Interest in value-based healthcare, generally defined as providing better care at lower cost, has grown worldwide, and learning health systems (LHSs) have been proposed as a key strategy for ...improving value in healthcare. LHSs are emerging around the world and aim to leverage advancements in science, technology and practice to improve health system performance at lower cost. However, there remains much uncertainty around the implementation of LHSs and the distinctive features of these systems. This paper presents a conceptual framework that has been developed in Canada to support the implementation of value-creating LHSs.
The framework was developed by an interdisciplinary team at the Institut national d'excellence en santé et en services sociaux (INESSS). It was informed by a scoping review of the scientific and grey literature on LHSs, regular team discussions over a 14-month period, and consultations with Canadian and international experts.
The framework describes four elements that characterise LHSs, namely (1) core values, (2) pillars and accelerators, (3) processes and (4) outcomes. LHSs embody certain core values, including an emphasis on participatory leadership, inclusiveness, scientific rigour and person-centredness. In addition, values such as equity and solidarity should also guide LHSs and are particularly relevant in countries like Canada. LHS pillars are the infrastructure and resources supporting the LHS, whereas accelerators are those specific structures that enable more rapid learning and improvement. For LHSs to create value, such infrastructures must not only exist within the ecosystem but also be connected and aligned with the LHSs' strategic goals. These pillars support the execution, routinisation and acceleration of learning cycles, which are the fundamental processes of LHSs. The main outcome sought by executing learning cycles is the creation of value, which we define as the striking of a more optimal balance of impacts on patient and provider experience, population health and health system costs.
Our framework illustrates how the distinctive structures, processes and outcomes of LHSs tie together with the aim of optimising health system performance and delivering greater value in health systems.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Population cardiovascular health, or improving cardiovascular health among patients and the population at large, requires a redoubling of primordial and primary prevention efforts as declines in ...cardiovascular disease mortality have decelerated over the past decade. Great potential exists for healthcare systems–based approaches to aid in reversing these trends. A learning healthcare system, in which population cardiovascular health metrics are measured, evaluated, intervened on, and re-evaluated, can serve as a model for developing the evidence base for developing, deploying, and disseminating interventions. This scientific statement on optimizing population cardiovascular health summarizes the current evidence for such an approach; reviews contemporary sources for relevant performance and clinical metrics; highlights the role of implementation science strategies; and advocates for an interdisciplinary team approach to enhance the impact of this work.
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, ...and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio‐environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual‐focused, health system‐focused, and community level and policy‐focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
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The publisher regrets that an error occurred which led to the premature publication of this paper. This error bears no reflection on the article or its authors. The publisher apologizes to the authors and the readers for this unfortunate error.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background & aim: The health system reform plan is a plan to improve health care systems in Iran, which started working in the hospitals of the Ministry of Health on May 15, 2014. This project was ...implemented with the approach of creating transformation in the health system and with the three goals of financial protection of the people, creating justice in access to health services and improving the quality of services. Since the health sector is often affected by the factors and components that are related to the functioning of all sectors of the country's development; therefore, the purpose of the present study was to determine and examine the state of the health system plan from the perspective of the patients of hospitals in Yasuj, Iran. Methods: The statistical population of the present descriptive study was 458 patients at Shahid Rajaei Hospital, 300 patients at Imam Sajjad Hospital, and 380 patients at Shahid Beheshti Hospital, all located in Yasuj, Iran. All the participants completed the questionnaire on the state of the health system plan from the patients' point of view. The collected data were analyzed using t-test and descriptive statistical tests, including frequency and average, by means of SPSS 18 software. Results: The results of the research showed that the health system implementation status of Shahid Beheshti Hospital (p=0.001 and t=57.19), Imam Sajjad Hospital (p=0.001 and t=50.17) and Shahid Rajaei Hospital (p=0.001 and t=50.001) p=0 and t=40.06) Yasuj city is somewhat favorable. These findings indicate that the plan of the health system in Yasuj city has been properly and correctly implemented. Conclusion: Considering that the examined indicators were well implemented in most of the hospitals, it gives the impression that the continuation, evaluation and continuous improvement of this plan can lead to the improvement of the performance indicators of the hospitals. Therefore, the programs of hospitals in Yasuj should be developed in such a way that the amount of expense of patients be reduced, more support be given to physicians in deprived areas, the quality of hoteling in hospitals be improved. Moreover, more use should be made of the presence of resident specialist doctors in government hospitals.
Recent health system shocks such as the Ebola outbreak of 2014-2016 and the global financial crisis of 2008 have generated global health interest in the concept of resilience. The concept is however ...not new, and has been applied to other sectors for a longer period of time. We conducted a review of empirical literature from both the health and other sectors to synthesize evidence on organizational resilience.
We systematically searched for literature in PubMed, Econlit, EBSCOHOST databases, google, and Google Scholar and manually searched the reference lists of selected papers. We identified 34 papers that met our inclusion criteria. We analysed data from the selected papers by thematic review.
Resilience was generally taken to mean a system's ability to continue to meet its objectives in the face of challenges. The concepts of resilience that were used in the selected papers emphasized not just a system's capacity to withstand shocks, but also to adapt and transform. The resilience of organizations was influenced by the following factors: Material resources, preparedness and planning, information management, collateral pathways and redundancy, governance processes, leadership practices, organizational culture, human capital, social networks and collaboration.
A common theme across the selected papers is the recognition of resilience as an emergent property of complex adaptive systems. Resilience is both a function of planning for and preparing for future crisis (planned resilience), and adapting to chronic stresses and acute shocks (adaptive resilience). Beyond resilience to acute shocks, the resilience of health systems to routine and chronic stress (everyday resilience) is also key. Health system software is as, if not more important, as its hardware in nurturing health system resilience.
Background: The concept of ABDM- Ayushman Bharat Digital Health Mission and Ayushman Bharat- Pradhan Mantri Jan Arogya Yojna are in root for overall aims of the research and importance of this ...research proposal. There is a need to study the acceptability & scalability of ICMR pre-validated technologies -Mobile Lab technology & digital technologies, skilled manpower needed for health data updating from individuals given individual health ids. Objectives: To do situational analysis of availability of medical diagnostic, testing facilities in under privileged/ remote areas. Methodology: Study Design – Implementation research, Sample - 1000 households (5000 population) have been equally enrolled from rural and urban areas which are further equally divided into two groups of control and intervention. Base Line Data has been collected on following information- socio-demographic characteristics, blood pressure measurement, health needs, health seeking behavior of community, availability and utilization of existing health care facilities and blood investigations. Study tools: Questionnaire for baseline survey – After informed consent, interview of the family head was done using set of quantitative and open-end qualitative questionnaires. Results: 77.9% and 69.3% belong to Upper Lower class in urban and rural areas. 21% and 15.6 % blood pressure measurements were deranged in urban and rural areas, 11.8 % and 10% population in urban and rural areas showed their willingness for lab investigations at door step through LABIKE. Blood glucose measurements of 5.4 % and 10.6% population in urban and rural areas were deranged. Haemoglobin values of 11.8 % and 17% population in urban and rural areas were low than 10 g/dl. 7 % and 12.7 % population in urban and rural areas utilized existing health care facilities. Conclusion: There is need to generate robust grass root level network by integrating community and health service providers.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
The 2014-2016 Ebola outbreak was a wake-up call regarding the critical importance of resilient health systems. Fragile health systems can become overwhelmed during public health crises, further ...exacerbating the human, economic, and political toll. Important work has been done to describe the general attributes of a health system resilient to these crises, and the next step will be to identify the specific capacities that health systems need to develop and maintain to achieve resiliency.
We conducted a scoping review of the literature to identify recurring themes and capacities needed for health system resiliency to infectious disease outbreaks and natural hazards and any existing implementation frameworks that highlight these capacities. We also sought to identify the overlap of the identified themes and capacities with those highlighted in the World Health Organization's Joint External Evaluation. Sources of evidence included PubMed, Web of Science, OAIster, and the websites of relevant major public health organizations.
We identified 16 themes of health system resilience, including: the need to develop plans for altered standards of care during emergencies, the need to develop plans for post-event recovery, and a commitment to quality improvement. Most of the literature described the general attributes of a resilient health system; no implementation frameworks were identified that could translate these elements into specific capacities that health system actors can employ to improve resilience to outbreaks and natural hazards in a variety of settings.
An implementation-oriented health system resilience framework could help translate the important components of a health system identified in this review into specific capacities that actors in the health system could work to develop to improve resilience to public health crises. However, there remains a need to further refine the concept of resilience so that health systems can simultaneously achieve sustainable transformations in healthcare practice and health service delivery as well as improve their preparedness for emergencies.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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