Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions

Pain experiences and intrapersonal change among patients with chronic non-cancer pain after using a pain diary: a mixed-methods study

Fa-ngam Charoenpol,1 Nuj Tontisirin,2 Borwornsom Leerapan,3 Rattaphol Seangrung,2 Roderick J Finlayson4 1Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; 2Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 4Department of Anesthesia, Alan Edwards Pain Management Unit, McGill University, Montreal, QC, Canada Objective: Pain diaries are a valuable self-assessment tool; however, their use in chronic non-cancer pain has received limited attention. In this study, we examined the effect of pain diary use on pain intensity, interference, and intrapersonal change in patients with chronic non-cancer pain.Method: A convergent mixed-methods design was used to prospectively evaluate a cohort of 72 patients. Daily pain intensity and weekly pain-interference were self-reported using pain diaries for a 4-week period. Outcomes were assessed by examining changes in pain scores (primary outcome) as well as the Brief Pain Inventory and Short-form McGill Pain Questionnaire-2. In addition, qualitative data obtained from pain diary entries and focus-group interviews were analyzed using thematic content analysis.Results: Pain intensity and average pain scores were significantly lower after using the diaries. Participants reported less pain interference in mood, walking ability, normal work, and enjoyment of life. No differences were found in SF-MPQ-2 scores. Qualitative analysis indicated that better pain recognition and more effective communication with care providers led to improved self-management and more effectual treatment plans.Conclusion: Use of a pain diary in patients with chronic non-cancer pain was associated with reduced pain intensity and improved mood as well as function. Further controlled trials examining the long-term effects of pain diaries are warranted. Keywords: pain diary, chronic non-cancer pain, pain experience, interpersonal change, mixed-methods researc