Pub Date : 2024-08-08DOI: 10.1101/2024.08.07.24311636
Amos Asiedu, Rachel Haws, Wahjib Mohammed, Joseph Boye-Doe, Charles Agblanya, Raphael Ntumy, Keziah Malm, Paul Boateng, Gladys Tetteh, Lolade Oseni
Effective decision-making for malaria prevention and control depends on timely, accurate, and appropriately analyzed and interpreted data. Poor quality data reported into national health management information systems (HMIS) prevent managers at the district level from planning effectively for malaria in Ghana. We analyzed reports from data coaching visits and follow-up supervision conducted to 231 health facilities in six of Ghana’s 16 regions between February and November 2021. The visits targeted health workers’ knowledge and skills in malaria data recording, HMIS reporting, and how managers visualized and used HMIS data for planning and decision making. A before-after design was used to assess how data coaching visits affected data documentation practices and compliance with standards of practice, quality and completeness of national HMIS data, and use of facility-based malaria indicator wall charts for decision-making at health facilities. The percentage of health workers demonstrating good understanding of standards of practice in documentation, reporting and data use increased from 72 to 83% (p<0.05). At first follow-up, reliability of HMIS data entry increased from 29 to 65% (p<0.001); precision increased from 48 to 78% (p<0.001); and timeliness of reporting increased from 67 to 88% (p<0.001). HMIS data showed statistically significant improvement in data completeness (from 62 to 87% (p<0.001)) and decreased error rate (from 37 to 18% (p<0.001)) from baseline to post-intervention. By the second follow-up visit, 98% of facilities had a functional data management system (a 26-percentage-point increase from the first follow-up visit, p<0.0001), 77% of facilities displayed wall charts, and 63% reported using data for decision-making and local planning. There are few documented examples of data coaching to improve malaria surveillance and service data quality. Data coaching provides support and mentorship to improve data quality, visualization, and use, modeling how other malaria programs can use HMIS data effectively at the local level.
{"title":"Coaching visits and supportive supervision for primary care facilities to improve malaria service data quality in Ghana: an intervention case study","authors":"Amos Asiedu, Rachel Haws, Wahjib Mohammed, Joseph Boye-Doe, Charles Agblanya, Raphael Ntumy, Keziah Malm, Paul Boateng, Gladys Tetteh, Lolade Oseni","doi":"10.1101/2024.08.07.24311636","DOIUrl":"https://doi.org/10.1101/2024.08.07.24311636","url":null,"abstract":"Effective decision-making for malaria prevention and control depends on timely, accurate, and appropriately analyzed and interpreted data. Poor quality data reported into national health management information systems (HMIS) prevent managers at the district level from planning effectively for malaria in Ghana. We analyzed reports from data coaching visits and follow-up supervision conducted to 231 health facilities in six of Ghana’s 16 regions between February and November 2021. The visits targeted health workers’ knowledge and skills in malaria data recording, HMIS reporting, and how managers visualized and used HMIS data for planning and decision making. A before-after design was used to assess how data coaching visits affected data documentation practices and compliance with standards of practice, quality and completeness of national HMIS data, and use of facility-based malaria indicator wall charts for decision-making at health facilities. The percentage of health workers demonstrating good understanding of standards of practice in documentation, reporting and data use increased from 72 to 83% (p<0.05). At first follow-up, reliability of HMIS data entry increased from 29 to 65% (p<0.001); precision increased from 48 to 78% (p<0.001); and timeliness of reporting increased from 67 to 88% (p<0.001). HMIS data showed statistically significant improvement in data completeness (from 62 to 87% (p<0.001)) and decreased error rate (from 37 to 18% (p<0.001)) from baseline to post-intervention. By the second follow-up visit, 98% of facilities had a functional data management system (a 26-percentage-point increase from the first follow-up visit, p<0.0001), 77% of facilities displayed wall charts, and 63% reported using data for decision-making and local planning. There are few documented examples of data coaching to improve malaria surveillance and service data quality. Data coaching provides support and mentorship to improve data quality, visualization, and use, modeling how other malaria programs can use HMIS data effectively at the local level.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141941629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
ABSTRACT Background: Sepsis is a critical medical condition characterized by life-threatening organ dysfunction triggered by a dysregulated response to infection. It poses a substantial global health burden, with significant morbidity, mortality, and economic costs, particularly pronounced in low- and middle-income countries. Effective management of sepsis relies on early recognition and appropriate intervention, underscoring the importance of accurate classification to guide treatment decisions. Objective: This longitudinal observational study aimed to assess the distribution of sepsis categories and the use of empirical antibiotics classified by the WHO AWaRe system in a tertiary care hospital in Northern India. The study also aimed to highlight implications for antimicrobial stewardship by examining the use of AWaRe group antibiotics and their correlation with sepsis classifications. Methods: A total of 1867 patients admitted with suspected sepsis were screened, with 230 meeting inclusion criteria. Patients were categorized into different sepsis classes (Asepsis, Possible Sepsis, Probable Sepsis, Confirm Sepsis) and followed until discharge or Day-28. Descriptive statistical analysis was employed to assess sepsis categories and empirical antibiotic usage classified by Access, Watch, and Reserve categories according to the WHO AWaRe system. Results: Among the study cohort (mean age 40.70 +/- 14.49 years, 50.9% female), initial sepsis classification predominantly included Probable Sepsis (51.3%) and Possible Sepsis (35.7%), evolving to Asepsis (57.8%) upon final classification. Empirical antibiotic use showed a concerning predominance of Watch group antibiotics (92.5%), with Ceftriaxone (45.7%) and piperacillin-tazobactam (31.7%) being the most commonly prescribed. Conclusion: The dynamic nature of sepsis classification underscores the complexity of diagnosing and managing this condition. Accurate categorization is pivotal for clinical decision-making, optimizing antibiotic use, and combating antimicrobial resistance. The majority of the asepsis category was levelled as probable or possible sepsis and given antibiotics. The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation, potentially reducing unnecessary antibiotic exposure. Future efforts should focus on establishing sepsis classification checklists and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.
{"title":"RIGHT SEPSIS CLASSIFICATION- MUST FOR ANTIMICROBIAL STEWARDSHIP: A LONGITUDINAL OBSERVATIONAL STUDY","authors":"Jaideep Pilania, Prasan Kumar Panda, Ananya Das, Udit Chauhan, Ravi Kant","doi":"10.1101/2024.08.07.24311603","DOIUrl":"https://doi.org/10.1101/2024.08.07.24311603","url":null,"abstract":"ABSTRACT\u0000Background: Sepsis is a critical medical condition characterized by life-threatening organ dysfunction triggered by a dysregulated response to infection. It poses a substantial global health burden, with significant morbidity, mortality, and economic costs, particularly pronounced in low- and middle-income countries. Effective management of sepsis relies on early recognition and appropriate intervention, underscoring the importance of accurate classification to guide treatment decisions. Objective: This longitudinal observational study aimed to assess the distribution of sepsis categories and the use of empirical antibiotics classified by the WHO AWaRe system in a tertiary care hospital in Northern India. The study also aimed to highlight implications for antimicrobial stewardship by examining the use of AWaRe group antibiotics and their correlation with sepsis classifications. Methods: A total of 1867 patients admitted with suspected sepsis were screened, with 230 meeting inclusion criteria. Patients were categorized into different sepsis classes (Asepsis, Possible Sepsis, Probable Sepsis, Confirm Sepsis) and followed until discharge or Day-28. Descriptive statistical analysis was employed to assess sepsis categories and empirical antibiotic usage classified by Access, Watch, and Reserve categories according to the WHO AWaRe system. Results: Among the study cohort (mean age 40.70 +/- 14.49 years, 50.9% female), initial sepsis classification predominantly included Probable Sepsis (51.3%) and Possible Sepsis (35.7%), evolving to Asepsis (57.8%) upon final classification. Empirical antibiotic use showed a concerning predominance of Watch group antibiotics (92.5%), with Ceftriaxone (45.7%) and piperacillin-tazobactam (31.7%) being the most commonly prescribed. Conclusion: The dynamic nature of sepsis classification underscores the complexity of diagnosing and managing this condition. Accurate categorization is pivotal for clinical decision-making, optimizing antibiotic use, and combating antimicrobial resistance. The majority of the asepsis category was levelled as probable or possible sepsis and given antibiotics. The high reliance on Watch group antibiotics in empirical therapy signals a need for enhanced diagnostic strategies to refine treatment initiation, potentially reducing unnecessary antibiotic exposure. Future efforts should focus on establishing sepsis classification checklists and promoting adherence to antimicrobial stewardship principles to mitigate the global threat of antimicrobial resistance.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"64 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141941716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper examines the application of Results Based Management (RBM) in a health program aimed at combating noncommunicable diseases (NCDs) in rural Egypt. The study focuses on a three-year initiative implemented from 2019 to 2022 across five governorates, targeting diabetes, hypertension, and cardiovascular diseases. Using a mixed-methods approach, we analyze the program's design, implementation, and outcomes through the lens of RBM principles. Our findings indicate that the adoption of RBM led to improved goal clarity, enhanced monitoring and evaluation processes, and increased accountability among stakeholders. The program achieved a 15% reduction in NCD-related mortality and a 22% increase in early detection rates. However, challenges were encountered in data collection and local capacity building. This case study contributes to the growing body of literature on RBM in public health contexts, particularly in resource-limited settings. We conclude by offering recommendations for policymakers and program managers on effectively integrating RBM into health initiatives targeting NCDs in similar environments. Keywords: Results Based Management, Noncommunicable diseases, Rural health, Egypt, Program evaluation
{"title":"From Goals to Gains: Results Based Management Revolutionizes NCD Care in Rural Egypt","authors":"Sonia Utterman, Muhammad Ragaa Hussein, Mona ElKady, Walaa Awad, Amanda Marrison","doi":"10.1101/2024.08.07.24311599","DOIUrl":"https://doi.org/10.1101/2024.08.07.24311599","url":null,"abstract":"This paper examines the application of Results Based Management (RBM) in a health program aimed at combating noncommunicable diseases (NCDs) in rural Egypt. The study focuses on a three-year initiative implemented from 2019 to 2022 across five governorates, targeting diabetes, hypertension, and cardiovascular diseases. Using a mixed-methods approach, we analyze the program's design, implementation, and outcomes through the lens of RBM principles.\u0000Our findings indicate that the adoption of RBM led to improved goal clarity, enhanced monitoring and evaluation processes, and increased accountability among stakeholders. The program achieved a 15% reduction in NCD-related mortality and a 22% increase in early detection rates. However, challenges were encountered in data collection and local capacity building.\u0000This case study contributes to the growing body of literature on RBM in public health contexts, particularly in resource-limited settings. We conclude by offering recommendations for policymakers and program managers on effectively integrating RBM into health initiatives targeting NCDs in similar environments.\u0000Keywords: Results Based Management, Noncommunicable diseases, Rural health, Egypt, Program evaluation","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141941630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-05DOI: 10.1101/2024.08.04.24311459
Tanya Schultz, Sandra Gabriel, Muhammad Hussein, Jennifer Swint, Mona ElBoray, Amanda Peter, Zahra Zeinhom, Hend Abbas, Samah Anwar, Wei Zhang
This case study examines the implementation of a results-based management (RBM) approach in a childhood vaccination program across rural Egypt. The project, initiated in 2020, aimed to address the persistently low immunization rates in remote areas by restructuring healthcare delivery and resource allocation. The study details how the RBM framework was applied to set clear, measurable objectives, develop key performance indicators, and establish a robust monitoring and evaluation system. It highlights the innovative use of mobile health technologies for data collection and analysis, enabling real-time adjustments to the program strategy. Over a three-year period, the initiative achieved a remarkable 40% increase in vaccination coverage, significantly reducing the incidence of preventable childhood diseases in the target regions. The case study explores the challenges encountered, including cultural barriers and logistical hurdles, and describes the adaptive management techniques employed to overcome these obstacles. This research provides valuable insights into the effective application of RBM principles in resource-constrained settings, demonstrating how data-driven decision-making and stakeholder engagement can lead to substantial improvements in public health outcomes. The findings offer practical guidelines for healthcare managers and policymakers seeking to enhance the efficiency and impact of their programs in similar contexts.
{"title":"Transforming Childhood Vaccination Rates in Rural Egypt: A Case Study on Results-Based Management in Healthcare Programs","authors":"Tanya Schultz, Sandra Gabriel, Muhammad Hussein, Jennifer Swint, Mona ElBoray, Amanda Peter, Zahra Zeinhom, Hend Abbas, Samah Anwar, Wei Zhang","doi":"10.1101/2024.08.04.24311459","DOIUrl":"https://doi.org/10.1101/2024.08.04.24311459","url":null,"abstract":"This case study examines the implementation of a results-based management (RBM) approach in a childhood vaccination program across rural Egypt. The project, initiated in 2020, aimed to address the persistently low immunization rates in remote areas by restructuring healthcare delivery and resource allocation.\u0000The study details how the RBM framework was applied to set clear, measurable objectives, develop key performance indicators, and establish a robust monitoring and evaluation system. It highlights the innovative use of mobile health technologies for data collection and analysis, enabling real-time adjustments to the program strategy.\u0000Over a three-year period, the initiative achieved a remarkable 40% increase in vaccination coverage, significantly reducing the incidence of preventable childhood diseases in the target regions. The case study explores the challenges encountered, including cultural barriers and logistical hurdles, and describes the adaptive management techniques employed to overcome these obstacles.\u0000This research provides valuable insights into the effective application of RBM principles in resource-constrained settings, demonstrating how data-driven decision-making and stakeholder engagement can lead to substantial improvements in public health outcomes. The findings offer practical guidelines for healthcare managers and policymakers seeking to enhance the efficiency and impact of their programs in similar contexts.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141941717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1101/2024.08.01.24311159
Charity Oga-Omenka, Angelina Sassi, Nathaly Vasquez Aguilera, Namrata Rana, Mohammad Yasir Essar, Darryl Ku, Hanna Diploma, Lavanya Huria, Kiran Saqib, Rishav Das, Guy Stallworthy, Madhukar Pai
Background: For many diseases, early diagnosis and treatment are more cost-effective, reduce community spread of infectious diseases, and result in better patient outcomes. However, healthcare-seeking and diagnoses for several diseases are unnecessarily delayed. For example, in 2022, 3 million and 5.6 million people living with TB and HIV respectively were undiagnosed. Many patients never access appropriate testing, remain undiagnosed after testing or drop out shortly after treatment initiation. This underscores challenges in accessing healthcare for many individuals. Understanding healthcare-seeking obstacles can expose bottlenecks in healthcare delivery and promote equity of access. We aimed to synthesize methodologies used to portray healthcare-seeking trajectories and provide a conceptual framework for patient journey analyses. Design/Methods: We conducted a literature search using keywords related to patient/care healthcare-seeking/journey/pathway analysis AND TB OR infectious/pulmonary diseases in PubMED, CINAHL, Web of Science and Global Health (OVID). From a preliminary scoping search and expert consultation, we developed a conceptual framework and honed the key data points necessary to understand patients healthcare-seeking journeys, which then served as our inclusion criteria for the subsequent expanded review. Retained papers included at least three of these data points. Results: Our conceptual framework included 5 data points and 7 related indicators that contribute to understanding patients experiences during healthcare-seeking. We retained 66 studies that met our eligibility criteria. Most studies (56.3%) were in Central and Southeast Asia, explored TB healthcare-seeking experiences (76.6%), were quantitative (67.2%), used in-depth, semi-structured, or structured questionnaires for data collection (73.4%). Healthcare-seeking journeys were explored, measured and portrayed in different ways, with no consistency in included information. Conclusions: We synthesized various methodologies in exploring patient healthcare-seeking journeys and found crucial data points necessary to understand challenges patients encounter when interacting with health systems. and offer insights to researchers and healthcare practitioners. Our framework proposes a standardized approach to patient journey research.
背景：对于许多疾病而言，早期诊断和治疗更具成本效益，可减少传染病在社区的传播，并为患者带来更好的治疗效果。然而，一些疾病的就医和诊断却被不必要地延误了。例如，在 2022 年，分别有 300 万和 560 万肺结核和艾滋病毒感染者未得到诊断。许多患者从未接受过适当的检测，检测后仍未确诊，或在开始治疗后不久就放弃了治疗。这凸显了许多人在获得医疗保健方面面临的挑战。了解就医障碍可以揭示医疗服务的瓶颈，促进公平就医。我们的目的是对用于描绘医疗保健寻求轨迹的方法进行综合，并为患者旅程分析提供一个概念框架：我们在 PubMED、CINAHL、Web of Science 和 Global Health (OVID) 中使用与患者/医疗保健寻求/旅程/路径分析和结核病或传染性/肺部疾病相关的关键词进行了文献检索。通过初步的范围界定搜索和专家咨询，我们制定了一个概念框架，并完善了了解患者就医历程所需的关键数据点，这些数据点成为我们后续扩大综述的纳入标准。保留的论文至少包含其中三个数据点：我们的概念框架包括 5 个数据点和 7 个相关指标，它们有助于了解患者在寻求医疗保健过程中的经历。我们保留了 66 篇符合资格标准的研究。大多数研究（56.3%）位于中亚和东南亚，探讨了结核病的就医经历（76.6%），采用定量研究（67.2%），使用深度、半结构化或结构化问卷进行数据收集（73.4%）。对就医历程的探索、衡量和描述方式各不相同，所纳入的信息也不一致：我们综合运用了各种方法来探索患者的医疗保健寻求之旅，发现了了解患者在与医疗系统互动时遇到的挑战所需的关键数据点，并为研究人员和医疗保健从业人员提供了见解。我们的框架提出了患者旅程研究的标准化方法。
{"title":"A Methodological Review of Patient Healthcare-Seeking Journeys from Symptom Onset to Receipt of Care","authors":"Charity Oga-Omenka, Angelina Sassi, Nathaly Vasquez Aguilera, Namrata Rana, Mohammad Yasir Essar, Darryl Ku, Hanna Diploma, Lavanya Huria, Kiran Saqib, Rishav Das, Guy Stallworthy, Madhukar Pai","doi":"10.1101/2024.08.01.24311159","DOIUrl":"https://doi.org/10.1101/2024.08.01.24311159","url":null,"abstract":"Background: For many diseases, early diagnosis and treatment are more cost-effective, reduce community spread of infectious diseases, and result in better patient outcomes. However, healthcare-seeking and diagnoses for several diseases are unnecessarily delayed. For example, in 2022, 3 million and 5.6 million people living with TB and HIV respectively were undiagnosed. Many patients never access appropriate testing, remain undiagnosed after testing or drop out shortly after treatment initiation. This underscores challenges in accessing healthcare for many individuals. Understanding healthcare-seeking obstacles can expose bottlenecks in healthcare delivery and promote equity of access. We aimed to synthesize methodologies used to portray healthcare-seeking trajectories and provide a conceptual framework for patient journey analyses.\u0000Design/Methods: We conducted a literature search using keywords related to patient/care healthcare-seeking/journey/pathway analysis AND TB OR infectious/pulmonary diseases in PubMED, CINAHL, Web of Science and Global Health (OVID). From a preliminary scoping search and expert consultation, we developed a conceptual framework and honed the key data points necessary to understand patients healthcare-seeking journeys, which then served as our inclusion criteria for the subsequent expanded review. Retained papers included at least three of these data points.\u0000Results: Our conceptual framework included 5 data points and 7 related indicators that contribute to understanding patients experiences during healthcare-seeking. We retained 66 studies that met our eligibility criteria. Most studies (56.3%) were in Central and Southeast Asia, explored TB healthcare-seeking experiences (76.6%), were quantitative (67.2%), used in-depth, semi-structured, or structured questionnaires for data collection (73.4%). Healthcare-seeking journeys were explored, measured and portrayed in different ways, with no consistency in included information.\u0000Conclusions: We synthesized various methodologies in exploring patient healthcare-seeking journeys and found crucial data points necessary to understand challenges patients encounter when interacting with health systems. and offer insights to researchers and healthcare practitioners. Our framework proposes a standardized approach to patient journey research.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141886693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1101/2024.07.31.24311327
Laura Sutton, Annika Wilson, Rose Nash, James Andrew Black, Senali Jayasinghe, James E Sharman, Niamh Chapman
Background Rapid Access Chest Pain Clinics (RACPCs) are outpatient cardiac services designed to promptly assess and manage patients experiencing chest pain. Despite the establishment of 25 RACPCs across Australia, a standardised implementation framework has yet to be developed. This study aimed to identify the core components of successful delivery of an existing RACPC. Methods A qualitative process evaluation study was conducted at a RACPC in a metropolitan, tertiary hospital in Tasmania, Australia, from November 2022 to July 2023. Clinical observations and semi-structured interviews were conducted with seven RACPC clinicians. Deductive data analysis was undertaken according to a Context-Mechanism-Outcome framework. Results Core components of successful RACPC delivery included: (1) a multidisciplinary team-based approach to care with discreet clinical roles; (2) timely patient review by RACPC clinicians within 30 days of referral; (3) embedded patient education; (4) ongoing clinical team training and education; and (5) a shared understanding of the RACPC service's identity and purpose. Challenges to RACPC delivery were also identified and included resource constraints and administrative burdens. Conclusions Successful delivery of a RACPC model of care relies on a range of interrelated factors. These findings align with the broader theme of ongoing health service evaluation as a driver for continuous quality improvement and care standards within RACPCs. Further research aimed at developing and implementing effective strategies to enhance service delivery is needed to determine a national model of care.
{"title":"Requirements for the delivery of an Australian Rapid Access Chest Pain Clinic","authors":"Laura Sutton, Annika Wilson, Rose Nash, James Andrew Black, Senali Jayasinghe, James E Sharman, Niamh Chapman","doi":"10.1101/2024.07.31.24311327","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311327","url":null,"abstract":"Background\u0000Rapid Access Chest Pain Clinics (RACPCs) are outpatient cardiac services designed to promptly assess and manage patients experiencing chest pain. Despite the establishment of 25 RACPCs across Australia, a standardised implementation framework has yet to be developed. This study aimed to identify the core components of successful delivery of an existing RACPC. Methods\u0000A qualitative process evaluation study was conducted at a RACPC in a metropolitan, tertiary hospital in Tasmania, Australia, from November 2022 to July 2023. Clinical observations and semi-structured interviews were conducted with seven RACPC clinicians. Deductive data analysis was undertaken according to a Context-Mechanism-Outcome framework.\u0000Results\u0000Core components of successful RACPC delivery included: (1) a multidisciplinary team-based approach to care with discreet clinical roles; (2) timely patient review by RACPC clinicians within 30 days of referral; (3) embedded patient education; (4) ongoing clinical team training and education; and (5) a shared understanding of the RACPC service's identity and purpose. Challenges to RACPC delivery were also identified and included resource constraints and administrative burdens. Conclusions\u0000Successful delivery of a RACPC model of care relies on a range of interrelated factors. These findings align with the broader theme of ongoing health service evaluation as a driver for continuous quality improvement and care standards within RACPCs. Further research aimed at developing and implementing effective strategies to enhance service delivery is needed to determine a national model of care.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"54 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141886692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-02DOI: 10.1101/2024.07.31.24310863
Wen-Chien Yang, Catherine Arsenault, Victoria Y. Fan, Hannah H. Leslie, Fouzia Farooq, Andrea B. Pembe, Theodros Getachew, Emily R. Smith
Background Antenatal corticosteroids (ACS) use among pregnant women with a high likelihood of preterm labor improves newborn survival. ACS adoption in low- and middle-income countries (LMICs) remains limited. Giving ACS in inadequately equipped settings could be harmful to mothers and newborns. Thus, health facilities have to demontrate readiness to administer ACS. However, the degree to which health systems are ready is unknown. Objective We assessed facility readiness to administer ACS based on the 2022 WHO recommendations on ACS use and ACS utilization. Methods The study used Service Provision Assessment surveys administered between 2013 and 2022 in nine LMICs. The primary outcome was whether facilities had ever provided ACS. We also assessed injectable corticosteroid (dexamethasone or betamethasone) availability and facility readiness to administer ACS. We used a total of 35 indicators, grouped into four readiness categories based on the WHO recommendations, to measure facility readiness. Findings Across eight countries with comparable sampling strategies, only 10.7% (median, range 6.7% - 35.2%) of facilities had ever provided ACS; one-fourth (median 25.3%, range 4.6% - 61.5%) of facilities had injectable corticosteroids available at the time of the survey; overall readiness indices were low ranging from 8.1% for Bangladesh to 32.9% for Senegal. Across four readiness categories, the readiness index was the lowest for criterion 1 (ability to assess gestational age accurately and identify a high likelihood of preterm birth) (7.3%), followed by criterion 2 (ability to identify maternal infections) (24.8%), criterion 4 (ability to provide adequate preterm care) (31.3%), and criterion 3 (ability to provide adequate childbirth care) (32.9%). Conclusion We proposed a strategy for measuring facility readiness to implement one of the most effective interventions to improve neonatal survival. Countries should operationalize readiness measurement, improve facilities readiness to deliver this life-saving intervention, and encourage ACS uptake by targeting facilities that are well-equipped.
{"title":"Antenatal corticosteroids for pregnant women at risk of preterm labor in low- and middle-income countries: utilization and facility readiness","authors":"Wen-Chien Yang, Catherine Arsenault, Victoria Y. Fan, Hannah H. Leslie, Fouzia Farooq, Andrea B. Pembe, Theodros Getachew, Emily R. Smith","doi":"10.1101/2024.07.31.24310863","DOIUrl":"https://doi.org/10.1101/2024.07.31.24310863","url":null,"abstract":"Background Antenatal corticosteroids (ACS) use among pregnant women with a high likelihood of preterm labor improves newborn survival. ACS adoption in low- and middle-income countries (LMICs) remains limited. Giving ACS in inadequately equipped settings could be harmful to mothers and newborns. Thus, health facilities have to demontrate readiness to administer ACS. However, the degree to which health systems are ready is unknown.\u0000Objective We assessed facility readiness to administer ACS based on the 2022 WHO recommendations on ACS use and ACS utilization.\u0000Methods\u0000The study used Service Provision Assessment surveys administered between 2013 and 2022 in nine LMICs. The primary outcome was whether facilities had ever provided ACS. We also assessed injectable corticosteroid (dexamethasone or betamethasone) availability and facility readiness to administer ACS. We used a total of 35 indicators, grouped into four readiness categories based on the WHO recommendations, to measure facility readiness.\u0000Findings Across eight countries with comparable sampling strategies, only 10.7% (median, range 6.7% - 35.2%) of facilities had ever provided ACS; one-fourth (median 25.3%, range 4.6% - 61.5%) of facilities had injectable corticosteroids available at the time of the survey; overall readiness indices were low ranging from 8.1% for Bangladesh to 32.9% for Senegal. Across four readiness categories, the readiness index was the lowest for criterion 1 (ability to assess gestational age accurately and identify a high likelihood of preterm birth) (7.3%), followed by criterion 2 (ability to identify maternal infections) (24.8%), criterion 4 (ability to provide adequate preterm care) (31.3%), and criterion 3 (ability to provide adequate childbirth care) (32.9%).\u0000Conclusion\u0000We proposed a strategy for measuring facility readiness to implement one of the most effective interventions to improve neonatal survival. Countries should operationalize readiness measurement, improve facilities readiness to deliver this life-saving intervention, and encourage ACS uptake by targeting facilities that are well-equipped.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141886691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1101/2024.07.30.24311228
Ajit Kerketta, Dr. Sathiyaseelan Balasundaram
Introduction: Despite considerable progress in the healthcare sector, rural regions continue to grapple with healthcare deficiencies. However, the emergence of AI technology offers promising solutions to overcome these hurdles. Hence, the study explores the potential and efficacy of introducing artificial intelligence (AI) tools to address the healthcare disparity in rural India. Methods: The research employed a literature review method and gathered data from various databases such as Science Direct, PubMed, and Google Scholar. The screening process was aided by the Rayyan electronic software. Articles published in English between January 2020 and December 2022 were selected, followed by a thematic analysis of the findings. Results: Results indicate the potential of AI in rural healthcare settings, showing AI-driven solutions addressing healthcare access gaps and contributing to their bridging. The study also highlights hurdles related to AI tool adoption in rural healthcare and proposes collaborative efforts among policymakers, healthcare providers, and technology developers to integrate AI tools effectively. This necessitates advocating for digital infrastructure investments, capacity-building initiatives, and conducive regulatory frameworks for AI implementation. Conclusion: The study underscores AI's transformative role in bridging the healthcare gap in rural India. By harnessing AI technologies, healthcare providers and policymakers can surmount barriers, empower local healthcare workers, and improve health outcomes for rural communities. The insights and recommendations contribute to the evolving knowledge base on leveraging AI for adequate healthcare delivery, guiding future initiatives in similar contexts.
{"title":"Leveraging AI Tools to Bridge the Healthcare Gap in Rural Areas in India","authors":"Ajit Kerketta, Dr. Sathiyaseelan Balasundaram","doi":"10.1101/2024.07.30.24311228","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311228","url":null,"abstract":"Introduction: Despite considerable progress in the healthcare sector, rural regions continue to grapple with healthcare deficiencies. However, the emergence of AI technology offers promising solutions to overcome these hurdles. Hence, the study explores the potential and efficacy of introducing artificial intelligence (AI) tools to address the healthcare disparity in rural India.\u0000Methods: The research employed a literature review method and gathered data from various databases such as Science Direct, PubMed, and Google Scholar. The screening process was aided by the Rayyan electronic software. Articles published in English between January 2020 and December 2022 were selected, followed by a thematic analysis of the findings.\u0000Results: Results indicate the potential of AI in rural healthcare settings, showing AI-driven solutions addressing healthcare access gaps and contributing to their bridging. The study also highlights hurdles related to AI tool adoption in rural healthcare and proposes collaborative efforts among policymakers, healthcare providers, and technology developers to integrate AI tools effectively. This necessitates advocating for digital infrastructure investments, capacity-building initiatives, and conducive regulatory frameworks for AI implementation.\u0000Conclusion: The study underscores AI's transformative role in bridging the healthcare gap in rural India. By harnessing AI technologies, healthcare providers and policymakers can surmount barriers, empower local healthcare workers, and improve health outcomes for rural communities. The insights and recommendations contribute to the evolving knowledge base on leveraging AI for adequate healthcare delivery, guiding future initiatives in similar contexts.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141871177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1101/2024.07.27.24311004
Jackline Jushua, Muhammad R. Hussein, Sonia Utterman, Mony Thomas
Abstract: Background: Cancer disparities persist in the United States, with significant variations in incidence, mortality, and survival rates across different population groups. This systematic review aims to synthesize current evidence on the relationship between social determinants of health and cancer disparities, and to identify effective interventions for promoting equitable cancer prevention and control. Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library databases for peer-reviewed articles published between 2010 and 2024. Studies were included if they examined the association between social determinants (e.g., socioeconomic status, race/ethnicity, education, healthcare access) and cancer outcomes, or evaluated interventions addressing these factors. Two independent reviewers screened articles, extracted data, and assessed study quality using standardized tools. Results: Of 3,247 initially identified studies, 142 met inclusion criteria. The review found strong evidence linking various social determinants to cancer disparities, particularly in screening rates, stage at diagnosis, and survival outcomes. Socioeconomic status and healthcare access were the most frequently studied determinants. Effective interventions identified included patient navigation programs, community-based education initiatives, and policy changes to expand insurance coverage. However, the quality and long-term impact of many interventions were limited by short follow-up periods and small sample sizes. Conclusion: This systematic review confirms the significant role of social determinants in perpetuating cancer disparities and highlights promising strategies for addressing these inequities. Future research should focus on developing and evaluating multilevel interventions that target both individual and structural determinants. Policy makers and healthcare providers should prioritize evidence-based approaches to reduce social barriers and promote equitable cancer prevention and control.
{"title":"Unpacking Social Determinants of Cancer Disparities: A Systematic Review and Strategic Framework for Equitable Prevention and Control","authors":"Jackline Jushua, Muhammad R. Hussein, Sonia Utterman, Mony Thomas","doi":"10.1101/2024.07.27.24311004","DOIUrl":"https://doi.org/10.1101/2024.07.27.24311004","url":null,"abstract":"Abstract:\u0000Background: Cancer disparities persist in the United States, with significant variations in incidence, mortality, and survival rates across different population groups. This systematic review aims to synthesize current evidence on the relationship between social determinants of health and cancer disparities, and to identify effective interventions for promoting equitable cancer prevention and control.\u0000Methods: We conducted a systematic search of PubMed, Embase, and Cochrane Library databases for peer-reviewed articles published between 2010 and 2024. Studies were included if they examined the association between social determinants (e.g., socioeconomic status, race/ethnicity, education, healthcare access) and cancer outcomes, or evaluated interventions addressing these factors. Two independent reviewers screened articles, extracted data, and assessed study quality using standardized tools.\u0000Results: Of 3,247 initially identified studies, 142 met inclusion criteria. The review found strong evidence linking various social determinants to cancer disparities, particularly in screening rates, stage at diagnosis, and survival outcomes. Socioeconomic status and healthcare access were the most frequently studied determinants. Effective interventions identified included patient navigation programs, community-based education initiatives, and policy changes to expand insurance coverage. However, the quality and long-term impact of many interventions were limited by short follow-up periods and small sample sizes.\u0000Conclusion: This systematic review confirms the significant role of social determinants in perpetuating cancer disparities and highlights promising strategies for addressing these inequities. Future research should focus on developing and evaluating multilevel interventions that target both individual and structural determinants. Policy makers and healthcare providers should prioritize evidence-based approaches to reduce social barriers and promote equitable cancer prevention and control.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141871055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1101/2024.07.30.24311208
Jennifer Swint, Margaret Fischer, Wei Zhang, Xi Zhang
Background: The COVID-19 pandemic has accelerated the adoption of telehealth services in mental healthcare. This systematic review aims to evaluate the effectiveness of telehealth interventions for mental health conditions compared to traditional face-to-face treatment. Methods: We searched major electronic databases (PubMed, PsycINFO, CINAHL, and Cochrane Library) for randomized controlled trials published between 2010 and 2023. Studies comparing telehealth interventions to face-to-face treatment for adults with mental health disorders were included. Two independent reviewers assessed study quality and extracted data. Meta-analyses were conducted where appropriate. Results: Thirty-five studies met the inclusion criteria, encompassing 4,827 participants across various mental health conditions. Telehealth interventions demonstrated non-inferiority to face-to-face treatment for depression (standardized mean difference [SMD] = -0.03, 95% CI [-0.15, 0.09]) and anxiety disorders (SMD = -0.06, 95% CI [-0.19, 0.07]). For post-traumatic stress disorder, telehealth showed a small but significant advantage (SMD = -0.21, 95% CI [-0.37, -0.05]). Patient satisfaction and therapeutic alliance were comparable between telehealth and face-to-face interventions. However, dropout rates were slightly higher in telehealth conditions (risk ratio = 1.27, 95% CI [1.11, 1.46]). Conclusion: This review suggests that telehealth interventions are generally as effective as face-to-face treatment for common mental health disorders. While promising, these findings should be interpreted cautiously due to heterogeneity in study designs and interventions. Future research should focus on long-term outcomes, cost-effectiveness, and strategies to improve engagement in telehealth settings.
背景：COVID-19 大流行加速了远程医疗服务在精神卫生保健领域的应用。本系统性综述旨在评估远程医疗干预对精神疾病的疗效，并与传统的面对面治疗进行比较：我们在主要电子数据库（PubMed、PsycINFO、CINAHL 和 Cochrane Library）中检索了 2010 年至 2023 年间发表的随机对照试验。其中包括比较远程医疗干预与面对面治疗成人精神疾病的研究。两名独立评审员对研究质量进行评估并提取数据。在适当的情况下进行了元分析：有 35 项研究符合纳入标准，涉及各种精神健康状况的 4827 名参与者。在抑郁症（标准化平均差 [SMD] = -0.03，95% CI [-0.15, 0.09]）和焦虑症（SMD = -0.06，95% CI [-0.19, 0.07]）方面，远程医疗干预不劣于面对面治疗。在创伤后应激障碍方面，远程医疗显示出微小但显著的优势（SMD = -0.21，95% CI [-0.37，-0.05]）。远程医疗和面对面干预的患者满意度和治疗联盟相当。然而，远程医疗条件下的辍学率略高（风险比 = 1.27，95% CI [1.11，1.46]）：本综述表明，对于常见的心理健康障碍，远程医疗干预通常与面对面治疗一样有效。虽然这些研究结果很有希望，但由于研究设计和干预措施存在异质性，因此应谨慎解读。未来的研究应关注长期结果、成本效益以及提高远程保健参与度的策略。
{"title":"Therapy Without Borders: A Systematic Review on Telehealth's Role in Expanding Mental Health Access","authors":"Jennifer Swint, Margaret Fischer, Wei Zhang, Xi Zhang","doi":"10.1101/2024.07.30.24311208","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311208","url":null,"abstract":"Background: The COVID-19 pandemic has accelerated the adoption of telehealth services in mental healthcare. This systematic review aims to evaluate the effectiveness of telehealth interventions for mental health conditions compared to traditional face-to-face treatment.\u0000Methods: We searched major electronic databases (PubMed, PsycINFO, CINAHL, and Cochrane Library) for randomized controlled trials published between 2010 and 2023. Studies comparing telehealth interventions to face-to-face treatment for adults with mental health disorders were included. Two independent reviewers assessed study quality and extracted data. Meta-analyses were conducted where appropriate.\u0000Results: Thirty-five studies met the inclusion criteria, encompassing 4,827 participants across various mental health conditions. Telehealth interventions demonstrated non-inferiority to face-to-face treatment for depression (standardized mean difference [SMD] = -0.03, 95% CI [-0.15, 0.09]) and anxiety disorders (SMD = -0.06, 95% CI [-0.19, 0.07]). For post-traumatic stress disorder, telehealth showed a small but significant advantage (SMD = -0.21, 95% CI [-0.37, -0.05]). Patient satisfaction and therapeutic alliance were comparable between telehealth and face-to-face interventions. However, dropout rates were slightly higher in telehealth conditions (risk ratio = 1.27, 95% CI [1.11, 1.46]).\u0000Conclusion: This review suggests that telehealth interventions are generally as effective as face-to-face treatment for common mental health disorders. While promising, these findings should be interpreted cautiously due to heterogeneity in study designs and interventions. Future research should focus on long-term outcomes, cost-effectiveness, and strategies to improve engagement in telehealth settings.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"50 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141871056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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