Covid-19 and Routine Vaccination Programme: Did it Affect Badly?

Background: The impact of COVID-19 on general health care delivery systems has been huge including the immunization services. Several measures were taken by most of the government all over the world to prevent the spread of infection such as lockdown, wearing masks, social distancing, etc. People have suffered a lot during the pandemic, not only due to the burden of the disease but have also faced difficulties in other domains of life. One of the important concerns is the interruption of routine immunization services. The consequences of interrupted immunization services may be life-threatening, as chances of outbreaks of vaccine-preventable diseases (VPD) in susceptible children could be high. Aim: To find out delay in routine immunization services during covid-19 and also to determine the factors associated with delay in immunization. Materials and Methods: This study was a cross-sectional hospital-based observational study at Career Institute Of Medical Sciences And Hospital, Lucknow, India. We collected the vaccination record after lockdown from Well-Baby Clinic and telephonically from the parents, starting from 1st June 2020 till 31st December 2020. We checked the records of vaccination of infants to find out delay in the vaccinations, as per the National Immunization Schedule. The records of a total of 265 infants were enrolled. Out of which, 33 did not fit the inclusion criteria and therefore were excluded from this study. Results: Findings of our study pointed that there was significant delay in routine immunization among infants. The factors responsible for delay in different vaccination observed in this study were, Phobia of COVID-19- 20%, lockdown- 22%, interruption of routine health services-15%, social myths-8%, poor transport facility- 10%, illness of child- 8%, did not notice- 3% and multiple factors- 13%. Conclusion: COVID -19 pandemic has affected the routine immunization services that results in delay of different vaccines at different ages which may lead to outbreak of vaccine preventable diseases, so it is need of the hour to intervene at the earliest to prevent such outbreaks among children.

Innovation Centers in Health Care Delivery Systems: Structures for Success (Preprint)

UNSTRUCTURED Calls for innovation in health care delivery have been widespread due to payment reforms and access to digital tools, and innovations have been accelerated by the shift to virtual care as part of the COVID-19 response. Prior to the pandemic, a growing number of health systems set up innovation centers to focus on creating new services and exploring new business models relevant to value-based care. This is distinct from process improvement or implementation science, and often needs a different set of incentives to succeed within a large organization. We used a national survey to identify a diverse sample of centers, and interviewed leaders to describe their aims, organizational structures and activities. They all aim to improve patient outcomes and experience while reducing costs, but their strategic focus may differ. The centers also vary in their reporting structure, how they build internal capacity, and how they measure success. We highlight the range of strategies through examples of projects that improve quality, reduce costs and generate new revenue. While the optimal forms and impact of innovation centers are still emerging, the fiscal pressures and the rapid uptake of digital technologies present opportunities for redesign of health services in the post-pandemic era. The experiences of these centers illustrate a set of approaches to increase any organization’s capacity for innovation.

Overcoming Current and Preventing Future Nosocomial Outbreaks during the COVID-19 Pandemic: Lessons Learned at Three Hospitals in Japan

Hospitals are increasingly challenged by nosocomial infection (NI) outbreaks during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Although standardized guidelines and manuals regarding infection prevention and control (IPC) measures are available worldwide, case-studies conducted at specified hospitals that are required to cope with real settings are limited. In this study, we analyzed three hospitals in Japan where large-scale NI outbreaks occurred for hints on how to prevent NI outbreaks. We reviewed openly available information from each hospital and analyzed it applying a three domain framework: operation management; identification of infection status; and infection control measures. We learned that despite having authorized infection control teams and using existing standardized IPC measures, SARS-CoV-2 may still enter hospitals. Early detection of suspected cases and confirmation by PCR test, carefully dealing with staff-to-staff transmission were the most essential factors to prevent NI outbreaks. It was also suggested that ordinary training on IPC for staff does not always provide enough practical knowledge and skills; in such cases external technical and operational supports are crucial. It is expected that our results will provide insights into preventing NI outbreaks of COVID-19, and contribute to mitigate the damage to health care delivery systems in various countries.

Future-Proofing Geriatric Mental Health Care Services in India: Training and Policy Directions

Background: A burgeoning rise in the elderly subpopulation is being noted in India. This rise has already earned the designation as a shining nation by the United Nations/World Health Organization. This growth will take the elderly subpopulation to 324 million persons above 60 years by 2050. The mental health needs of this subpopulation are varied and nuanced compared to that of the general population. The risk and prevalence of mental health morbidity are also greater. There is an urgent need to gear up the health care systems. Considerations: Various aspects of the ongoing demographic transitions are considered alongside available health information. Legislative mandates and laws are also reviewed to provide context to qualify the action points and recommendations. Recommendations, India must act urgently to strengthen health care delivery systems in a concurrent multipronged approach. These efforts should focus on developing trained Human Resources and adequate infrastructural resources. Review mechanisms to inform on required updates on best practices and evidence-based medicine must also be incorporated and developed to perform periodically.

Current developments in delivering customized care: a scoping review

Background In recent years, there has been a growing interest in health care personalization and customization (i.e. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for health care delivery systems. The present study undertakes a scoping review of articles on customized care to describe which patient characteristics are used for segmenting care, and to identify the challenges face to implement customized intervention in routine care. Methods Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PsycINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included “care customization”, “personalized service and health care”, individualized care” and “targeting population” in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers. Results We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed these characteristics often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A small number of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n = 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation. Conclusions There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customization in health care delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. These steps would allow them to use customization to reduce costs and improve quality of care.

Patient-centered care pathways: what does it mean? An integrative conceptual framework to meet the need of an international consensus: a qualitative systematic review protocol

Background: Faced with increased expectations regarding the quality and safety of health care delivery systems, a number of stakeholders are increasingly looking for more qualitative and efficient ways to deliver care. This study is conducted to provide a clear definition of the patient-centered care pathway and its characteristics to meet the need for an international consensus. Methods: This qualitative systematic review aims to perform a systematic synthesis of published evidence concerning (1) the definition of the patient trajectory, patient pathway or patient journey and (2) their characteristics. With a consulting librarian, a comprehensive and systematic search in three databases was conducted (PUBMED, Embase, ABI/Inform), from 1995 to 2020 without language criteria. Eligibility criteria guiding data selection will follow the PICo mnemonic criteria consisting of (1) Population : all types of patients managed by health care delivery systems for an acute or chronic condition regardless of age or condition, (2) Phenomena : studies that contribute to the definition and conceptualization of the concepts of care trajectory, care pathway and patient journey resulting in a theoretical and conceptual contribution, and (3) Context : health care providers include all providers of primary, secondary, tertiary, and quaternary care in any geographic area. Two reviewers will independently screen, select, extract data and make a critical assessment of the methodology used with the JBI Qualitative Assessment and Review Instrument (JBI QARI).Discussion: This systematic review will provide much-needed knowledge regarding patient-centered pathways. The results will benefit clinicians, decision makers, and researchers by giving them a clear and integrated definition and understanding of the patient-centered care pathways and their characteristics to finally meet the need for an international consensus.

The Lived Experiences of Esophageal Cancer Patients With The Concept of Uncovering Pathways to Seeking Treatment and Follow-Up: A Qualitative Study in Arsi Zone, Oromia, Ethiopia

Objective: Esophageal cancer patients experience multifaceted challenges but studies often focus on the prevalence and risk factors of esophageal cancer with no documentation of the lived experiences of patients. This study aimed at exploring the lived experiences of esophageal cancer patients with the concept of uncovering pathways to seeking treatment, and follow-up. Results:- The experience of seeking care began with self-care followed by visiting traditional healers, and hierarchical layers of health care delivery systems. The barriers to treatment follow-up were inaccessibility, unaffordability of health care services, and negative attitudes towards treatment. Patients experienced distresses linked to food intakes, treatment side effects, reduced quality of life, psychological and physical impairments. Esophageal cancer patients in this study experienced complex pathways to seeking treatment, multidimensional obstacles to treatment follow-up, and live with unbearable challenges.