Evaluating Innovative Health Programs: Lessons for Health Policy

The Global Development Network’s (GDN) project “Evaluating Innovative Health Programs” (EIHP), funded by the Bill & Melinda Gates Foundation, seeks to inform policy on the effectiveness of health solutions that have the potential to improve health outcomes in developing countries. It evaluates the impact of nineteen programs from across developing and transition countries that focus on the health-related Millennium Development Goals (MDGs) of reducing child and maternal mortality, and halting and reversing the trend of communicable diseases such as HIV/AIDS, malaria and other diseases. The policy implications of the diverse set of interventions are distinguished between programs that involved earmarking resources, changing incentives, and developing innovative methods of health care delivery.Millennium Development Goals; child and maternal health; communicable diseases; impact evaluation; capacity building; Asia; Africa; Latin America

Medical Staff Services Quality to Patients Satisfaction Based on SERVQUAL Dimensions

Hospital service quality was a degree of discrepancy between patients\u27 perceptions and their expectations about hospitals services. Service quality which was provided by medical staff emphasizes the actual hospital service process. In the hospital, patients\u27 satisfaction could be widely used to determine hospital service quality. The purpose of this study was to analyze the influence of medical staff services quality on patients satisfaction based on SERVQUAL dimensions. This study used an analytic observational design with cross-sectional approach. There were 314 respondents taken from inpatients hospital admission using simple random sampling. Based on regression analysis results, five dimensions of health services quality affect patients\u27 level of satisfaction and obtained the equation of Y = 0.026 + 0.226X1 + 0.332X2 + 0.1X3 + 0.075X4 + 0.235X5, this explained that patients\u27 satisfaction was affected by all dimensions of health service quality (RATER) simultaneously. However, different values will be obtained if all dimensions were measured separately, range from 10% to 33.2%. It could be concluded that patients\u27 satisfaction were influenced by the quality of medical staff services through its five components: reliability, assurance, tangible, empathy and responsiveness

Less-developed countries and innovation in health: notes and data about the Brazilian case

This communication discusses the specificity of health innovation in a lessdeveloped country, investigating the Brazilian case. To evaluate the specificity of the Brazilian system, this communication presents data about employment, expenditures, industrial firms in health-related industrial sectors, scientific resources, and diffusion of medical equipment. This communication concludes summarising the main characteristics of the Health Innovation System in Brazil.health; innovation; Brazil

A parallel approach to analysis of costs/benefits and efficiency changes resulting from privatisation of health services

The marketisation of public health care systems is part of a long process, which is not necessarily clearly set out or understood at the beginning. Public policy plays an important role in creating internal markets and changing public health care systems. The findings of this review show that there are now recognisable steps in the process of moving from a state/ government run health care system to a marketised and privatised system but this can take place over many years

Evaluating the Impact of Community-Based Health Interventions: Evidence from Brazil's Family Health Program

This paper analyzes the direct and indirect impacts of Brazil's Family Health Program. We estimate the effects of the program on mortality and on household behavior related to child labor and schooling, employment of adults, and fertility. We find consistent effects of the program on reductions in mortality throughout the age distribution, but mainly at earlier ages. Municipalities in the poorest regions of the country benefit particularly from the program. For these regions, implementation of the program is also robustly associated with increased labor supply of adults, reduced fertility, and increased schooling. Evidence suggests that the Family Health Program is a highly cost-effective tool for improving health in poor areas.family health program, mortality, household behavior, impact evaluation, Brazil

Análise do desempenho de hospitais públicos e filantrópicos brasileiros

This paper presents the results of a research that aimed at identifying optimal performance standards of Brazilian public and philanthropic hospitals. In order to carry out the analysis, a model based on Data Envelopment Analysis (DEA) was developed. We collected financial data from hospitals’ financial statements available on the internet, as well as operational data from the Information Technology Department of the Brazilian Public Health Care System – SUS (DATASUS). Data from 18 hospitals from 2007 to 2011 were analyzed. Our DEA model used both operational and financial indicators (variables). In order to develop this model, two indicators were considered inputs: Values (in Brazilian Reais) of Fixed Assets and Planned Capacity. On the other hand, the following indicators were considered outputs: Net Margin, Return on Assets and Institutional Mortality Rate. As regards the proposed model, there were five hospitals with optimal performance and four hospitals were considered inefficient, upon the analysis of the variables, considering the analyzed period. Analysis of the weights indicated the most relevant variables for determining efficiency and scale variable values, which is an important tool to aid the decision-making by hospital managers. Finally, the scale variables determined the returns on production, indicating that 14 hospitals work with scale diseconomies. This may indicate inefficiency in the resource management of the Brazilian public health-care system, by analyzing this set of proposed variables.Este artigo apresenta os resultados de uma pesquisa que visou identificar padrões ótimos de desempenho empregados por hospitais públicos e filantrópicos brasileiros. Para realizar tal análise, desenvolveu-se um modelo com base na análise envoltória de dados (Data Envelopment Analysis – DEA). Foram coletados dados financeiros a partir das demonstrações financeiras dos hospitais disponíveis na Internet, assim como dados operacionais coletados por meio do Departamento de Informática do Sistema Único de Saúde (DATASUS). No total, foram analisados dados de 18 hospitais entre os anos de 2007 e 2011. O modelo DEA desenvolvido considerou simultaneamente indicadores (variáveis) operacionais e financeiros. No desenvolvimento desse modelo, foram considerados como inputs (entradas) os seguintes indicadores: Valor (em R$) empregado no Imobilizado e Capacidade Planejada. Por sua vez, foram utilizados como outputs (saídas) os seguintes indicadores: Margem Líquida, Retorno Sobre o Ativo e Taxa de Mortalidade Institucional. No que tange ao modelo proposto, considerando o período analisado, cinco hospitais apresentaram um desempenho ótimo e quatro hospitais foram considerados ineficientes ao analisar o conjunto de variáveis utilizadas. Por meio da análise dos pesos foram identificadas as variáveis mais relevantes para a determinação da eficiência e dos valores da Variável de Escala, o que constitui uma importante ferramenta no auxílio da tomada de decisão por parte dos gestores hospitalares. Por fim, as variáveis de escala determinaram os retornos de produção, indicando que 14 hospitais trabalham com deseconomias de escala. Isto pode indicar uma ineficiência na gestão dos recursos na saúde pública brasileira, ao menos analisando o conjunto de variáveis propostas

Evidence-based practice educational intervention studies: A systematic review of what is taught and how it is measured

Abstract Background Despite the established interest in evidence-based practice (EBP) as a core competence for clinicians, evidence for how best to teach and evaluate EBP remains weak. We sought to systematically assess coverage of the five EBP steps, review the outcome domains measured, and assess the properties of the instruments used in studies evaluating EBP educational interventions. Methods We conducted a systematic review of controlled studies (i.e. studies with a separate control group) which had investigated the effect of EBP educational interventions. We used citation analysis technique and tracked the forward and backward citations of the index articles (i.e. the systematic reviews and primary studies included in an overview of the effect of EBP teaching) using Web of Science until May 2017. We extracted information on intervention content (grouped into the five EBP steps), and the outcome domains assessed. We also searched the literature for published reliability and validity data of the EBP instruments used. Results Of 1831 records identified, 302 full-text articles were screened, and 85 included. Of these, 46 (54%) studies were randomised trials, 51 (60%) included postgraduate level participants, and 63 (75%) taught medical professionals. EBP Step 3 (critical appraisal) was the most frequently taught step (63 studies; 74%). Only 10 (12%) of the studies taught content which addressed all five EBP steps. Of the 85 studies, 52 (61%) evaluated EBP skills, 39 (46%) knowledge, 35 (41%) attitudes, 19 (22%) behaviours, 15 (18%) self-efficacy, and 7 (8%) measured reactions to EBP teaching delivery. Of the 24 instruments used in the included studies, 6 were high-quality (achieved ≥3 types of established validity evidence) and these were used in 14 (29%) of the 52 studies that measured EBP skills; 14 (41%) of the 39 studies that measured EBP knowledge; and 8 (26%) of the 35 studies that measured EBP attitude. Conclusions Most EBP educational interventions which have been evaluated in controlled studies focus on teaching only some of the EBP steps (predominantly critically appraisal of evidence) and did not use high-quality instruments to measure outcomes. Educational packages and instruments which address all EBP steps are needed to improve EBP teaching

Applying the Maternal Near Miss Approach for the Evaluation of Quality of Obstetric Care: A Worked Example from a Multicenter Surveillance Study

Objective. To assess quality of care of women with severe maternal morbidity and to identify associated factors. Method. This is a national multicenter cross-sectional study performing surveillance for severe maternal morbidity, using the World Health Organization criteria. the expected number of maternal deaths was calculated with the maternal severity index (MSI) based on the severity of complication, and the standardized mortality ratio (SMR) for each center was estimated. Analyses on the adequacy of care were performed. Results. 17 hospitals were classified as providing adequate and 10 as nonadequate care. Besides almost twofold increase in maternal mortality ratio, the main factors associated with nonadequate performance were geographic difficulty in accessing health services (P < 0.001), delays related to quality of medical care (P = 0.012), absence of blood derivatives (P = 0.013), difficulties of communication between health services (P = 0.004), and any delay during the whole process (P = 0.039). Conclusions. This is an example of how evaluation of the performance of health services is possible, using a benchmarking tool specific to Obstetrics. in this study the MSI was a useful tool for identifying differences in maternal mortality ratios and factors associated with nonadequate performance of care.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Univ Campinas UNICAMP, Sch Med Sci, Dept Obstet & Gynaecol, BR-13083881 Campinas, SP, BrazilCtr Res Reprod Hlth Campinas Cemicamp, BR-13083888 Campinas, SP, BrazilUniv Fed Amazonas, Manaus, Amazonas, BrazilSch Med Sci, CISAM, Recife, PE, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilUniv Fed Bahia, Salvador, BA, BrazilHosp Geral Cesar Cals, Fortaleza, Ceara, BrazilHosp Geral Fortaleza, Fortaleza, Ceara, BrazilMaternidade Odete Valadares, Belo Horizonte, MG, BrazilHosp Materno Infantil, Goiania, Go, BrazilInst Materno Infantil Pernambuco, Recife, PE, BrazilUniv Fed Pernambuco, Recife, PE, BrazilUniv Fed Campina Grande, Campina Grande, PB, BrazilUniv Fed Maranhao, Sao Luis, MA, BrazilUniv Fed Parana, BR-80060000 Curitiba, Parana, BrazilUniv Fed Paraiba, BR-58059900 Joao Pessoa, Paraiba, BrazilHosp Maternidade Fernando Magalhaes, Rio de Janeiro, RJ, BrazilUniv Fed Rio Grande do Sul, Porto Alegre, RS, BrazilHosp Maternidade Celso Pierro, Campinas, SP, BrazilInst Fernandes Figueira Fiocruz, Rio de Janeiro, RJ, BrazilHosp Israelita Albert Einstein, São Paulo, BrazilUniv State São Paulo, Botucatu, SP, BrazilJundiai Sch Med, Jundiai, SP, BrazilUniv São Paulo, BR-14049 Ribeirao Preto, SP, BrazilSanta Casa Limeira, Limeira, SP, BrazilSanta Casa Sao Carlos, Sao Carlos, SP, BrazilMaternidade Leonor Mendes de Barros, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilUniversidade Federal de São Paulo, São Paulo, BrazilCNPq: 402702/2008-5Web of Scienc