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INTRODUCTION: Every year 2.4 million deaths occur worldwide in babies younger than 28 days. Approximately 70% of these deaths occur in low-resource settings because of failure to implement evidence-based interventions. Digital health technologies may offer an implementation solution. Since 2014, we have worked in Bangladesh, Malawi, Zimbabwe and the UK to develop and pilot Neotree: an android app with accompanying data visualisation, linkage and export. Its low-cost hardware and state-of-the-art software are used to improve bedside postnatal care and to provide insights into population health trends, to impact wider policy and practice. METHODS AND ANALYSIS: This is a mixed methods (1) intervention codevelopment and optimisation and (2) pilot implementation evaluation (including economic evaluation) study. Neotree will be implemented in two hospitals in Zimbabwe, and one in Malawi. Over the 2-year study period clinical and demographic newborn data will be collected via Neotree, in addition to behavioural science informed qualitative and quantitative implementation evaluation and measures of cost, newborn care quality and usability. Neotree clinical decision support algorithms will be optimised according to best available evidence and clinical validation studies. ETHICS AND DISSEMINATION: This is a Wellcome Trust funded project (215742_Z_19_Z). Research ethics approvals have been obtained: Malawi College of Medicine Research and Ethics Committee (P.01/20/2909; P.02/19/2613); UCL (17123/001, 6681/001, 5019/004); Medical Research Council Zimbabwe (MRCZ/A/2570), BRTI and JREC institutional review boards (AP155/2020; JREC/327/19), Sally Mugabe Hospital Ethics Committee (071119/64; 250418/48). Results will be disseminated via academic publications and public and policy engagement activities. In this study, the care for an estimated 15 000 babies across three sites will be impacted. TRIAL REGISTRATION NUMBER: NCT0512707; Pre-results.
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Salud del Lactante , Atención Posnatal , Mejoramiento de la Calidad , Telemedicina , Algoritmos , Sistemas de Apoyo a Decisiones Clínicas/normas , Recursos en Salud , Humanos , Salud del Lactante/economía , Salud del Lactante/normas , Recién Nacido , Malaui , Aplicaciones Móviles , Proyectos Piloto , Atención Posnatal/economía , Atención Posnatal/métodos , Atención Posnatal/normas , Pobreza , Desarrollo de Programa/economía , Desarrollo de Programa/normas , Mejoramiento de la Calidad/economía , Mejoramiento de la Calidad/normas , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/normas , Telemedicina/economía , Telemedicina/métodos , Telemedicina/normas , ZimbabweRESUMEN
Scaling is a ubiquitous concept in agricultural research in the global south as donors require their research grantees to prove that their results can be scaled to impact upon the livelihoods of a large number of beneficiaries. Recent studies on scaling have brought critical perspectives to the rather technocratic tendencies in the agricultural innovations scaling literature. Drawing on theoretical debates on spatial strategies and practical experience of agricultural innovation scaling in Ethiopia, this paper adds to the current debate on what constitutes scaling and how to overcome critical scaling constraints. The data for the paper came from a qualitative assessment using focus group discussions, key informant interviews, and document analysis on scaling work done in Ethiopia by a USAID-funded research for development project. The paper concludes with four broad lessons for the current understating of agricultural innovation scaling. First, scaling of agricultural innovations requires a balanced focus on technical requirements and associated social dynamics surrounding scaling targets, actors involved and their social relations. Second, appreciating the social dynamics of scaling emphasizes the fact that scaling is more complex than a linear rolling out of innovations towards diffusion. Third, scaling may not be strictly planned; instead, it might be an extension of the innovation generation process that relies heavily on both new and long-term relationships with key partners, trust, and continuous reflection and learning. Fourth, the overall implication of the above three conclusions is that scaling strategies need to be flexible, stepwise, and reflective. Despite the promises of flourishing scaling frameworks, scaling strategies it would appear from the Africa RISING experience that, if real impact is to be achieved, approaches will be required to be flexible enough to manage the social, processual and emergent nature of the practice of scaling.
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Agricultura/métodos , Invenciones/economía , Desarrollo de Programa/métodos , Desarrollo Sostenible/tendencias , Financiación del Capital/estadística & datos numéricos , Etiopía , Humanos , Desarrollo de Programa/economía , Desarrollo Sostenible/economíaRESUMEN
There is a need to foster future generations of radiation oncology physician scientists, but the number of radiation oncologists with sufficient education, training, and funding to make transformative discoveries is relatively small. A large number of MD/PhD graduates have entered he field of radiation oncology over the past 2 decades, but this has not led to a significant cohort of externally funded physician scientists. Because radiation oncologists leading independent research labs have the potential to make transformative discoveries that advance our field and positively affect patients with cancer, we created the Duke Radiation Oncology Research Scholar (RORS) Program. In crafting this program, we sought to eliminate barriers preventing radiation oncology trainees from becoming independent physician scientists. The RORS program integrates the existing American Board of Radiology Holman Pathway with a 2-year post-graduate medical education instructor position with 80% research effort at the same institution. We use a separate match for RORS and traditional residency pathways, which we hope will increase the diversity of our residency program. Since the inception of the RORS program, we have matched 2 trainees into our program. We encourage other radiation oncology residency programs at peer institutions to consider this training pathway as a means to foster the development of independent physician scientists and a diverse workforce in radiation oncology.
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Internado y Residencia/organización & administración , Desarrollo de Programa , Oncólogos de Radiación/educación , Oncología por Radiación/educación , Investigadores/educación , Apoyo a la Formación Profesional , Selección de Profesión , Humanos , North Carolina , Desarrollo de Programa/economía , Oncólogos de Radiación/organización & administración , Oncólogos de Radiación/provisión & distribución , Oncología por Radiación/organización & administración , Investigadores/economía , Investigadores/organización & administración , Investigadores/provisión & distribuciónRESUMEN
BACKGROUND: Multiple international organizations have called for exercise to become standard practice in the setting of oncology care. The feasibility of integrating exercise within systemic chemotherapy has not been investigated. METHODS: Patients slated to receive infusion therapy between April 2017 and October 2018 were screened for possible inclusion. The study goal was to establish the acceptability and feasibility of embedding an exercise professional into the chemotherapy infusion suite as a method of making exercise a standard part of cancer care. The exercise prescriptions provided to patients were individualized according to results of brief baseline functional testing. RESULTS: In all, 544 patients were screened, and their respective treating oncologists deemed 83% of them to be medically eligible to participate. After further eligibility screening, 226 patients were approached. Nearly 71% of these patients (n = 160) accepted the invitation to participate in the Exercise in All Chemotherapy trial. Feasibility was established because 71%, 55%, 69%, and 63% of the aerobic, resistance, balance, and flexibility exercises prescribed to patients were completed. Qualitative data also supported the acceptability and feasibility of the intervention from the perspective of patients and clinicians. The per-patient cost of the intervention was $190.68 to $382.40. CONCLUSIONS: Embedding an exercise professional into the chemotherapy infusion suite is an acceptable and feasible approach to making exercise standard practice. Moreover, the cost of the intervention is lower than the cost of other common community programs. Future studies should test whether colocating an exercise professional with infusion therapy could reach more patients in comparison with not colocating. LAY SUMMARY: Few studies have tested the implementation of exercise for patients with cancer by embedding an exercise professional directly into the chemotherapy infusion suite. The Exercise in All Chemotherapy trial shows that this approach is both acceptable and feasible from the perspective of clinicians and patients.
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Antineoplásicos/uso terapéutico , Ejercicio Físico , Neoplasias/terapia , Adulto , Anciano , Anciano de 80 o más Años , Costos y Análisis de Costo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/tratamiento farmacológico , Seguridad del Paciente , Selección de Paciente , Rendimiento Físico Funcional , Desarrollo de Programa/economíaRESUMEN
Despite an increasing literature, there are many unanswered questions about transition to adult care for youth with chronic disorders. This paper questions the definition and components of optimal transition programs, their effectiveness and costs. Few transition programs have been comprehensively evaluated and effectiveness studies are usually based on a historical control group. Transition clinics for neurological disorders are described but not evaluated. Studies in diabetes, renal transplant, and rheumatologic disorders provide the best available evidence, albeit limited, of the value of transition clinics/programs. A few studies have addressed the cost of transition clinics and suggest that the incremental costs of the clinic are recouped by reduced medical costs in adult care. There is room for a great deal more research about transition.
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Progresión de la Enfermedad , Enfermedades del Sistema Nervioso/terapia , Desarrollo de Programa , Transición a la Atención de Adultos , Adolescente , Adulto , Humanos , Desarrollo de Programa/economía , Desarrollo de Programa/normas , Adulto JovenRESUMEN
There is an urgent need to strengthen early childhood development and education in emergencies (ECDEiE) globally. Colombia has faced protracted and acute crises for decades. Also, the country has applied a unique approach to holistic and integrated ECDE policy formulation. We argue that these characteristics offer a valuable country-case to identify barriers and levers to the operationalization of ECDEiE. We applied a sector-wide analysis protocol that harmonized components of the Humanitarian Programme Cycle by the Inter-Agency Standing Committee and of a framework to characterize the governance of ECDE systems. The study outlines how the policy and program characteristics identified may represent levers or barriers to the effective operationalization of ECDEiE in Colombia. We discuss how these attributes could be considered in the trans-sectoral dialogue between ECDE and humanitarian actors with the aim of strengthening ECDEiE systems globally.
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Desarrollo Infantil , Educación , Urgencias Médicas , Desarrollo de Programa , Niño , Preescolar , Colombia , Salud Global , Humanos , Colaboración Intersectorial , Desarrollo de Programa/economíaRESUMEN
BACKGROUND: With health care practice consolidation, the increasing geographic scope of health care systems, and the advancement of mobile telecommunications, there is increasing interest in telemedicine-based health care consultations. Anesthesiology has had experience with telemedicine consultation for preoperative evaluation since 2004, but the majority of studies have been conducted in rural settings. There is a paucity of literature of use in metropolitan areas. In this article, we describe the implementation of a telemedicine-based anesthesia preoperative evaluation and report the program's patient satisfaction, clinical case cancellation rate outcomes, and cost savings in a large metropolitan area (Los Angeles, CA). METHODS: This is a descriptive study of a telemedicine-based preoperative anesthesia evaluation process in an academic medical center within a large metropolitan area. In a 2-year period, we evaluated 419 patients scheduled for surgery by telemedicine and 1785 patients who were evaluated in-person. RESULTS: Day-of-surgery case cancellations were 2.95% and 3.23% in the telemedicine and the in-person cohort, respectively. Telemedicine patients avoided a median round trip driving distance of 63 miles (Q1 24; Q3 119) and a median time saved of 137 (Q1 95; Q3 195) and 130 (Q1 91; Q3 237) minutes during morning and afternoon traffic conditions, respectively. Patients experienced time-based savings, particularly from traveling across a metropolitan area, which amounted to $67 of direct and opportunity cost savings. From patient satisfaction surveys, 98% (129 patients out of 131 completed surveys) of patients who were consulted via telemedicine were satisfied with their experience. CONCLUSIONS: This study demonstrates the implementation of a telemedicine-based preoperative anesthesia evaluation from an academic medical center in a metropolitan area with high patient satisfaction, cost savings, and without increase in day-of-procedure case cancellations.
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Centros Médicos Académicos/normas , Cuidados Preoperatorios/normas , Desarrollo de Programa/normas , Telemedicina/normas , Centros Médicos Académicos/economía , Centros Médicos Académicos/tendencias , Anciano , Ahorro de Costo/economía , Ahorro de Costo/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cuidados Preoperatorios/economía , Cuidados Preoperatorios/tendencias , Desarrollo de Programa/economía , Estudios Retrospectivos , Telemedicina/economía , Telemedicina/tendenciasRESUMEN
Background: The costs of cancer registration have previously been estimated for registries in the continental United States and many international registries; however, to date, there has been no economic assessment of population-based registries in the US-Affiliated Pacific Islands. This study estimates the costs and factors affecting the operations of US-Affiliated Pacific Island population-based cancer registries. Methods: The web-based International Registry Costing Tool1 was used to collect costs, resources used, cancer cases processed, and other registry characteristics from the Pacific Regional Central Cancer Registry (PRCCR), Federated States of Micronesia National Cancer Registry, and nine satellite jurisdictional registries within the US Pacific Islands. The registries provided data on costs for June 30, 2016-June 29, 2017, and cases processed during 2014. Results: Local host institutions provided a vital source of support for US-Affiliated Pacific Islands registries, covering substantial fixed costs, such as management and overhead. The cost per cancer case processed had an almost tenfold variation across registries, with the average total cost per case of about $1,413. The average cost per inhabitant in the US-Affiliated Pacific Islands was about $1.77 per person. Discussion: The challenges of collecting data from dispersed populations spread across multiple islands of the US-Affiliated Pacific Islands are likely leading factors driving the magnitude of the registries' cost per case. The economic information from this study provides a valuable source of activity-based cost data that can both help guide cancer control initiatives and help registries improve operations and efficiency.
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Neoplasias/diagnóstico , Desarrollo de Programa/economía , Sistema de Registros/estadística & datos numéricos , Análisis Costo-Beneficio/métodos , Humanos , Neoplasias/economía , Neoplasias/epidemiología , Islas del Pacífico/epidemiología , Desarrollo de Programa/métodosRESUMEN
OBJECTIVE: A state-wide service plan was introduced to guide local practice of the inpatient management of patients with an eating disorder. There was significant change in our management of such patients in our regional hospital. Our aim is to describe the changes and characterise our current practice. METHOD: We undertook a retrospective review of the characteristics of nine consecutive inpatients and a descriptive qualitative study to examine the care provided to the patients and to identify the resultant care provisions a year after the introduction of the service plan. RESULTS: Patient demographics and clinical characteristics were within the expected range. By the end of the year, the following changes were identified: (i) a team of local champions emerged; (ii) a case conference and template became routine; (iii) high utilisation of the new Eating Disorder Outreach Service (EDOS); (iv) common treatment challenges and methods to address them. CONCLUSIONS: Standardisation of care and a systematic team approach are helpful in allowing small regional non-specialist centres to successfully manage complex patients. Funding of a local coordinator and assistance from EDOS was paramount to facilitate change. Other regional services may wish to adopt some of the practices described.
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Trastornos de Alimentación y de la Ingestión de Alimentos/terapia , Personal de Salud/educación , Accesibilidad a los Servicios de Salud , Servicios de Salud Mental/organización & administración , Adolescente , Adulto , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Desarrollo de Programa/economía , Estudios Retrospectivos , Adulto JovenRESUMEN
Anatomy and Physiology courses taught at community colleges tend to focus laboratory hours primarily on anatomy as opposed to physiology. However, research demonstrates that, when instructors utilize active learning approaches (such as in laboratory settings) where students participate in their own learning, students have improved outcomes, such as higher test scores and better retention of material. To provide community college students with opportunities for active learning in physiology, we developed two laboratory exercises to engage students in cardiac and skeletal muscle physiology. We utilized low-cost SpikerBox devices to measure electrical activity during cardiac (electrocardiogram) and skeletal muscle (electromyogram) contraction. Laboratory activities were employed in Anatomy and Physiology courses at two community colleges in southeast Michigan. A 2-h laboratory period was structured with a 20-min slide presentation covering background material on the subject and experiments to examine the effects of environmental variables on nervous system control of cardiac and skeletal muscle contraction. Students were asked to provide hypotheses and proposed mechanisms, complete a results section, and provide conclusions for the experiments based on their results. Our laboratory exercises improved student learning in physiology and knowledge of the scientific method and were well-received by community college students enrolled in Anatomy and Physiology. Our results demonstrate that the use of a SpikerBox for cardiac and skeletal muscle physiology concepts is a low-cost and effective approach to integrate physiology activities into an Anatomy and Physiology course.
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Análisis Costo-Beneficio , Corazón/fisiología , Ciencia del Laboratorio Clínico/educación , Músculo Esquelético/fisiología , Fisiología/educación , Aprendizaje Basado en Problemas/métodos , Adulto , Anatomía/economía , Anatomía/educación , Curriculum , Femenino , Humanos , Masculino , Ciencia del Laboratorio Clínico/economía , Fisiología/economía , Aprendizaje Basado en Problemas/economía , Desarrollo de Programa/economía , Desarrollo de Programa/métodos , Estudiantes , Universidades/economía , Adulto JovenRESUMEN
In this review article, the authors present the many challenges that orthopedic surgeons in developing countries face when implementing arthroplasty programs. The issues of cost, sterility, and patient demographics are specifically addressed. Despite the many challenges, developing countries are beginning to offer hip and knee reconstructive surgery to respond to the increasing demand for such elective operations as the prevalence of osteoarthritis continues to increase. The authors shed light on these nascent arthroplasty programs.
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Artroplastia de Reemplazo/normas , Países en Desarrollo , Osteoartritis/cirugía , Desarrollo de Programa/normas , Artroplastia de Reemplazo/economía , Artroplastia de Reemplazo/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Femenino , Salud Global/economía , Salud Global/normas , Humanos , Masculino , Misiones Médicas/economía , Misiones Médicas/normas , Misiones Médicas/estadística & datos numéricos , Osteoartritis/economía , Osteoartritis/epidemiología , Desarrollo de Programa/economía , Sistema de Registros/estadística & datos numéricosRESUMEN
Multiple costing tools have been developed to understand the resources required to build and sustain implementation of the International Health Regulations (IHR), including a detailed costing tool developed by WHO ("WHO Costing Tool") and 2 action-based costing tools, Georgetown University's IHR Costing Tool and CDC's Priority Actions Costing Tool (PACT). The relative performance of these tools is unknown. Nigeria costed its National Action Plan for Health Security (NAPHS) using the WHO Costing Tool. We conducted a desktop review, using the other tools to compare the cost estimates generated using different costing approaches. Technical working groups developed activity plans and estimated component costs using the WHO Costing Tool during a weeklong workshop with approximately 60 participants from various ministries, departments, and federal agencies. We retrospectively applied the IHR Costing Tool and PACT to generate rapid cost estimates required to achieve a Joint External Evaluation (JEE) score of "demonstrated capacity" (level 4). The tools generated similar activities for implementation. Cost estimates varied based on the anticipated procurement and human resources requirements and by the level of implementation (eg, health facility-level versus local government area-level procurement). The desktop IHR Costing Tool and PACT tools required approximately 2 and 8 person-hours to complete, respectively. A strategic costing approach, wherein governments select from a menu of recommended and costed actions following the JEE to develop a NAPHS, could accelerate implementation of plans. Major cost drivers, including procurement and human resources, should be prioritized based on anticipated resource availability and countries' priorities.
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Política de Salud/economía , Reglamento Sanitario Internacional/economía , Salud Pública/economía , Brotes de Enfermedades/prevención & control , Salud Global , Agencias Gubernamentales/economía , Humanos , Nigeria , Desarrollo de Programa/economía , Desarrollo de Programa/métodos , Salud Pública/legislación & jurisprudencia , Organización Mundial de la SaludRESUMEN
Specialized vocational rehabilitation (VR) programs in epilepsy have routinely performed more successfully than general or state-federal VR programs. This article presents the key areas of emphasis in successful epilepsy VR program development to include initial program drivers, choice of VR services model, perspectives on program elements, clients, staffing, service evaluation metrics, operational considerations, and the partnering sponsor's personnel support. Considerable emphasis is placed on the importance and diversity of funding in sustaining a specialized epilepsy VR program. This template of considerations provides potential program implementers with a general framework for successful epilepsy VR program development.
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Empleo/métodos , Epilepsia/rehabilitación , Desarrollo de Programa/métodos , Rehabilitación Vocacional/métodos , Empleo/economía , Empleo/psicología , Epilepsia/economía , Epilepsia/psicología , Humanos , Desarrollo de Programa/economía , Rehabilitación Vocacional/economía , Rehabilitación Vocacional/psicologíaRESUMEN
PURPOSE AND OBJECTIVES: We evaluated the costs of implementing coordinated systems of stroke care by state health departments from 2012 through 2015 to help policy makers and planners gain a sense of the potential return on investments in establishing a stroke care quality improvement (QI) program. INTERVENTION APPROACH: State health departments funded by the Paul Coverdell National Acute Stroke Program (PCNASP) implemented activities to support the start and proficient use of hospital stroke registries statewide and coordinate data-driven QI efforts. These efforts were aimed at improving the treatment and transition of stroke patients from prehospital emergency medical services (EMS) to in-hospital care and postacute care facilities. Health departments provided technical assistance and data to support hospitals, EMS agencies, and posthospital care agencies to carry out small, rapid, incremental QI efforts to produce more effective and efficient stroke care practices. EVALUATION METHODS: Six of the 11 PCNASP-funded state health departments in the United States volunteered to collect and report programmatic costs associated with implementing the components of stroke systems of care. Six health departments reported costs paid directly by Centers for Disease Control and Prevention-provided funds, 5 also reported their own in-kind contributions, and 4 compiled data from a sample of their partners' estimated costs of resources, such as staff time, involved in program implementation. Costs were analyzed separately for PCNASP-funded expenditures and in-kind contributions by the health department by resource category and program activity. In-kind contributions by partners were also analyzed separately. RESULTS: PCNASP-funded expenditures ranged from $790,123 to $1,298,160 across the 6 health departments for the 3-year funding period. In-kind contributions ranged from $5,805 to $1,394,097. Partner contributions (n = 22) ranged from $3,912 to $362,868. IMPLICATIONS FOR PUBLIC HEALTH: Our evaluation reports costs for multiple state health departments and their partners for implementing components of stroke systems of care in the United States. Although there are limitations, our findings represent key estimates that can guide future program planning and efforts to achieve sustainability.
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Desarrollo de Programa/economía , Mejoramiento de la Calidad/economía , Indicadores de Calidad de la Atención de Salud , Accidente Cerebrovascular/economía , Centers for Disease Control and Prevention, U.S. , Recolección de Datos , Humanos , Transferencia de Pacientes/economía , Accidente Cerebrovascular/prevención & control , Accidente Cerebrovascular/terapia , Estados UnidosRESUMEN
The National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention funds the agency's largest investment in Indian Country, Good Health and Wellness in Indian Country. This 5-year program, launched in 2014, supports American Indian and Alaska Native communities and tribal organizations to address chronic diseases and risk factors simultaneously and in coordination. This article describes the development, funding, and implementation of the program. Dialogue with tribal members and leaders helped shape the program, and unlike previous programs that funded a small number of tribes to work on specific diseases, this program funds multiple tribal entities to reach widely into Indian Country. Implementation included culturally developed and adapted practices and opportunities for peer sharing and problem solving. This program identified approaches useful for the Centers for Disease Control and Prevention, other federal agencies, or other organizations working with American Indians and Alaska Natives.
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Enfermedad Crónica , Promoción de la Salud , Salud Holística/etnología , Servicios Preventivos de Salud , Desarrollo de Programa , Centers for Disease Control and Prevention, U.S. , Enfermedad Crónica/epidemiología , Enfermedad Crónica/prevención & control , Promoción de la Salud/métodos , Promoción de la Salud/organización & administración , Humanos , Indígenas Norteamericanos , Modelos Organizacionales , Servicios Preventivos de Salud/métodos , Servicios Preventivos de Salud/organización & administración , Desarrollo de Programa/economía , Desarrollo de Programa/métodos , Evaluación de Programas y Proyectos de Salud , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Sexually transmitted disease (STD) partner services (PS) are a core component of STD programs. Data on costs are needed to support PS programming. METHODS: In Washington State STD PS programs, disease intervention specialists (DIS) conduct telephone-based interviews and occasional field visits, offer expedited partner therapy to heterosexuals with gonorrhea or chlamydia, and promote human immunodeficiency virus (HIV) testing, preexposure prophylaxis, and HIV care. We conducted activity-based microcosting of PS, including: observational and self-reported time studies and interviews. We analyzed cost, surveillance, and service delivery data to determine costs per program outcomes. RESULTS: In King, Pierce, and Spokane counties, respectively, DIS allocated 6.5, 6.4, and 28.8 hours per syphilis case and 1.5, 1.6, and 2.9 hours per gonorrhea/chlamydia case, on average. In 2016, each full-time DIS investigated 270, 268, and 61 syphilis and 1177, 1105, and 769 gonorrhea/chlamydia cases. Greater than 80% of syphilis cases in King and Pierce were among men who have sex with men versus 38% in Spokane. Disease intervention specialists spent 12% to 39% of their time actively interviewing cases and notifying partners (clients), and the remaining time locating clients, coordinating and verifying care, and managing case reports. Time spent on expedited partner therapy, HIV testing, and referrals to HIV treatment or preexposure prophylaxis, was minimal (<5 minutes per interview) at locations with resources outside PS staff. Program cost-per-interview ranged from US $527 to US $2210 for syphilis, US $219 to US $484 for gonorrhea, and US $164 to US $547 for chlamydia. DISCUSSION: The STD PS resource needs depended on epidemic characteristics and program models. Integrating HIV prevention objectives minimally impacted PS-specific program costs. Results can inform program planning, future budget impact, and cost-effectiveness analyses.
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Recursos en Salud/economía , Servicios Preventivos de Salud/economía , Parejas Sexuales , Enfermedades de Transmisión Sexual/economía , Enfermedades de Transmisión Sexual/epidemiología , Infecciones por Chlamydia/economía , Trazado de Contacto/economía , Costo de Enfermedad , Femenino , Gonorrea/economía , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Incidencia , Masculino , Estudios Observacionales como Asunto , Desarrollo de Programa/economía , Enfermedades de Transmisión Sexual/prevención & control , Sífilis/economía , Washingtón/epidemiologíaRESUMEN
BACKGROUND: Since 2011, a tailored, interdisciplinary head and neck rehabilitation (IHNR) program, covered by the basic healthcare insurance, is offered to advanced head and neck cancer (HNC) patients in the Netherlands Cancer Institute (NKI). This program is developed to preserve or restore patients' functioning, and to optimize health-related quality of life (HRQoL). It applies an integrated approach to define patients' individual goals and provide rehabilitation care throughout the cancer care continuum. The aim of the current study is to assess the (cost-) effectiveness of the IHNR approach compared to usual supportive care (USC) consisting of monodisciplinary and multidisciplinary care in advanced HNC patients. METHODS: This multicenter prospective observational study is designed to compare (cost-)effectiveness of the IHNR to USC for advanced HNC patients treated with chemoradiotherapy (CRT) or bioradiotherapy (BRT). The primary outcome is HRQoL represented in the EORTC QLQ-C30 summary score. Functional HRQoL, societal participation, utility values, return to work (RTW), unmet needs (UN), patient satisfaction and clinical outcomes are secondary outcomes, assessed using the EORTC QLQ-H&N35, USER-P, EQ-5D-5 L, and study-specific questionnaires, respectively. Both patient groups (required sample size: 64 per arm) are requested to complete the questionnaires at: diagnosis (baseline; T0), 3 months (T1), 6 months (T2), 9 months (T3) and 12 months (T4) after start of medical treatment. Differences in outcomes between the intervention and control group will be analyzed using mixed effects models, Chi-square test and descriptive statistics. In addition, a cost-effectiveness analysis (CEA) will be performed by means of a Markov decision model. The CEA will be performed using a societal perspective of the Netherlands. DISCUSSION: This prospective multicenter study will provide evidence on the effectiveness and cost-effectiveness of IHNR compared to USC. RTW and societal participation, included as secondary outcomes, have not been studied sufficiently yet in cancer rehabilitation. Interdisciplinary rehabilitation has not yet been implemented as usual care in all centers, which offers the opportunity to perform a controlled clinical study. If demonstrated to be (cost-)effective, national provision of the program can probably be advised. TRIAL REGISTRATION: The study has been retrospectively registered in the Netherlands Trial Registry on April 24th 2018 ( NTR7140 ).