Health Outcomes Management Evaluation—A National Analysis of Dutch Heart Care

Aims A group of heart centres in the Netherlands have been at the forefront internationally to implement the principles of value-based healthcare. This study aims to give an up-to-date assessment of outcome-based quality improvement in 2020 at a national level in Dutch heart care. Methods and results Physicians and healthcare professionals for each participating hospital filled out a questionnaire with 26 detailed questions on quality improvement and organization of care. In total, 20 hospitals participated; 11 heart centres with thoracic surgery and 9 without thoracic surgery. Results show that outcome reports are actively used within the heart centres to support quality improvement initiatives. In 50% of the centres, apart from physicians, also nurses and hospital management are involved. For 60% of the heart centres, outcome measurement is embedded in strategy and annual plans. The stage of development of supporting IT infrastructure (outcome measurement in the Electronic Health Record and dashboards) is very diverse. A wide range of different learning strategies supports outcome-based quality improvement. Conclusion Health outcomes have become a relevant element in quality improvement and organization of Dutch heart centres. Earlier research shows that in 2012–2016 heart centres focused mainly on measuring outcomes. Now in 2020, heart centres are more able to actually use the acquired insights based on these measurements to initiate improvement projects. The diversity in how this is done indicates that this field is still strongly developing and shows potential for heart centres to share best practices in the implementation of value-based healthcare.

Differences in management and treatment of traumatic adult pan brachial plexus injuries: a global perspective regarding continental variations

An expert opinion study was designed to query five countries and six brachial plexus surgeons regarding the demographics, mechanisms of injury, evaluation, timing of surgery, reconstructive strategies and controversies in adult traumatic pan brachial plexus injuries. Variations in assessing outcomes, management of neuropathic pain and future considerations were elucidated. Clear differences in regional demographics, mechanisms of injury, patient evaluation and treatment strategies were identified. The role of phrenic nerve and contralateral C7 transfer, acute use of free functioning muscle transfers, root reimplantation and amputation/myoelectric prosthetic fitting were regional/surgeon dependent. Comparison of outcomes across regions requires an understanding of the regional nuances of patient demographics, injury mechanisms, preferred reconstructive strategies and how outcomes are measured. Future studies are required to allow accurate regional comparisons.

WAR THORACIC WOUNDS AMONG CIVILIANS CASUALTIES IN ADEN DURING THE 2015

Thoracic injury during warfare was associated with a high incidence of morbidity and mortality. In wartime, civilians have became a direct target and accounted for one-half to two-thirds of the casualties. We aimed to highlight the incidence and pattern of thoracic injury and its outcomes management among civilians during the war in Aden. This retrospective study was based on the data were prospectively recorded in Medical Registry. There were 84 civilian casualties identified during the study period. Of those, 97.6% of casualties were males and 2.4% were females. The overall mean age was 30.8 ± 9.8 years (range: 10 – 65 years). Of those, 73.8% of casualties were produced by rifle bullets, while 26.2% of casualties were due to fragmentation weapons. Hemopneumothorax was the most common injury patterns. Abdomen injury was the most common associated injuries. Of those, 91.7% of casualties were treated with chest tube insertion alone. Thoracotomy was performed for 7.1% of casualties. The overall complications were 54.8%. Wound infection was the most frequent complications. The overall mortality rate was 3.6%. The overall mean hospital stay was 8.3 ± 5.9 days. We concluded that chest drain is best option for treatment the majority penetrating chest wounds.

Outcomes Management in a Real-World Evidence Context: The Case of Abiraterone and Enzalutamide in the Treatment of Metastatic Castration-Resistant Prostate Cancer

ABSTRACT At present, for patients with metastatic and castration-resistant prostate cancer, European Society for Medical Oncology and National Comprehensive Cancer Network guidelines recommend enzalutamide (E) or abiraterone (A). There are still a few studies comparing both drugs in a real-world setting, thus, in this article, we discuss an outcomes management methodology, supporting the follow-up of patients. This involves measuring relevant baseline traits and outcomes, such as overall survival (OS), treatment duration, patient-reported outcomes, and adverse events. We include 38 men in the A group and 15 in the E group. When comparing the survival of both drugs, both present similar OS. Regarding the quality-of-life analysis (QoL) with EPIC26, reported Standard QoL score was 58.3% in our patients, which was in line with the European Organization for the Research and Treatment of Cancer reference. As a result, by showing that we can capture the distinctive clinical benefits of A and E, and that patient-reported outcomes can be systematically collected for more than 2 years per living patient, we can now incorporate these findings in clinical discussions, risk-sharing agreements, or policy-level arguments.

Diabetes Registry of Pakistan

Diabetes registries can be used to monitor the prevalence and incidence of diabetes. Diabetes registries are used in many countries for population management of diabetes, outcomes management, and development of Clinician finding Support Structure, for example, National Diabetes Registry (NDR) in Sweden and Singapore diabetes registry. According to 2nd National Diabetes Survey of Pakistan (NDSP) 2016-2017, overall 26.3% adult (≥20) suffer from diabetes (27.4 million people). Health Research Advisory Board (HRAB) of Pakistan has initiated the mission of developing disease registries countrywide. Diabetes Registry of Pakistan (DROP) under the supervision of Prof. Abdul Basit and Dr. Asher Fawwad to enumerate the degree of the national disease burden. For type 1 diabetes, Diabetes Registry of Pakistan for type 1 (DROP-1) has already started. DROP-1 can be a good pilot arm for developing the robust methodology for DROP. The upcoming and the ongoing research is periodically being linked with the registry to ensure its modernization. This registry is a useful tool for tracking the status of patient, in order to limit the burden of data collection. A web-based data entry system and automated random sampling has enabled useful data collection and tracking with relatively minimal effort. doi: https://doi.org/10.12669/pjms.36.3.1877 How to cite this:Basit A, Fawwad A, Baqa K. Diabetes Registry of Pakistan. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1877 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.