Reporting clinical trial results to inform providers, payers, and consumers

Results of randomized clinical trials are the preferred "evidence" for establishing the benefits and safety of medical treatments. We present evidence suggesting that the conventional approach to reporting clinical trials has fundamental flaws that can result in overlooking identifiable subgroups harmed by a treatment while underestimating benefits to others. A risk-stratified approach can dramatically reduce the chances of such errors. Since professional and economic incentives reward advocating treatments for as broad a patient population as possible, we suggest that payers and regulatory bodies might need to act to motivate prompt, routine adoption of risk-stratified assessments of medical treatments' safety and benefits.     

Promotional model: a new direction for the National Programme on Immunization (NPI) and Oral Rehydration Therapy (ORT) in Nigeria

The National Programme on Immunization (NPI), which was formerly known as the Expanded Program on Immunization (EPI), and Oral Rehydration Therapy (ORT) were relaunched in 1984 after the problems of vaccine supply had been corrected. The aim of the NPI was to protect children against six childhood killer diseases and ORT to rehydrate the dehydrated child caused by diarrhoea. In order to achieve these objectives, a Partner-in-Health strategy was set up to educate, convince and motivate mothers, pregnant women and the community to accept the programme. To assess the effect of the promotional strategy, the government decided to conduct a National Immunization Coverage survey. The results showed that some states were able to reach the target while some were not. The survey also reported that 32% of the reason for immunization failure was due to lack of information and that 9% was lack of motivation. It therefore became necessary to design a promotional model for effective and rapid implementation of the programme. After an evaluation of the promotional strategy set up by the government, a pilot survey was conducted from which nine promotional elements were selected. These promotional elements were regarded as sources of information and motivation. Based on these, a promotional model was set up which stated that promotion depends on consumer information which in turn depends on the extent of interaction between the consumer and the promotional elements. The implication of the model is the need for the formation of a Public Health Organisation with a Public Health Committee at all levels of government.     

Strategic information systems planning for health service providers.

There is significant opportunity for health service providers to gain competitive advantage through the innovative use of strategic information systems. This analysis presents some key strategic information systems issues that will enable managers to identify opportunities within their organizations.     

Implementation of cancer clinical care pathways: s successful model of collaboration between payers and providers

Despite rising medical costs within the US healthcare system, quality and outcomes are not improving. Without significant policy reform, the cost-quality imbalance will reach unsustainable proportions in the foreseeable future. The rising cost of healthcare in part results from an expanding aging population with an increasing number of life-threatening diseases. This is further compounded by a growing arsenal of high-cost therapies. In no medical specialty is this more apparent than in the area of oncology. Numerous attempts to reduce costs have been attempted, often with limited benefit and brief duration. Because physicians directly or indirectly control or influence the majority of medical care costs, physician behavioral changes must occur to bend the healthcare cost curve in a sustainable fashion. Experts within academia, health policy, and business agree that a significant paradigm change in stakeholder collaboration will be necessary to accomplish behavioral change. Such a collaboration has been pioneered by Blue Cross Blue Shield of Michigan and Physician Resource Management, a highly specialized oncology healthcare consulting firm with developmental and ongoing technical, analytic, and consultative support from Cardinal Health Specialty Solutions, a division of Cardinal Health. We describe a successful statewide collaboration between payers and providers to create a cancer clinical care pathways program. We show that aligned stakeholder incentives can drive high levels of provider participation and compliance in the pathways that lead to physician behavioral changes. In addition, claims-based data can be collected, analyzed, and used to create and maintain such a program.     

Municipal health policy planning and implementation

Municipal health policy planning can include exemplary practices for expanding the population's access to health services. The current study seeks to analyze the limits and possibilities of planning practices for policy implementation by a municipal health department. The empirical data were analyzed based on a concept of planning practices and the theoretical link between the three spheres of government and the postulate of coherence. The use of unstructured strategic planning practices by the management team allowed a significant expansion in the supply of services to the population, but lacked the scope to overcome the limits imposed on the organization's governability by the health services funding model, characterized by strong induction from the federal level. The project was the most robust vertex in the government triangle and led to the development of initial expertise by the municipal management team, thereby ensuring a certain level of governability over the health project. The goals of increasing the supply of health services were constrained by the method's weakness and the organization's institutional insipience.     

National health data for policy and planning.

The role of the National Center for Health Statistics (NCHS) in providing data for health policy and planning at the national and local level is discussed. Four specific examples are considered. First, data from the Hospital Discharge Survey are used to identify surgical procedures with large increases between 1965 and 1976: 30 percent rise in the incidence of hysterectomy, 169 percent increase in cesarean section, 100 percent increase in lens extraction, and 35 percent increase in orthopedic surgery. The extent to which such increases represent unnecessary utilization and their impact on costs are discussed. Second, the combination of data from two sources (Health Interview Survey and Health and Nutrition Examination Survey) is illustrated by considering selected policy issues related to hypertension. Next, the problem of designating medically underserved areas is discussed in relation to the difficulties in implementing federal policies at the local level without local data. The potential for national data systems to provide guidance for these policies is also considered. The final example discusses the use of vital statistics to provide small area data for local health planning. In conclusion several areas are considered which need development in order to maximize the use of data for policy and planning: research on measurement of health status, with particular emphasis on how health policy can affect health status; research on appropriate levels of health resources and services; development of shared data systems to reduce cost and respondent burden; and training, especially at the undergraduate level and in interdisciplinary graduate programs.     

An evaluation of contraception mobile applications for providers of family planning services

ObjectiveWe aimed to identify mobile applications (apps) about contraception and to evaluate those targeted toward providers of family planning services in order to assess their quality and comprehensiveness.MethodsWe systematically searched the Apple iTunes Store using contraception search terms. We created a master list of relevant and unique apps and divided the apps into categories and subcategories according to intended audience and purpose. We then checked availability of contraception apps for providers in the Google Play Store. We scored apps on objective and subjective components using the APPLICATIONS scoring system, a tool developed to evaluate health-related mobile apps with a maximum score of 17 points.ResultsFrom a total of 1218 apps found using 41 contraception search terms, 113 were unique and relevant to contraception. We determined that six apps (5.3%) were potentially useful for providers of family planning services and evaluated them. Four apps received 12 points, one received 11 points and one received 8 points. The two free apps were among those with the highest scores. Three of these apps were also available in the Google Play Store.ConclusionsA small number of contraception apps are targeted toward providers of family planning services. Available apps are variable in quality and comprehensiveness.ImplicationsThere is potential for further mobile resource development in the area of contraception, given the limited number and inconsistent quality of available apps.     

Evaluation of planning and implementation for an innovative health centre

The South Calgary Health Centre, a new venture for the Calgary Health Region, was mandated to be an accessible, integrated, community-based health services facility. A comprehensive evaluation provided details on planning and implementation. Functional integration was a large focus of the planning and was operationalized as central admitting, shared charts, shared space and co-location of clinical services with no history of integration. Challenges are discussed and recommendations for future health centres developed.