Moving beyond formulae: a review of international population-based resource allocation policy and implications for Ireland in an era of healthcare reform

Background: Population-based resource allocation is a specific approach to population health planning that is used to address differences in population need to promote equity and efficiency in health and health system outcomes. However, while previous studies have described this type of funding model, they have not compared how such policies and practices have been implemented across jurisdictions. This research examined the impacts and outcomes of population-based resource allocation across six high-income countries, with a view to informing strategic decision-making as Ireland progresses its universal healthcare reform agenda. Methods: A concurrent multi-method approach was employed to examine the experiences of six jurisdictions selected for analysis: Australia (New South Wales), Canada (Alberta), England, New Zealand, Scotland and Sweden (Stockholm). A documentary analysis of key policy, strategy and planning publications was combined with a narrative rapid review of peer-reviewed and grey literature (n = 8) to determine how population-based resource allocation is specified and implemented. The findings were checked and verified by national experts. Results: Notable differences were observed across countries in terms of the stated objectives and descriptions of models as well as the criteria for choosing variables and the variables ultimately used in funding formulae. While population-based resource allocation can help improve equity related to healthcare outcomes and access, a number of tensions were revealed between the need to ensure alignment between policy goals and model design; transition between models; support regionalisation policies; and develop robust governance and monitoring mechanisms to maximise outcomes. Conclusions: The review progresses ‘thinking’ about population-based resource allocation beyond the technical aspects of model or formulae construction. Population-based resource allocation should be viewed as just one lever of large-scale health system reform that can be thoughtfully developed, monitored and adjusted in a way that supports the goals of Sláintecare and the delivery of universal healthcare.

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Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

Health Research Policy and Systems ◽

10.1186/s12961-021-00756-4 ◽

2021 ◽

Vol 19 (S3) ◽

Cited By ~ 6

Author(s):

Karen LeBan ◽

Maryse Kok ◽

Henry B. Perry

Keyword(s):

Health System ◽

Community Health ◽

Community Health Workers ◽

Large Scale ◽

Health Workers ◽

Local Level ◽

Grey Literature ◽

Community Context ◽

New Era

Abstract Background This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities. Methods The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes. Results The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders. Conclusion To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.

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Clinicians’ Experience of Providing Care: A Rapid Review

10.21203/rs.3.rs-26639/v3 ◽

2020 ◽

Author(s):

Maha Pervaz Iqbal ◽

Elizabeth Manias ◽

Laurel Mimmo ◽

Stephen Mears ◽

Briony Jack ◽

...

Keyword(s):

Health Care ◽

Health System ◽

Care Delivery ◽

Grey Literature ◽

Clinical Work ◽

Models Of Care ◽

Rapid Review ◽

Measurement Tools ◽

Clinician Experience ◽

System Sustainability

Abstract BackgroundHealth care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation.Methods:A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health.Results:Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion:Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

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Burden of severe illness associated with laboratory confirmed influenza in adults aged 50-64 years: a rapid review

10.22541/au.163871937.74680730/v1 ◽

2021 ◽

Author(s):

Dong Kim ◽

Allison McGeer ◽

Elizabeth Uleryk ◽

Brenda Coleman

Keyword(s):

Seasonal Influenza ◽

Burden Of Illness ◽

Grey Literature ◽

Case Fatality ◽

The Elderly ◽

Mortality Rates ◽

Population Based ◽

Rapid Review ◽

Severe Illness ◽

Vaccination Programs

Background: While the high burden of illness caused by seasonal influenza in children and the elderly is well-recognized, less is known about the burden in adults 50-64 years of age. The lack of data for this age group is a key challenge in evaluating the cost-effectiveness of vaccination programs. We aimed to assess influenza-associated hospitalization and mortality rates, and case fatality rates for hospitalized cases among adults aged 50-64 years. Methods: This review was conducted according to the PRISMA: we searched MEDLINE, EMBASE, Cochrane, Web of Science, and grey literature for articles and reports published since 2010. Studies reporting rates of hospitalization and/or mortality associated with laboratory-confirmed influenza among adults 50-64 or 45-64 years of age for the 2010-11 through 2019-20 seasons were included. Results: Twenty studies from 13 countries were included. Reported hospitalization rates associated with laboratory-confirmed influenza 5.7 to 112.8 per 100,000. Rates tended to be higher in 2015-2019 compared to 2010-2014, and were higher in studies reporting data from high income versus low and middle-income countries. Mortality rates were reported in only one study, with rates ranging from 0.8-3.5 per 100,000 in four different seasons. The case fatality rate among those hospitalized with influenza, as reported by population-based studies, ranged from 1.3% to 5.6%. Conclusions: Seasonal influenza imposes a significant burden of morbidity in adults 50-64 years of age, but with high heterogeneity across seasons and geographic regions. Ongoing surveillance is required to improve estimates of burden to better inform influenza vaccination and other public health policy.

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Clinicians’ experience of providing care: a rapid review

BMC Health Services Research ◽

10.1186/s12913-020-05812-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Maha Pervaz Iqbal ◽

Elizabeth Manias ◽

Laurel Mimmo ◽

Stephen Mears ◽

Briony Jack ◽

...

Keyword(s):

Health Care ◽

Health System ◽

Health Care Services ◽

Care Delivery ◽

Grey Literature ◽

Clinical Work ◽

Models Of Care ◽

Rapid Review ◽

Measurement Tools ◽

Clinician Experience

Abstract Background Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. Methods A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. Results Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

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Clinicians’ Experience of Providing Care: A Rapid Review

10.21203/rs.3.rs-26639/v2 ◽

2020 ◽

Author(s):

Maha Pervaz Iqbal ◽

Elizabeth Manias ◽

Laurel Mimmo ◽

Stephen Mears ◽

Briony Jack ◽

...

Keyword(s):

Health Care ◽

Health System ◽

Health Care Services ◽

Care Delivery ◽

Grey Literature ◽

Clinical Work ◽

Models Of Care ◽

Rapid Review ◽

Measurement Tools ◽

Clinician Experience

Abstract Background Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation.Methods A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health.Results Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

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Clinicians’ Experience of Providing Care: A Rapid Review

10.21203/rs.3.rs-26639/v1 ◽

2020 ◽

Author(s):

Maha Pervaz Iqbal ◽

Elizabeth Manias ◽

Laurel Mimmo ◽

Stephen Mears ◽

Briony Jack ◽

...

Keyword(s):

Health Care ◽

Health System ◽

Health Care Services ◽

Care Delivery ◽

Grey Literature ◽

Clinical Work ◽

Models Of Care ◽

Rapid Review ◽

Measurement Tools ◽

Clinician Experience

Abstract Background Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. Methods: A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. 79 studies retrieved from the literature were included in the review. 14 articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. Results: Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician’s experience has been identified to have a paucity of measurement tools. Conclusion: Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader ‘clinician pulse’ style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

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Reaction-based Enumeration, Active Learning, and Free Energy Calculations to Rapidly Explore Synthetically Tractable Chemical Space and Optimize Potency of Cyclin Dependent Kinase 2 Inhibitors

10.26434/chemrxiv.7841270.v2 ◽

2019 ◽

Author(s):

Kyle Konze ◽

Pieter Bos ◽

Markus Dahlgren ◽

Karl Leswing ◽

Ivan Tubert-Brohman ◽

...

Keyword(s):

Free Energy ◽

Drug Discovery ◽

Active Learning ◽

Large Scale ◽

Chemical Space ◽

Population Based ◽

Free Energy Calculations ◽

Computational Technique ◽

Cyclin Dependent Kinase ◽

Energy Calculations

We report a new computational technique, PathFinder, that uses retrosynthetic analysis followed by combinatorial synthesis to generate novel compounds in synthetically accessible chemical space. Coupling PathFinder with active learning and cloud-based free energy calculations allows for large-scale potency predictions of compounds on a timescale that impacts drug discovery. The process is further accelerated by using a combination of population-based statistics and active learning techniques. Using this approach, we rapidly optimized R-groups and core hops for inhibitors of cyclin-dependent kinase 2. We explored greater than 300 thousand ideas and identified 35 ligands with diverse commercially available R-groups and a predicted IC<sub>50</sub> < 100 nM, and four unique cores with a predicted IC<sub>50</sub> < 100 nM. The rapid turnaround time, and scale of chemical exploration, suggests that this is a useful approach to accelerate the discovery of novel chemical matter in drug discovery campaigns.

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Reaction-based Enumeration, Active Learning, and Free Energy Calculations to Rapidly Explore Synthetically Tractable Chemical Space and Optimize Potency of Cyclin Dependent Kinase 2 Inhibitors

10.26434/chemrxiv.7841270 ◽

2019 ◽

Author(s):

Kyle Konze ◽

Pieter Bos ◽

Markus Dahlgren ◽

Karl Leswing ◽

Ivan Tubert-Brohman ◽

...

Keyword(s):

Free Energy ◽

Drug Discovery ◽

Active Learning ◽

Large Scale ◽

Chemical Space ◽

Population Based ◽

Free Energy Calculations ◽

Computational Technique ◽

Cyclin Dependent Kinase ◽

Energy Calculations

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The impact of economic sanctions on health and health systems in low- and middle-income countries

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.912 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Suhrcke ◽

M Pinna Pintor ◽

C Hamelmann

Keyword(s):

Health Outcomes ◽

Health System ◽

Health Systems ◽

Grey Literature ◽

Economic Sanctions ◽

Political Crisis ◽

Middle Income ◽

Financial Flows ◽

Adverse Health ◽

The Impact

Abstract Background Economic sanctions, understood as measures taken by one state or a group of states to coerce another into a desired conduct (eg by restricting trade and financial flows) do not primarily seek to adversely affect the health or health system of the target country's population. Yet, there may be indirect or unintended health and health system consequences that ought to be borne in mind when assessing the full set of effects of sanctions. We take stock of the evidence to date in terms of whether - and if so, how - economic sanctions impact health and health systems in LMICs. Methods We undertook a structured literature review (using MEDLINE and Google Scholar), covering the peer-reviewed and grey literature published from 1970-2019, with a specific focus on quantitative assessments. Results Most studies (23/27) that met our inclusion criteria focus on the relationship between sanctions and health outcomes, ranging from infant or child mortality as the most frequent case over viral hepatitis to diabetes and HIV, among others. Fewer studies (9/27) examined health system related indicators, either as a sole focus or jointly with health outcomes. A minority of studies explicitly addressed some of the methodological challenges, incl. control for relevant confounders and the endogeneity of sanctions. Taking the results at face value, the evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. Conclusions Quantitatively assessing the impact of economic sanctions on health or health systems is a challenging task, not least as it is persistently difficult to disentangle the effect of sanctions from many other, potentially major factors at work that matter for health (as, for instance, war). In addition, in times of severe economic and political crisis (which often coincide with sanctions), the collection of accurate and comprehensive data that could allow appropriate measurement is typically not a priority. Key messages The existing evidence is almost unanimous in highlighting the adverse health and health system effects of economic sanctions. There is preciously little good quality evidence on the health (system) impact of economic sanctions.

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Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

BMJ Open ◽

10.1136/bmjopen-2020-043091 ◽

2021 ◽

Vol 11 (4) ◽

pp. e043091

Author(s):

Rikke Siersbaek ◽

John Alexander Ford ◽

Sara Burke ◽

Clíona Ní Cheallaigh ◽

Steve Thomas

Keyword(s):

Health System ◽

Healthcare Access ◽

Grey Literature ◽

Realist Review ◽

Access To Healthcare ◽

Staff Retention ◽

Programme Theory ◽

Eligibility Criteria ◽

Ovid Medline ◽

High Level

ObjectiveThe objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.DesignA realist review.Data sourcesOvid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019.Eligibility criteria for selecting studiesThe purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer-reviewed articles were identified through a systematic search, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.AnalysisInductive and deductive coding was used to generate context–mechanism–outcome configurations, which were refined and then used to build several iterations of the overarching programme theory.ResultsSystematic searching identified 330 review articles, of which 24 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation. Additional purposive searching of grey literature yielded 50 records, of which 12 were included, for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma, generating trusting relationships between patients and staff/practitioners. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention.ConclusionsWith homelessness on the rise internationally, healthcare systems should focus on high-level factors such as funding stability, building inclusive cultures and setting goals which encourage and support staff to provide flexible, timely and connected services to improve access.

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