Decentralization and health care prioritization process in Tanzania: from national rhetoric to local reality

2010 ◽  
Vol 26 (2) ◽  
pp. e102-e120 ◽  
Author(s):  
Stephen Oswald Maluka ◽  
Anna-Karin Hurtig ◽  
Miguel San Sebastián ◽  
Elizabeth Shayo ◽  
Jens Byskov ◽  
...  
Keyword(s):  
Health Care ◽  
Prioritization Process ◽  
National Rhetoric

scholarly journals Development and Characteristics of the Provincial Overdose Cohort in British Columbia, Canada

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Laura MacDougall ◽  
Kate Smolina ◽  
Michael Otterstatter ◽  
Margot Ko ◽  
David Godfrey ◽  
...  
Keyword(s):  
Health Care ◽  
First Nations ◽  
Hospital Admissions ◽  
Data Sources ◽  
Opioid Overdose ◽  
Surveillance Systems ◽  
Hospital Data ◽  
Physician Visits ◽  
Administrative Dataset ◽  
Prioritization Process

IntroductionBritish Columbia has the highest rate of opioid overdose in Canada, driven by the use of illegal opioids such as fentanyl. In addition to ongoing surveillance, there is a need for more comprehensive data to identify risk factors, inform the development of interventions, and evaluate the public health emergency response. Objectives and ApproachThe Provincial Overdose Cohort is a linked administrative dataset based on information from hospital admissions, physician visits, prescription dispensations, poison centre calls, ambulance, emergency department, coroner’s data, and First Nations Client File. Overdoses in the province were identified for the period January 2015-November 2016. Overdoses occurring within a 24 hour period across data sources were grouped as a single episode. For identified cases and for a control population (a 20% random sample of the BC residents), health care and prescribing history was appended dating back to 2010. Initial analyses were conducted based on a prioritization process with knowledge users. ResultsIntegration of distinct data sources about overdose events provided a more complete understanding of the extent of the opioid crisis than use of a single dataset alone. Between January 1, 2015 and November 30, 2016 10,456 overdoses occurred in BC. Overdose deaths represented only 13% of individuals overdosing; 54% of all overdoses were captured through ambulance records and 46\% through emergency and hospital records, with some overlap between the datasets. Most cases had contact with the health care system in the year before overdose suggesting opportunities for intervention. Some demographic differences were noted when comparing fatal and non-fatal overdoses, but few differences in health or prescribing histories were identifiable using administrative data. Conclusion/ImplicationsThe Provincial Overdose Cohort is a uniquely comprehensive dataset in a jurisdiction at the forefront of the opioid overdose response. Jurisdictions developing surveillance systems should consider the inclusion of ambulance, emergency room and hospital data in order to more completely characterize the population at risk.

VP01 A Disinvestment Toolkit: The Prioritization Of Technologies Of No Or Low Added Value

2018 ◽  
Vol 34 (S1) ◽  
pp. 159-159
Author(s):  
Julie Polisena ◽  
Leonor Varela-Lema ◽  
Iñaki Gutiérrez-Ibarluzea ◽  
Brian Godman
Keyword(s):  
Health Care ◽  
Cost Effectiveness ◽  
Health Care Professionals ◽  
Grey Literature ◽  
Nominal Group Technique ◽  
Added Value ◽  
Nominal Group ◽  
Potential Health ◽  
Health Technologies ◽  
Prioritization Process

Introduction:Candidate health technologies identified for disinvestment will require prioritization depending on the system's capacity for dealing with the assessments or for further considerations. Compilations of low value lists, such as the National Institutes for Health and Clinical Excellence's, “Do not do recommendations”, can serve as databases for prioritization topics. Prioritization processes can also be triggered by experience or event-based regional requests and decisions; new evidence on safety, effectiveness and cost-effectiveness, variations in clinical practice, patient or consumer voicing, discrepancies between practice and guidelines; and or time-based mechanisms, such as approval of new health technologies and reassessment five years after introduction.Methods:A search of the published and grey literature was conducted to identify the current methods or tools used to prioritize potential health technologies and services for disinvestment. The description of the methods and tools identified, the prioritization criteria, and the stakeholders involved in the process were reviewed and summarized.Results:The methods and tools used for prioritization that were identified in the literature include the PriTec Prioritization tool, nominal group technique, Program Budgeting and Marginal Analysis, consensus building, and online surveys. Further, common criteria for prioritization centered on the disease burden, possible risks and benefits, costs and cost-effectiveness, utilization, and time-based criteria. Prioritization can be conducted by health care professionals, decision makers, patients or patient groups and representative community members.Conclusions:The prioritization process for disinvestment candidates should be transparent and guided largely by evidence. It is highly recommended that the list of predefined criteria be developed with input from all relevant stakeholders to meet the objectives of the specific health care setting. The commonly cited basic requirements include clinical parameters, economic measures, and social, ethical or legal considerations.

scholarly journals Relating the All Hazard Approach of Hospitals to that of Public Authorities

2019 ◽  
Vol 34 (s1) ◽  
pp. s80-s80
Author(s):  
Pieter van der Torn ◽  
Roel Geene ◽  
Dennis den Hartog
Keyword(s):  
Health Care ◽  
Healthcare Sector ◽  
Public Authorities ◽  
The Public ◽  
Prioritization Process ◽  
Impact Scale ◽  
Stepwise Development ◽  
Maximum Effort ◽  
Knowledge Platform ◽  
Response State

Introduction:Hospitals and the healthcare sector suffer from chronic work overload and personnel shortages in many nations. This poses strong incentives to rationalize all activities not directly related to care, such as the preparations for disasters and other hazards. One such rationalization is to turn from a rule-based to a risk-based approach. However, the risk landscape of hospitals and the relationship to the risk landscape of public authorities are ill-defined. Health Care Coalitions (HCCs) are in a good position to fill this gap and serve as an intermediary. We developed a scheme for defining the risk landscape of HCCs and its members and performed a prioritization process.Aim:Objectives were to develop a knowledge platform of hospitals on risk assessment, promote integrated risk management by the HCC and its members, and determine the limiting (response) state for all relevant hazards.Methods:We put maximum effort in limiting the time consumption for hospitals and align with the regular practices in hospitals for business continuity management. Strong points included the cooperation with the public authorities for safety and for health, a stepwise development of risk awareness and stepwise guidance for the assessment by hospitals, and formalization of the scenario-selection and choice of priorities by the HCC board.Results:A gross list of (>230) safety hazards was produced along with a netlist of (>80) hazards relevant to health care. In addition, an impact-scale for the continuity of care serving as a measurement stick for all health care sectors was developed. Risk diagrams were developed to present the results in a simple and clear format.Discussion:The HCC risk landscape served its purpose in improving the mutual understanding with the public authorities. The formal assessment provides a solid basis for operational planning, education, training, and future investments.

scholarly journals VP201 From A Systematic Review To Addressing Evidence Gaps

2017 ◽  
Vol 33 (S1) ◽  
pp. 244-245
Author(s):  
Marie Österberg ◽  
Christel Hellberg ◽  
Lena Wallgren
Keyword(s):  
Health Care ◽  
Social Services ◽  
Systematic Reviews ◽  
Research Policy ◽  
Future Research ◽  
Prioritization Process ◽  
Adhd Treatment ◽  
Primary Focus ◽  
Good Quality Research ◽  
New Research

INTRODUCTION:In both health care and social services it is important to continuously summarize and analyze existing research in the form of systematic reviews. At the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) (www.SBU.se) we collect the evidence gaps identified by systematic reviews in a database. These evidence gaps are methods used in health care/social services for which there is not enough good quality research available. By analyzing this database we can highlight populations or methods where evidence gaps are more frequent. This knowledge can be used to find areas that might need assistance in developing research structure and also when arranging research prioritization processes involving patients, consumers and clinicians.METHODS:Systematic reviews and evidence maps (methodical collections of systematic reviews) are used by SBU to identify evidence gaps. SBU has adapted the James Lindh alliance approach to give patients, consumers, relatives and clinicians the opportunity to give their view of what research they find most important to execute. SBU also collaborates with governmental research funders to communicate the content of the SBU database.RESULTS:A prioritizing process regarding evidence gaps within Attention Deficit Hyperactivity Disorder (ADHD)-treatment has been finalized (1). This was accomplished by people with ADHD and caretakers, as well as clinicians and staff. Another prioritization process on the topic of treatments for injuries after vaginal birth is ongoing. In November 2016 the Swedish government presented the research policy bill where they, based on analyses of the SBU database, pointed out areas of specific importance in future research.CONCLUSIONS:It is of great importance that evidence gaps get addressed and that new research is promoted in order to fill these gaps. In areas where there are numerous gaps, prioritizations involving different stakeholders is needed. Considering areas with large amounts of evidence gaps the primary focus might be on building infrastructure surrounding research before research calls can be directed towards these areas.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

A Tribute to the Late William J. Curran

1996 ◽  
Vol 24 (3) ◽  
pp. 274-275
Author(s):  
O. Lawrence ◽  
J.D. Gostin
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
United Nations ◽  
Mental Health Care ◽  
Harvard University ◽  
Legal Medicine ◽  
General Assembly ◽  
International Institute ◽  
University Professor

In the summer of 1979, a group of experts on law, medicine, and ethics assembled in Siracusa, Sicily, under the auspices of the International Commission of Jurists and the International Institute of Higher Studies in Criminal Science, to draft guidelines on the rights of persons with mental illness. Sitting across the table from me was a quiet, proud man of distinctive intelligence, William J. Curran, Frances Glessner Lee Professor of Legal Medicine at Harvard University. Professor Curran was one of the principal drafters of those guidelines. Many years later in 1991, after several subsequent re-drafts by United Nations (U.N.) Rapporteur Erica-Irene Daes, the text was adopted by the U.N. General Assembly as the Principles for the Protection of Persons with Mental Illness and for the Improvement of Mental Health Care. This was the kind of remarkable achievement in the field of law and medicine that Professor Curran repeated throughout his distinguished career.

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