Understanding Impacts of Online Dual Practice on Health System Performance: A Qualitative Study in China.

The outbreak of the COVID-19 pandemic has boosted the global development of online healthcare platforms. An increasing number of public hospital doctors are providing online services on private third-party healthcare platforms, creating a new form of dual practice-online dual practice. To explore the impacts of online dual practice on health system performance as well as potential policy responses, we undertook a qualitative approach that uses in-depth interviews and thematic analysis. Following a purposive sampling, we interviewed 57 Chinese respondents involved in online dual practice. We asked respondents for their opinions on the effects of online dual practice on access, efficiency, quality of care, and advice on regulatory policy. The results suggest that online dual practice can generate mixed impacts on health system performance. The benefits include improved accessibility due to increased labor supply of public hospital doctors, better remote access to high-quality services, and lower privacy concerns. It can improve efficiency and quality by optimizing patient flows, reducing repetitive tasks, and improving the continuity of care. However, the potential distraction from designated work at public hospitals, inappropriate use of virtual care, and opportunistic physician behaviors may undermine overall accessibility, efficiency, and quality. Countries should mitigate these adverse consequences via regulations that are appropriate to their healthcare system context, policy priority, and governance capacity.

HEALTH RESOURCE ALLOCATION METHOD AT CORDON SANITAIRE FOR PANDEMIC CONTROL AND PREVENTION

The outbreak of COVID-19 and its variants has profoundly disrupted our normal life. Many local authorities enforced cordon sanitaires for the protection of sensitive areas. Travelers can only cross the cordon after being tested. This paper aims to propose a method to determine the optimal deployment of cordon sanitaires in terms of minimum queueing delay time with available health testing resources. A sequential two-stage model is formulated where the first-stage model describes transportation system equilibrium to predict traffic ows. The second-stage model, a nonlinear integer programming, optimizes health resource allocation along the cordon sanitaire. This optimization aims to minimize the system's total delay time among all entry gates. Note that a stochastic queueing model is used to represent the queueing phenomenon at each entry link. A heuristic algorithm is designed to solve the proposed two-stage model where the Method of Successive Averages (MSA) is adopted for the first-stage model, and a genetic algorithm (GA) with elite strategy is adopted for the second-stage model. An experimental study is conducted to demonstrate the effectiveness of the proposed method and algorithm. The results show that these methods can find a good heuristic solution, and it is not cost-effective for authorities to keep adding health resources after reaching a certain limit. These methods are useful for policymakers to determine the optimal deployment of health resources at cordon sanitaires for pandemic control and prevention. © 2023.

Status of the health information system in Ireland and its fitness to support health system performance assessment: a multimethod assessment based on stakeholder involvement.

BACKGROUND: Between 2019 and 2021, the first Irish health system performance assessment (HSPA) framework was developed. As routinely collected health data are necessary to continuously populate indicators of an HSPA framework, a purpose-driven assessment of the health information system (HIS) in Ireland and its fitness to support the implementation of an HSPA framework was conducted. This study reports on the status of the Irish HIS through a multimethod assessment based on continuous broad stakeholder involvement. METHODS: Between May and November 2020, over 50 informants were engaged in individual and group interviews and stakeholder consultation workshops as part of the HIS assessment process. Descriptive themes and high-level data availability heatmaps were derived from interview and workshop data using thematic analysis. Indicator "passports" for the HSPA framework were populated during stakeholder consultation workshops and analysed using univariate descriptive statistics. RESULTS: The HIS in Ireland was able to provide administrative, survey and registry-based data for public sector acute care services, focusing on structure, process and output metrics. Significant data availability gaps, most notably from primary care, private hospitals and community care, were reported, with little availability of electronic health record and people-reported data. Data on outcome metrics were mostly missing, as were linkage possibilities across datasets for care pathway monitoring. The COVID-19 pandemic highlighted the national HIS's shortcomings but also the capacity for rapid development and improvement. CONCLUSIONS: A tailor-made assessment of the HIS in Ireland, involving a broad set of relevant stakeholders, revealed strengths, weaknesses and areas for improvement in the Irish health data landscape. It also contributed to the development of a national HSPA framework and momentum to further strengthen data infrastructure and governance, while working towards a more data-driven and person-centred healthcare system. This work demonstrates the utility of an inclusive HIS assessment process and is applicable beyond Ireland, where this case study was conducted.

Primary Care's Challenges and Responses in the Face of the COVID-19 Pandemic: Insights From AHRQ's Learning Community.

The COVID-19 pandemic dramatically disrupted health care systems and delivery in the United States. Despite emotional, psychological, logistical, and financial stress, primary care clinicians responded to the challenges that COVID-19 presented and continued to provide essential health services to their communities. As the lead federal agency for primary care research, the Agency for Healthcare Research and Quality (AHRQ) identified a need to engage and support primary care in responding to COVID-19. AHRQ initiated a learning community from December 2020-November 2021 to connect professionals and organizations that support primary care practices and clinicians. The learning community provided a forum for participants to share learning and peer support, better understand the stressors and challenges confronting practices, ascertain needs, and identify promising solutions in response to the pandemic. We identified challenges, responses, and innovations that emerged through learning community engagement, information sharing, and dialog. We categorized these across 5 domains that reflect core areas integral to primary care delivery: patient-centeredness, clinician and practice, systems and infrastructure, and community and public health; health equity was crosscutting across all domains. The engagement of the community to identify real-time response and innovation in the context of a global pandemic has provided valuable insights to inform future research and policy, improve primary care delivery, and ensure that the community is better prepared to respond and contribute to ongoing and future health challenges.

Modeling the impact of mitigation policies in a pandemic: A system dynamics approach

In the absence of effective and adequate vaccines, healthcare decision-makers must rely on non-pharmaceutical interventions (NPIs), such as lockdown, testing, hospital capacity building, and increasing the number of medical staff to control the outbreak of an infectious disease like COVID-19. This manuscript presents a System Dynamics (SD) model to analyze the healthcare system performance under various NPIs during a pandemic. The proposed model, which extends the commonly-used Susceptible-Exposed-Infectious-Recovered (SEIR) model, comprises four sub-models: outbreak, hospital performance, medicine supply, and staff functionality. These sub-models work in harmony to stimulate the impact of NPIs on the disease outbreak pattern and the healthcare system's response to demand surge. The proposed model considers the uncertainty about the nature of the disease, the public's behavior, medicine availability, and medical staff efficiency. The proposed model was applied for the ex-ante evaluation of candidate NPIs adoptable against the COVID-19 outbreak in Iran. Consistent with the reported statistics, the results show that the peak demand can significantly exceed the healthcare system's initial capacity if no action is taken. If simultaneously implemented, lockdown and testing can considerably delay the peak of infections, reduce its magnitude, dampen the hospital demand, and decrease mortality. The proposed model is unique as it determines the extent to which system components (e.g., community, healthcare system, and medicine supply chain) impact the observed outcomes (e.g., morbidity and mortality rates). Its structure is generic and flexible, which facilitates the extension and application of the model to evaluate candidate mitigation policies in various geographical contexts.

Health resource allocation method at cordon sanitaire for pandemic control and prevention

The outbreak of COVID-19 and its variants has profoundly disrupted our normal life. Many local authorities enforced cordon sanitaires for the protection of sensitive areas. Travelers can only cross the cordon after being tested. This paper aims to propose a method to determine the optimal deployment of cordon sanitaires in terms of minimum queueing delay time with available health testing resources. A sequential two-stage model is formulated where the first-stage model describes transportation system equilibrium to predict traffic flows. The second-stage model, a nonlinear integer programming, optimizes health resource allocation along the cordon sanitaire. This optimization aims to minimize the system's total delay time among all entry gates. Note that a stochastic queueing model is used to represent the queueing phenomenon at each entry link. A heuristic algorithm is designed to solve the proposed two-stage model where the Method of Successive Averages (MSA) is adopted for the first-stage model, and a genetic algorithm (GA) with elite strategy is adopted for the second-stage model. An experimental study is conducted to demonstrate the effectiveness of the proposed method and algorithm. The results show that these methods can find a good heuristic solution, and it is not cost-effective for authorities to keep adding health resources after reaching a certain limit. These methods are useful for policymakers to determine the optimal deployment of health resources at cordon sanitaires for pandemic control and prevention.

The COVID-19 Pandemic and U.S. Aviation: System Adaptation and Performance Impact

The COVID-19 pandemic drastically impacted nearly all aspects of life throughout the world during 2020. It had a particularly severe impact on air transportation with U.S. demand initially dropping by over 90%. In this paper, we investigate the impact on the performance of the U.S. domestic air transportation system. We analyze both the changes in the volume and characteristics of flight operations and also changes in system performance metrics. We also discuss various adjustments made by the Federal Aviation Administration (FAA) both to take advantage of reduced system congestions and also to cope with COVID-19 infections among controllers. © ATM 2021. All rights reserved.

Engaging citizens in the development of a health system performance assessment framework: a case study in Ireland.

BACKGROUND: The launch in 2017 of the Irish 10-year reform programme Sláintecare represents a key commitment in the future of the health system. An important component of the programme was the development of a health system performance assessment (HSPA) framework. In 2019, the Department of Health of Ireland (DoH) and Health Service Executive (HSE) commissioned the technical support of researchers to develop an outcome-oriented HSPA framework which should reflect the shared priorities of multiple stakeholders, including citizens. This study describes the method applied in the Irish context and reflects on the added value of using a citizen panel in the development of an HSPA framework. METHODS: A panel of 15 citizens was convened, recruited by a third-party company using a sampling strategy to achieve a balanced mix representing the Irish society. Panellists received lay-language preparatory materials before the meeting. Panellists used a three-colour scheme to signal the importance of performance measures. An exit questionnaire was administered to understand how participants experienced being part of the panel. The citizen panel was the first in a series of three panels towards the development of the HSPA framework, followed by panels including representatives of the DoH and HSE, and representatives from professional associations and special interest groups. RESULTS: The citizen panel generated 249 health performance measures ranging across 13 domains. Top-ranking domains to the citizen panel (people-centredness, coordination of care, and coverage) were less prioritized by the other panels; domains less prioritized by the citizen panel, such as accessibility, responsiveness, efficiency, and effectiveness, were of higher priority in the other panels. Citizen panellists shared a similar understanding of what a citizen panel involves and described their experience at the panel as enjoyable, interesting, and informative. CONCLUSIONS: The priorities of the citizen panel were accounted for during all phases of developing the HSPA framework. This was possible by adopting an inclusive development process and by engaging citizens early on. Citizen engagement in HSPA development is essential for realizing citizen-driven healthcare system performance and generating trust and ownership in performance intelligence. Future research could expand the use of citizen panels to assess, monitor, and report on the performance of healthcare systems.

How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.

Routine Health Information Systems in the European Context: A Systematic Review of Systematic Reviews.

(1) Background: The aim of this study is to provide a better understanding of the requirements to improve routine health information systems (RHISs) for the management of health systems, including the identification of best practices, opportunities, and challenges in the 53 countries and territories of the WHO European region. (2) Methods: We conducted an overview of systematics reviews and searched the literature in the databases MEDLINE/PubMed, Cochrane, EMBASE, and Web of Science electronic databases. After a meticulous screening, we identified 20 that met the inclusion criteria, and RHIS evaluation results were presented according to the Performance of Routine Information System Management (PRISM) framework. (3) Results: The reviews were published between 2007 and 2020, focusing on the use of different systems or technologies and aimed to analyze interventions on professionals, centers, or patients' outcomes. All reviews examined showed variability in results in accordance with the variability of interventions and target populations. We have found different areas for improvement for RHISs according to the three determinants of the PRISM framework that influence the configuration of RHISs: technical, organizational, or behavioral elements. (4) Conclusions: RHIS interventions in the European region are promising. However, new global and international strategies and the development of tools and mechanisms should be promoted to highly integrate platforms among European countries.