Research to inform health systems' responses to rapid population ageing: a collection of studies funded by the WHO Centre for Health Development in Kobe, Japan.

Population ageing is a global phenomenon that has profound implications for all aspects of health systems development. Research is needed to understand and improve the health system response to this demographic shift, especially in low- and middle-income countries where the change is happening rapidly. This Supplement was organized by the WHO Centre for Health Development in Kobe, Japan (WHO Kobe Centre) whose mission is to promote innovation and research for equitable and sustainable universal health coverage considering the impacts of population ageing. The Supplement features 10 papers all based on studies that were funded by the WHO Kobe Centre in recent years. The studies involve a diverse set of 10 countries in the Asia Pacific (Cambodia, Japan, the Lao People's Democratic Republic, Malaysia, Mongolia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam); address various aspects of the health system including service delivery, workforce development and financing; and utilize a wide range of research methods, including economic modelling, household surveys and intervention evaluations. This introductory article offers a brief description of each study's methods, key findings and implications. Collectively, the studies demonstrate the potential contribution that health systems research can make toward addressing the challenges of ensuring sustainable universal health coverage even while countries undergo rapid population ageing.

WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Network (TPRN): Report of the Kobe Expert Meeting.

The WHO Thematic Platform for Health Emergency and Disaster Risk Management Research Network (TPRN) was established in 2016 in response to the Sendai Framework for Disaster Risk Reduction 2015⁻2030. The TPRN facilitates global collaborative action for improving the scientific evidence base in health emergency and disaster risk management (Health EDRM). In 2018, the WHO convened a meeting to identify key research questions, bringing together leading experts from WHO, TPRN, World Association for Disaster and Emergency Medicine (WADEM), and the Japan International Cooperation Agency, and delegates to the Asia Pacific Conference on Disaster Medicine (APCDM). The meeting identified research questions in five major areas for Health EDRM: health data management, psychosocial management, community risk management, health workforce development, and research methods and ethics. Funding these key research questions is essential to accelerate evidence-based actions during emergencies and disasters.

Patient safety initiatives in obstetrics: a rapid review.

OBJECTIVES: This review was commissioned by WHO, South Africa-Country office because of an exponential increase in medical litigation claims related to patient safety in obstetrical care in the country. A rapid review was conducted to examine the effectiveness of quality improvement (QI) strategies on maternal and newborn patient safety outcomes, risk of litigation and burden of associated costs. DESIGN: A rapid review of the literature was conducted to provide decision-makers with timely evidence. Medical and legal databases (eg, MEDLINE, Embase, LexisNexis Academic, etc) and reference lists of relevant studies were searched. Two reviewers independently performed study selection, abstracted data and appraised risk of bias. Results were summarised narratively. INTERVENTIONS: We included randomised clinical trials (RCTs) of QI strategies targeting health systems (eg, team changes) and healthcare providers (eg, clinician education) to improve the safety of women and their newborns. Eligible studies were limited to trials published in English between 2004 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES: RCTs reporting on patient safety outcomes (eg, stillbirths, mortality and caesarean sections), litigation claims and associated costs were included. RESULTS: The search yielded 4793 citations, of which 10 RCTs met our eligibility criteria and provided information on over 500 000 participants. The results are presented by QI strategy, which varied from one study to another. Studies including provider education alone (one RCT), provider education in combination with audit and feedback (two RCTs) or clinician reminders (one RCT), as well as provider education with patient education and audit and feedback (one RCT), reported some improvements to patient safety outcomes. None of the studies reported on litigation claims or the associated costs. CONCLUSIONS: Our results suggest that provider education and other QI strategy combinations targeting healthcare providers may improve the safety of women and their newborns during childbirth.

Evaluative reports on medical malpractice policies in obstetrics: a rapid scoping review.

BACKGROUND: The clinical specialty of obstetrics is under particular scrutiny with increasing litigation costs and unnecessary tests and procedures done in attempts to prevent litigation. We aimed to identify reports evaluating or comparing the effectiveness of medical liability reforms and quality improvement strategies in improving litigation-related outcomes in obstetrics. METHODS: We conducted a rapid scoping review with a 6-week timeline. MEDLINE, EMBASE, LexisNexis Academic, the Legal Scholarship Network, Justis, LegalTrac, QuickLaw, and HeinOnline were searched for publications in English from 2004 until June 2015. The selection criteria for screening were established a priori and pilot-tested. We included reports comparing or evaluating the impact of obstetrics-related medical liability reforms and quality improvement strategies on cost containment and litigation settlement across all countries. All levels of screening were done by two reviewers independently, and discrepancies were resolved by a third reviewer. In addition, two reviewers independently extracted relevant data using a pre-tested form, and discrepancies were resolved by a third reviewer. The results were summarized descriptively. RESULTS: The search resulted in 2729 citations, of which 14 reports met our eligibility criteria. Several initiatives for improving the medical malpractice litigation system were found, including no-fault approaches, patient safety policy initiatives, communication and resolution, caps on compensation and attorney fees, alternative payment system and liabilities, and limitations on litigation. CONCLUSIONS: Only a few litigation policies in obstetrics were evaluated or compared. Included documents showed that initiatives to reduce medical malpractice litigation could be associated with a decrease in adverse and malpractice events. However, due to heterogeneous settings (e.g., economic structure, healthcare system) and variation in the outcomes reported, the advantages and disadvantages of initiatives may vary.