Prioritization of patient safety health policies: Delphi survey using patient safety experts in Japan.

Various patient safety interventions have been implemented since the late 1990s, but their evaluation has been lacking. To obtain basic information for prioritizing patient safety interventions, this study aimed to extract high-priority interventions in Japan and to identify the factors that influence the setting of priority. Six perspectives (contribution, dissemination, impact, cost, urgency, and priority) on 42 patient safety interventions classified into 3 levels (system, organizational, and clinical) were evaluated by Japanese experts using the Delphi technique. We examined the relationships of the levels and the perspectives on interventions with the transition of the consensus state in rounds 1 and 3. After extracting the high-priority interventions, a chi-squared test was used to examine the relationship of the levels and the impact/cost ratio with high priority. Regression models were used to examine the influence of each perspective on priority. There was a significant relationship between the level of interventions and the transition of the consensus state (p = 0.033). System-level interventions had a low probability of achieving consensus. "Human resources interventions," "professional education and training," "medication management/reconciliation protocols," "pay-for performance (P4P) schemes and financing for safety," "digital technology solutions to improve safety," and "hand hygiene initiatives" were extracted as high-priority interventions. The level and the impact/cost ratio of interventions had no significant relationships with high priority. In the regression model, dissemination and impact had an influence on priority (ß = -0.628 and 0.941, respectively; adjusted R-squared = 0.646). The influence of impact and dissemination on the priority of interventions suggests that it is important to examine the dissemination degree and impact of interventions in each country for prioritizing interventions.

Generating Global Priority for Addressing Rheumatic Heart Disease: A Qualitative Policy Analysis.

Background Rheumatic heart disease (RHD) poses a high burden in low-income countries, as well as among indigenous and other socioeconomically disadvantaged populations in high-income countries. Despite its severity and preventability, RHD receives insufficient global attention and resources. We conducted a qualitative policy analysis to investigate the reasons for recent growth but ongoing inadequacy in global priority for addressing RHD. Methods and Results Drawing on social science scholarship, we conducted a thematic analysis, triangulating among peer-reviewed literature, organizational documents, and 20 semistructured interviews with individuals involved in RHD research, clinical practice, and advocacy. The analysis indicates that RHD proponents face 3 linked challenges, all shaped by the nature of the issue. With respect to leadership and governance, the fact that RHD affects mostly poor populations in dispersed regions complicates efforts to coordinate activities among RHD proponents and to engage international organizations and donors. With respect to solution definition, the dearth of data on aspects of clinical management in low-income settings, difficulties preventing and addressing the disease, and the fact that RHD intersects with several disease specialties have fueled proponent disagreements about how best to address the disease. With respect to positioning, a perception that RHD is largely a problem for low-income countries and the ambiguity on its status as a noncommunicable disease have complicated efforts to convince policy makers to act. Conclusions To augment RHD global priority, proponents will need to establish more effective governance mechanisms to facilitate collective action, manage differences surrounding solutions, and identify positionings that resonate with policy makers and funders.

Clinical and metabolic effect of a multidisciplinary intervention through a comprehensive care program for children and adolescents with obesity / [Efecto clínico y metabólico de una intervención multidisciplinaria en el marco de un programa de atención integral para niños y adolescentes con obesidad].

Introduction: The approach to childhood obesity requires multidisciplinary programs including all the dimensions susceptible to management. Objective: To describe the clinical and metabolic changes in patients with obesity after a comprehensive care program for childhood obesity. Materials and methods: We conducted a retrospective observational and analytical study in a cohort of patients between 6 and 17 years old treated in the obesity program at the Hospital Universitario San Vicente Fundación (2012-2015). We carried out multidisciplinary care and educational intervention. Anthropometric and laboratory variables were evaluated both at admission to the program and in the last evaluation and statistical differences were sought according to the follow-up time. Results: We evaluated 53 patients, of whom 52.8% were men, with an average age of 11 ± 2 years. The follow-up extended for 18 ± 6 months though 30% of the patients were followed for 31 to 36 months. There was a decrease in the BMI (Z score) between admission (2.75 ± 0.58 and the last control (2.32 ± 0.63) with a p-value of 0.000 (95% CI: 0.27 -0.58); 79.25% of the patients reduced the BMI Z score. This decrease was significant regardless of the follow-up time. The proportion of patients with a BMI Z score >3 decreased from 33.4% to 14.6%. The number of positive criteria for metabolic syndrome decreased in the follow-up. Triglycerides and HbA1c were the metabolic variables that improved significantly. Conclusions: The management of childhood obesity with an interdisciplinary intervention associated with continuous group educational support can significantly impact on clinical and metabolic changes. It is necessary to continue monitoring over time to prevent relapse.

Introducción. La obesidad infantil requiere una atención con programas multidisciplinarios que integren todas sus dimensiones. Objetivo. Describir los cambios clínicos y metabólicos en pacientes con obesidad después de su participación en un programa de atención integral en obesidad infantil. Materiales y métodos. Se hizo un estudio observacional y analítico retrospectivo de una cohorte de pacientes de 6 a 17 años de edad atendidos en el programa de obesidad del Hospital Universitario de San Vicente Fundación (2012-2015), el cual incluyó la atención multidisciplinaria y una intervención educativa. Se evaluaron variables antropométricas y de laboratorio en el momento del ingreso al programa y en la última evaluación. Se exploraron las diferencias según el tiempo de seguimiento. Resultados. Se evaluaron 53 pacientes con una edad promedio de 11 ± 2 años, 52,8 % de los cuales eran hombres. El seguimiento de los pacientes fue de 18 ± 6 meses, aunque en el 30 % de ellos fue de 31 a 36 meses. Se encontró una disminución del índice de masa corporal (IMC; puntaje Z) entre el ingreso (2,75 ± 0,58) y el último control (2,32 ± 0,63) con un valor de p de 0,000 (IC95% 0,27-0,58). El 79,25 % de los pacientes redujo el puntaje Z del IMC. Esta disminución fue significativa independientemente del tiempo de seguimiento. La proporción de pacientes con un puntaje Z del IMC mayor de 3 pasó del 33,4 al 14,6 %. El número de criterios positivos para el síndrome metabólico disminuyó en el seguimiento. Los niveles de triglicéridos y de hemoglobina 'glicada' o 'glicosilada' (HbA1c) mejoraron significativamente. Conclusiones. El manejo de la obesidad infantil con una intervención multidisciplinaria asociada a apoyo educativo grupal continuo puede influir significativamente en los cambios clínicos y metabólicos. Es necesario prolongar el tiempo de seguimiento para prevenir las recaídas.

Unique challenges for health equity in Latin America: situating the roles of priority-setting and judicial enforcement.

Overcoming continuing polarization regarding judicial enforcement of health rights in Latin America requires clarifying divergent normative and political premises, addressing the lack of reliable empirical data, and establishing the conditions for fruitful inter-sectoral, inter-disciplinary dialogue.

The significance of 'severity'.

This essay considers whether permitting the cost-effectiveness of healthcare to govern its allocation is ethically objectionable on the grounds that it fails to give sufficient weight to the severity of people's health states. After documenting the popular sentiment that appears to support this criticism, the essay considers how to implement prioritising severity, focusing on Erik Nord's work. The remainder of the essay scrutinises the ethical arguments supporting policies prioritising severity and challenges those who would prioritise severity to define a notion of severity whose prioritisation they can defend.

Governance Functions to Accelerate Progress toward Universal Health Coverage (UHC) in the Asia-Pacific Region.

Many countries in the Asia-Pacific region have committed to universal health coverage (UHC), which is reflected in both their political commitment and the governance actions they have taken in steering their health systems toward the goals of universal access to care and protection from financial hardship. Countries throughout the region are at different stages of development and have different political and governance contexts, which in turn shape how they pursue governance for UHC. This article reviews the governance functions deployed in the Asia-Pacific and finds that, in many, governance reforms adapting their health systems toward greater regulation, accountability, oversight, and stewardship of the health system have been part of their wider move toward UHC. Countries have not followed a set pattern, but shared aspects include establishing UHC as a goal in national policy making and priority setting; the creation of new roles and/or new institutions within the health system; establishing systems of monitoring and evaluation; and putting in place mechanisms to facilitate collaboration and ensure greater accountability. The relationship between governance and UHC in the Asia-Pacific region is found to be complex, negotiated, and shaped by a number of factors in both the internal and external environment, including broader governance arrangements in the public sector (institutional changes and decentralization are particularly prominent factors) and the ability of governments to implement policies and steer the health system.

Global Evolution of Obesity Research in Children and Youths: Setting Priorities for Interventions and Policies.

BACKGROUND: Childhood obesity has become a major global epidemic that causes substantial social and health burdens worldwide. The effectiveness of childhood obesity control and prevention depends largely on understanding the issue, including its current development and associated factors in a contextualized perspective. OBJECTIVES: Our study aimed to gauge this kind of understanding. METHODS: We systematically searched the Web of Science database for studies concerning child obesity published up to 2017 and analyzed the volume of publications, growth rates, impact scores, collaborations, authors, affiliations, and journals. A total of 57,444 research papers were included. RESULTS: The three subject categories with the highest number of papers (over 3,000) were (1) nutrition and dietetics, (2) pediatrics, and (3) public, environmental, and occupational health. We found a dramatic increase in the amount of scientific literature on childhood obesity in the past one or two decades, led by scholars from the USA - ranking at the top regarding the total number of papers (23,965 papers; 30.8%) and total number of citations (859,793 citations) - and multiple Western countries where the obesity epidemic is prevalent. CONCLUSIONS: The findings highlight the need for improving international and local research capacities and collaboration to accelerate knowledge production and translation into contextualized and effective childhood obesity prevention.

Agnet y Judicialization en Salud en Argentina.

Argentina considers its first National HTA Agency (AGNET) amidst expectations that it would stop "the scourge of judicialization". We suspect this argument is counterintuitive: the creation of HTA Agencies, or Health Benefits Packages in the Region, whatever their breadth, have so far failed to contain judicialisation by themselves. We discuss that judicialization thrives not only because of the laws of the land, but also because the design and creation of these technical Agencies, informing benefits lists, has been largely divorced from the more difficult task of seeking system-wide priority-setting (PS) processes and institutions, capable of eliciting the social values on which difficult coverage decisions should rest. We propose that, in order for explicit PS to gain a foothold in Argentina, a social "agreement on scarcity" has to be built first, consciously and openly, by (a) seeking more transparency in the way healthcare is financed across sub-sectors, with public access to auditable data; and (b) debating optimal levels of satisfaction of individual right to health, as rights of access, within the inevitable distributive conflict of a collective right to health and access, and never in isolation.

Challenges in Priority Setting from a Legal Perspective in Brazil, Costa Rica, Chile, and Mexico.

Priority setting is the process through which a country's health system establishes the drugs, interventions, and treatments it will provide to its population. Our study evaluated the priority-setting legal instruments of Brazil, Costa Rica, Chile, and Mexico to determine the extent to which each reflected the following elements: transparency, relevance, review and revision, and oversight and supervision, according to Norman Daniels's accountability for reasonableness framework and Sarah Clark and Albert Wale's social values framework. The elements were analyzed to determine whether priority setting, as established in each country's legal instruments, is fair and justifiable. While all four countries fulfilled these elements to some degree, there was important variability in how they did so. This paper aims to help these countries analyze their priority-setting legal frameworks to determine which elements need to be improved to make priority setting fair and justifiable.

Advancing the Legislative Priorities of Cardiothoracic Surgeons: The Society of Thoracic Surgeons Political Action Committee.

In the late 1990s, several federal government health policy decisions threatened the viability of thoracic surgery as a specialty. To respond to such decisions, active participation in political processes was given extremely high priority by the Executive Committee of The Society of Thoracic Surgeons (STS). Creation of the STS Political Action Committee (STS-PAC) in 1997 was a part of the platform of participation. The purpose of the STS-PAC is to enhance the Society's voice and stature in health care policymaking. Although the STS-PAC receives voluntary contributions from STS members, on average, only 10% of STS members contribute to the STS-PAC. For the 2015-2016 election cycle, there were 542 contributors to the STS-PAC totaling $273,000. An annual contribution of $100 from every STS member would put the STS-PAC into the top 10 for medical PACs (whereas currently it is ranked 22nd of 28 in the group of physician and dental association PACs). Despite the relatively small dollar amount the STS-PAC directs, its strategic disbursement of these dollars has yielded impressive results. For example, the STS-PAC was able to use its influence to effectively stop the Centers for Medicare and Medicaid Services from implementing a potentially calamitous rule that would effectively end traditional global surgical payments. Other advocacy successes include providing guidance to the Centers for Medicare and Medicaid Services in developing the national coverage determination for transcatheter aortic valve replacement and structuring its complex reimbursement schedule, and ensuring that a provision was included in the bill that would give the STS National Database access to claims data. The STS-PAC is a principal component of the STS' advocacy armamentarium. Despite the many successes of the STS-PAC, with even modest contributions by more STS members, the STS-PAC could become a leading medical PAC, and would give the STS an even stronger presence and voice in Washington, DC. Clearly, contributing to the STS-PAC provides STS members the opportunity to have a voice and an impact on health policy and the care of their patients.

Future-proofing global health: Governance of priorities.

The year 2015 was a significant anniversary for global health: 15 years since the adoption of the Millennium Development Goals and the creation of the Global Alliance for Vaccines and Immunization, followed two years later by the Global Fund to Fight AIDS, TB and Malaria. 2015 was also the 10-year anniversary of the adoption of the International Health Regulations (May 2005) and the formal entering into force of the Framework Convention on the Tobacco Control (February 2005). The anniversary of these frameworks and institutions illustrates the growth and contribution of 'global' health diplomacy. Each initiative has also revealed on-going issues with compliance, sustainable funding and equitable attention in global health governance. In this paper, we present four thematic challenges that will continue to challenge prioritisation within global health governance into the future unless addressed: framing and prioritising within global health governance; identifying stakeholders of the global health community; understanding the relationship between health and behaviour; and the role of governance and regulation in supporting global health.

Is Aboriginal nutrition a priority for local government? A policy analysis.

OBJECTIVE: The present study aimed to explore how Australian local governments prioritise the health and well-being of Aboriginal populations and the extent to which nutrition is addressed by local government health policy. DESIGN: In the state of Victoria, Australia, all seventy-nine local governments' public health policy documents were retrieved. Inclusion of Aboriginal health and nutrition in policy documents was analysed using quantitative content analysis. Representation of Aboriginal nutrition 'problems' and 'solutions' was examined using qualitative framing analysis. The socio-ecological framework was used to classify the types of Aboriginal nutrition issues and strategies within policy documents. SETTING: Victoria, Australia. SUBJECTS: Local governments' public health policy documents (n 79). RESULTS: A small proportion (14 %, n 11) of local governments addressed Aboriginal health and well-being in terms of nutrition. Where strategies aimed at nutrition existed, they mostly focused on individual factors rather than the broader macroenvironment. CONCLUSIONS: A limited number of Victorian local governments address nutrition as a health issue for their Aboriginal populations in policy documents. Nutrition needs to be addressed as a community and social responsibility rather than merely an individual 'behaviour'. Partnerships are required to ensure Aboriginal people lead government policy development.