scholarly journals A Community-Powered, Asset-Based Approach to Intersectoral Urban Health System Planning in Chicago

2016 ◽  
Vol 106 (10) ◽  
pp. 1872-1878 ◽  
Author(s):  
Stacy Tessler Lindau ◽  
Katherine Diaz Vickery ◽  
HwaJung Choi ◽  
Jennifer Makelarski ◽  
Amber Matthews ◽  
...  
Keyword(s):  
Health System ◽  
Urban Health ◽  
System Planning ◽  
Health System Planning

Public Engagement and the Changing Face of Health System Planning

2008 ◽  
Vol 21 (4) ◽  
pp. 22-26 ◽  
Author(s):  
John Grant ◽  
Nancy A. Sears ◽  
Karen Born
Keyword(s):  
Health System ◽  
Public Engagement ◽  
System Planning ◽  
Health System Planning

Cancer care in the time of COVID-19: A conceptual framework to improve cancer outcomes during a pandemic.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18628-e18628
Author(s):  
Vivienne Milch ◽  
Cleola Anderiesz ◽  
Debra Hector ◽  
Scott Turnbull ◽  
Melissa Austen ◽  
...  
Keyword(s):  
Decision Making ◽  
Health System ◽  
Conceptual Framework ◽  
Cancer Patients ◽  
Cancer Care ◽  
Cancer Outcomes ◽  
System Planning ◽  
Screening Programs ◽  
Cancer Management ◽  
Health System Planning

e18628 Background: At the start of the COVID-19 pandemic, a plan for cancer management during a pandemic did not exist. It soon became clear that without proper planning, cancer outcomes would worsen. Cancer patients are at increased risk of COVID-19 infection, morbidity, and mortality. Health sectors internationally reduced or paused non-urgent cancer care to protect cancer patients from COVID-19. However, disproportionate delays in screening, diagnosis, and treatment can unduly impact cancer outcomes, and backlogs can further burden a strained health system. Tailored approaches to cancer management are required which balance health resource availability along with the risks of exposure and benefits of treatment. Australia’s relatively low COVID-19 case numbers afforded Cancer Australia an opportunity to proactively plan for optimal cancer management during this, and future, pandemics. Methods: Cancer Australia’s Cancer care in the time of COVID-19: A conceptual framework for the management of cancer during a pandemic (the framework) maps evidence-based cancer care considerations in relation to a health system’s capacity across acute and recovery pandemic phases, in relation to steps of the cancer care pathway. The framework promotes infection control and resource prioritisation in the context of innovative care models, triaging approaches and individualised treatment plans, underpinned by effective communication and shared decision-making. Results: The framework supports health system planning and risk-stratified approaches to guide decision-making and improve cancer outcomes. Many aspects of cancer care are recommended to continue (to varying degrees) in most pandemic phases, with modifications or pauses in some aspects of care as the pandemic curve approaches or exceeds health system capacity. Principles of the framework were employed during the second wave of COVID-19 in the Australian state of Victoria, with continuation of cancer screening programs, diagnostic investigations, and treatments wherever it was safe to do so. This resulted in reductions in cancer services and treatment being relatively smaller than in the first wave. Conclusions: Cancer management in a pandemic is not a one-size-fits-all. Countries and jurisdictions need to tailor cancer care according to the risk of the health system becoming overwhelmed. The framework guides optimal cancer care to improve outcomes for people with cancer, while minimising COVID-19 infection. As further evidence becomes available from this pandemic or in future pandemics, this framework can be refined to inform ongoing and future pandemic health system planning.

scholarly journals Delayed Colorectal Cancer Diagnosis during the COVID-19 Pandemic in Alberta: A Framework for Analyzing Barriers to Diagnosis and Generating Evidence to Support Health System Changes Aimed at Reducing Time to Diagnosis

2021 ◽  
Vol 18 (17) ◽  
pp. 9098
Author(s):  
Emily Walker ◽  
Yunting Fu ◽  
Daniel C. Sadowski ◽  
Douglas Stewart ◽  
Patricia Tang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health System ◽  
Severe Disease ◽  
Adjusted Relative Risk ◽  
System Planning ◽  
Health System Planning ◽  
System Changes ◽  
Diagnostic Pathways ◽  
Diagnostic Intervals ◽  
Alberta Cancer Registry

The frequency of colorectal cancer (CRC) diagnosis has decreased due to the COVID-19 pandemic. Health system planning is needed to address the backlog of undiagnosed patients. We developed a framework for analyzing barriers to diagnosis and estimating patient volumes under different system relaunch scenarios. This retrospective study included CRC cases from the Alberta Cancer Registry for the pre-pandemic (1 January 2016–4 March 2020) and intra-pandemic (5 March 2020–1 July 2020) periods. The data on all the diagnostic milestones in the year prior to a CRC diagnosis were obtained from administrative health data. The CRC diagnostic pathways were identified, and diagnostic intervals were measured. CRC diagnoses made during hospitalization were used as a proxy for severe disease at presentation. A modified Poisson regression analysis was used to estimate the adjusted relative risk (adjRR) and a 95% confidence interval (CI) for the effect of the pandemic on the risk of hospital-based diagnoses. During the study period, 8254 Albertans were diagnosed with CRC. During the pandemic, diagnosis through asymptomatic screening decreased by 6·5%. The adjRR for hospital-based diagnoses intra-COVID-19 vs. pre-COVID-19 was 1.24 (95% CI: 1.03, 1.49). Colonoscopies were identified as the main bottleneck for CRC diagnoses. To clear the backlog before progression is expected, high-risk subgroups should be targeted to double the colonoscopy yield for CRC diagnosis, along with the need for a 140% increase in monthly colonoscopy volumes for a period of 3 months. Given the substantial health system changes required, it is unlikely that a surge in CRC cases will be diagnosed over the coming months. Administrators in Alberta are using these findings to reduce wait times for CRC diagnoses and monitor progression.

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