Simulating the council-specific impact of anti-malaria interventions: A tool to support malaria strategic planning in Tanzania.

INTRODUCTION: The decision-making process for malaria control and elimination strategies has become more challenging. Interventions need to be targeted at council level to allow for changing malaria epidemiology and an increase in the number of possible interventions. Models of malaria dynamics can support this process by simulating potential impacts of multiple interventions in different settings and determining appropriate packages of interventions for meeting specific expected targets. METHODS: The OpenMalaria model of malaria dynamics was calibrated for all 184 councils in mainland Tanzania using data from malaria indicator surveys, school parasitaemia surveys, entomological surveillance, and vector control deployment data. The simulations were run for different transmission intensities per region and five interventions, currently or potentially included in the National Malaria Strategic Plan, individually and in combination. The simulated prevalences were fitted to council specific prevalences derived from geostatistical models to obtain council specific predictions of the prevalence and number of cases between 2017 and 2020. The predictions were used to evaluate in silico the feasibility of the national target of reaching a prevalence of below 1% by 2020, and to suggest alternative intervention stratifications for the country. RESULTS: The historical prevalence trend was fitted for each council with an agreement of 87% in 2016 (95%CI: 0.84-0.90) and an agreement of 90% for the historical trend (2003-2016) (95%CI: 0.87-0.93) The current national malaria strategy was expected to reduce the malaria prevalence between 2016 and 2020 on average by 23.8% (95% CI: 19.7%-27.9%) if current case management levels were maintained, and by 52.1% (95% CI: 48.8%-55.3%) if the case management were improved. Insecticide treated nets and case management were the most cost-effective interventions, expected to reduce the prevalence by 25.0% (95% CI: 19.7%-30.2) and to avert 37 million cases between 2017 and 2020. Mass drug administration was included in most councils in the stratification selected for meeting the national target at minimal costs, expected to reduce the prevalence by 77.5% (95%CI: 70.5%-84.5%) and to avert 102 million cases, with almost twice higher costs than those of the current national strategy. In summary, the model suggested that current interventions are not sufficient to reach the national aim of a prevalence of less than 1% by 2020 and a revised strategic plan needs to consider additional, more effective interventions, especially in high transmission areas and that the targets need to be revisited. CONCLUSION: The methodology reported here is based on intensive interactions with the NMCP and provides a helpful tool for assessing the feasibility of country specific targets and for determining which intervention stratifications at sub-national level will have most impact. This country-led application could support strategic planning of malaria control in many other malaria endemic countries.

ACO Affiliated Hospitals Increase Implementation of Care Coordination Strategies.

BACKGROUND: Hospitals affiliated with Accountable Care Organizations (ACOs) may have a greater capacity to collaborate with providers across the care continuum to coordinate care, due to formal risk sharing and payment arrangements. However, little is known about the extent to which ACO affiliated hospitals implement care coordination strategies. OBJECTIVES: To compare the implementation of care coordination strategies between ACO affiliated hospitals (n=269) and unaffiliated hospitals (n=502) and examine whether the implementation of care coordination strategies varies by hospital payment model types. MEASURES: We constructed a care coordination index (CCI) comprised of 12 indicators that describe evidence-based care coordination strategies. Each indicator was scored on a 5-point Likert scale from 1="not used at all" to 5="used widely" by qualified representatives from each hospital. The CCI aggregates scores from each of the 12 individual indicators to a single summary score for each hospital, with a score of 12 corresponding to the lowest and 60 the highest use of care coordination strategies. RESEARCH DESIGN: We used state-fixed effects multivariable linear regression models to estimate the relationship between ACO affiliation, payment model type, and the use care coordination strategies. RESULTS: We found ACO affiliated hospitals reported greater use of care coordination strategies compared to unaffiliated hospitals. Fee-for-service shared savings and partial or global capitation payment models were associated with a greater use of care coordination strategies among ACO affiliated hospitals. CONCLUSION: Our findings suggest ACO affiliation and multiple payment model types are associated with the increased use of care coordination strategies.

Relatório de gestão CNS/MS: exercício 2011 / CNS/MS management report: financial year 2011

O Relatório de Gestão do Conselho Nacional de Saúde ­ CNS é uma ferramenta de controle e avaliação, que busca a transparência das ações realizadas. Assim, a apresentação desse Relatório é uma forma de prestação de contas com a sociedade, mostrando a ela como o Conselho utilizou os recursos públicos, o planejamento em médio prazo e principalmente as ações e os objetivos alcançados em 2011. Os resultados apresentados são decorrentes das atividades realizadas pelo Conselho Nacional como um todo, e pelas suas subdivisões. Serão apresentadas as reuniões e deliberações do Plenário e da Mesa Diretora. No tocante a presidência, foram elencadas as reuniões em que o presidente esteve representando o Conselho. Quanto a Secretaria-Executiva, foram reunidas as suas principais atividades, juntamente com as da área de Comunicação. Na parte destinada as Comissões e aos Grupos de Trabalho, destacou-se as reuniões e eventos realizados. É importante frisar que 2011 foi um ano diferenciado para o Controle Social e para o Conselho. Em virtude do Decreto Nº 7.446 de 1 de março que reduziu os limites para o empenho de diárias e passagens, alguns eventos e o número de reuniões foram reduzidas. Mesmo com essa redução a Secretaria-Executiva conseguiu se organizar para realizar as principais atividades programas. Foram realizados 6 eventos, 10 reuniões da Mesa Diretora, 12 Reuniões Ordinárias, 69 reuniões de Comissões, além das reuniões dos Grupos de Trabalho e outras atividades.