MIHARI project, a preceding study of MID-NET, adverse event detection database of Ministry Health of Japan-Validation study of the signal detection of adverse events of drugs using export data from EMR and medical claim data.

We studied the effectiveness of the direct data collection from electronic medical records (EMR) when it is used for monitoring adverse drug events and also detection of already known adverse events. In this study, medical claim data and SS-MIX2 standardized storage data were used to identify four diseases (diabetes, dyslipidemia, hyperthyroidism, and acute renal failure) and the validity of the outcome definitions was evaluated by calculating positive predictive values (PPV). The maximum positive predictive value (PPV) for diabetes based on medical claim data was 40.7% and that based on prescription data from SS-MIX2 Standardized Storage was 44.7%. The PPV for dyslipidemia was 50% or higher under either of the conditions. The PPV for hyperthyroidism based on disease name data alone was 20-30%, but exceeded 60% when prescription data was included in the evaluation. Acute renal failure was evaluated using information from medical records in addition to the data. The PPV for acute renal failure based on the data of disease names and laboratory examination results was slightly higher at 53.7% and increased to 80-90% when patients who previously had a high serum creatinine (Cre) level were excluded. When defining a disease, it is important to include the condition specific to the disease; furthermore, it is very useful if laboratory examination results are also included. Therefore, the inclusion of laboratory examination results in the definitions, as in the present study, was considered very useful for the analysis of multi-center SS-MIX2 standardized storage data.

Coordination of services for people with serious mental illness and general medical conditions: Perspectives from rural northeastern United States.

OBJECTIVE: The objective of the study was to investigate providers' perspectives on how medical, mental health, and social services are coordinated for people with serious mental illnesses and general medical conditions in 2 predominantly rural states. METHOD: To achieve multiple perspectives on service coordination, this study includes perspectives from providers employed in community mental health centers, social service agencies, and primary care settings in 2 northern rural New England states with contrasting approaches to financing and organizing services. We conducted 29 individual semistructured interviews and 1 focus group, which included administrative leaders, team leaders, primary care providers, social workers, and case managers who provide services for people with serious mental illness. Data were analyzed using qualitative thematic content analysis. RESULTS: We identified key themes at 3 levels: (a) provider-level coordination: bridging across services; managing interprofessional communications; and contrasting perspectives on the locus of responsibility for coordination; (b) individual-level coordination: support for self-management and care navigation; trusting and continuous relationships; and the right to individual choice and autonomy; (c) system-level coordination: linking appropriate residential and care provision services, funding, recruiting and retaining staff, policy enablers, and integration solutions. CONCLUSIONS: Three levels of provider-reported coordination themes are described for the 2 states, reflecting efforts to coordinate and integrate service delivery across medical, mental health, and social services. IMPLICATIONS: Improvements in patient outcomes will need additional actions that target key social determinants of health. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Desabastecimiento de medicamentos en España. Un problema de salud / Shortage of supply of drugs in Spain. A health problem

No disponible

Interagency collaborative care for young people with complex needs: Front-line staff perspectives.

Worldwide, a growing burden of health and social issues now affect young people. Interagency collaboration and the "integration" of health and social care services are advocated to address the increasingly complex needs of at-risk youth and to reduce barriers to accessing care. In New Zealand, Youth-One-Stop-Shops (YOSSs) provide integrated health and social care to young people with complex needs. Little is known about how YOSSs facilitate collaborative care. This study explored the collaboration between YOSSs and external agencies between 2015 and 2017 using a multiple case study method. This paper reports qualitative focus group and individual interview data from two of four case sites including six YOSS staff and 14 external agency staff. Results showed participants regarded collaboration as critical to the successful care of high needs young people and were positive about working together. They believed YOSSs provided effective wraparound collaborative care and actively facilitated communication between diverse agencies on behalf of young people. The main challenges participants faced when working together related to the different "world views" and cultures of agencies which can run contrary to collaborative practice. Despite this, some highly collaborative relationships were apparent and staff in the different agencies perceived YOSSs had a lead role in co-ordinating collaborative care and were genuinely valued and trusted. However without the YOSS involvement, collaboration between agencies in relation to young people was less frequent and rarely went beyond limited information exchange. Establishing and maintaining trusting interpersonal relationships with individual staff was key to successfully negotiating agency differences. The study confirms that collaboration when caring for young people with high needs is complex and challenging, yet agencies from diverse sectors value collaboration and see the YOSS integrated wraparound approach as an important model of care.

Surveillance of antibiotic consumption in Spain: The importance of the DHD indicator. Author's reply / Vigilancia del consumo de antibióticos en España: la importancia del indicador DHD. Respuesta de los autores

No disponible

The continuum of breast cancer care and outcomes in the U.S. Military Health System: an analysis by benefit type and care source.

PURPOSE: This study investigates transition rates between breast cancer diagnosis, recurrence, and death by insurance benefit type and care source in U.S. Military Health System (MHS). METHODS: The MHS data repository and central cancer registry linked data were used to identify women aged 40-64 with histologically confirmed breast cancer between 2003 and 2007. Three-state continuous time Markov models were used to estimate transition rates and transition rate ratios (TRRs) by TRICARE benefit type (Prime or non-Prime) and care source (direct, purchased, or both), adjusted for demographic, tumor, and treatment variables. RESULTS: Analyses included 2668 women with transitions from diagnosis to recurrence (n = 832), recurrence to death (n = 79), and diagnosis to death without recurrence (n = 91). Compared to women with Prime within each care source, women with non-Prime using both care sources had higher transition rates (TRR 1.47, 95% CI 1.03, 2.10). Compared to those using direct care within each benefit type, women utilizing both care sources with non-Prime had higher transition rates (TRR 1.86, 95% CI 1.11, 3.13), while women with Prime utilizing purchased care had lower transition rates (TRR 0.82, 95% CI 0.68, 0.98). CONCLUSIONS: In the MHS, women with non-Prime benefit plans compared to Prime had higher transition rates along the breast cancer continuum among both care source users. Purchased care users had lower transition rates than direct care users among Prime beneficiaries. IMPLICATIONS FOR CANCER SURVIVORS: Benefit plan and care source may be associated with breast cancer progression. Further research is needed to demonstrate differences in survivorship.

The Implementation of a Structured Nursing Leadership Development Program for Succession Planning in a Health System.

Preparing future nursing leaders to be successful is important because many current leaders will retire in large numbers in the future. A structured nursing leadership development program utilizing the Essentials of Nurse Manager Orientation online program provided future nursing leaders with content aligned with nursing leadership competencies. Paired with assigned mentors and monthly leadership sessions, the participants increased their perception of leadership competence.

Interagency collaboration in children and young people's mental health: a systematic review of outcomes, facilitating factors and inhibiting factors.

BACKGROUND: In the UK and internationally, there have been increasing calls for interagency collaboration across mental health services for children and young people. However, it is not clear whether such practices do, indeed, have a positive impact and, if so, what factors facilitate and inhibit collaboration across agencies. METHODS: Electronic searches were carried out on seven key computerized bibliographic databases. For inclusion in the review, studies needed to report on close working by two or more services that provided mental health support for children and/or young people and that had some systematic collection of qualitative and/or quantitative data. Outcomes were analysed narratively, and facilitating and inhibiting factors were examined using thematic analysis. RESULTS: A final sample of 33 studies was identified from 4136 initial records. Outcomes were mixed, with some findings indicating that interagency collaboration was associated with greater service use and equity of service provision, but other suggesting negative outcomes on service use and quality. However, interagency collaboration was perceived as helpful and important by both service users and professionals, and collaborative initiatives were evaluated positively. The factors most commonly identified as facilitating interagency collaboration were good interagency communication, joint trainings, good understandings across agencies, mutual valuing across agencies, senior management support, protocols on interagency collaboration and a named link person. The most commonly perceived barriers to interagency collaboration were inadequate resourcing, poor interagency communication, lack of valuing across agencies, differing perspectives, poor understandings across agencies and confidentiality issues. CONCLUSIONS: The results are consistent with findings from previous reviews of interagency collaboration across adult and child services: there were some indications of benefit; and facilitating and inhibiting factors involved working relationships and multi-agency processes, resources and management. The identification of these factors has implications for practitioners, service managers, trainers, commissioners and researchers.

Perspectives of HIV agencies on improving HIV prevention, treatment, and care services in the USA.

HIV healthcare services in the USA are made available through a complex funding and delivery system. We present perspectives of HIV agencies on improvements that could lead to an ideal system of HIV prevention, treatment and care. We conducted semi-structured interviews with representatives from 21 HIV agencies offering diverse services in Baltimore, MD. Thematic analysis revealed six key themes: (1) Focusing on HIV prevention, (2) Establishing common entry-points for services, (3) Improving information availability, (4) Streamlining funding streams, (5) Removing competitiveness and (6) Building trust. We recommend that in addition to addressing operational issues regarding service delivery and patient care, initiatives to improve HIV service systems should address underlying social issues such as building trust.

A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System.

Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices.

Las agencias de evaluación de tecnología médica en el siglo XXI / Health technology assessment agencies in the XXI century

Los orígenes de las agencias de evaluación de tecnologías sanitarias se remontan a la década de los setenta en Estados Unidos; en el contexto europeo, la actual Agència de Qualitat i Avaluació Sanitàries de Catalunya estuvo entre las pioneras en 1991. Los cambios epidemiológicos, sociales, tecnológicos y económicos de los últimos años han provocado que las agencias hayan incorporado nuevas funciones, actividades y proyectos que permiten ofrecer mejores servicios (información y conocimiento) a los distintos actores del sistema sanitario (pacientes, profesionales, proveedores, aseguradoras y policy-makers), con el fin de aumentar la calidad y preservar la sostenibilidad del sistema sanitario (AU)

The origins of th e health technology assessment (HTA) agencies date back to the 70s in the United States; in the European context, the current Agency for Quality and Health Assessment of Catalonia was among the pioneers in 1991. Epidemiological, social, technological and economic changes of recent years have led to the incorporation, by the agencies, of new functions, activities and projects that can offer better services (information and knowledge) to the various players in the healthcare system (patients, professionals, providers, insurers and policy-makers) in order to increase healthcare quality and preserve the sustainability of the health system (AU)

Health systems' responsiveness and reporting behaviour: Multilevel analysis of the influence of individual-level factors in 64 countries.

Health systems' responsiveness encompasses attributes of health system encounters valued by people and measured from the user's perspective in eight domains: dignity, autonomy, confidentiality, communication, prompt attention, social support, quality of basic amenities and choice. The literature advocates for adjusting responsiveness measures for reporting behaviour heterogeneity, which refers to differential use of the response scale by survey respondents. Reporting behaviour heterogeneity between individual respondents compromises comparability between countries and population subgroups. It can be studied through analysing responses to pre-defined vignettes - hypothetical scenarios recounting a third person's experience in a health care setting. This paper describes the first comprehensive approach to studying reporting behaviour heterogeneity using vignettes. Individual-level variables affecting reporting behaviour are grouped into three categories: (1) sociodemographic, (2) health-related and (3) health value system. We use cross-sectional data from 150,000 respondents in 64 countries from the World Health Organization's World Health Survey (2002-03). Our approach classifies effect patterns for the scale as a whole, in terms of strength and in relation to the domains. For the final eight variables selected (sex; age; education; marital status; use of inpatient services; perceived health (own); caring for close family or friends with a chronic illness; the importance of responsiveness), the strongest effects were present for education, health, caring for friends or relatives with chronic health conditions, and the importance of responsiveness. Patterns of scale elongation or contraction were more common than uniform scale shifts and were usually constant for a particular factor across domains. The dependency of individual-level reporting behaviour heterogeneity on country is greatest for prompt attention, quality of basic amenities and confidentiality domains.

The Vidant Health quality transformation.

BACKGROUND: Vidant Health (VH), a private, not-for-profit health system in eastern North Carolina, began a systemwide quality transformation in 2006 after a serious blood event resulted in a patient's death. METHODS: Systemwide patient safety training served as the foundation of the transformation. Strategic planning of the quality work outlined a series of approaches that included board literacy in quality, an aggressive transparency policy, patient-family partnerships, and leader and physician engagement. RESULTS: The transformation of the system has resulted in an 85% reduction in serious safety events, a 62% reduction in health care-associated infections, 98% optimal care in the Centers for Medicare & Medicaid Services (CMS)/Joint Commission core measures, Hospital Consumer Assessment of Healthcare Providers and Systems performance in the top 20%, and more than 150 patient advisors partnering with leaders, physicians, and frontline staff. From the bedside to the boardroom the improvement in quality is evident across VH's nine hospitals, 70 physician practices, ambulatory surgery, and home health, hospice, and wellness services. CONCLUSION: Strategic planning for quality set an ambitious agenda for VH's quality work and continues to drive action today. Engaging patients in quality work at all levels--as partners on performance improvement teams, in safety rounds, in quality improvement committee meetings, and in the boardroom--has been a deliberate strategy and a significant part of the quality transformation at VH. Additional requirements for public reporting, CMS's new payment reform, and the challenges inherent in the evolving health care industry at large make it imperative to maintain a focus on zero events of harm and exceptional patient experiences.

In and across bureaucracy: structural and administrative issues for the tobacco endgame.

This article assesses the structural choices for the proposed tobacco endgame strategies. I focus on the issues associated with particular structural choices for the location of the implementation. Specifically, I discuss issues related to implementation of the endgame within a specific single agency, and issues related to a more widespread, broad implementation involving several agencies. Where appropriate, I provide examples of how the dynamics discussed would apply to particular endgame strategies. Issues related to design, administration, authority and finances are raised.

Mapping of multiple criteria for priority setting of health interventions: an aid for decision makers.

BACKGROUND: In rationing decisions in health, many criteria like costs, effectiveness, equity and feasibility concerns play a role. These criteria stem from different disciplines that all aim to inform health care rationing decisions, but a single underlying concept that incorporates all criteria does not yet exist. Therefore, we aim to develop a conceptual mapping of criteria, based on the World Health Organization's Health Systems Performance and Health Systems Building Blocks frameworks. This map can be an aid to decision makers to identify the relevant criteria for priority setting in their specific context. METHODS: We made an inventory of all possible criteria for priority setting on the basis of literature review. We categorized the criteria according to both health system frameworks that spell out a country's health system goals and input. We reason that the criteria that decision makers use in priority setting exercises are a direct manifestation of this. RESULTS: Our map includes thirty-one criteria that are distributed among five categories that reflect the goals of a health system (i.e. to improve level of health, fair distribution of health, responsiveness, social & financial risk protection and efficiency) and leadership/governance one category that reflects feasibiliy based on the health system building blocks (i.e. service delivery, health care workforce , information, medical products, vaccines & technologies, financing and). CONCLUSIONS: This conceptual mapping of criteria, based on well-established health system frameworks, will further develop the field of priority setting by assisting decision makers in the identification of multiple criteria for selection of health interventions.

Collaboration between local health and local government agencies for health improvement.

BACKGROUND: In many countries, national, regional and local inter- and intra-agency collaborations have been introduced to improve health outcomes. Evidence is needed on the effectiveness of locally developed partnerships which target changes in health outcomes and behaviours. OBJECTIVES: To evaluate the effects of interagency collaboration between local health and local government agencies on health outcomes in any population or age group. SEARCH METHODS: We searched the Cochrane Public Health Group Specialised Register, AMED, ASSIA, CENTRAL, CINAHL, DoPHER, EMBASE, ERIC, HMIC, IBSS, MEDLINE, MEDLINE In-Process, OpenGrey, PsycINFO, Rehabdata, Social Care Online, Social Services Abstracts, Sociological Abstracts, TRoPHI and Web of Science from 1966 through to January 2012. 'Snowballing' methods were used, including expert contact, citation tracking, website searching and reference list follow-up. SELECTION CRITERIA: Randomized controlled trials (RCTs), controlled clinical trials (CCTs), controlled before-and-after studies (CBAs) and interrupted time series (ITS) where the study reported individual health outcomes arising from interagency collaboration between health and local government agencies compared to standard care. Studies were selected independently in duplicate, with no restriction on population subgroup or disease. DATA COLLECTION AND ANALYSIS: Two authors independently conducted data extraction and assessed risk of bias for each study. MAIN RESULTS: Sixteen studies were identified (28,212 participants). Only two were considered to be at low risk of bias. Eleven studies contributed data to the meta-analyses but a narrative synthesis was undertaken for all 16 studies. Six studies examined mental health initiatives, of which one showed health benefit, four showed modest improvement in one or more of the outcomes measured but no clear overall health gain, and one showed no evidence of health gain. Four studies considered lifestyle improvements, of which one showed some limited short-term improvements, two failed to show health gains for the intervention population, and one showed more unhealthy lifestyle behaviours persisting in the intervention population. Three studies considered chronic disease management and all failed to demonstrate health gains. Three studies considered environmental improvements and adjustments, of which two showed some health improvements and one did not.Meta-analysis of three studies exploring the effect of collaboration on mortality showed no effect (pooled relative risk of 1.04 in favour of control, 95% CI 0.92 to 1.17). Analysis of five studies (with high heterogeneity) looking at the effect of collaboration on mental health resulted in a standardised mean difference of -0.28, a small effect favouring the intervention (95% CI -0.51 to -0.06). From two studies, there was a statistically significant but clinically modest improvement in the global assessment of function symptoms score scale, with a pooled mean difference (on a scale of 1 to 100) of -2.63 favouring the intervention (95% CI -5.16 to -0.10).For physical health (6 studies) and quality of life (4 studies) the results were not statistically significant, the standardised mean differences were -0.01 (95% CI -0.10 to 0.07) and -0.08 (95% CI -0.44 to 0.27), respectively. AUTHORS' CONCLUSIONS: Collaboration between local health and local government is commonly considered best practice. However, the review did not identify any reliable evidence that interagency collaboration, compared to standard services, necessarily leads to health improvement. A few studies identified component benefits but these were not reflected in overall outcome scores and could have resulted from the use of significant additional resources. Although agencies appear enthusiastic about collaboration, difficulties in the primary studies and incomplete implementation of initiatives have prevented the development of a strong evidence base. If these weaknesses are addressed in future studies (for example by providing greater detail on the implementation of programmes; using more robust designs, integrated process evaluations to show how well the partners of the collaboration worked together, and measurement of health outcomes) it could provide a better understanding of what might work and why. It is possible that local collaborative partnerships delivering environmental Interventions may result in health gain but the evidence base for this is very limited.Evaluations of interagency collaborative arrangements face many challenges. The results demonstrate that collaborative community partnerships can be established to deliver interventions but it is important to agree goals, methods of working, monitoring and evaluation before implementation to protect programme fidelity and increase the potential for effectiveness.

A multicenter collaborative approach to reducing pediatric codes outside the ICU.

OBJECTIVES: The Child Health Corporation of America formed a multicenter collaborative to decrease the rate of pediatric codes outside the ICU by 50%, double the days between these events, and improve the patient safety culture scores by 5 percentage points. METHODS: A multidisciplinary pediatric advisory panel developed a comprehensive change package of process improvement strategies and measures for tracking progress. Learning sessions, conference calls, and data submission facilitated collaborative group learning and implementation. Twenty Child Health Corporation of America hospitals participated in this 12-month improvement project. Each hospital identified at least 1 noncritical care target unit in which to implement selected elements of the change package. Strategies to improve prevention, detection, and correction of the deteriorating patient ranged from relatively simple, foundational changes to more complex, advanced changes. Each hospital selected a broad range of change package elements for implementation using rapid-cycle methodologies. The primary outcome measure was reduction in codes per 1000 patient days. Secondary outcomes were days between codes and change in patient safety culture scores. RESULTS: Code rate for the collaborative did not decrease significantly (3% decrease). Twelve hospitals reported additional data after the collaborative and saw significant improvement in code rates (24% decrease). Patient safety culture scores improved by 4.5% to 8.5%. CONCLUSIONS: A complex process, such as patient deterioration, requires sufficient time and effort to achieve improved outcomes and create a deeply embedded culture of patient safety. The collaborative model can accelerate improvements achieved by individual institutions.

Using agency data for evidence-based programming: a university-agency collaboration.

Agencies providing residential treatment are encouraged, or even mandated, to collect outcomes data and to implement evidence based practices, yet little guidance has been provided on how to do so using agency administrative data that are collected on an ongoing basis. We examined data on Child and Adolescent Functional Assessment Scale (CAFAS) scores for 1608 admissions to a residential treatment center from 2002 through 2008. CAFAS scores were measured every 90 days, providing multiple CAFAS scores for each individual. Results demonstrated that on average residents improved in functioning over time. Sensitive to the evolving needs of residents who had been entering the program, the treatment center made significant program changes in 2006 to attempt to better serve residents through a broad array of specialized programming. Compared to the overall results, the analysis suggested that residents who entered the program since October 2006 appeared to have made larger improvements in their CAFAS scores. Results were derived by employing multilevel models appropriate for estimating growth trajectories with repeated measures data. Conversations with agency staff suggested that using administrative data, and advanced statistical models, were extremely helpful for organizational decision making and evidence-based programming.