Complex Care Management Program Overview

This report includes brief updates on various forms of complex care management including: Aetna - Medicare Advantage Embedded Case Management ProgramBrigham and Women's Hospital - Care Management ProgramIndependent Health - Care PartnersIntermountain Healthcare and Oregon Health and Science University - Care Management PlusJohns Hopkins University - Hospital at HomeMount Sinai Medical Center -- New York - Mount Sinai Visiting Doctors Program/ Chelsea-Village House Calls ProgramsPartners in Care Foundation - HomeMeds ProgramPrinceton HealthCare System - Partnerships for PIECEQuality Improvement for Complex Chronic Conditions - CarePartner ProgramSenior Services - Project Enhance/EnhanceWellnessSenior Whole Health - Complex Care Management ProgramSumma Health/Ohio Department of Aging - PASSPORT Medicaid Waiver ProgramSutter Health - Sutter Care Coordination ProgramUniversity of Washington School of Medicine - TEAMcar

Report on the evaluation of surveillance systems relevant to zoonotic diseases in Kenya, 2015: A basis for design of an integrated human–livestock surveillance system

The Zoonoses in Livestock in Kenya (ZooLinK) is a project that seeks to enable Kenya develop an effective surveillance programme for zoonotic diseases (infectious diseases transmissible between animals and human beings). The surveillance programme will be integrated across both human and animal health sectors. To achieve this goal the project will work in close collaboration with Kenyan government departments in responsible for animal and human health. As a prelude to the start of the project, an evaluation of the existing surveillance systems for human and animal health was carried out. The evaluation focused on the national surveillance system and the systems at the western part of Kenya (Busia county, Kakamega county and Bungoma county) where the initial programme will be developed. In conducting the evaluation the investigators used key informant interviews, focused group discussion participant questionnaires, audio recordings and observation for data collection. Data analysis for the qualitative data focused on generating themes or theory around the responses obtained in the key informants interviews and focused group discussions. Univariate analysis was performed by use of simple proportions in calculation for surveillance system attributes like sensitivity, completeness, PVP and Timeliness for the human health surveillance systems. The findings of the evaluation revealed that there was poor linkage between animal health surveillance and the human health surveillance systems. None of the systems had surveillance structures dedicated to zoonotic diseases. Most practitioners used clinical signs for diagnosis of diseases with little reference to acceptable case definitions. Laboratory diagnosis in animal health services focused more on suspected notifiable diseases as opposed to being a standard operating procedure for diagnosis. In Human health services the health care facilities that had laboratory within the facility conducted laboratory diagnosis for cases referred by the clinicians. However, some clinicians preferred using clinical signs for diagnosis to avoid the wait or turn-around time in the laboratory. For effective surveillance of zoonoses to be realized it would be advisable to establish surveillance structures specific to zoonoses and the necessary resources allocated to the surveillance activities. In addition, an integrated approach that incorporated both human and animal disease surveillance should be employed in the surveillance of zoonoses

Parental evaluation of a telemonitoring service for children with Type 1 Diabetes

Introduction In the past years, we developed a telemonitoring service for young patients affected by Type 1 Diabetes. That service provides data to the clinical staff and offers an important tool to the parents, that are able to oversee in real time their children. The aim of this work was to analyze the parents' perceived usefulness of the service. Methods The service was tested by the parents of 31 children enrolled in a seven-day clinical trial during a summer camp. To study the parents' perception we proposed and analyzed two questionnaires. A baseline questionnaire focused on the daily management and implications of their children's diabetes, while a post-study one measured the perceived benefits of telemonitoring. Questionnaires also included free text comment spaces. Results Analysis of the baseline questionnaires underlined the parents' suffering and fatigue: 51% of total responses showed a negative tendency and the mean value of the perceived quality of life was 64.13 in a 0-100 scale. In the post-study questionnaires about half of the parents believed in a possible improvement adopting telemonitoring. Moreover, the foreseen improvement in quality of life was significant, increasing from 64.13 to 78.39 ( p-value\u2009=\u20090.0001). The analysis of free text comments highlighted an improvement in mood, and parents' commitment was also proved by their willingness to pay for the service (median\u2009=\u2009200\u2009euro/year). Discussion A high number of parents appreciated the telemonitoring service and were confident that it could improve communication with physicians as well as the family's own peace of mind

Assessing Network Applications for Economic Development

PAE Team’s Objectives Ø Create a survey instrument to assess the impact of technology intervention in rural India Ø Advise on potential applications for village-level Internet terminals The aim of the Sustainable Access in Rural India (SARI) project is to improve the lives of individuals in poor rural communities by leveraging information and communications technologies to facilitate economic development. Ultimately, the project’s success will be measured by its social and economic impact and viability, which depends critically on the appropriateness of applications provided to end-users. Our conclusions and recommendations concerning applications are as follows: A price application that posts the daily price fluctuations of certain goods in order to promote competition among sellers and improve the economic decision making of villagers and traders may not increase efficiency or further economic development; its effectiveness depends critically on geographic scope and a focus on goods whose prices exhibit sufficient price volatility and differentiation. We recommend a central web sitebased price application, with independent kiosk operators responsible for inputting price information from villages in which markets exist. A spot labor market application that aggregates supply and demand of jobs for clusters of villages holds much promise—there are potential benefits from coordinating labor markets in the area studied. The relatively constant need for work coupled with unmet demand suggests that there is a significant willingness to pay for a service that matches supply and demand for labor in a timely and accountable way. We recommend a bulletin-board type labor market application that connects small numbers of nearby villages. EXECUTIVE SUMMARY iv An agriculture application that addresses the basic knowledge needs of farmers, providing weather forecasts and information on farming techniques must include tailored content, given the diversity of crops grown and methods employed throughout the region. We recommend a local content creation mechanism, facilitating farmer access to agricultural expertise via simple voice or text communications, or a more robust web-based application. Deficiencies in the current state-provided healthcare infrastructure may limit the initial impact of IT within local Public Health Centers (PHCs). Instead, we suggest a health care application that delivers information and services to villagers directly through community centers. Based on villager awareness levels and needs, we recommend a government services application that would enable villagers to access information on relevant government programs and initiate online requests for necessary government documents. While applications to facilitate education (particularly adult learning) may be useful, there appear to be significant implementation barriers at the school level. The motivation for these proposed applications stems from several regional attributes, inferred from local economic data and extensive interviews with villagers, school representatives, health workers and NGO staff members: Ø Many if not most villages exhibit segregation along religious and/or caste lines. Ø While some data is readily available and disseminated (e.g., prices of heavily traded goods), other potentially critical pieces of information are not easily accessible to villagers (e.g., livestock prices, agricultural advice, government programs). Ø A majority of all economic activity either directly or indirectly involves agriculture, and much of a typical villager’s social activity relates to agriculture. Ø A majority of laborers are without a regular source of employment—unemployment is extremely cyclical, reaching high levels during the agricultural off-season.NYU, Stern School of Business, IOMS Department, Center for Digital Economy Researc

The impact of an intervention to introduce malaria rapid diagnostic tests on fever case management in a high transmission setting in Uganda: A mixed-methods cluster-randomized trial (PRIME).

Rapid diagnostic tests for malaria (mRDTs) have been scaled-up widely across Africa. The PRIME study evaluated an intervention aiming to improve fever case management using mRDTs at public health centers in Uganda. A cluster-randomized trial was conducted from 2010-13 in Tororo, a high malaria transmission setting. Twenty public health centers were randomized in a 1:1 ratio to intervention or control. The intervention included training in health center management, fever case management with mRDTs, and patient-centered services; plus provision of mRDTs and artemether-lumefantrine (AL) when stocks ran low. Three rounds of Interviews were conducted with caregivers of children under five years of age as they exited health centers (N = 1400); reference mRDTs were done in children with fever (N = 1336). Health worker perspectives on mRDTs were elicited through semi-structured questionnaires (N = 49) and in-depth interviews (N = 10). The primary outcome was inappropriate treatment of malaria, defined as the proportion of febrile children who were not treated according to guidelines based on the reference mRDT. There was no difference in inappropriate treatment of malaria between the intervention and control arms (24.0% versus 29.7%, adjusted risk ratio 0.81 95\% CI: 0.56, 1.17 p = 0.24). Most children (76.0\%) tested positive by reference mRDT, but many were not prescribed AL (22.5\% intervention versus 25.9\% control, p = 0.53). Inappropriate treatment of children testing negative by reference mRDT with AL was also common (31.3\% invention vs 42.4\% control, p = 0.29). Health workers appreciated mRDTs but felt that integrating testing into practice was challenging given constraints on time and infrastructure. The PRIME intervention did not have the desired impact on inappropriate treatment of malaria for children under five. In this high transmission setting, use of mRDTs did not lead to the reductions in antimalarial prescribing seen elsewhere. Broader investment in health systems, including infrastructure and staffing, will be required to improve fever case management

Usability assessment of an interactive health technology for kidney living donors : protocol for a prospective cross-sectional survey

Introduction Several web portals for kidney patients are available, but assessments of their performance are scarce. A crucial aspect of living donation is to provide standardised information about the risks of the procedure. This is of particular interest among candidates for kidney living donation. In 2019, the Digital Care Path for Living Kidney Donor Candidates was launched in Finland as part of the Health Village portal, containing information about the donation process and facilitating communication between clinicians, transplant coordinators and patients. The performance of this eHealth service has not yet been studied. The present study will investigate living donor candidates' experience with the Health Village and Digital Care Path for Living Kidney Donor Candidates. Participants' general attitudes towards the use of eHealth services will also be explored as a secondary objective. Methods and analysis A prospective cross-sectional survey study will take place. Participants will be kidney donor candidates who have used the digital care path since its implementation in January 2019 up to 1 March 2021 (N=122). The surveys will include demographic data, electronic device ownership and digital health literacy. Platform's ease of use will be assessed with the System Usability Scale. Open-ended questions will be used to gather suggestions. Ethics and dissemination The research protocol has been approved by the Helsinki University Hospital ethical committee (HUS/501/2021) to ensure that the work is done in accordance with the declaration of Helsinki and Declaration of Istanbul. Recruitment will start during the first semester of 2021. Initial results are expected during the second semester of 2021.Peer reviewe