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    The effects of state rules on opioid prescribing in Indiana.
    BMC Health Serv Res 2018 Jan 18;18(1):29. Epub 2018 Jan 18.
    Indiana University-Purdue University School of Liberal Art, Indianapolis, IN, USA.
    Background: Prescription opioids have been linked to over half of the 28,000 opioid overdose deaths in 2014. High rates of prescription opioid non-medical use have continued despite nearly all states implementing large-scale prescription drug monitoring programs (PDMP), which points to the need to examine the impact of state PDMP's on curbing inappropriate opioid prescribing. In the short-term, PDMPs have been associated with short-term prescribing declines. Read More

    A systematic review on the use of healthcare services by undocumented migrants in Europe.
    BMC Health Serv Res 2018 Jan 18;18(1):30. Epub 2018 Jan 18.
    Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200, MD, Maastricht, The Netherlands.
    Background: Undocumented migrants face particular challenges in accessing healthcare services in many European countries. The aim of this study was to systematically review the academic literature on the utilization of healthcare services by undocumented migrants in Europe.

    Methods: The databases Embase, Medline, Global Health and Cinahl Plus were searched systematically to identify quantitative, qualitative and mixed methods studies published in 2007-2017. Read More

    An integrated primary care approach for frail community-dwelling older persons: a step forward in improving the quality of care.
    BMC Health Serv Res 2018 Jan 17;18(1):28. Epub 2018 Jan 17.
    Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, the Netherlands.
    Background: High-quality care delivery for frail older persons, many of whom have multiple complex needs, is among the greatest challenges faced by healthcare systems today. The Chronic Care Model (CCM) may guide quality improvement efforts for primary care delivery to frail older populations. Objectives of this study were to assess the implementation of interventions in CCM dimensions, and to investigate the quality of primary care as perceived by healthcare professionals, in practices following the Finding and Follow-up of Frail older persons (FFF) integrated care approach and those providing usual care. Read More

    Development and pilot evaluation of a clinic-based mHealth app referral service to support adult cancer survivors increase their participation in physical activity using publicly available mobile apps.
    BMC Health Serv Res 2018 Jan 16;18(1):27. Epub 2018 Jan 16.
    Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute, School of Health Sciences, University of South Australia, Adelaide, Australia.
    Background: Participation in regular physical activity holds key benefits for cancer survivors, yet few cancer survivors meet physical activity recommendations. This study aimed to develop and pilot test a mHealth app referral service aimed at assisting cancer survivors to increase their physical activity. In particular, the study sought to examine feasibility and acceptability of the service and determine preliminary efficacy for physical activity behaviour change. Read More

    Barriers and facilitators to cultural competence in rehabilitation services: a scoping review.
    BMC Health Serv Res 2018 Jan 15;18(1):23. Epub 2018 Jan 15.
    University of Ottawa, Roger Guindon Hall, 455 Smyth Road, Ottawa, ON, K1H 8L1, USA.
    Background: There is an important need to evaluate whether rehabilitation services effectively address the needs of minority culture populations with North America's increasingly diverse population. The objective of this paper was therefore to review and assess the state of knowledge of barriers and facilitators to cultural competence in rehabilitation services.

    Method: Our scoping review focused on cultural competence in rehabilitation services. Read More

    Evaluating the impact of a falls prevention community of practice in a residential aged care setting: a realist approach.
    BMC Health Serv Res 2018 Jan 15;18(1):21. Epub 2018 Jan 15.
    School of Physiotherapy and Exercise Science, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia.
    Background: Falls are a major socio-economic problem among residential aged care (RAC) populations resulting in high rates of injury including hip fracture. Guidelines recommend that multifactorial prevention strategies are implemented but these require translation into clinical practice. A community of practice (CoP) was selected as a suitable model to support translation of the best available evidence into practice, as it could bring together like-minded people with falls expertise and local clinical knowledge providing a social learning opportunity in the pursuit of a common goal; falls prevention. Read More

    Care relationships at stake? Home healthcare professionals' experiences with digital medicine dispensers - a qualitative study.
    BMC Health Serv Res 2018 Jan 15;18(1):26. Epub 2018 Jan 15.
    Queen Maud University College, Trondheim, Norway.
    Background: Although digital technologies can mitigate the burdens of home healthcare services caused by an ageing population that lives at home longer with complex health problems, research on the impacts and consequences of digitalised remote communication between patients and caregivers is lacking. The present study explores how home healthcare professionals had experienced the introduction of digital medicine dispensers and their influence on patient-caregiver relationships.

    Methods: The multi-case study comprised semi-structured interviews with 21 healthcare professionals whose home healthcare service involved using the digital medicine dispensers. Read More

    Factors influencing the length of hospital stay of patients with anorexia nervosa - results of a prospective multi-center study.
    BMC Health Serv Res 2018 Jan 15;18(1):22. Epub 2018 Jan 15.
    Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Martinistr. 52, W37, 20246, Hamburg, Germany.
    Background: The length of stay (LOS) strongly influences anorexia nervosa (AN) inpatient weight outcomes. Hence, understanding the predictors of LOS is highly relevant. However, the existing evidence is inconsistent and to draw conclusions, additional evidence is required. Read More

    Temporary exclusion of ill children from childcare centres in Switzerland: practice, problems and potential solutions.
    BMC Health Serv Res 2018 Jan 15;18(1):25. Epub 2018 Jan 15.
    Division of Infectious Diseases and Hospital Epidemiology and Children's Research Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zürich, Switzerland.
    Background: In childcare centres, temporary exclusion of ill children, if their illness poses a risk of spread of harmful diseases to others, is a central approach to fight disease transmission. However, not all ill children need to be excluded. Previous studies suggested that childcare centre staff have difficulties in deciding whether or not to exclude an ill child, even when official ill-child guidelines are used. Read More

    Relative contribution of various chronic diseases and multi-morbidity to potential disability among Dutch elderly.
    BMC Health Serv Res 2018 Jan 15;18(1):24. Epub 2018 Jan 15.
    Population Research Centre, University of Groningen, Groningen, the Netherlands.
    Background: The amount of time spent living with disease greatly influences elderly people's wellbeing, disability and healthcare costs, but differs by disease, age and sex.

    Methods: We assessed how various single and combined diseases differentially affect life years spent living with disease in Dutch elderly men and women (65+) over their remaining life course. Multistate life table calculations were applied to age and sex-specific disease prevalence, incidence and death rates for the Netherlands in 2007. Read More

    The cost of a pediatric neurocritical care program for traumatic brain injury: a retrospective cohort study.
    BMC Health Serv Res 2018 Jan 12;18(1):20. Epub 2018 Jan 12.
    Washington University in St. Louis, School of Medicine, St. Louis, MO, USA.
    Background: Inpatient care for children with severe traumatic brain injury (sTBI) is expensive, with inpatient charges averaging over $70,000 per case (Hospital Inpatient, Children Only, National Statistics. Diagnoses- clinical classification software (CCS) principal diagnosis category 85 coma, stupor, and brain damage, and 233 intracranial injury. Diagnoses by Aggregate charges [ https://hcupnet. Read More

    The relevance of clinical ethnography: reflections on 10 years of a cultural consultation service.
    BMC Health Serv Res 2018 Jan 11;18(1):19. Epub 2018 Jan 11.
    Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 4 rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.
    Background: Training health professionals in culturally sensitive medical interviewing has been widely promoted as a strategy for improving intercultural communication and for helping clinicians to consider patients' social and cultural contexts and improve patient outcomes. Clinical ethnography encourages clinicians to explore the patient's explanatory model of illness, recourse to traditional and alternative healing practices, healthcare expectations and social context, and to use this information to negotiate a mutually acceptable treatment plan. However, while clinical ethnographic interviewing skills can be successfully taught and learned, the "real-world" context of medical practice may impose barriers to such patient-centered interviewing. Read More

    Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study.
    BMC Health Serv Res 2018 Jan 11;18(1):18. Epub 2018 Jan 11.
    Department of Rehabilitation, LAM-Motion Analysis Laboratory, AUSL of Reggio Emilia, S. Sebastiano Hospital, Via Mandriolo Superiore 11, 42015, Correggio, RE, Italy.
    Background: Falls are a common adverse event in both elderly inpatients and patients admitted to rehabilitation units. The Hendrich Fall Risk Model II (HIIFRM) has been already tested in all hospital wards with high fall rates, with the exception of the rehabilitation setting. This study's aim is to address the feasibility and predictive performances of HIIFRM in a hospital rehabilitation department. Read More

    Gastroenterologist and primary care perspectives on a post-endoscopy discharge policy: impact on clinic wait times, provider satisfaction and provider workload.
    BMC Health Serv Res 2018 Jan 10;18(1):16. Epub 2018 Jan 10.
    Division of Gastroenterology, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.
    Background: To reduce unnecessary ambulatory gastroenterology (GI) visits and increase access to GI care, San Francisco Health Network gastroenterologists and primary care providers implemented guidelines in 2013 that discharged certain patients back to primary care after endoscopy with formal written recommendations. This study assesses the longer-term impact of this policy on GI clinic access, workflow, and provider satisfaction.

    Methods: An email-based survey assessed gastroenterologist and primary care provider (PCP) opinions about the discharge process. Read More

    Lay health worker experiences administering a multi-level combination intervention to improve PMTCT retention.
    BMC Health Serv Res 2018 Jan 10;18(1):17. Epub 2018 Jan 10.
    ICAP at Columbia University, Mailman School of Public Health, 722 W. 168th Street, New York, NY, 10032, USA.
    Background: The recent scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has rapidly accelerated antiretroviral therapy (ART) uptake among pregnant and postpartum women in sub-Saharan Africa. The Mother and Infant Retention for Health (MIR4Health) study evaluates the impact of a combination intervention administered by trained lay health workers to decrease attrition among HIV-positive women initiating PMTCT services and their infants through 6 months postpartum.

    Methods: This was a qualitative study nested within the MIR4Health trial. Read More

    "The system here isn't on patients' side"- perspectives of women and men on the barriers to accessing and utilizing maternal healthcare services in South Sudan.
    BMC Health Serv Res 2018 Jan 9;18(1):10. Epub 2018 Jan 9.
    Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW, 2006, Australia.
    Background: In fragile and war-affected setting such as South Sudan, a combination of physical environmental, socioeconomic factors and healthcare's characteristic contributes to higher rates of home delivery attended by unskilled attendants. This study aims to understand the community members' experience, perceptions and the barriers in relation to accessing and utilizing maternal healthcare services in South Sudan.

    Methods: We conducted in-depth one-on-one interview with 30 women and 15 men to investigate their perspectives on the barriers to access maternal and child health related services. Read More

    Extending coverage to informal sector populations in Kenya: design preferences and implications for financing policy.
    BMC Health Serv Res 2018 Jan 9;18(1):13. Epub 2018 Jan 9.
    Health Economics Unit, University of Cape Town, Cape Town, South Africa.
    Background: Universal health coverage (UHC) is important in terms of improving access to quality health care while protecting households from the risk of catastrophic health spending and impoverishment. However, progress to UHC has been hampered by the measures to increase mandatory prepaid funds especially in low- and middle-income countries where there are large populations in the informal sector. Important considerations in expanding coverage to the informal sector should include an exploration of the type of prepayment system that is acceptable to the informal sector and the features of such a design that would encourage prepayment for health care among this population group. Read More

    Association of hospice utilization and publicly reported outcomes following hospitalization for pneumonia or heart failure: a retrospective cohort study.
    BMC Health Serv Res 2018 Jan 9;18(1):12. Epub 2018 Jan 9.
    Center for Humanizing Critical Care, Intermountain Healthcare, Murray, UT, USA.
    Background: The Center for Medicare and Medicaid Services (CMS) and the Hospital Quality Alliance began collecting and reporting United States hospital performance in the treatment of pneumonia and heart failure in 2008. Whether the utilization of hospice might affect CMS-reported mortality and readmission rates is not known.

    Methods: Hospice utilization (mean days on hospice per decedent) for 2012 from the Dartmouth Atlas (a project of the Dartmouth Institute that reports a variety of public health and policy-related statistics) was merged with hospital-level 30-day mortality and readmission rates for pneumonia and heart failure from CMS. Read More

    Understanding the impact of external context on community-based implementation of an evidence-based HIV risk reduction intervention.
    BMC Health Serv Res 2018 Jan 9;18(1):11. Epub 2018 Jan 9.
    UCLA Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, 38-240 NPI, Box 175919, Los Angeles, CA, 90024-1759, USA.

    Impact of a New York City supportive housing program on Medicaid expenditure patterns among people with serious mental illness and chronic homelessness.
    BMC Health Serv Res 2018 Jan 10;18(1):15. Epub 2018 Jan 10.
    Bureau of Epidemiology Services, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York, NY, USA.
    Background: A rapid increase of Medicaid expenditures has been a serious concern, and housing stability has been discussed as a means to reduce Medicaid costs. A program evaluation of a New York City supportive housing program has assessed the association between supportive housing tenancy and Medicaid savings among New York City housing program applicants with serious mental illness and chronic homelessness or dual diagnoses of mental illness and substance use disorder, stratified by distinctive Medicaid expenditure patterns.

    Methods: The evaluation used matched data from administrative records for 2827 people. Read More

    Use of an electronic medical record reminder improves HIV screening.
    BMC Health Serv Res 2018 Jan 10;18(1):14. Epub 2018 Jan 10.
    Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA.
    Background: More than 1 in 7 patients with human immunodeficiency virus (HIV) infection in the United States are unaware of their serostatus despite recommendations of US agencies that all adults through age 65 be screened for HIV at least once. To facilitate universal screening, an electronic medical record (EMR) reminder was created for our primary care practice. Screening rates before and after implementation were assessed to determine the impact of the reminder on screening rates. Read More

    Determinants of new drugs prescription in the Swiss healthcare market.
    BMC Health Serv Res 2018 Jan 9;18(1). Epub 2018 Jan 9.
    Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois and Faculty of Biology and Medicine, Route de la Corniche 10, 1010, Lausanne, Switzerland.
    Background: Drug markets are very complex and, while many new drugs are registered each year, little is known about what drives the prescription of these new drugs. This study attempts to lift the veil from this important subject by analyzing simultaneously the impact of several variables on the prescription of novelty.

    Methods: Data provided by four Swiss sickness funds were analyzed. Read More

    Challenges and opportunities for healthcare workers in a rural district of Chad.
    BMC Health Serv Res 2018 Jan 8;18(1). Epub 2018 Jan 8.
    Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
    Background: Trained healthcare workers are an essential resource for effective health systems. However, healthcare workers' perspective on healthcare, the challenges they face to provide quality health services, and opportunities to improve motivation and providing adequate care are rarely investigated in resource-constrained settings of sub-Saharan Africa.

    Methods: All reachable nurses of Abou Deia, a primarily rural district in the south-eastern part of Chad, were invited to participate. Read More

    Physicians' knowledge and practice on death certification in the North West Bank, Palestine: across sectional study.
    BMC Health Serv Res 2018 Jan 8;18(1). Epub 2018 Jan 8.
    Department of general surgery, Palestine medical complex, Ramallah, Palestine.
    Background: Mortality data are essential for many aspects of everyday public health practices at both national and international levels. Despite the current developments in various aspects of the medical field, the apparent inability of physicians to complete death notification forms (DNF) accurately is still worldwide concern. The aim of this study is to assess the physicians' knowledge and practice on completing the DNF. Read More

    A qualitative exploration of the discharge process and factors predisposing to readmissions to the intensive care unit.
    BMC Health Serv Res 2018 Jan 5;18(1). Epub 2018 Jan 5.
    Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA.
    Background: Quantitative studies have demonstrated several factors predictive of readmissions to intensive care. Clinical decision tools, derived from these factors have failed to reduce readmission rates. The purpose of this study was to qualitatively explore the experiences and perceptions of physicians and nurses to gain more insight into intensive care readmissions. Read More

    Factors associated with prolonged length of stay for elective hepatobiliary and neurosurgery patients: a retrospective medical record review.
    BMC Health Serv Res 2018 Jan 5;18(1). Epub 2018 Jan 5.
    National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
    Background: Patients with prolonged length of hospital stay (LOS) not only increase their risks of nosocomial infections but also deny other patients access to inpatient care. Hepatobiliary (HPB) malignancies have some of highest incidences in East and Southeast Asia and the management of patients undergoing HPB surgeries have yet to be standardized. With improved neurosurgery techniques for intracranial aneurysms and tumors, neurosurgeries (NS) can be expected to increase. Read More

    Being treated in higher volume hospitals leads to longer progression-free survival for epithelial ovarian carcinoma patients in the Rhone-Alpes region of France.
    BMC Health Serv Res 2018 Jan 4;18(1). Epub 2018 Jan 4.
    Univ Lyon, Léon Bérard Cancer Center, EA 7425 HESPER, F-69008, Lyon, France.
    Background: To investigate the relationship between hospital volume activities and the survival for Epithelial Ovarian Carcinoma (EOC) patients in France.

    Methods: This retrospective study using prospectively implemented databases was conducted on an exhaustive cohort of 267 patients undergoing first-line therapy during 2012 in the Rhone-Alpes Region of France. We compared Progression-Free Survival for Epithelial Ovarian Carcinoma patients receiving first-line therapy in high- (i. Read More

    The low indexes of metabolism intervention trial (LIMIT): design and baseline data of a randomized controlled clinical trial to evaluate how alerting primary care teams to low metabolic values, could affect the health of patients aged 75 or older.
    BMC Health Serv Res 2018 Jan 5;18(1). Epub 2018 Jan 5.
    The Department of Family Medicine, Azrieli Faculty of Medicine, Bar-Ilan University, Safed; The Department of Family Medicine, Clalit Health Services, North district, Israel.
    Background: Too-low body mass index (BMI), HbA1c% or cholesterol levels predicts poor survival. This study investigates whether e-mails about these low values, improve health of people older than 75 years.

    Methods: LIMIT - an open label randomized trial - compares usual care to the addition of an e-mail which alerts the family physicians and nurses to low metabolic indexes of a specific patient and advises on nutritional and medical changes. Read More

    Iterative co-creation for improved hand hygiene and aseptic techniques in the operating room: experiences from the safe hands study.
    BMC Health Serv Res 2018 Jan 4;18(1). Epub 2018 Jan 4.
    School of Business, Economics and Law, Department of Business Administration, University of Gothenburg, Gothenburg, Sweden.
    Background: Hand hygiene and aseptic techniques are essential preventives in combating hospital-acquired infections. However, implementation of these strategies in the operating room remains suboptimal. There is a paucity of intervention studies providing detailed information on effective methods for change. Read More

    Research capacity building integrated into PHIT projects: leveraging research and research funding to build national capacity.
    BMC Health Serv Res 2017 Dec 21;17(Suppl 3):825. Epub 2017 Dec 21.
    Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, USA.
    Background: Inadequate research capacity impedes the development of evidence-based health programming in sub-Saharan Africa. However, funding for research capacity building (RCB) is often insufficient and restricted, limiting institutions' ability to address current RCB needs. The Doris Duke Charitable Foundation's African Health Initiative (AHI) funded Population Health Implementation and Training (PHIT) partnership projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania and Zambia) to implement health systems strengthening initiatives inclusive of RCB. Read More

    Tithing programs: pathways for enhancing and improving the health status of the underprivileged.
    BMC Health Serv Res 2017 Dec 13;17(Suppl 4):806. Epub 2017 Dec 13.
    Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA.
    Background: While quick and easy access to healthcare services is a reality for some, others experience significant hardships, even for receipt of the most basic health and medical care and attention. To those who effectively have been shut out of the healthcare marketplace due largely to economic deficiencies, healthcare providers engaged in the delivery of charitable services are a critical lifeline. Myriad attempts by governmental entities to remedy disparate access and shore up the delivery of healthcare services directed toward the disadvantaged have failed to close gaps, warranting pursuit of novel methods that offer potential and the hope that sufficient access might one day become a reality. Read More

    Bridging access gaps experienced by the underserved: the need for healthcare providers to look within for answers.
    BMC Health Serv Res 2017 Dec 13;17(Suppl 4):791. Epub 2017 Dec 13.
    Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA.
    Background: Health and medical providers dedicated to serving the poor face daunting challenges, with the most obvious one pertaining to the provision of services with little or no expectation of remuneration. This hardship often is overlooked by broad society as many view the delivery of healthcare services to indigent populations to be covered fully by government health insurance programs or other forms of public assistance. This, however, is only partially true and, even when reimbursements or similar payments are provided, they often fall short of covering the actual costs associated with rendering services. Read More

    Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative.
    BMC Health Serv Res 2017 Dec 21;17(Suppl 3):828. Epub 2017 Dec 21.
    Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.
    Background: High-quality data are critical to inform, monitor and manage health programs. Over the seven-year African Health Initiative of the Doris Duke Charitable Foundation, three of the five Population Health Implementation and Training (PHIT) partnership projects in Mozambique, Rwanda, and Zambia introduced strategies to improve the quality and evaluation of routinely-collected data at the primary health care level, and stimulate its use in evidence-based decision-making. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this paper: 1) describes and categorizes data quality assessment and improvement activities of the projects, and 2) identifies core intervention components and implementation strategy adaptations introduced to improve data quality in each setting. Read More

    Bridging the intervention-implementation gap in primary health care delivery: the critical role of integrated implementation research.
    BMC Health Serv Res 2017 12 21;17(Suppl 3):772. Epub 2017 Dec 21.
    Ghana Health Service, Private Mail Bag, Ministries Post Office, Accra, Ghana.
    For national and local leaders to achieve universal health coverage, a new approach or technique to gathering evidence and understanding the contexts that influence the outcome of a study and goes beyond the quantitative results of clinical trials and pilot projects is important. The Doris Duke Charitable Foundation's African Health Initiative (AHI) was designed to produce this type of knowledge through embedding implementation research into Population Health Implementation and Training (PHIT) partnership projects in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) with the goal of improving primary health care and population health. In Ghana, this integration of research into implementation has contributed to the successful testing, adaptation and implementation of the Community-based Health Planning and Services (CHPS) model (The Navrongo Pilot Project), with results from the AHI-funded work informing national scale-up of effective practices. Read More

    Tackling the hard problems: implementation experience and lessons learned in newborn health from the African Health Initiative.
    BMC Health Serv Res 2017 Dec 21;17(Suppl 3):829. Epub 2017 Dec 21.
    Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
    Background: The Doris Duke Charitable Foundation's African Health Initiative supported the implementation of Population Health Implementation and Training (PHIT) Partnership health system strengthening interventions in designated areas of five countries: Ghana, Mozambique, Rwanda, Tanzania, and Zambia. All PHIT programs included health system strengthening interventions with child health outcomes from the outset, but all increasingly recognized the need to increase focus to improve health and outcomes in the first month of life. This paper uses a case study approach to describe interventions implemented in newborn health, compare approaches, and identify lessons learned across the programs' collective implementation experience. Read More

    Advancing indigent healthcare services through adaptive reuse: repurposing abandoned buildings as medical clinics for disadvantaged populations.
    BMC Health Serv Res 2017 Dec 13;17(Suppl 4):805. Epub 2017 Dec 13.
    Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA.
    Background: Challenges abound for healthcare providers engaged in initiatives directed toward disadvantaged populations, with financial constraints representing one of the most prominent hardships. Society's less fortunate typically lack the means to pay for healthcare services and even when they are covered by government health insurance programs, reimbursement shortcomings often occur, placing funding burdens on the shoulders of establishments dedicated to serving those of limited means. For such charitably-minded organizations, efficiencies are required on all fronts, including one which involves significant operational costs: the physical space required for care provision. Read More

    Measuring health systems strength and its impact: experiences from the African Health Initiative.
    BMC Health Serv Res 2017 Dec 21;17(Suppl 3):827. Epub 2017 Dec 21.
    Department of Public Health, University of Zambia School of Medicine, Lusaka, Zambia.
    Background: Health systems are essential platforms for accessible, quality health services, and population health improvements. Global health initiatives have dramatically increased health resources; however, funding to strengthen health systems has not increased commensurately, partially due to concerns about health system complexity and evidence gaps demonstrating health outcome improvements. In 2009, the African Health Initiative of the Doris Duke Charitable Foundation began supporting Population Health Implementation and Training Partnership projects in five sub-Saharan African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) to catalyze significant advances in strengthening health systems. Read More

    Billboard advertising: an avenue for communicating healthcare information and opportunities to disadvantaged populations.
    BMC Health Serv Res 2017 Dec 13;17(Suppl 4):787. Epub 2017 Dec 13.
    Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA.
    Background: Healthcare communications directed toward the disadvantaged have the potential to elevate the health status of these underprivileged and highly-challenged individuals. From conveying advice which encourages healthy lifestyles to communicating the location and availability of various medical resources, healthier lives and communities can be realized. Success on this front first requires establishing an effective communications link, something that is made more difficult as communications options available to the disadvantaged are more limited than those available to advantaged populations. Read More

    The hub-and-spoke organization design revisited: a lifeline for rural hospitals.
    BMC Health Serv Res 2017 Dec 13;17(Suppl 4):795. Epub 2017 Dec 13.
    Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA, 71103, USA.
    Background: Characterized by declining populations, high poverty, reduced employment opportunities, and high numbers of uninsured residents, rural communities pose significant challenges for healthcare providers desirous of addressing these medically underserved areas. Such difficult environments, in fact, have forced the closure of many rural hospitals across America, with scores facing the same threat, compelling intensive efforts to identify pathways which will yield an improved future.

    Discussion: Collaborations with stronger urban or suburban healthcare institutions offer a prudent avenue for rural hospitals to continue serving their patients. Read More

    Health system strengthening: a qualitative evaluation of implementation experience and lessons learned across five African countries.
    BMC Health Serv Res 2017 Dec 21;17(Suppl 3):826. Epub 2017 Dec 21.
    University of Global Health Equity, Kigali, Rwanda.
    Background: Achieving the United Nations Sustainable Development Goals in sub-Saharan Africa will require substantial improvements in the coverage and performance of primary health care delivery systems. Projects supported by the Doris Duke Charitable Foundation's (DDCF) African Health Initiative (AHI) created public-private-academic and community partnerships in five African countries to implement and evaluate district-level health system strengthening interventions. In this study, we captured common implementation experiences and lessons learned to understand core elements of successful health systems interventions. Read More

    Mentorship and coaching to support strengthening healthcare systems: lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa.
    BMC Health Serv Res 2017 Dec 21;17(Suppl 3):831. Epub 2017 Dec 21.
    Policy, Planning, Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana.
    Background: Despite global efforts to increase health workforce capacity through training and guidelines, challenges remain in bridging the gap between knowledge and quality clinical practice and addressing health system deficiencies preventing health workers from providing high quality care. In many developing countries, supervision activities focus on data collection, auditing and report completion rather than catalyzing learning and supporting system quality improvement. To address this gap, mentorship and coaching interventions were implemented in projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) as components of health systems strengthening (HSS) strategies funded through the Doris Duke Charitable Foundation's African Health Initiative. Read More

    Data-driven quality improvement in low-and middle-income country health systems: lessons from seven years of implementation experience across Mozambique, Rwanda, and Zambia.
    BMC Health Serv Res 2017 Dec 21;17(Suppl 3):830. Epub 2017 Dec 21.
    Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
    Background: Well-functioning health systems need to utilize data at all levels, from the provider, to local and national-level decision makers, in order to make evidence-based and needed adjustments to improve the quality of care provided. Over the last 7 years, the Doris Duke Charitable Foundation's African Health Initiative funded health systems strengthening projects at the facility, district, and/or provincial level to improve population health. Increasing data-driven decision making was a common strategy in Mozambique, Rwanda and Zambia. Read More

    It's hard to play ball: A qualitative study of knowledge exchange and silo effects in public health.
    BMC Health Serv Res 2018 Jan 2;18(1). Epub 2018 Jan 2.
    Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
    Background: Partnerships in public health form an important component of commissioning and implementing services, in England and internationally. In this research, we examine the views of staff involved in a City-wide health improvement programme which ran from 2009 to 2013 in England. We examine the practicalities of partnership work in community settings, and we describe some of barriers faced when implementing a large, multi-organisation health improvement programme. Read More

    Impact on healthcare resource utilization of multiple sclerosis in Spain.
    BMC Health Serv Res 2017 12 29;17(1):854. Epub 2017 Dec 29.
    Medical Department, Roche Farma, Madrid, Spain.
    Background: Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS.

    Methods: A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Read More

    Patient experiences of engagement with care plans and healthcare professionals' perceptions of that engagement.
    BMC Health Serv Res 2017 12 29;17(1):853. Epub 2017 Dec 29.
    Chairperson of Clinical and Applied Research Department, Research Center, King Fahad Medical City, P.O. Box 59046, Riyadh, 11525, Saudi Arabia.
    Background: Although patient engagement is internationally recognized as a core quality indicator of healthcare systems, no report has yet explored patient engagement in Saudi Arabia. Thus, we explored patients' experiences of engagement with healthcare services and assessed physicians' and nurses' perceptions of this engagement.

    Methods: We performed a cross-sectional study on patients and their family members admitted to either the rehabilitation or neurology department of King Fahad Medical City, Riyadh, Saudi Arabia. Read More

    A systematic review of the economic impact of rapid diagnostic tests for dengue.
    BMC Health Serv Res 2017 12 29;17(1):850. Epub 2017 Dec 29.
    Centre for Primary Care and Public health, Queen Mary University of London, London, UK.
    Background: Dengue fever is rapidly expanding geographically, with about half of the world's population now at risk. Among the various diagnostic options, rapid diagnostic tests (RDTs) are convenient and prompt, but limited in terms of accuracy and availability.

    Methods: A systematic review was conducted of published data on the use of RDTs for dengue with respect to their economic impact. Read More

    Improving equity in health care financing in China during the progression towards Universal Health Coverage.
    BMC Health Serv Res 2017 12 29;17(1):852. Epub 2017 Dec 29.
    Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, 17 Liverpool St (Private Bag 23), Hobart, TAS, 7000, Australia.
    Background: China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage.

    Methods: We used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. Read More

    Satisfaction of doctors with their training: evidence from UK.
    BMC Health Serv Res 2017 12 29;17(1):851. Epub 2017 Dec 29.
    Department of Economics and Management, University of Pavia, Via S. Felice, 5/7, 27100, Pavia, Italy.
    Background: This study considers the primary training environment factors affecting the satisfaction of doctors in training with their training.

    Methods: An OLS multiple regression analysis was performed on responses given by doctors in training (trainees) to General Medical Council (UK) National Trainee Survey annually from 2012 to 2015. Two different research models investigate the determinant of trainee doctor satisfaction. Read More

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