Управление здравоохранением

[Наталья П.]

Cochrane Effective Practice and Organisation of Care Group
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The following new reviews and updates were published in Issue 3, 2009 of The Cochrane Library, submitted by the Cochrane Effective Practice and Organisation of Care Group.

Reviews:
McGowan JL, Grad R, Pluye P, Hannes K, Deane K, Labrecque M, Welch V, Tugwell P.
Electronic retrieval of health information by healthcare providers to improve practice and patient care.
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Shojania KG, Jennings A, Mayhew A, Ramsay CR, Eccles MP, Grimshaw J.
The effects of on-screen, point of care computer reminders on processes and outcomes of care.
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Updated Reviews:
Zwarenstein M, Goldman J, Reeves S.
Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes.
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[Наталья П.]

Health Systems Evidence database
Hosted by the McMaster Health Forum at McMaster University, Canada, this is a continuously updated repository of syntheses of research evidence about governance, financial and delivery arrangements within health systems, and about implementation strategies that can support change in health systems. The syntheses address a broad range of questions, including those about the effectiveness of particular options for strengthening health systems.

The database can help health system managers and policymakers quickly identify a synthesis of the best available research evidence on a given topic that has been prepared in a systematic and transparent way. Additionally, users will have access to details such as how recently the search for studies was conducted, the quality of the synthesis, the countries in which the studies included in the synthesis were conducted, and the key findings from the synthesis.

This is a collaboration between the McMaster Health Forum, McMaster University’s Program in Policy Decision-making, the Canadian Cochrane Centre, and Rx for Change.

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Using mortality rates to measure hospital quality is easily measured and seemingly important, but tends to create bias in hospital performance.
This bias can be alleviated by basing performance on other outcomes and clinical processes, according to an article published April 20 in the British Medical Journal.

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Introduction to Health Economics Concepts

A beginners guide to health economics concepts, laid out in an easy to understand format

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Innovative health service delivery models in low and middle income countries
- what can we learn from the private sector?


Onil Bhattacharyya 1, Sara Khor 1, Anita McGahan 2, David Dunne 2, Abdallah S Daar 3 and Peter A Singer 4

1 Li Ka Shing Knowledge Institute Toronto, ON, Canada

2 Rotman School of Management, University of Toronto, ON Canada

3 MaRS Centre, Toronto, ON Canada

4 McLaughlin- Rotman Centre for Global Health, MaRS Centre, Toronto, ON, Canada




Health Research Policy and Systems – July 2010, 8:24doi:10.1186/1478-4505-8-24



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“……The poor in low and middle income countries have limited access to health services due to limited purchasing power, residence in underserved areas, and inadequate health literacy. This produces significant gaps in health care delivery among a population that has a disproportionately large burden of disease. They frequently use the private health sector, due to perceived or actual gaps in public services.

A subset of private health organizations, some called social enterprises, have developed novel approaches to increase the availability, affordability and quality of health care services to the poor through innovative health service delivery models. This study aims to characterize these models and identify areas of innovation

that have led to effective provision of care for the poor.

An environmental scan of the relevant literature was conducted to select exemplars of innovation. A case series of organizations was then purposively sampled to maximize variation. These cases were examined using content analysis and constant comparison to characterize their strategies, focusing on business processes. After an initial sample of 46 studies, 10 case studies of exemplars were developed spanning different geography, disease areas and health service delivery models.

These ten organizations had innovations in their marketing, financing, and operating strategies. These included approaches such a social marketing, cross-subsidy, high-volume, low cost models, and process reengineering. They tended to have a narrow clinical focus, which facilitates standardizing processes of care, and experimentation with novel delivery models. Despite being well-known, information on the social impact of these organizations was variable, with more data on availability and affordability and less on quality of care.

These private sector organizations demonstrate a range of innovations in health service delivery that have the potential to better serve the poor's health needs and be replicated. There is a growing interest in investing in social enterprises, like the ones profiled here. However, more rigorous evaluations are needed to investigate the impact and quality of the health services provided and determine the effectiveness of particular strategies.

[Наталья П.]

Policy-Making as a Struggle for Meaning:
Disentangling Knowledge Translation across International Health Contexts

Aris Komporozos-Athanasiou, Eivor Oborn, Michael Barrett and Yolande Chan

School of Management, Royal Holloway University of London

Working Paper Series SoMWP–1005 -June 2010

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“……While evidence-based medicine has increasingly sought to transform decision making in clinical practice, this trend has not been followed by a similar logic in health management and policy-making. This has ultimately led to significant discrepancies between policy and practice (Walshe and Rundall 2001, van der Schee et al 2007).

In this paper, we argue the need to step back and analyze the development of policy discourse in different institutional and national contexts as an important starting point in further understanding how this policy-practice „gap‟ develops over time. We consider this discourse not only regarding its role in directing healthcare policy, but moreover vis-à-vis its ability to render visible concurrent political structures and mechanisms (Moon and Brown 2000).

Moreover, we explore the linkages between the rise of a public sector discourse and its varied manifestations with the different notions of citizen, user and, in our case, patient in co-designing best practice and transferring knowledge during service restructuring (Löffler 2009), which has emerged as an important area of debate in healthcare policy (Dawson and Morris 2009). Rather than being viewed as a passive recipient, the patient as service user may be central in re-structuring care, especially through making “informed choices” and as well as participating in the service design and thereby acquiring more control over the process of care delivery (Fotaki 2005; Le Grand 2004; Löffler 2009).

Our approach is to unearth how different underlying meanings of best practices - deemed as gold standards by medical science - are discursively enacted in health policies across different institutional and political contexts.

To this end, we analyzed stroke care related policies in the UK and Canada. In the UK, we examined both the general “umbrella” healthcare strategies that informed and influenced the re-organizing of stroke care services as well as the various reviews and policy guidelines that were generated after the launch of the National Stroke Strategy….”

[Наталья П.]

The effect of social franchising on access to and quality of health services in low- and middle-income countries


Tracey Perez Koehlmoos1, Rukhsana Gazi2, S. Shahed Hossain2, K Zaman3

1 Head, Health and Family Planning Systems Programme, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
2 Health Systems and Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
3 Child Health Unit, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh


Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD007136. DOI: 10.1002/14651858.CD007136.pub2.



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Background

Social franchising has developed as a possible means of improving provision of health services through engaging the non-state sector in low- and middle-income countries.

Objectives

To examine the evidence that social franchising has on access to and quality of health services in low- and middle-income countries.

Search strategy

We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (up to October 2007), Cochrane Central Register of Controlled Trials (The Cochrane Library 2007, Issue 3), MEDLINE, Ovid (1950 to September Week 3 2007), EMBASE, Ovid (1980 to 2007 Week 38), CINAHL, Ovid (1982 to September Week 3 2007), EconLit, WebSPIRS (1969 to Sept 2007), LILACS, Science Citation Index Expanded and Social Sciences Citation Index (1975 to March 2008), Sociological Abstracts, CSA Illumnia (1952 September 2007), WHOLIS (1948 November 2007).

Selection criteria

Randomized controlled trials, non-randomized controlled trials, controlled before and after studies and interrupted time series comparing social franchising models with other models of health service delivery, other social franchising models or absence of health services.

Data collection and analysis

Two review authors independently applied the criteria for inclusion and exclusion of studies to scan titles and abstracts. The same two review authors independently screened full reports of selected citations . At each stage, results were compared and discrepancies settled through discussion.

Main results

No studies were found which were eligible for inclusion in this review.

Authors' conclusions

There is a need to develop rigorous studies to evaluate the effects of social franchising on access to and quality of health services in low- and middle-income countries. Such studies should be informed by the wider literature to identify models of social franchising that have a sound theoretical basis and empirical research addressing their reach, acceptability, feasibility, maintenance and measurability.


Plain language summary
Social franchising to increase access to and quality of health services in low- and middle-income countries
Governments are looking for ways to increase the access to and quality of health care services in low- and middle-income countries. One system not connected to the public sector, has been to provide health services through a franchise, called social franchising. The concept of franchising for health services is similar to franchises in business. A franchiser develops a successful way to provide the health services, and then other franchisees copy the model in other franchises. Each franchisee, though, has to follow the original model. There is also usually specific training, protocols and standards to follow, monitoring, and a brand name or logo which identifies that the provider is part of a franchise.

There is hope and early work reports that social franchising may quickly spread health services in low- and middle income countries to improve health. But this Cochrane review did not find any rigorous evidence to demonstrate the effect of social franchising on access to and quality of care in low- and middle-income countries….”

[Наталья П.]

READ Portal. Research, Evidence and Analysis for Decision-makers, an online resource for Health Care managers
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This site is run by the Centre for Health Care Management at the University of British Columbia and aims to provide health care decision-makers with current articles, news items, reports, and publications that are of professional interest. Thier focus is on Canadian gray literature (articles that are not published in peer-reviewed articles or publishing firms, such as: government reports, corporate reports, studies conducted by private organisations), however they will also post original book reviews and links to items of particular interest in peer-reviewed journals and the mass media.

With the exception of original book reviews and working papers by members of the Centre for Health Care Management, they do not provide access to the original article, but post a brief abstract, citation, and a link to the article. For this reason, the focus is on open access material which is freely available to all our visitors.