Paying for Performance When Health Care Production is Multi-Dimensional: The Impact of Rwanda's National Program on Rewarded Services, Multitasking and Health Outcomes

2012 ◽  
Author(s):  
Tisamarie B Sherry ◽  
Sebastian Bauhoff ◽  
Manoj Mohanan
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
National Program ◽  
The Impact ◽  
Health Care Production

Impact of community participation in primary health care: what is the evidence?

2015 ◽  
Vol 21 (1) ◽  
pp. 2 ◽  
Author(s):  
Jessamy Bath ◽  
John Wakerman
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Outcomes ◽  
Community Participation ◽  
Service Providers ◽  
Developmental Process ◽  
Service Access ◽  
Primary Health ◽  
Intermediate Outcomes ◽  
The Impact

Community participation is a foundational principle of primary health care, with widely reputed benefits including improved health outcomes, equity, service access, relevance, acceptability, quality and responsiveness. Despite considerable rhetoric surrounding community participation, evidence of the tangible impact of community participation is unclear. A comprehensive literature review was conducted to locate and evaluate evidence of the impact of community participation in primary health care on health outcomes. The findings reveal a small but substantial body of evidence that community participation is associated with improved health outcomes. There is a limited body of evidence that community participation is associated with intermediate outcomes such as service access, utilisation, quality and responsiveness that ultimately contribute to health outcomes. Policy makers should strengthen policy and funding support for participatory mechanisms in primary health care, an important component of which is ongoing support for Aboriginal Community Controlled Health Services as exemplars of community participation in Australia. Primary health-care organisations and service providers are encouraged to consider participatory mechanisms where participation is an engaged and developmental process and people are actively involved in determining priorities and implementing solutions.

scholarly journals Interdisciplinary Collaboration among Health Professionals: A Panacea for effective and Evidence-based Health Care delivery

2020 ◽  
Vol 34 (1) ◽  
pp. 12-23
Author(s):  
Joseph D Z ◽  
Aminu B ◽  
Halilu S ◽  
Mark A D ◽  
Kayode O ◽  
...  
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Patient Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Interdisciplinary Collaboration ◽  
Healthcare Delivery ◽  
Evidence Based ◽  
Search Term ◽  
The Impact

Introduction: Interdisciplinary collaboration (IDC) is important in health care settings as the complex nature and demands of the health care work environment requires the expertise and knowledge of different individuals or specialists working together to solve multifaceted and complex patient care problems. Objective: To assess the health professionals' attitude towards the development of an interdisciplinary collaborative approach to patient care in health institutions and to systematically review the impact of IDC as a panacea for effective health outcomes in Nigeria. Methodology: The research is a systematic review that provides various approaches for studying interdisciplinary teams. Fifty articles were selected from different search engines such as Google, google scholar, science direct and research gate with the search term Interdisciplinary collaboration among health care professionals. Articles were arranged based on most relevant, relevant and closely related articles. Result: The study revealed that IDC is pivotal in evidence-based care and contributes immensely to effective and efficient health outcomes. It puts the patient at the centre of the healthcare team's focus and allows all health professionals, with the patient, to collaboratively provide input, be part of the decision making, and improve outcomes. Although there are several obstacles to IDC, adopting this team-based culture of mutual respect and understanding is possible and, in fact, necessary. Conclusion: This study reveals that there are many benefits to IDC. It can improve safety and healthcare delivery, as well as reduce costs. The interprofessional team supports patient and personnel engagement, organizational efficiency and innovation.

scholarly journals Improving the Measurement of Health System Performance across the Rural-Urban Continuum

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Naushaba Degani ◽  
Sharon Gushue ◽  
Alex Yurkiewich ◽  
Emmalin Buajitti ◽  
Matthew Kumar ◽  
...  
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Health System ◽  
Performance Indicators ◽  
System Performance ◽  
Working Group ◽  
Geographic Location ◽  
Key Performance Indicators ◽  
Health System Performance ◽  
The Impact

IntroductionWe report on key performance indicators to highlight quality and variation in health care. Given Ontario’s diverse geography, we have prioritized improving measurement across the rural-urban continuum. This will improve our ability to discern the impact of geography on health care and health status to inform planning and decision making. Objectives and ApproachBuilding on previous work to advance measurement of equity in health care, we struck a technical working group of experts to review methods for stratifying health system performance data by geographic location in the Ontario context. These methods were applied to a set of key performance indicators. The working group’s review of the results of this analysis will lead to recommendations for the best method to refine and standardize how geographic location is measured and stratified. This will improve our ability to discern the impact of geography on health system performance and health status for our suite of public-reporting products. ResultsThe technical working group identified three methodologies for consideration that used linked postal code data: Population Centre (POPCTR), Statistical Area Classification (SAC) and a hybrid POPCTR/SAC methodology. These methods were tested against a set of key performance indicators across dimensions of quality including timeliness, effectiveness, population health and health outcomes. The results show that, in the health system performance dimensions of effectiveness and timeliness, as well as for a subset of health outcomes, there is variation in performance across the urban-rural continuum, though not always in a linear way. This may reflect differences in health care access, health risk factors, sociodemographic or socioeconomic characteristics across the urban-rural continuum. More definitive conclusions and recommendations will be available when the working group meets to review the results. Conclusion/ImplicationsIdentifying a robust methodology for measuring performance across geographic locations will improve our ability to discern the impact of geography on health care including where geography may impact access and effectiveness of services as well as health outcomes. This information will enable better health system planning and decision-making.

scholarly journals Public-Private Partnership in Health Care and Its Impact on Health Outcomes: Evidence from Ruharo Mission Hospital in Uganda

2018 ◽  
Vol 6 (12) ◽  
pp. 79
Author(s):  
Justus Asasira ◽  
Frank Ahimbisibwe
Keyword(s):  
Health Care ◽  
Health Services ◽  
Health Outcomes ◽  
Public Private Partnership ◽  
Private Partnership ◽  
The Public ◽  
Public Facilities ◽  
Mission Hospital ◽  
Private Providers ◽  
The Impact

Background: Uganda’s government has embraced private provision of social services including health care. The involvement of private providers is an indicator that the public facilities are not sufficient enough to meet the high demands of the ever-increasing population. This has been done through partnership arrangements. This paper discusses the impact of Public-Private Partnership (PPP) in health care outcomes of the local population and opportunities for improving health outcomes, challenges facing private providers in a low income setting.Methodology: Data were collected using qualitative methods in January 2017 through interview (using semi-structured questions) at Ruharo Mission Hospital (RMH) administration, health workers, district health office and used a structured questionnaire for patients/clients. This was a nascent study, with a sample size of 22 respondents. The hospital has three departments; Organized Useful Rehabilitation Services (OURS), General Medical Services (GMS) and Eye Department (ED). All the departments of the hospital were represented in this study.Results: The hospital is a Church of Uganda project and runs a budget of 5 billion shillings ($ 1,351,351.4) annually, had multiple sources of funding including PHC funding annually and that, health services were delivered adequately to clients. Much as some services were accessed at no costs, other services like eye treatment were found expensive on the side of clients. The hospital’s hybrid mode of delivering health services through outreaches and facility-based services was cherished, however it had no ambulance and relied only on a hospital van.Conclusions and Recommendations: Our study concluded that if private providers are supported under the partnership arrangement, they can adequately deliver services to the clients and decongest the public facilities. We recommend that the government devote funds to support the hospital through employing more sub-seconded staff, procuring medicines, and ambulances to enable it to subsidize services especially eye treatment and other services not supported under the partnership.

scholarly journals The association between depressive symptoms or depression and health outcomes in adults with low back pain with or without radiculopathy: protocol of a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Jessica J. Wong ◽  
Andrea C. Tricco ◽  
Pierre Côté ◽  
Laura C. Rosella
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Depressive Symptoms ◽  
Health Outcomes ◽  
Risk Of Bias ◽  
Considerable Proportion ◽  
Low Back ◽  
The Impact

Abstract Background A considerable proportion of adults with low back pain (LBP) suffer from depressive symptoms or depression. Those with depressive symptoms or depression may be at risk of poorer LBP recovery and require more health care. Understanding the role of prognostic factors for LBP is critically important to guide management and health services delivery. Our objective is to conduct a systematic review to assess the association between depressive symptoms or depression and health outcomes in adults with LBP with or without radiculopathy. Methods Electronic databases including MEDLINE, Embase, CINAHL, and PsycINFO will be searched from inception to April 2019 to identify relevant studies. Additional citations will be identified by searching reference lists of included studies and related systematic reviews. Cohort and case-control studies assessing the association between depressive symptoms/depression and health outcomes in adults aged 16 years and older with LBP with or without radiculopathy will be included. The following will be included: depressive symptoms as measured on standardized questionnaires (e.g., Center for Epidemiologic Studies Depression Scale, Beck Depression Index), and depression as standardized diagnoses (e.g., International Classification of Diseases codes) or self-reported depression diagnosis on standardized questionnaires. Outcomes of interest are standardized measures for pain, disability, overall health status, satisfaction with care, and health care utilization. These are informed by core outcome domains that international expert panels consider important for LBP research. Pairs of reviewers will screen articles retrieved from the search, extract data, and assess risk of bias using the Risk Of Bias In Non-randomized Studies-of Exposures (ROBINS-E) tool. Reviewers will use these criteria to inform their judgment on the internal validity of studies (e.g., low, moderate, or high risk of bias). If studies are deemed homogeneous, a random effects meta-analysis on the association between depressive symptoms and health outcomes will be performed. The results of the included studies will be descriptively outlined if studies are deemed heterogeneous. Discussion The impact of depressive symptoms and depression on health- and health care-related outcomes for LBP with or without radiculopathy will be assessed and quantified. Findings of this systematic review will advance our understanding of LBP prognosis, and guide decision-making and improve quality of care for adults with LBP. Systematic review registration PROSPERO CRD42019130047

scholarly journals The Sustained Psychological Impact of the COVID-19 Pandemic on Health Care Workers One Year after the Outbreak—A Repeated Cross-Sectional Survey in a Tertiary Hospital of North-East Italy

2021 ◽  
Vol 18 (24) ◽  
pp. 13374
Author(s):  
Antonio Lasalvia ◽  
Luca Bodini ◽  
Francesco Amaddeo ◽  
Stefano Porru ◽  
Angela Carta ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Outcomes ◽  
Health Care Workers ◽  
Maslach Burnout Inventory ◽  
Mental Health Outcomes ◽  
Care Workers ◽  
Post Traumatic ◽  
One Year ◽  
The Impact

This study aimed to evaluate the mental health outcomes of health care workers (HCWs) of the Verona academic hospital trust (Italy) one year after the outbreak of COVID-19 and to identify predicted risk factors. A web-based survey was conducted from mid-April to mid-May 2021 on hospital workers one year after the first evaluation performed during the lock-down phase of the COVID-19 pandemic. Post-traumatic stress, general anxiety, depression, and burnout were assessed by using, respectively, the impact of event scale (IES-R), the self-rating anxiety scale (SAS), the patient health questionnaire (PHQ-9) and the Maslach burnout inventory-general survey (MBI-GS). Multivariate logistic regression analysis was performed to identify factors associated with each of the four mental health outcomes one year after the COVID-19 outbreak. A total of 1033 HCWs participated. The percentage of HCWs scoring above the cut-off increased from 2020 to 2021 in all of the outcome domains (anxiety, 50.1% vs. 55.7, p < 0.05; depression, 26.6% vs. 40.6%, p < 0.001; burnout, 28.6% vs. 40.6%, p < 0.001; chi-square test), with the exception of post-traumatic distress. There was also an increase when stratifying by occupation and workplace, with a greater increase for depression and burnout. Multivariate analysis revealed that, one year after the COVID-19 outbreak, nurses were at the greatest risk of anxiety and depression, whereas residents were at the greatest risk of burnout (in terms of low professional efficacy). Working in intensive care units was associated with an increased risk of developing severe emotional exhaustion and a cynical attitude towards work.

scholarly journals The impact of hospital competition and insurer concentration on health care volume and cost in Dutch hospitals

2019 ◽  
Vol 93 (7/8) ◽  
pp. 203-213
Author(s):  
Yvonne Krabbe-Alkemade ◽  
Tom Groot ◽  
Jaap Boter
Keyword(s):  
Health Care ◽  
Hospital Competition ◽  
Production Volume ◽  
Managed Competition ◽  
Spatial Concentration ◽  
Hospital Data ◽  
Health Care Reforms ◽  
Hospital Markets ◽  
The Impact ◽  
Health Care Production

This study analyses the effect of spatial concentration of general hospitals, the appearance of independent treatment centers (in Dutch: Zelfstandige Behandelcentra: ZBCs) and the concentration of health insurers on production volume and costs since the introduction of market-oriented health care reforms in the Netherlands. We use regression analyses of 1,345,144 patient-level hospital data for fifteen major diagnosis treatment combinations (in Dutch: Diagnose Behandeling Combinaties: DBCs), representing 70% of the managed competition segment (the so-called B-segment). We find that spatial concentration of hospitals and concentration of insurers do not affect health care production volume. More competitive hospital markets are associated with higher cost of most DBCs studied. Surprisingly, hospitals operating under insurers with high monopsonic power incur higher average DBC-cost than hospitals operating under insurers with more dispersed power. The number of independent treatment centers in the hospital’s vicinity is positively related to health care volume and average cost.

scholarly journals The Impacts Of A Free Health Insurance Policy In Vietnam

2021 ◽  
Author(s):  
◽  
Khoa Nguyen
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Outcomes ◽  
Social Health Insurance ◽  
Health Care Use ◽  
Social Health ◽  
Insurance Policy ◽  
Education Outcomes ◽  
Positive Effects ◽  
The Impact

<p>Social Health Insurance (SHI) is promoted as a policy that tackles the impoverishing effects of catastrophic spending that results from unexpected health shocks. This thesis contributes to the literature on the impact of social health insurance by examining the impact of a policy introduced in Vietnam in 2005. The new policy provided free health insurance for all children under six years. Using a difference-in-difference estimation strategy and eight national household surveys conducted between 2002 and 2016, I examine a variety of direct, indirect, and spill over effects of the policy. The direct effects of the policy are on insurance coverage, health care use, health care expenses, and self-reported morbidity of targeted children. The indirect effects are the persistent effects of the policy on the same set of health outcomes (and education outcomes) beyond the period of exposure to the policy. A third set of impacts cover spill over effects of the policy - on the health and education outcomes of older children living with targeted children, and a variety of household-level outcomes that reflect various dimensions of the wellbeing of household members. The results show that a free health insurance policy for young children has significant impacts on the health outcomes of children while they are covered by the policy and these persist, and also extend to educational outcomes beyond the age of eligibility. The policy also has positive spill over effects on older (untargeted) children living in targeted households, and positive effects on household wage income, and income per capita. On the other hand, the policy has no effects on the standard of living, household health expenditure, caloric consumption, and the likelihood of household spending on catastrophic healthcare.</p>

The Role of the Pastoral Practitioner in Health Outcomes and Wellbeing During Acute Illness: Exploring the Patient Experience of a Pastoral Visit

2017 ◽  
Vol 71 (4) ◽  
pp. 230-236 ◽  
Author(s):  
Janie Brown ◽  
Jennifer Gardner
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Patient Outcomes ◽  
Patient Experience ◽  
Health Care Services ◽  
Care Facility ◽  
Acute Illness ◽  
Care Services ◽  
The Impact

The role of the pastoral practitioner is embedded in many health care services and organizations. Despite this, there is little evidence to describe the impact of this role on patient outcomes, in particular how visits by a pastoral practitioner influence patient healing and recovery. This paper describes a small study that explored the patient experience of pastoral practitioner visits in an acute care facility.

scholarly journals The Prevalence of Metabolic Disease Multimorbidity and Its Associations With Spending and Health Outcomes in Middle-Aged and Elderly Chinese Adults

2021 ◽  
Vol 9 ◽  
Author(s):  
Yang Zhao ◽  
Puhong Zhang ◽  
John Tayu Lee ◽  
Brian Oldenburg ◽  
Alexander van Heusden ◽  
...  
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Activities Of Daily Living ◽  
Outpatient Care ◽  
Daily Living ◽  
Service Use ◽  
Health Care Service ◽  
National Level ◽  
Chinese Adults ◽  
The Impact

Objective: Metabolic diseases have been a clinical challenge worldwide and a major public health issue. Very few studies from China investigated the impact of metabolic multimorbidity on healthcare and health outcomes at the national level. This study aims to examine the association of metabolic multimorbidity with health service utilization, spending, functional and mental health.Materials and Methods: This is a nationally representative cross-sectional study, utilizing the data from the China Health and Retirement Longitudinal Study in 2015, including 11,377 participants aged 45 years and older. Multivariable regression models were used to assess the association of metabolic multimorbidity with healthcare, out-of-pocket expenditure (OOPE), the activities of daily living (ADL) limitation, the instrumental activities of daily living (IADL) limitation, and depression.Results: Overall, 30.50% of total participants had metabolic multimorbidity in 2015 in China. Compared with single disease, metabolic multimorbidity were associated with the number of outpatient visits [incident rate ratio (IRR) = 1.30, 95% CI = 1.05, 1.62] and days of inpatient care (IRR = 1.52, 95% CI = 1.28, 1.81). Metabolic multimorbidity was positively associated with the OOPE on outpatient care (coefficient = 82.99, 95% CI = 17.70, 148.27) and physical functional difficulties, including ADL limitation (odds ratio = 1.36, 95% CI = 1.18, 1.57).Conclusions: Metabolic multimorbidity is associated with higher levels of health-care service use, greater expenditure for outpatient care, and more difficulties in ADL among Chinese adults. China's health-care systems need to shift from single-disease models to new financing and service delivery models to effectively manage metabolic multimorbidity.

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