Perinatal Outcomes among Women Identified by a Community Health Needs Assessment

Objective The aim of the study is to compare perinatal outcomes for women with greater social needs, as identified by the Community Health Needs Assessment, to those of women living in other areas of the county. Study Design This was a retrospective cohort study of pregnant women delivering at a large inner-city county hospital. Perinatal outcomes were analyzed for women living within a target area with substantial health disparities and social needs, and compared with those women living outside the target area. Statistical analysis included student's t-test, Chi square, and logistic regression. Results Between January 2015 and July 2020, 66,936 women delivered at Parkland hospital. Of these, 7,585 (11%) resided within the target area. These women were younger (26.8 ± 6.5 vs. 27.9 ± 6.4 years, p < 0.001), more likely to be black (37 vs. 13%, p < 0.001), and had a higher body mass index or BMI (33.3 ± 7.0 vs. 32.6 ± 6.4 kg/m2, p < 0.001). All women were likely to access prenatal care, with 7,320 (96.5%) in the target area and 57,677 (97.2%) outside the area attending at least one visit. Adverse perinatal outcomes were increased for women living within the target area, which persisted after adjustment for age, race, and BMI. This included an increased risk of preeclampsia (adjusted risk ratio [aRR] 1.1, 95% confidence interval or CI [1.03, 1.2]) and abruption (aRR 1.3, 95% CI [1.1, 1.7]), as well as preterm birth before both 34 weeks (aRR 1.3, 95% CI [1.2, 1.5]) and 28 weeks (aRR 1.3, 95% CI [1.02,1.7]). It follows that neonatal ICU admission (aRR 2.1, 95% CI [1.3, 3.4]) and neonatal death (aRR 1.2, 95% CI [1.1, 1.3]) were increased within the target area. Interestingly, rate of postpartum visit attendance was higher in the target area (57 vs. 48%), p < 0.001. Conclusion Even among vulnerable populations, women in areas with worse health disparities and social needs are at greater risk of adverse perinatal outcomes. Efforts to achieve health equity will need to address social disparities. Key Points

Sexual and reproductive health needs assessment and interventions in a female psychiatric intensive care unit

Aims and method To assess the sexual and reproductive health (SRH) needs of women admitted to a psychiatric intensive care unit (PICU), and acceptability of delivering specialist SRH assessments and interventions in this setting. Within a quality improvement framework, staff were trained, a clinical protocol developed and clinical interventions made accessible. Results Thirty per cent of women were identified as having unmet SRH needs and proceeded to a specialist appointment, representing a 2.5-fold increase in unmet need detection. Forty-two per cent of women were assessed, representing a 3.5-fold increase in uptake. Twenty-one per cent of women initiated SRH interventions, of which 14% had all their SRH needs met. Staff, patients and carers highlighted the acceptability and importance of SRH care, if interventions were appropriately timed and patients’ individual risk profiles were considered. Barriers to access included lack of routine enquiry, illness acuity and impact of the COVID-19 pandemic. Clinical implications SRH needs for PICU admissions are greater than previously realised. Providing a nurse-led SRH assessment is acceptable, feasible and beneficial for PICU patients.

The Emperor’s New Clothes: Head-to-Health Centres expand in the absence of evaluation of efficacy

Objective: To discuss concerns about the Australian federal government announcement of further funding expansion of the Adult Mental Health Centres (AMHCs), now known as Head-to-Health centres. Conclusions: The expansion of AMHCs prior to evaluation recapitulates the policy predicaments and perils of the headspace federal-infrastructure allied-health private-practice model. Comprehensive evidence-based mental healthcare planning and practice is needed, rather than stand-alone services of unclear efficacy. We describe the principles of such an approach based upon an evidence-based Health Needs Assessment.

Health Needs Assessment: Impact on Planning and Purchasing in the Public Health Sector in New Zealand

<p>Health needs assessment (HNA) is one of the features of the New Zealand health system established by the New Zealand Public Health and Disability Act 2000. District Health Boards (DHBs) are to conduct HNAs, and planning of health services is intended to take into account the health needs of the population. Key questions for research relate to the impact of HNA on DHB planning and purchasing in a political/bureaucratic model of governance. This research was undertaken within a public policy framework that focused on evaluating the reforms against policy goals and expectations, and particularly against the influences that might be predicted from the HNA and prioritisation policy. Consideration was given to the range and effectiveness of past HNAs as well as the expectations and experiences of the DHB model in regard to HNA. Document analysis and 34 interviews were conducted regarding 50 HNAs conducted in the public health sector from 1991-2000 to assess their impact on service delivery, decision-making, and policy. Document analysis was undertaken on DHB HNAs, prioritisation frameworks, board priorities, District Strategic Plans, and District Annual Plans for each of 20 DHBs. Planning and Funding managers were interviewed using semi-structured interview techniques to ascertain their experiences and views regarding the use of HNAs in planning. Grounded theory approaches were mainly used for the interview analysis. Case studies of five DHBs provided an in-depth understanding of the connections between health needs assessment, prioritisation, District Strategic Plans and District Annual Plans. Collection of contextual data provided an understanding of the influence of other policy decisions made locally or nationally. Using triangulation, conclusions were drawn regarding the effectiveness and impact of HNA and prioritisation on planning and health service purchasing by DHBs. The implications for public policy were then considered. Recent needs assessments conducted by DHBs mostly met the minimum requirements of the Ministry of Health, but the quality was variable. DHB Planning and Funding Managers were unanimously positive regarding the usefulness of HNAs, and felt that there were good connections between them and the planning process (Connection Score). However, the impact of HNAs on planning and purchasing measured using document analysis (Impact Factor) was lower than expected. A number of barriers to effective use were identified. More focused HNA by DHBs is recommended with the use of mixed scanning approaches and service development groups directed towards specific service planning areas. Recommendations are made regarding future policy for HNA and prioritisation.</p>

Health Needs Assessment: Impact on Planning and Purchasing in the Public Health Sector in New Zealand

<p>Health needs assessment (HNA) is one of the features of the New Zealand health system established by the New Zealand Public Health and Disability Act 2000. District Health Boards (DHBs) are to conduct HNAs, and planning of health services is intended to take into account the health needs of the population. Key questions for research relate to the impact of HNA on DHB planning and purchasing in a political/bureaucratic model of governance. This research was undertaken within a public policy framework that focused on evaluating the reforms against policy goals and expectations, and particularly against the influences that might be predicted from the HNA and prioritisation policy. Consideration was given to the range and effectiveness of past HNAs as well as the expectations and experiences of the DHB model in regard to HNA. Document analysis and 34 interviews were conducted regarding 50 HNAs conducted in the public health sector from 1991-2000 to assess their impact on service delivery, decision-making, and policy. Document analysis was undertaken on DHB HNAs, prioritisation frameworks, board priorities, District Strategic Plans, and District Annual Plans for each of 20 DHBs. Planning and Funding managers were interviewed using semi-structured interview techniques to ascertain their experiences and views regarding the use of HNAs in planning. Grounded theory approaches were mainly used for the interview analysis. Case studies of five DHBs provided an in-depth understanding of the connections between health needs assessment, prioritisation, District Strategic Plans and District Annual Plans. Collection of contextual data provided an understanding of the influence of other policy decisions made locally or nationally. Using triangulation, conclusions were drawn regarding the effectiveness and impact of HNA and prioritisation on planning and health service purchasing by DHBs. The implications for public policy were then considered. Recent needs assessments conducted by DHBs mostly met the minimum requirements of the Ministry of Health, but the quality was variable. DHB Planning and Funding Managers were unanimously positive regarding the usefulness of HNAs, and felt that there were good connections between them and the planning process (Connection Score). However, the impact of HNAs on planning and purchasing measured using document analysis (Impact Factor) was lower than expected. A number of barriers to effective use were identified. More focused HNA by DHBs is recommended with the use of mixed scanning approaches and service development groups directed towards specific service planning areas. Recommendations are made regarding future policy for HNA and prioritisation.</p>

Health needs assessment

This chapter begins with a consideration of the technical processes used for conducting health needs assessment. The relationship between health needs assessment and health economics is then examined and the philosophy of utilitarianism and its influence on health economics is explored. Cost utility analysis and its links to studies of quality of life are described and the important relationships between equity and efficiency are considered. The chapter then proceeds to explore the political and philosophical issues attaching to health needs assessment. This leads to an elaboration of the concept of justice derived from the work of Sen. Using ideas about the importance of human capabilities an argument is developed about the relational approach to understanding justice. The relational as against the individualistic position is found to provide a novel and useful way of describing health need and of attempting to meet that need. It also provides a set of precepts about the ways that services might be configured.