Integrating Data To Advance Research, Operations, And Client-Centered Services In California.

The value of using administrative records for operational and evaluation purposes has been well established in health and human services. However, these records typically reflect the reach of a single government agency or program and fail to capture the experiences of individuals as they engage with different agencies or programs over time. Thus, the potential for these data to improve everyday operations, coordinate services, develop targeted interventions, and advance the science behind broader social policies has yet to be fully realized. A first step toward realizing that potential is to transition from an agency-centered to a client- or person-centered organization of data. We systematically linked tens of millions of records across California's largest health and human services programs. Our results underscore how the integration of records can help shift discussions from the programs that administer services to the people who are served.

Developing and Pilot Testing an Integrated Technology-Moderated Institutional Health Promotion Model Using Operational Research Approach.

The study aimed to develop and pilot test an Integrated Technology-Moderated Institutional Health Promotion Model for university staff in Nigeria. An operational research approach using mixed concurrent design was adopted to develop the model, and pretest-posttest method was used to evaluate the utilization and effectiveness of the developed model. The participants in the study were university staff. Health-promoting lifestyle behavior and health status were measured via the adapted Health-Promoting Lifestyle Profile II instrument. The emerging model (an Integrated Technology-Moderated Institutional Health Promotion Model, which is an Android phone app named Tertiary Staff Health Promotion App) was deployed. Data were collected before and 12 weeks after the app deployment. The quantitative and qualitative data findings were combined to develop an integrated technology-moderated institutional health promotion model as a means to enhance health-promoting lifestyle behavior and health status of staff. The result of the pilot testing of the model showed that the model enhances health-promoting lifestyle behaviors and improves the health status of staff. Nurses, especially in community/public health nursing practice, can provide innovative interventions to drive and enhance health-promoting lifestyle behavior and improve health status of workers and other population groups through effective use of information and communication technology.

Application of discrete event simulation in health care: a systematic review.

BACKGROUND: The objective was to explore the current advances and extent of DES (Discrete Event Simulation) applied to assisting with health decision making, as well as to categorize the wide spectrum of health-related topics where DES was applied. METHODS: A systematic review was conducted of the literature published over the last two decades. Original research articles were included and reviewed if they concentrated on the topic of DES technique applied to health care management with model frameworks explicitly demonstrated. No restriction regarding the settings of DES application was applied. RESULTS: A total of 211 papers met the predefined inclusion criteria. The number of publications included increased significantly especially after 2010.101 papers (48%) stated explicitly disease areas targeted, the most frequently modeled of which are related to circulatory system, nervous system and Neoplasm. The DES applications were distributed unevenly into 4 major classes: health and care systems operation (HCSO) (65%), disease progression modeling (DPM) (28%), screening modeling (SM) (5%) and health behavior modeling (HBM) (2%). More than 68% of HCSO by DES were focused on specific problems in individual units. However, more attempts at modeling highly integrated health service systems as well as some new trends were identified. CONCLUSIONS: DES technique has been an effective tool to approach a wide variety of health care issues. Among all DES applications in health care, health system operations research occupied the most considerable proportion and increased most significantly. Health Economic Evaluation (HEE) was the second most common topic for DES in health care, but with stable rather than increasing numbers of publications.

Assessing Trends in Hospital System Structures From 2008 to 2015.

BACKGROUND: The Affordable Care Act introduced a major systematic change aimed to promote coordination across the care continuum. Yet, it remains unknown the extent to which hospital system structures have changed following the Affordable Care Act. The structure of hospital systems has important implications for the cost, quality, and accessibility of health services. OBJECTIVES: To assess trends in the structures of hospital systems. RESEARCH DESIGN: We aggregated data from the American Hospital Association (AHA) Annual Survey to the system level. Using a panel of hospital systems from 2008 to 2015, we assessed trends in the number of hospital systems, their size, ownership characteristics, geospatial arrangements, and integration with outpatient services. RESULTS: In the period 2008-2015, there was an increasing percentage of hospitals that were system affiliated as well as growth in the number of hospital systems. A greater percentage of hospital systems that were organized as moderately centralized systems transitioned to centralized systems than to decentralized systems (19.8% vs. 4.7%; P<0.001). In terms of geospatial arrangement, a greater percentage of hub-and-spoke systems moved to a regional design than to national systems (20.0% vs. 8.2%; P<0.05). An increasing trend over time toward greater integration with outpatient services was found in a measure of total system level integration with outpatient services. CONCLUSIONS: Our findings suggest that hospital systems may be moving toward more regional designs. In addition, the trend of increasing integration offered across hospital systems overall, and as portion of total integration, suggests that systems may be increasing their services along the continuum of care.

Coverage, compliance, acceptability and feasibility of a program to prevent pre-eclampsia and eclampsia through calcium supplementation for pregnant women: an operations research study in one district of Nepal.

BACKGROUND: Calcium supplementation during pregnancy has been shown to reduce the incidence of pre-eclampsia/eclampsia among women with low calcium intake. Universal free calcium supplementation through government antenatal care (ANC) services was piloted in the Dailekh district of Nepal. Coverage, compliance, acceptability and feasibility of the intervention were evaluated. METHODS: Antenatal care providers were trained to distribute and counsel pregnant women about calcium use, and female community health volunteers (FCHVs) were trained to reinforce calcium-related messages. A post-intervention cluster household survey was conducted among women who had given birth in the last six months. Secondary data analysis was performed using monitoring data from health facilities and FCHVs. RESULTS: One Thousand Two hundred-forty postpartum women were interviewed. Most (94.6 %) had attended at least one ANC visit; the median gestational age at first ANC visit was 4 months. All who attended ANC were counseled about calcium and received calcium tablets to take daily until delivery.79.5 % of the women reported consuming the entire quantity of calcium they received. The full course of calcium (300 tablets for 150 days) was provided to 82.3 % of the women. Consumption of the full course of calcium was reported by 67.3 % of all calcium recipients. Significant predictors of completing a full course were gestational age at first ANC visit and number of ANC visits during their most recent pregnancy (p < 0.01). Nearly all (99.2 %) reported taking the calcium as instructed with respect to dose, timing and frequency. Among women who received both calcium and iron (n = 1,157), 98.0 % reported taking them at different times of the day, as instructed. Over 97 % reported willingness to recommend calcium to others, and said they would like to use it during a subsequent pregnancy. There were no stock-outs of calcium. CONCLUSIONS: Calcium distribution through ANC was feasible and effective, achieving 94.6 % calcium coverage of pregnant women in the district. Most women (over 80 %) attended ANC early enough in pregnancy to receive the full course of calcium supplements and benefit from the intervention. High coverage, compliance, acceptability among pregnant women and feasibility were reported, suggesting that this intervention can be scaled up in other areas of Nepal.

Strategies for dealing with the diversity-validity dilemma in personnel selection: where are we and where should we go? / Estrategias para manejar el dilema validez-diversidad en selección de personal: ¿dónde estamos y hacia dónde deberíamos ir?

The diversity-validity dilemma has been a dominant theme in personnel selection research and practice. As some of the most valid selection instruments display large ethnic performance differences, scientists attempt to develop strategies that reduce ethnic subgroup differences in selection performance, while simultaneously maintaining criterion-related validity. This paper provides an evidence-based overview of the effectiveness of six strategies for dealing with the diversity-validity dilemma: (1) using ‘alternative’ cognitive ability measures, (2) employing simulations, (3) using statistical approaches to combine predictor and criterion measures, (4) reducing criterion-irrelevant predictor variance, (5) fostering positive candidate reactions, and (6) providing coaching and opportunity for practice to candidates. Three of these strategies (i.e., employing simulation-based assessments, developing alternative cognitive ability measures, and using statistical procedures) are identified as holding the most promise to alleviate the dilemma. Potential areas in need for future research are discussed(AU)

El dilema validez-diversidad ha sido un tema dominante en la investigación y la práctica de la selección de personal. Dado que algunos de los instrumentos de selección más válidos presentan grandes diferencias étnicas en sus puntuaciones, los científicos intentan desarrollar estrategias que reduzcan las diferencias de los subgrupos en la selección mientras mantienen simultáneamente la validez de criterio. Este artículo proporciona una revisión basada en la evidencia de la efectividad de seis estrategias utilizadas para manejar el dilema validez-diversidad: (1) usar medidas de capacidad cognitiva “alternativas”, (2) emplear simulaciones, (3) utilizar procedimientos estadísticos para combinar las medidas predictoras y del criterio, (4) reducir la varianza de los predictores irrelevante para el criterio, (5) fomentar reacciones positivas en los candidatos y (6) facilitarles preparación y posibilidades de practicar. Tres estrategias (emplear evaluaciones basadas en simulaciones, desarrollar medidas alternativas de capacidad cognitiva y usar procedimientos estadísticos) son las más prometedoras para aminorar el problema. Se discuten áreas potenciales que requieren investigación en un futuro(AU)

Translating evidence into practice in childbirth: a case from the Occupied Palestinian Territory.

OBJECTIVE: To investigate possible changes in practices during normal childbirth by implementing interventions which reduce the frequency of: intravenous fluids; bladder catheterization; analgesia; artificial rupture of membranes; oxytocin use for augmentation; vaginal examination; episiotomy, and increase: mobility; oral intake of fluids; and initiation of immediate breastfeeding. DESIGN: An operational research design. SETTING: A referral governmental hospital in the Occupied Palestinian Territory (oPt) between 2006 and 2010. PARTICIPANTS: 2345 women (baseline: 134 women, intervention: 1860 women, post-intervention: 351 women) and 17 providers (10 midwives and 7 physicians). INTERVENTIONS: Multifaceted interventions; a combination of on-the-job training, audit, and feedback, supported by a core team and informal meetings. MAIN OUTCOME MEASURES: Change of practices during normal childbirth according to best evidence and the WHO recommendations. FINDINGS: Significant sustained improvements in practices during childbirth from baseline to post-intervention including artificial rupture of membranes, liberal use of oxytocin to augment normal labour, intravenous fluids, frequency of vaginal examinations, oral intake, immediate breastfeeding and routine episiotomy (P<0.005). There was positive change in the mobility during labour, but this change was not sustained after 9 months from intervention to post-intervention. The usage of analgesia did not change. KEY CONCLUSIONS: Certain changes in practices during normal childbirth were possible in this hospital. A combination of on-the-job training with other interactive approaches increased midwives' awareness, capacities and self-confidence to implement fewer interventions during normal labour.

Sustainability of integrated leprosy services in rural India: perceptions of community leaders in Uttar Pradesh.

As part of a community-based action research to reduce leprosy stigma, village committees were formed in 3 hyper endemic states of India. From a total of 10 village committees with nearly 200 members from Uttar Pradesh, a systematic random sample of 69 men and 23 women were interviewed in-depth regarding their views on sustainability of integrated leprosy services, as currently adopted. Their recommendations were also sought for further enhancement. Percentages were computed and compared for statistical significance using the z-normal test. The findings show that less than 50% of the respondents were confident that the present trend in voluntary early reporting for MDT and management of complications was adequate to sustain the integrated leprosy services. There were no differences by men or women members and they felt that lack of proper facilities, training and orientation of staff are most influencing factors. Many suggestions were given for improving the sustainability.

The HIV/AIDS epidemic in sub-Saharan Africa: thinking ahead on programmatic tasks and related operational research.

Until now, we have all been desperately trying to run behind the HIV/AIDS epidemic and catch up with it, but despite all our efforts, the epidemic remains well ahead of us. In 2010, the antiretroviral treatment (ART) gap was about 60%, AIDS-related deaths were almost two million a year, and on top of these figures, for every one person started on ART, there were two new HIV infections. What is needed to change this situation is to think ahead of the epidemic in terms of the programmatic tasks we will be faced with and try to act boldly in trying to implement those tasks. From a programmatic perspective, we: a) highlight what needs to fundamentally change in our thinking and overall approach to the epidemic; and b) outline a number of key task areas for implementation and related operational research.

The Union and Médecins Sans Frontières approach to operational research.

Operational research (OR) has become a hot topic at national meetings, international conferences and donor fora. The International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) Operational Centre Brussels strongly promote and implement OR with colleagues in low- and middle-income countries. Here we describe how the two organisations define OR, and explain the guiding principles and methodology that underpin the strategy for developing and expanding OR in those countries. We articulate The Union's and MSF's approach to supporting OR, highlighting the main synergies and differences. Then, using the Malawi National Tuberculosis Control Programme as an example, we show how OR can be embedded within tuberculosis control activities, leading to changes in policy and practice at the national level. We discuss the difficult, yet vitally important, issue of capacity building, and share our vision of a new paradigm of product-related training and performance-based OR fellowships as two ways of developing the necessary skills at country level to ensure research is actually performed. Finally, we highlight the need to consider and incorporate into practice the ethical components of OR. This is a key moment to be involved in OR. We are confident that in partnership with interested stakeholders, including the World Health Organization, we can stimulate the implementation of quality, relevant OR as an integral part of health service delivery that in turn will lead to better health for people, particularly for those living in the poorer parts of the world.

Integration of leprosy into GHS in India: a follow up study (2006-2007).

In India leprosy services, were integrated into the General Health Services (GHS), in a phased manner, in different provinces, from 2001 to 2004. This study reports the findings from a follow-up operational research undertaken in 2006-2007, to assess the level of integration, on predetermined indicators related to: referral services, training of health functionaries, availability of diagnosis, treatment, MDT dispersal and counselling guidelines in health facilities, recording and reporting by GHS staff, MDT stock management and involvement of health sub-centres in different Indian provinces. Nine provinces, 18 districts, 88 health facilities and 108 sub-centres were selected, by using multistage stratified random sampling techniques. Reverse integration, as reflected by the training and deployment of vertical staff in GHS, was also assessed. Data was collected by medical officers experienced in leprosy, with the assistance of state health functionaries, and recorded on separate schedules for health facility and sub-centre levels. The study also touched on the issue of client perception towards MDT services by interviewing 149 under treatment/cured leprosy cases (who had completed treatment within the last year), in the community with the help of local interpreters. Results showed wide variations across the selected provinces in various parameters. District leprosy nuclei were understaffed in 12(66.7%) districts, and district hospitals were not working as referral institutions anywhere. The training status of medical officers and multi-purpose workers in leprosy was low in Andhra Pradesh (6.9 and 22.4%), Madhya Pradesh (26.3 and 14.5%), Rajasthan (19.7 and 40.9%) and Kerala (25.5 and 65.7%). MDT stock availability as per the National Leprosy Eradication Programme (NLEP) guidelines was not adequate in all provinces. Availability of patient counseling guidelines was nil/low in Kerala, Karnataka, West Bengal, Orissa, Rajasthan and Andhra Pradesh. The involvement of sub-centres, in case referral, recording and dispensing MDT was nil Kerala and Rajasthan and poor in Andhra Pradesh. Ninety percent of clients in Kerala and 38.0% in Andhra Pradesh and Madhya Pradesh did not get MDT in the nearest health facilities or sub-centres.

All together now: a conceptual exploration of integrated care.

Integrated care is a key strategy in reforming health systems around the world. Despite its importance, the concept's polymorphous nature and lack of specificity and clarity significantly hamper systematic understanding, successful application and meaningful evaluation. This article explores the many definitions, concepts, logics and methods found in health system and service integration. In addition to framing this evolving, albeit imprecise field, the article summarizes the main elements or building blocks of integrated care and suggests a way to address its various complexities and unknowns in a real-world sense.

Mental health care roles of non-medical primary health and social care services.

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Prevalência de diabetes mellitus pós-transplante renal: uma experiência do Hospital das Clínicas da UFPE / Prevalence of diabetes mellitus after renal transplantation: A experience in University Hospital - Federal University of Pernambuco

RESUMO: Diabetes mellitus pós-transplante (DMPT) renal é uma hiperglicemia persistente desenvolvida por alguns pacientes, sem história prévia de diabetes, tendo incidência extremamente variável (2% a 54%), por falta de critério-diagnóstico internacional. Este é um estudo retrospectivo que traça a incidência desta enfermidade no primeiro ano pós-cirúrgico, no setor de transplante renal do HC/UFPE, utilizando-se prontuários de pacientes acompanhados em enfermaria e ambulatório. Dos 95 pacientes, transplantados entre 2004 e 2005, estudou-se 43, que atendiam aos critérios da pesquisa, analisando-se o comportamento glicêmico referente ao primeiro ano pós-transplante(tx). 79,1% foram masculinos, com idade total do grupo de 16 a 64 anos e IMC de 21,9 ± 2,48. Na correlação linear da glicemia de jejum (GJ) / IMC e GJ/ creatinina, observou-se tendência positiva no 6º e 1º meses pós-tx, respectivamente. A GJ, segundo idade, doador e número de pulsoterapia, não apresentou alterações significativas, observando-se tendência de elevação dos níveis glicêmicos nos pacientes de 40 a 64 anos, no pré-tx. Predominaram enxertos (62,8%) de doador cadáver; a maioria dos pacientes realizou, entre 4 e 10 pulsoterapias, tendo como imunossupressão predominante Azatioprina/Ciclosporina/Prednisona. A elevação glicêmica mostrou correlação positiva com IMC (p=0,004), creatinina (p=0,03) e sexo masculino (p=0,0006), não ocorrendo entre outros fatores de risco analisados. Os resultados evidenciam uma prevalência de DMPT (34,8%), apontando para a necessidade, entre outros fatores, de um bom controle nutricional no pré e pós operatório de TX renal

Modeling participation in the NHII: operations research approach.

Regional health information organizations (RHIOs) form the core building blocks of any approach to creating the National Health Information Infrastructure. RHIOs are computer-supported information sharing alliances composed of health care institutions that need to exchange clinical, financial or administrative data. Many uncertainties, including institution conversion costs, price-to-participate, and RHIO governance decisions make estimating the cost consequences difficult to establish. Current approaches to health information technology investment rely on a net-present-value analysis, which is inadequate to capture the dynamic, uncertain course likely to occur in the RHIO environment. Methods from operations research provide decision makers robust tools for exploring the cost and consequences of RHIO structures. We present here an initial modeling approach that allows explicit examination of RHIO structure and pricing options. Once refined, these models will provide the core of a suite of decision support tools for evaluation of RHIO pricing options, discount rates, and optimal organizational structures.

Early-stage success in service line implementation.

The results of a multimethod, qualitative data collection approach reveal a high level of consistency between early-stage dynamics identified in service line implementation and dynamics viewed within life cycle theory as more observable during the birth stage of development. This finding supports the idea that service line implementation unfolds similarly compared with other types of structures. In addition, it presents a more complex view of service line implementation at any given point in time by linking its unique aspects with issues and dynamics particular to the developmental stage in which the structure exists. The organization examined was the Behavioral Health Service Line of the Upstate New York Veterans Healthcare Network.

How do integrated delivery systems adopt and implement clinical information systems?

We examined how five integrated delivery systems make decisions about and implement clinical information systems. Using case study methods, we identified general themes and explored how organizational context factors and information technology characteristics affect adoption and implementation processes.

Complexity theory in the management of communicable diseases.

In nature, apparently complex behavioural patterns are the result of repetitive simple rules. Complexity science studies the application of these rules and looks for applications in society. Complexity management opportunities have developed from this science and are providing a revolutionary approach in the constantly changing workplace. This article discusses how complexity management techniques have already been applied to communicable disease management in Wales and suggests further developments. A similar approach is recommended to others in the field, while complexity management probably has wider applications in the NHS, not least in relation to the developing managed clinical networks.

Shifting the focus of tuberculosis research in India.

India has a long and distinguished tradition of research in the field of tuberculosis (TB). Pioneering studies from India demonstrated the efficacy and safety of domiciliary treatment, the necessity of direct observation of treatment, the feasibility of case detection through sputum smear microscopy in primary health care institutions, and the effectiveness of intermittent short-course chemotherapy. These findings laid the foundation of directly observed treatment, short course (DOTS), which has been adopted by nearly 150 countries worldwide. Today, India has the second-largest and the fastest-growing DOTS programme in the world. A strong component of programme evaluation and operational research is needed to sustain and expand DOTS in the context of a suboptimal primary health care system, a large and unregulated private health care system, and the dual threats of HIV and multidrug-resistant TB (MDR-TB). Therefore, the focus of TB research in India has shifted to the following operational research areas: evaluating models to involve the private health sector; assessing the role of incentives in increasing treatment compliance; examining gender differentials in the access to TB services; assessing risk factors for delay in diagnosis; evaluating diagnosis, treatment and prevention of TB among HIV-infected persons; monitoring MDR-TB; estimating cost-effectiveness of the DOTS programme; monitoring the quality of smear microscopy services; and measuring the current burden of TB. Research for developing newer diagnostic tools, drugs and vaccines remains a long-term priority. Greater networking is needed among national researchers, programme managers and policy-makers to translate the findings of research into policies and programmes to make TB control in India more effective and efficient.