Consultancy to progress hospital in the home care provision: Final report, CHERE Project Report No 13

In July 1998, the Commonwealth Department of Health and Family Services commissioned the Centre for Health Economics Research and Evaluation (CHERE) to identify and document Hospital in the Home (HITH) care models nationally and internationally. The purpose of this consultancy was to examine the appropriateness of this form of care for acutely ill patients and to make recommendations about how to increase the utilisation and cost effectiveness of services. Hospital in the Home is emerging internationally and within Australia as a viable alternative form of provision of acute care. The benefits of HITH have generally been seen in terms of its capacity to provide a cost-effective and acceptable alternative to hospital inpatient care, which reduces pressure on hospital beds. However, so far there has only been limited evaluation to lend support to these claims. Over the past decade a wide range of hospital in the home programs have been introduced across the Australian health care system. These programs have often emerged in response to local factors and have a range of different purposes, funding and organisational arrangements, and varying levels of success. In some states hospital in the home has been formalised into a program, whereas in other parts of Australia the introduction of HITH has been left to local decision makers. Thus, the experience of HITH has been extremely variable. It is appropriate at this stage to draw together information about what services are available, how acceptable these services are and what they have achieved. This information is important for determining the future directions of HITH in Australia, as well as providing a valuable resource for service providers and policy makers.Hospital in the home, Australia

Organisatie van geestelijke gezondheidszorg voor kinderen en jongeren : literatuurstudie en internationaal overzicht

INTRODUCTIE: In de laatste decennia van de vorige eeuw werden er in de Westerse landen belangrijke hervormingen ingezet in de sector van de geestelijke gezondheidszorg (GGZ). In de GGZ voor volwassenen kwam er geleidelijk een model van “balanced care” (“gebalanceerde zorg”) op de voorgrond: een diversiteit aan diensten biedt de zorg zo kort mogelijk bij de eigen leefwereld van de patiënt aan, en enkel indien nodig in een instelling. Tegelijkertijd moet men ook een vlotte en naadloze overgang van de ene dienst naar de andere garanderen. Geestelijke gezondheidsproblemen bij kinderen en jongeren zijn niet onfrequent. De WGO (Wereldgezondheidsorganisatie) schat de prevalentie in Westerse landen op ongeveer 20%. Ongeveer 5% zou een klinische tussenkomst nodig hebben. De sector van GGZ voor kinderen en jongeren is pas veel later ontstaan dan deze van de volwassenen, en kent een andere zorgstructuur. Toch dringen de hierboven geschetste hervormingsprincipes ook hier door. Bovendien dient zorg voor kinderen en jongeren vaak over de grenzen van de GGZ sector heen te gebeuren, bijvoorbeeld door de huisarts of kinderarts, en komen veel problemen bij kinderen en jongeren voor het eerst aan het licht buiten de zorgsector, zoals op school. GGZ voor kinderen en jongeren dient dan ook deze zogenaamde “belendende sectoren” mee te betrekken: welzijnswerk, justitie, gehandicaptenzorg, onderwijs. DOELSTELLING: De doelstelling van dit rapport is om kennis bijeen te brengen over organisatorische en financieringsaspecten van GGZ voor kinderen en jongeren, en dit in het licht van de hierboven geschetste context. De specifieke therapie-inhoud blijft buiten beschouwing. Het rapport bestaat uit twee delen: een overzicht van de literatuur en van de organisatie van GGZ voor kinderen en jongeren in België en drie andere landen. Dit rapport formuleert nog geen voorstellen voor de zorgorganisatie in België. Voor dit proces zullen Belgische stakeholders betrokken worden. Het resultaat hiervan zal beschreven worden in een afzonderlijk rapport. METHODE: Zowel voor het literatuuronderzoek als voor het internationale overzicht werd gezocht in databases met peer-reviewed publicaties en in de grijze literatuur. In het literatuuronderzoek werden naast vergelijkend onderzoek ook descriptieve studies en kwalitatief onderzoek geïncludeerd. Voor het internationaal overzicht werd de beschikbare literatuur aangevuld met gegevens van lokale informanten. MODELLEN VAN ZORGORGANISATIE: Dit rapport legt de focus op de meest geciteerde modellen, en die modellen waarvoor er vergelijkend onderzoek gebeurde. De twee meest geciteerde modellen in de literatuur zijn het WGO-model en het Systems of care model. Beide zijn vrij algemeen en vragen verdere uitwerking door het land of de regio die GGZ voor kinderen en jongeren wil implementeren. De meeste vergelijkende studies zijn wel gekenmerkt door talrijke methodologische beperkingen zoals onduidelijke inclusiecriteria, onduidelijke uitkomstmaten of kleine steekproeven. INTERNATIONAAL OVERZICHT: Om redenen van haalbaarheid werd gekozen om dit deel te beperken tot België, Nederland, Canada (British Columbia) en Engeland. De selectie vertrok van een long-list waarop vervolgens een aantal selectiecriteria werden toegepast. CONCLUSIE: Het belang van een nationaal/regionaal beleid voor kinder- en jeugd GGZ, geconcretiseerd in een duidelijk plan, is al langer bekend. Toch is de literatuur over organisatiemodellen binnen kinder- en jeugd GGZ weinig richtinggevend voor beleidsmakers. De twee belangrijkste modellen die in de literatuur aangetroffen werden geven enkel grote beleidslijnen van algemene aard aan. Bovendien zijn de wetenschappelijke studies in dit domein van beperkte kwaliteit en blijft een groot deel van de beleidsvraagstukken niet of onvoldoende onderzocht. Wel kan men uit het onderzoek ivm. het Systems of care besluiten dat de overheid niet enkel een betere zorgorganisatie en –coordinatie dient te stimuleren. Zij dient ook het ontwikkelen en verspreiden van doelmatige therapeutische concepten te bevorderen. Het onderzoek ivm. preventie en behandeling van angststoornissen via scholen toont aan dat men moet durven zoeken naar oplossingen in samenwerking met andere sectoren buiten de gezondheidszorg. In de bestudeerde landen gaan de hervormingen uit van theoretische denkkaders die gebaseerd zijn op belangrijke ethische principes en waarden; deze overlappen in belangrijke mate tussen de verschillende landen. Echter, bij het praktisch realiseren van dit denkkader ondervindt men talrijke moeilijkheden, en in een aantal gevallen mislukt men in de vooropgestelde doelstellingen. Over het daadwerkelijke resultaat van de gevoerde hervormingen zijn er meestal weinig harde gegevens. Wellicht kan men pas tot een positief resultaat komen als zowel klinische, organisatorische, als financiële aspecten alle tegelijk aangepakt worden; en als ook de eigenheid van elk van de betrokken sectoren daarbij niet uit het oog verloren wordt. In de volgende faze van deze studie zullen samen met de Belgische stakeholders voorstellen voor hervormingen geformuleerd worden. De resultaten hiervan worden afzonderlijk gepubliceerd

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Effectiveness on stroke health care: a comparison between Brazil and France

Both healthcare systems were structured as universal access and comprehensive care attention, hierarchized by the level of care, politically and administratively decentralized. To measure the effectiveness of the Brazilian healthcare system, a comparison with another country is desirable. The French healthcare system is considered to be one of the best in the world, the following hypothesis has been developed: Is the French health system more effective in terms of results than the Brazilian in terms of strategies and care in stroke? The general objective was to compare the effectiveness of the Brazilian and French healthcare systems related to stroke care. It was sought to identify the commonalities and discrepancies between both national health policies related to stroke care through the specific objectives that sought to describe health strategies and clinical practice for stroke care in both healthcare systems; to research and to describe the number of acute hospitalizations, the average length of stay in the hospital, hospital mortality rate, deaths and the cost of in-hospital stroke treatment. Methods: Comparison and description of the similarities, differences, or relationships between the data regarding policies, risk factors, and health indicators about stroke care, from 2010 to 2017. The data were obtained from both countries (publicly accessible information or on request) from the respective Ministries of Health or international agencies. As a result, about acute stroke hospitalizations, the in-hospital mortality rate in Brazil was 163 per 1.000 hospitalized people versus 263 in France. The average length of stay of acute hospitalizations was 7.6 days in Brazil versus 12.6 in France. The prevalence of strokes by age group shows from 0 to 39 years old the rate did not show any significant growth or decrease and it can be considered stable; from 40-59 years it was increasing in both countries; from 60-79 and 80+ years this average rate has been increasing in France and decreasing in Brazil. Regarding the acute stroke hospitalizations costs from 2010 to 2017, Brazil had an average expenditure of Power Purchasing Parity $79.579.810.78 per year. France had$446.919.476.40. So, after this result, two hypotheses have been put forward to explain these differences: 1) The cost is lower in Brazil because of the economies of scale? This hypothesis is refuted because even if economies of scale are achieved thanks to larger purchases linked to technologies and materials for health services and the optimization of institutional and professional spaces, this hypothesis is not sufficient to explain the difference observed in-hospital costs between Brazil and France. 2) Can the different ways of allocating and managing costs interfere with the final cost? This hypothesis is plausible but would require further investigation. It would be interesting to calculate the costs of hospitalizations for stroke in France using the absorption method and, in turn, in Brazil calculate then using the Diagnoses Related Group method. In this way, it would be possible to know the difference between both countries. This second hypothesis could neither be refuted nor affirmed. Thus, a third hypothesis has been raised - the exchange difference between Brazil (Real) and France (Euros) would lead to the illusion that Brazil is spending less on hospitalizations for stroke? As the Brazilian currency fluctuates in the international forex market, it devalues over time due to the international economic scenario. Although this is a probable hypothesis, it is outside the scope of this thesis, and, for this reason, it was not be tested. The hypotheses discussed are not sufficient to explain the difference in acute hospitalization costs by stroke between Brazil and France. In conclusion, the initial hypothesis seems refuted. Compared to the French healthcare system, the Brazilian healthcare system is more efficient, and it is more effective in terms of in-hospital average stay and in-hospital mortality rate. To conclude, both healthcare systems are constantly changing to meet new needs and obtain sufficient financial resources to provide a quality service to their population. No major differences were found about the health care policies and the National Health Plans related to stroke. However, the data directly linked to the period of hospitalization differed substantially between countries. Subsequent studies can be implemented to identify the explanatory factors, notably among the risk factors and actions in primary care and the moments after hospital care, such as secondary prevention and palliative care.Les systèmes de santé brésilien et français ont été structurés comme d’accès universel et une prise en charge globale, hiérarchisés par le niveau de soins, décentralisés politiquement et administrativement. Comme le système de santé français est considéré comme l'un des meilleurs au monde l'hypothèse suivante a été élaborée : Est-ce-que le système de santé français est-il plus efficace en résultats que le brésilien en matière de stratégies et soins de santé en cas d’accident vasculaire cérébral ? L'objectif général était de comparer l'efficacité de résultats entre les systèmes de santé brésilien et français liés aux soins de l'Accident Vasculaire Cérébral. L’étude a cherché à identifier les points communs et les divergences entre les deux politiques nationales de santé liées aux soins de l'accident vasculaire cérébral à travers les objectifs spécifiques qui visaient à décrire : les politiques de santé et la pratique clinique pour les soins de l'accident vasculaire cérébral dans les deux systèmes de santé ; de rechercher et de décrire le nombre d'hospitalisations aiguës ; la durée moyenne de séjour à l'hôpital ; le taux de mortalité hospitalière ; les décès et le coût du traitement des accidents vasculaires cérébraux à l'hôpital. Méthodes : Comparaison et description des similitudes, des différences ou des relations entre les données concernant les politiques, les facteurs de risque et les indicateurs de santé concernant les soins de l'accident vasculaire cérébral, de 2010 à 2017. Comme résultats, les données ont été obtenues des deux pays auprès des Ministères de la Santé ou des agences internationales respectifs. Les résultats ont montré que les données directement liées à la période d'hospitalisation entre 2010 et 2017 différaient considérablement d'un pays à l'autre. Par rapport aux hospitalisations dues à un AVC aigu, le taux de mortalité hospitalière au Brésil est de 163 pour 1.000 hospitalisés contre 263 en France. La durée moyenne de séjour des hospitalisations aiguës était de 7.6 jours au Brésil contre 12.6 en France. La prévalence des accident vasculaire cérébraux par tranche d'âge entre 2010 et 2017 montre que pour les 0 à 39 ans le taux n'a pas montré aucune croissance ou diminution importante et peut être considérée comme stable ; des 40-59 ans, il a augmenté dans les deux pays et que de 60-79 ans et 80+ ans, le taux était en augmentation en France alors qu’en baisse au Brésil. Concernant les coûts d'hospitalisation pour AVC aigu de 2010 à 2017, le Brésil avait une dépense moyenne de Parité de Pouvoir d’Achat $79.579.810.78 par an et la France avait$446.919.476.40. Deux hypothèses ont été posées pour expliquer ces différences : 1) le coût est plus faible au Brésil à cause des économies d’échelle ? Cette hypothèse est réfutée car même si des économies d'échelle sont réalisées grâce à des achats plus importants liés aux technologies et aux matériels pour les services de santé ainsi qu’à l'optimisation des espaces institutionnels et professionnels, cette hypothèse ne suffit pas à expliquer la différence constatée entre les coûts d'hospitalisation pour accident vasculaire cérébral au Brésil et en France. 2) La manière différente de répartir et de gérer les coûts peut interférer avec le coût final ? Cette hypothèse est plausible mais nécessiterait une enquête plus approfondie. Il serait intéressant de calculer les coûts des hospitalisations pour accident vasculaire cérébral en France en utilisant la méthode d'absorption et, à son tour, au Brésil, de faire le calcul via le système Diagnoses Related Group. De cette façon, il serait possible de connaître la différence exacte entre les coûts de chaque pays. Comme cette seconde hypothèse ne pouvait être ni réfutée ni affirmée, une troisième hypothèse a été soulevée : la différence de change entre le Brésil (Real) et la France (Euros) conduirait à l'illusion que le Brésil dépense moins en hospitalisations pour accident vasculaire cérébral ? Au fur et à mesure que la monnaie brésilienne fluctue sur le marché des changes international, elle se dévalue avec le temps à cause du scénario économique international. Bien qu'il s'agisse d'une hypothèse probable, elle sort du cadre de cette thèse et, pour cette raison, elle ne fera pas l'objet de recherches. Les hypothèses discutées ne sont pas suffisantes pour expliquer la différence des coûts d'hospitalisation aiguë pour cause d’AVC entre le Brésil et la France. En conclusion, l'hypothèse initiale semble réfutée. Le système de santé brésilien par rapport au système de santé français est plus efficient et il est plus efficace en résultats en ce qui concerne le séjour moyen à l'hôpital et pour le taux de mortalité hospitalière. Les deux systèmes de santé sont en constante évolution pour répondre aux nouveaux besoins et obtenir des ressources financières suffisantes pour fournir un service de qualité à leur population. Aucune différence majeure n'a été trouvée concernant les politiques de santé et les plans nationaux de santé liés à l'AVC. Des études ultérieures peuvent être mises en oeuvre pour identifier les facteurs explicatifs, notamment parmi les facteurs de risque et les actions en soins primaires, et la prise en charge après les soins hospitaliers aigus en termes de prévention secondaire, de réhabilitation, voire en soins palliatifs

Emerging Practices in Intergovernmental Functional Assignment

Attaining the benefits of (especially fiscal) decentralization in government remains an enduring challenge, in part because the re-arrangement of public functions across levels of government has often been carried out poorly. This book aims to provide a firmer conceptual basis for the re-arrangement of public functions across levels of government. In doing so, it offers practical advice for policy makers from developing and emerging countries and development cooperation practitioners engaged in such activity. Combining a theoretical approach for inter-governmental functional assignment with an in-depth analysis of real-life country cases where functional assignment (FA) has been supported in the context of international development cooperation, it underscores the common technical and political challenges of FA, and also demonstrates the need to expect and support country made and context-specific solutions to FA processes and results. Examples are drawn from a number of developing/transition countries from the Asia-Pacific region, Africa and the OECD, which outline and suggest advisory approaches, tools, principles and good practices and approaches. This text will be of key interest to scholars, students, policy-makers and practitioners in public policy, decentralization, local governance studies, public administration and development administration/studies. The Open Access version of this book, available at www.taylorfrancis.com, has been made available under a Creative Commons Attribution-Non Commercial-No Derivatives 4.0 license

Nursing care models in primary care and hospital settings: implementation and evaluation

In the last year, the COVID\u201119 pandemic has made clear how vulnerabilities in health systems can have profound implications for the health of people. Thus, organizations are taking in place significant changes which are also influencing nursing staff and the nursing care model. This dissertation aims to: 1) explore the effects of primary nursing on patient, -staff,-organizational-related outcomes in hospital settings; 2) identify barriers and facilitators of nursing role implementation in primary care; and 3) assess the effects of the family and community nursing (FCN) practice model on patient-, organizational-related outcomes. Method. To reach aim 1 a multi-centre, prospective before-after study is performed. Primary outcome are healthcare-associated infections. Also, staff-related outcomes are included. To reach aim 2 an integrative literature review was conducted. It combines data from quantitative and qualitative studies from two databases searches (Medline and CINAHL) up to 09 June 2020. Data extraction and identification of emerging themes are performed using the Consolidating Framework for Research Implementation (CFIR). To reach aim 3 a prospective controlled study was designed. The study will recruit older and frail residents in municipalities belonging to Community Health Centres (CHC) of Santhi\ue0 and Gattinara (Local Health Authority of Vercelli). The Intervention is the FCN and it is allocating in one of the CHC. Primary outcome is hospitalization. Results. In this dissertation, the results of the integrative literature review are listed. 56 papers met the inclusion criteria. The major barriers identified are related to: i) the limited availability of nursing special education, ii) legislations and regulations, iii) organizational setting in which nurse\u2019s role implementation is embedded; and iv) lack of nurse\u2019s role clarity among stakeholders. Major facilitators include: i) prior planning for role introduction and nurses\u2019 involvement in the early stage of role implementation, ii) job satisfaction and nurses\u2019 access to high-quality education, iii) successful doctor-nurse collaboration. Finally, the two study protocols were submitted to the Local Ethics Committee. The before-after study has begun in 2019 with 10 Centres enrolled. Actually, the study has recruited 422 patients and 94 nurses. Discussion. Implementation and evaluation of the nurse\u2019s role in primary care and hospital settings are complex interventions due to several components which interact with each other. In this regard, the Medical Research Council framework has been used to guide the development and evaluation of complex interventions, related to nursing research and practice. Despite using this framework, two different studies have been designed to explore how the nursing care model works and its effects. The studies are still suspended due to restrictions imposed by the ongoing COVID-19 pandemic

Adolescent reproductive health in Cameroon : prevention of adolescent pregnancies through access to sexual and reproductive health measures in Cameroon

Preventing adolescent pregnancies and improving adolescent reproductive health are important as they not only touch on more tangible issues like maternal and child mortality, but also have a long-term effect on any country’s basic wellbeing, from economic growth to societal and cultural development, to gender and equality issues. Nevertheless, pregnancies in adolescence still represent an important health challenge in the sub-Saharan country of Cameroon. This study seeks to establish a better understanding of the current reproductive health situation for adolescents in Cameroon and determine if adolescents have the means available to prevent early age pregnancy. Its main objectives are to answer these questions: 1) What is the Cameroonian government doing with respect to health polices and sexual health programs in order to prevent adolescents from early pregnancies, and what are the main outcomes of any health programs implemented? 2) What are the main barriers limiting improvement of adolescents’ sexual and reproductive health situation in Cameroon? This study uses a review-based method to explore literature on the subject of adolescent reproductive health in Cameroon. The review considers the background to the current adolescent reproductive health situation in Cameroon, and describes the policies and programs used in efforts to meet the country’s reproductive health needs. The main findings show that the Cameroonian government has a set of written health policies, dating back to the early 1990s, which touch on reproductive health, but none of them specifically address the issues of the subject among adolescents in Cameroon. Most of the implemented reproductive health programs have been short-term efforts headed up by non-governmental entities. Among these initiatives, the “Aunties program” and those based on peer education have shown the most effectiveness and promise among adolescents. Overall the efforts expended so far have regrettably been inadequate. The main barriers limiting the improvement of sexual and reproductive health in Cameroon can be summarised as: lack of existence of and access to qualified “adolescent-friendly” health facilities and personnel, lack of political will in development and implementation of nationwide health policies and programs, and a too short time-frame for the programs implemented. The situation is further complicated by structural, political, cultural and religious factors that have created a standstill and frequent unwillingness to move towards progress in bettering the reproductive health situation of Cameroonian adolescents.Master in International Social Welfare and Health Polic

Semantic discovery and reuse of business process patterns

Patterns currently play an important role in modern information systems (IS) development and their use has mainly been restricted to the design and implementation phases of the development lifecycle. Given the increasing significance of business modelling in IS development, patterns have the potential of providing a viable solution for promoting reusability of recurrent generalized models in the very early stages of development. As a statement of research-in-progress this paper focuses on business process patterns and proposes an initial methodological framework for the discovery and reuse of business process patterns within the IS development lifecycle. The framework borrows ideas from the domain engineering literature and proposes the use of semantics to drive both the discovery of patterns as well as their reuse

Thirty Years of Rwandan-German Development Cooperation in the Health Sector. Vol. I: Evaluation Report

The evaluation was conducted by DEval between July 2012 and October 2013. The results shed light on how development cooperation in one sector (health) has developed over many years, while experiencing changing political and socioeconomic contexts and aid modalities. By documenting the entire process, including the phasing out and identifying of successful approaches, Rwandan partners can use the findings for their own management of the health sector and their cooperation with other development partners. GDC, at the same time, can draw lessons for future support to sector development in partner countries