Treatment Facility Case Volume and Disparities in Outcomes of Congenital Diaphragmatic Hernia Cases.

INTRODUCTION: Congenital diaphragmatic hernia (CDH) is a life-threatening, prenatally diagnosed congenital anomaly. We aim to characterize care and outcomes of infants with CDH in Texas and the impact of treating facilities volume of care. METHODS: Retrospective cohort study using a state-wide Hospital Inpatient Discharge Public Use Data File was conducted (2013-2021). Neonates and infants <1 year of age were included using CDH ICD-9/ICD-10 codes. Neonates transferred to an outside hospital were excluded to avoid double-counting. Descriptive statistics, chi-square and logistic regression analysis were performed. RESULTS: Of 1314 CDH patient encounters identified, 728 (55%) occurred at 5 higher volume centers (HVC, >75 cases), 326 (25%) at 9 mid-volume centers (MVC, 20-75 cases) and 268 (20%) at 79 low volume centers (LVC, <20 cases). HVC had lower mortality rates (18%, MVC 22% vs LVC 27%; p = 0.011) despite treating sicker patients (extreme illness severity: HVC 71%, MVC 62% vs LVC 50%; p < 0.001) with longer length-of-stay (p < 0.001). Extracorporeal membrane oxygenation was used in 136 (10%) and provided primarily at HVC. LVC treated proportionately more non-white Hispanic patients (p < 0.001) and patients from counties along the Mexican border (p < 0.001). The predicted probability of mortality in CDH patients decreases with higher treatment facility CDH case volume, with a 0.5% decrease in the odds of mortality for every additional CDH case treated (p < 0.001). CONCLUSIONS: Patients treated in HVC have significantly lower mortality despite increased severity. Our data suggest minority populations may be disproportionately treated at LVC associated with worse outcomes. TYPE OF STUDY: Retrospective Prognosis Study. LEVEL OF EVIDENCE: Level II.

Demanda, oferta e produção de cateterismo cardíaco no Estado do Rio de Janeiro / Demand, offer and production of cardiac catheterization in the state of Rio de Janeiro

Este trabalho, de caráter exploratório-descritivo, objetiva descrever a produção de serviços e a demanda ao Sistema Estadual de Regulação (SER), sistema responsável pela regulação do procedimento, aos serviços de cateterismo no estado do Rio de Janeiro, sob a ótica das regiões de saúde, com seus desafios e entraves regionais. O acesso oportuno e integral garantido pela Lei 8.080/1990 norteiam este trabalho quanto à análise da capacidade de oferta do procedimento de alta complexidade no estado do Rio de Janeiro. O planejamento em saúde também é abordado como instrumento viabilizador da garantia, para a população, do acesso à assistência, estabelecendo referências e fluxos de processos. O trabalho apresenta a produção por região de saúde e a distribuição de vagas ofertadas pelo estado através do Sistema Estadual de Regulação, evidenciando a rede de assistência habilitada em cateterismo, bem como o índice de aproveitamento dos recursos. A concentração da produção de cateterismo no estado do Rio de Janeiro é observada na Região Metropolitana I, onde há um agrupamento de hospitais habilitados no procedimento. No universo de 23 estabelecimentos hospitalares de alta complexidade cardiovascular, 52% são filantrópicos, 39% públicos e 9% são privados. A pesquisa busca ainda mostrar as disparidades entre a relação da produção realizada e a oferta de vagas do estado para esse procedimento. Este trabalho busca compreender, sem esgotar, o funcionamento da rede de alta complexidade cardiovascular no que diz respeito ao cateterismo no estado do Rio de Janeiro. (AU)

This work, of an exploratory and descriptive nature, aims to describe the production of services and the demand for the State Regulation Service (SER), the system responsible for regulating the procedure, for catheterization services in the state of Rio de Janeiro, from the perspective of health regions, with their challenges and regional obstacles. The timely and comprehensive access guaranteed by Law 8,080/1990 guides the evolution of this work regarding the analysis of the capacity to offer the highly complex procedure in the state of Rio de Janeiro. Health planning is also approached as an instrument to ensure access to care for the population, establishing references and process flows. The work presents production by health region and the distribution of vacancies offered by the state through the State Regulation System, highlighting the assistance network qualified in catheterization as well as the rate of use of resources. The concentration of catheterization production in the state of Rio de Janeiro is observed in metropolitan region I, where there is a group of hospitals qualified in the procedure. In the universe of 23 highly complex cardiovascular hospital establishments, 52% are philanthropic, 39% public and 9% are private. The research also seeks to show the disparities between the relationship between the production carried out and the state's supply of vacancies for this procedure. This work seeks to understand, without exhausting, the functioning of the highly complex cardiovascular network regarding catheterization in the state of Rio de Janeiro. (AU)

Availability of maternal, newborn care and child health Services at primary health care unit during COVID-19 outbreak in Ethiopia

Background: The COVID-19 pandemic is putting a pressure on global health systems. The disruption of essential health services (EHS) has an impact on the health of mothers, neonate and children in developing countries. Therefore, the main aim of this study was assessing the availability of Maternal, Newborn care and Child health (MNCHS) services at primary health care unit during COVID-19 outbreak. Methods: A cross-sectional survey was conducted in five regions of Ethiopia in 2021. Descriptive analyses were undertaken using STATA 16 software and the results presented using tables and different graphs. A continuity of EHS assessment tool adopted from WHO was used for data collection. Result: During COVID -19 pandemic, 30 (69.8%) of woreda health offices, 52 (56.5%) of health centers (HCs), 7 (44.4%) of hospitals, and 165 (48%) of health posts (HPs) had a defined list of EHS. In comparison with other EHS, family planning is the least available service in all regions. At HPs level care for sick children and antenatal care (ANC) were available at 59.1 and 58.82% respectively. Except immunization services at SNNP, all other maternal, newborn, and child health EHS were not available to all HPs at full scale. Conclusion: Immunization services were most available, while ANC and care for sick children were least available during COVID-19 at the HPs level. There was regional variation in MNCH EHS service availability at all levels.

Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017.

INTRODUCTION: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. METHODS: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. RESULTS: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. CONCLUSIONS: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.

Social Determinants of Racial Disparities in Breast Cancer Mortality Among Black and White Women.

INTRODUCTION: Mortality from breast cancer among Black women is 60% greater than that of White women in South Carolina (SC). The aim of this study was to assess racial differences in mortality among Black and White breast cancer patients based on variations in social determinants and access to state-based early detection programs. METHODS: We obtained a retrospective record for breast cancer patients diagnosed between 2002 and 2010 from the SC Central Cancer Registry. Mortality was the main outcome while race-stratified Cox proportional hazard models were performed to assess disparities in mortality. We assessed effect modification, and we used an automated backward elimination process to obtain the best fitting models. RESULTS: There were 3286 patients of which the majority were White women (2186, 66.52%). Compared with married White women, the adjusted hazard ratio (aHR) for mortality was greatest among Black unmarried women (aHR 2.31, CI 1.83, 2.91). Compared with White women who lived in the Low Country region mortality was greatest among Black women who lived in the Midland (aHR 2.17 CI 1.47, 3.21) and Upstate (aHR 2.96 CI 1.96, 2.49). Mortality was higher among Black women that were not receiving services in the Best Chance Network (BCN) program (aHR 1.70, CI 1.40, 2.04) compared with White women. CONCLUSIONS: To reduce the racial disparity gap in survival in SC, Black breast cancer patients who live in the Upstate, are unmarried, and those that are not enrolled in the BCN program may benefit from more intense navigation efforts directed at early detection and linkage to breast cancer treatments.

Communities of practice in Alberta Health Services: advancing a learning organisation.

BACKGROUND: In 2009, Alberta Health Services (AHS) became Canada's first and largest fully integrated healthcare system, involving the amalgamation of nine regional health authorities and three provincial services. Within AHS, communities of practice (CoPs) meet regularly to learn from one another and to find ways to improve service quality. This qualitative study examined CoPs as an applied practice of a learning organisation along with their potential influence in a healthcare system by exploring the perspectives of CoP participants. METHODS: A collective case study method was used to enable the examination of a cross-section of cases in the study organisation. Semi-structured interviews were conducted with 31 participants representing 28 distinct CoPs. Using Senge's framework of a learning organisation, CoP influences associated with team learning and organisational change were explored. RESULTS: CoPs in AHS were described as diverse in practice domains, focus, membership boundaries, attendance and sphere of influence. Using small-scale resource investments, CoPs provided members with opportunities for meaningful interactions, the capacity to build information pathways, and enhanced abilities to address needs at the point of care and service delivery. Overall, CoPs delivered a sophisticated array of engagement and knowledge-sharing activities perceived as supportive of organisational change, systems thinking, and the team learning practice critical to a learning organisation. CONCLUSION: CoPs enable the diverse wealth of knowledge embedded in people, local conditions and special circumstances to flow from practice domain groups to programme and service areas, and into the larger system where it can effect organisational change. This research highlights the potential of CoPs to influence practice and broad-scale change more directly than previously understood or reported in the literature. As such, this study suggests that CoPs have the potential to influence and advance widespread systems change in Canadian healthcare.

Saúde mental na IV região de saúde de Pernambuco: um relato de experiencia / Mental health in the IV health region of Pernambuco: an experience report

O presente artigo se propõe a refletir sobre a saúde mental na IV região de saúde do estado de Pernambuco, permeando pela Reforma Psiquiátrica Brasileira em um contexto de regionalização no agreste setentrional do estado. Foram consideradas as vivências de uma profissional de fisioterapia residente de saúde coletiva da Escola de Governo de Saúde Pública de Pernambuco ­ ESPPE, a qual passou dois anos na região e, dentre esse tempo, três meses na coordenação da política de saúde mental. A saúde mental ainda não é uma linha de cuidado prioritária para a gestão do SUS na região, mesmo tendo o estado de PE delimitado a mesma como uma das linhas de cuidado a ser estruturada nas regiões de saúde. A reforma psiquiátrica precisa ser descentralizada e chegar ao agreste setentrional do estado de Pernambuco. (AU)

This article proposes to reflect on mental health in the IV health region of the state of Pernambuco, permeating the Brazilian Psychiatric Reform in a context of regionalization in the northern agreste of the state. The experiences of a physiotherapist resident in Public Health of the School of Public Health of Pernambuco - ESPPE, who spent two years in the region and, during this time, three months in the coordination of mental health policy were considered. Mental health is still not a priority care line for the management of the SUS in the region, even if the state of PE delimited it as one of the care lines to be structured in the health regions. The psychiatric reform must be decentralized and reach the northern agreste of the state of Pernambuco. (AU)

Análise da participação dos gestores municipais de saúde nas reuniões da comissão intergestora da V região de saúde de Pernambuco nos anos de 2016 e 2017 / Analysis of the participation of municipal health managers in the meetings of the intergovernmental commission of the 5th health region of Pernambuco in the years 2016 and 2017

O artigo discorre sobre a Comissão Intergestora Regional (CIR) da V Região de Saúde de Pernambuco e a participação dos gestores municipais de saúde nesse espaço. É uma pesquisa de cunho quantitativo que utilizou, para coleta de dados, os documentos oficiais das reuniões da CIR, pautas e atas de frequência e reunião, do período de janeiro de 2016 a dezembro de 2017. Tais documentos foram analisados de acordo com o método de Bardin, e por fim dividido em duas categorias: frequências dos gestores municipais de saúde nas reuniões da CIR e; quantidades de pactuação realizadas nas reuniões. Os dados adquiridos revelaram que o período de agosto a outubro do ano de 2016 não atingiu o mínimo de participação dos gestores nas reuniões da CIR para pactuar propostas. Porém, em 2017, todas a reuniões realizadas obtiveram mais de 50% da frequência dos gestores municipais, por conseguinte o percentual de aprovação das pactuações foi maior que o ano anterior, mesmo com esta mudança, municípios próximos da sede continuaram com baixa frequência ao contrário de municípios distantes, com mais de 90km da sede, mostrando que a distância não é fator impeditivo para a frequência dos gestores nas reuniões. Vale salientar que devido a existência de um quórum mínimo de 11 municípios para aprovação das pactuações, a ausência dos gestores não afeta apenas o seu município, mas prejudica diretamente as pactuações que beneficiam os outros municípios, e consequentemente o fortalecimento da regional a qual faz parte. (AU)

The article discusses the Regional Interactive Commission (CIR) of the V Health Region of Pernambuco and the participation of municipal health managers in this area. It is a quantitative research that used, for data collection, the official documents of the meetings of the CIR, schedules and minutes of attendance and meeting, from January 2016 to December 2017. These documents were analyzed according to the Bardin method, and finally divided in two categories: frequencies of the municipal health managers in the meetings of the CIR and; agreed upon at the meetings. The acquired data revealed that the period from August to October of 2016 did not reach the minimum participation of the managers in the meetings of the CIR to negotiate proposals. However, in 2017, all the meetings held obtained more than 50% of the frequency of the municipal managers, therefore the approval percentage of the agreements was higher than the previous year, even with this change, municipalities near the headquarters continued with low frequency, unlike municipalities distant, with more than 90km from headquarters, showing that distance is not a factor preventing attendance of managers in meetings. It is worth mentioning that due to the existence of a minimum quorum of 11 municipalities to approve pacts, the absence of managers does not only affect their municipality, but directly affects the agreements that benefit the other municipalities, and consequently the strengthening of the regional one that makes part. (AU)

A strategic document as a tool for implementing change. Lessons from the merger creating the South-East Health region in Norway.

In 2007, the Norwegian Parliament decided to merge the two largest health regions in the country: the South and East Health Regions became the South-East Health Region (SEHR). In its resolution, the Parliament formulated strong expectations for the merger: these included more effective hospital services in the Oslo metropolitan area, freeing personnel to work in other parts of the country, and making treatment of patients more coherent. The Parliamentary resolution provided no specific instructions regarding how this should be achieved. In order to fulfil these expectations, the new health region decided to develop a strategy as its tool for change; a change "agent". SINTEF was engaged to evaluate the process and its results. We studied the strategy design, the tools that emerged from the process, and which changes were induced by the strategy. The evaluation adopted a multimethod approach that combined interviews, document analysis and (re)analysis of existing data. The latter included economic data, performance data, and work environment data collected by the South-East Health Region itself. SINTEF found almost no effects, whether positive or negative. This article describes how the strategy was developed and discusses why it failed to meet the expectations formulated in the Parliamentary resolution.

SUS Brazil: The health region as a way forward

The present article addresses the need to have regionalization of decentralization, in order to cluster together what this could supposedly have broken apart. On revisiting the constitutional guidelines on decentralization, the authors propose measures to provide assurance thereof, in addition to administrative tools that allow the formation of health regions to supply at least 95% of the health needs of the regional territory, to ensure sanitary independence. The authors suggest solutions that include the establishment of regional and associative corporate institutions resulting from the clustering of the federative institutes operating in the health area. The authors also state what has not worked out in the Brazilian National Health System (Sistema Único de Saúde - SUS), due to mistakes that have originated in the best of intentions, as also the opportunism that these mistakes have generated. The authors defend the need to bring judicial and administrative answers to a SUS that is interfederative in character, both in management, which requires some sharing, as also in financing which also remains interdependent. The conclusion reached is that the only way in which the SUS can be national is to regionalize it, and to give the health region all the instruments that are necessary for shared, interfederative and responsible management.

O presente artigo desenvolve o tema da necessidade de se regionalizar a descentralização no sentido de aglutinar o que esta supostamente poderia ter fracionado. Ao revisitar a diretriz constitucional da descentralização os autores propõem medidas que visem sua garantia ao lado de ferramentas administrativas que permitam a formação de regiões de saúde resolutivas em pelo menos 95% das necessidades de saúde do território regional, para garantir autonomia sanitária. Os autores propõem soluções que passam pela criação de pessoas jurídicas associativas regionais, resultantes da aglutinação dos entes federativos em região de saúde. Apontam ainda o que não deu certo no Sistema Único de Saúde - SUS Brasil em razão tanto de equívocos originados nas melhores intenções, quanto do oportunismo que esses equívocos geraram. Advogam os autores a necessidade de respostas jurídico-administrativas para um SUS de caráter interfederativo tanto na sua gestão, que exige compartilhamentos, quanto no seu financiamento, que se mantém interdependente também. Concluem que o único caminho para o SUS ser nacional, é regionalizá-lo e dotar a região de saúde de todo o instrumental necessário à gestão compartilhada, interfederativa e responsável.

Health region development from the perspective of system theory - an empirical cross-regional case study.

Governments are increasingly establishing health regions to deal with current challenges of public health service. These regions are seen as instruments to balance public and private stakeholders, and offer health care to regional citizens as well as to medical/health tourists. However, it is still unclear how the development of such health regions as well as their governance may be conceptualized. We apply Luhmann's system theory approach in the context of a cross-regional case study that compares health region developments in the Autonomous Province of Bolzano-South Tyrol (Italy) with particular regard to the Eastern Dolomites and in the province of Zeeland (the Netherlands). We suggest that Luhmann's system theory provides a useful set of criteria to evaluate and judge health region development. Fully developed health regions can be understood as auto-poietic systems. By emphasizing programs, personnel, and communication channels, these case studies illustrate the suitability of the system theory toolset to analyze the governance and spatial embeddedness of health regions. Additionally, the study contributes to literature by indicating that health regions are closely related to identity issues and to decision making in regions.

Study on division of China’s health region / 中国卫生政策研究

Objective:Development of health resources is extremely uneven in China. It is need to consider the situation of each region for China 's health regional planning, so area classification should be in progress. Methods Considering the economic, social, population and health factors, the study conducted principal component analysis and factor analysis by statistical yearbook data to calculate the composite score for each region. Then cluster analysis was conducted. Results Principal components and factor analysis were both divided the country in to six categories. Conclusions:The study divided the country into six regions, the first class area:Shanghai, Beijing;the second class area:Tianjin; the third class area: Jiangsu, Zhejiang, Guangdong; the fifth class area: Guangxi, Ningxia, Xin-jiang, Gansu, Guizhou, Yunnan, Qinghai;the sixth class area:Tibet. The rest is the forth class area.