria achievement. Conclusion The number of CVD survivors in Chile is a huge challenge for the health care system. Universal coverage does not guarantee the quality of chronic life long care. Specific surveillance in high-risk population is needed to assess the system's effectiveness and accountability. Acknowledgement/Funding ENS 2016-2017 was funded by the chilean Ministry of Health (MINSAL)

Telestroke and Teleneurology

2021 ◽  
pp. 95-108
Author(s):  
Hartmut Gross ◽  
Jeffrey A. Switzer
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Health Care Professionals ◽  
Stroke Patients ◽  
High Quality ◽  
Optimal Care ◽  
Widespread Application ◽  
Rural Sites ◽  
Physician Liability

Evaluation and treatment of acute stroke is the oldest and most widespread application of telemedicine. Telestroke systems allow provision of the same high quality of care provided at specialized stroke centers to patients at emergency departments without stroke coverage. The early treatment achieved with telestroke leads to better functional outcomes in stroke patients, thereby lowering overall cost of patient care. Telestroke networks facilitate optimal care, decrease hospital and physician liability, educate health care professionals, and keep many patients closer to home. Admissions to, rather than transfers from, rural sites retain hospitalization revenues locally and help keep small, financially struggling hospitals viable.

scholarly journals Characteristics of primary care practices associated with high quality of care

2013 ◽  
Vol 185 (12) ◽  
pp. E590-E596 ◽  
Author(s):  
M.-D. Beaulieu ◽  
J. Haggerty ◽  
P. Tousignant ◽  
J. Barnsley ◽  
W. Hogg ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Of Care ◽  
High Quality ◽  
Care Practices ◽  
Primary Care Practices

Developing a scale for measuring high performance partnerships

2015 ◽  
Vol 8 (1) ◽  
pp. 87-108 ◽  
Author(s):  
André de Waal ◽  
Robert Goedegebuure ◽  
Eveline Hinfelaar
Keyword(s):  
Value Chain ◽  
High Performance ◽  
Strong Relationship ◽  
Literature Study ◽  
High Quality ◽  
Content Type ◽  
World Class ◽  
Potential Factors ◽  
Cable Company

Purpose – The importance of partnerships to organizational success has increased considerably the past decennia and many organizations strive at creating high-performance partnerships (HPPs). For this to happen, organizations in the partnerships have to be of high quality and their collaborations should be world-class. Whereas the factors that create high-performance organizations (HPO) are by now reasonably well established, the HPP factors are still unclear. The purpose of this paper is to develop a scale for measuring the factors of importance for creating and maintaining HPPs, and relates these factors to the factors of the HPO framework and to the success of the partnership. Design/methodology/approach – During a literature study ten potential factors of importance for creating and maintaining HPPs were identified. These potential factors were put in a questionnaire, together with the factors that create the HPO and the factor that measures the success of the partnership. This questionnaire was administered to a cable company, which was working on becoming an HPO, and four of its main suppliers. The data were subjected to a factor analysis which yielded a HPP framework consisting of three factors and 19 underlying characteristics. In addition, these HPP factors were put in a regression analysis with the factors of the HPO framework and the success of the partnership factor. Findings – The research results show a strong relationship between three HPP factors, the five HPO factors, and the success of a partnership factor. Research limitations/implications – This research adds to the literature by extending the concept of HPOs to the value chain these HPOs operate in. Thus the research into the factors of successful partnerships has been brought forward. The practical benefit of the research is that organizations can use the HPP factors to increase the quality of the partnerships they have with their suppliers and customers. Originality/value – There is much literature on partnerships but not so much on partnerships between organizations which strive to become a HPOs, and in the process need to create partnership of high quality.

scholarly journals Public open spaces and physical activity: disparities of resources in Florianópolis

2019 ◽  
Vol 53 ◽  
pp. 112
Author(s):  
Sofia Wolker Manta ◽  
Rodrigo Siqueira Reis ◽  
Tânia Rosane Bertoldo Benedetti ◽  
Cassiano Ricardo Rech
Keyword(s):  
Physical Activity ◽  
Low Income ◽  
High Income ◽  
Sociodemographic Characteristics ◽  
Open Spaces ◽  
High Quality ◽  
Census Tracts ◽  
Physical Activity Facilities ◽  
Public Open Spaces

ABSTRACT OBJECTIVE: To analyze the association between sociodemographic characteristics of census tracts and the presence/quality of public open spaces and physical activity facilities. METHODS: A cross-sectional study was conducted in 643 census tracts in Florianópolis, Brazil, the presence and quality of public open spaces and physical activity facilities were objectively analyzed and the data by census tracts using Geographic Information Systems was treated. Outcomes were analyzed considering the census tracts as having: ≥ 1 public open spaces; ≥ 1 public open spaces with high quality; ≥ 2 physical activity facilities and high-quality physical activity facilities. Sociodemographic characteristics were the independent variables. Logistic regression analysis was performed. RESULTS: Census tracts with a medium-income (OR = 1.8; 95%CI 1.1–3.0) and high-income (OR = 2.4; 95%CI 1.4–4.0), in those with medium (OR = 1.7; 95%CI 1.0–2.7) and high residential density (OR = 2.0; 95%CI 1,2–3.3), and with higher proportions of older adults (OR = 3.3; 95%CI 1.9–5.7) had a higher proportion of public open spaces. Census tracts with higher proportions of children/adolescents (OR = 0.3; 95%CI 0.2–0.6) and non-white residents (OR= 0.6; 95%CI 0.3–0.9) were less likely to contain public open spaces. The tracts with medium (OR = 4.0; 95%CI 1.4–11.3) and high-income (OR = 3.6; 95%CI 1.2–10.2) were more likely to contain public open spaces with ≥ 2 structures for physical activity, compared with those with low-income. We observed the inverse in sectors with a high proportion of non-white residents (OR = 0.3; 95%CI 0.1–0.9). CONCLUSIONS: Census tracts with higher proportions of children or adolescents, non-white individuals and those in the low-income strata had lower odds of containing public open spaces and physical activity facilities.

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