The use and predictive performance of the Peninsula Health Falls Risk Assessment Tool (PH-FRAT) in 25 residential aged care facilities : a retrospective cohort study using routinely collected data

Background: The Peninsula Health Falls Risk Assessment Tool (PH-FRAT) is a validated and widely applied tool in residential aged care facilities (RACFs) in Australia. However, research regarding its use and predictive performance is limited. This study aimed to determine the use and performance of PH-FRAT in predicting falls in RACF residents. Methods: A retrospective cohort study using routinely-collected data from 25 RACFs in metropolitan Sydney, Australia from Jul 2014-Dec 2019. A total of 5888 residents aged ≥65 years who were assessed at least once using the PH-FRAT were included in the study. The PH-FRAT risk score ranges from 5 to 20 with a score > 14 indicating fallers and ≤ 14 non-fallers. The predictive performance of PH-FRAT was determined using metrics including area under receiver operating characteristics curve (AUROC), sensitivity, specificity, sensitivityEvent Rate(ER) and specificityER. Results: A total of 27,696 falls were reported over 3,689,561 resident days (a crude incident rate of 7.5 falls /1000 resident days). A total of 38,931 PH-FRAT assessments were conducted with a median of 4 assessments per resident, a median of 43.8 days between assessments, and an overall median fall risk score of 14. Residents with multiple assessments had increased risk scores over time. The baseline PH-FRAT demonstrated a low AUROC of 0.57, sensitivity of 26.0% (sensitivityER 33.6%) and specificity of 88.8% (specificityER 82.0%). The follow-up PH-FRAT assessments increased sensitivityER values although the specificityER decreased. The performance of PH-FRAT improved using a lower risk score cut-off of 10 with AUROC of 0.61, sensitivity of 67.5% (sensitivityER 74.4%) and specificity of 55.2% (specificityER 45.6%). Conclusions: Although PH-FRAT is frequently used in RACFs, it demonstrated poor predictive performance raising concerns about its value. Introducing a lower PH-FRAT cut-off score of 10 marginally enhanced its predictive performance. Future research should focus on understanding the feasibility and accuracy of dynamic fall risk predictive tools, which may serve to better identify residents at risk of falls

Rural and urban differences in health system performance among older Chinese adults : Cross-sectional analysis of a national sample

Background: Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method: We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings: Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). Conclusion: Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities

Trends of public health research output from India during 2001-2008

BACKGROUND: An understanding of how public health research output from India is changing in relation to the disease burden and public health priorities is required in order to inform relevant research development. We therefore studied the trends in the public health research output from India during 2001-2008 that was readily available in the public domain. METHODS: The scope and type of the published research from India in 2007 that was included in the PubMed database was assessed and compared with a previous similar assessment for 2002. Papers were classified based on the review of abstracts and original public health research papers were assessed in detail. Impact factors for the journals were used to compute quality-adjusted research output. The websites of governmental organizations, academic and research institutions and international organizations were searched in order to identify and review reports on original public health research produced in India from 2001 to 2008. The reports were classified based on the topics covered and quality and their trends over time were assessed. RESULTS: The number of original health research papers from India in PubMed doubled from 4494 in 2002 to 9066 in 2007. This included a 3.1-fold increase in public health research papers, but these comprised only 5% of the total papers in 2007. Within public health, the increase was lowest for the health system and policy category. Several major causes of disease burden in India continued to be underrepresented in the quality-adjusted public health research output in 2007. The number of papers evaluating population health interventions increased from 2002 to 2007, but there were none on the leading non-communicable causes of disease burden or on road traffic injuries. The number of identified original public health research reports increased by 64.7% from 204 in 2001-2004 to 336 in 2005-2008. The proportion of reports on reproductive and child health was very high but decreased slightly from 38.7% of the total in 2001-2004 to 31.5% in 2005-2008 (P = 0.09); those on the leading chronic non-communicable conditions and injuries increased from 6.4% to 13.4% (P = 0.01) but this was still much lower than their contribution to the disease burden. Health system/policy issues were the topic in 27.4% reports but health information issues were covered in a miniscule 0.6% reports. The proportion of reports that were evaluations increased slightly from 26% in 2001-2004 to 31.5% in 2005-2008, with this proportion being higher among the reports commissioned by international organizations (P < 0.001). The proportion of reports commissioned by Indian governmental organizations alone, or in collaboration with international organizations, doubled from 2001-2004 to 2005-2008 (P < 0.001). Only 25% of the total 540 reports had a quality score of adequate or better. The quality of reports produced by collaborations between Indian and international organizations was higher than those produced by Indian or international organizations alone (P < 0.001). CONCLUSION: This is the first analysis from India that includes research reports in addition to published papers. It provides the most up-to-date understanding of public health research output from India. The increase in available public health research output and the increase in commissioning of this research by Indian governmental organizations are encouraging. However, the distribution of research topics and the quality of research reports continue to be unsatisfactory. It is necessary for health policy to address these continuing deficits in public health research in order to reduce the very large disease burden in India.13 page(s

Essential health information available for India in the public domain on the internet

<p>Abstract</p> <p>Background</p> <p>Health information and statistics are important for planning, monitoring and improvement of the health of populations. However, the availability of health information in developing countries is often inadequate. This paper reviews the essential health information available readily in the public domain on the internet for India in order to broadly assess its adequacy and inform further development.</p> <p>Methods</p> <p>The essential sources of health-related information for India were reviewed. An extensive search of relevant websites and the PubMed literature database was conducted to identify the sources. For each essential source the periodicity of the data collection, the information it generates, the geographical level at which information is reported, and its availability in the public domain on the internet were assessed.</p> <p>Results</p> <p>The available information related to non-communicable diseases and injuries was poor. This is a significant gap as India is undergoing an epidemiological transition with these diseases/conditions accounting for a major proportion of disease burden. Information on infrastructure and human resources was primarily available for the public health sector, with almost none for the private sector which provides a large proportion of the health services in India. Majority of the information was available at the state level with almost negligible at the district level, which is a limitation for the practical implementation of health programmes at the district level under the proposed decentralisation of health services in India.</p> <p>Conclusion</p> <p>This broad review of the essential health information readily available in the public domain on the internet for India highlights that the significant gaps related to non-communicable diseases and injuries, private health sector and district level information need to be addressed to further develop an effective health information system in India.</p

Data sources for measuring the socioeconomic gradient of hypertension in rural populations of low- and middle-income countries [letter to the editor]

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Are interventions to reduce interruptions and errors during medication administration effective? : a systematic review

Background Medication administration errors are frequent and lead to patient harm. Interruptions during medication administration have been implicated as a potential contributory factor. Objective To assess evidence of the effectiveness of interventions aimed at reducing interruptions during medication administration on interruption and medication administration error rates. Methods In September 2012 we searched MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Effective Practice and Organisation of Care Group reviews, Google and Google Scholar, and hand searched references of included articles. Intervention studies reporting quantitative data based on direct observations of at least one outcome (interruptions, or medication administration errors) were included. Results Ten studies, eight from North America and two from Europe, met the inclusion criteria. Five measured significant changes in interruption rates pre and post interventions. Four found a significant reduction and one an increase. Three studies measured changes in medication administration error rates and showed reductions, but all implemented multiple interventions beyond those targeted at reducing interruptions. No study used a controlled design pre and post. Definitions for key outcome indicators were reported in only four studies. Only one study reported κ scores for inter-rater reliability and none of the multi-ward studies accounted for clustering in their analyses. Conclusions There is weak evidence of the effectiveness of interventions to significantly reduce interruption rates and very limited evidence of their effectiveness to reduce medication administration errors. Policy makers should proceed with great caution in implementing such interventions until controlled trials confirm their value. Research is also required to better understand the complex relationship between interruptions and error to support intervention design.8 page(s

The Quality of police data on RTC fatalities in India

BACKGROUND: Police records are the major source of data on road traffic collision (RTC) deaths in India. OBJECTIVE: To examine the utility and quality of police data on RTC deaths available from two sources. METHODS: Police data on RTC deaths available from National Crime Records Bureau (NCRB) and Ministry of Road Transport and Highways (MoRTH) were accessed. The utility of these data for surveillance and consistency of data reported by the two organisations was examined. Data completeness was assessed for India, its six geographic regions and for the mode of travel using cause of death estimates from the Sample Registration System (SRS) and Global Burden of Disease (GBD) as a reference. RESULTS: Data imperative for surveillance including deaths by age and sex for each state, the counterpart vehicle or object and use of safety equipment were not available. The total number of deaths reported by NCRB and MoRTH was similar across states but showed large differences by mode of travel categories. Compared with GBD, completeness of the number of fatalities reported by both sources in 2010 was approximately 50%. Completeness for the geographic regions ranged from 26.4% to 76.4%, using SRS data, in 2001-2003. CONCLUSIONS: This detailed examination of police data on RTC fatalities from two sources has raised several questions about the validity of these data and has highlighted a number of gaps that limit the usefulness of these data for surveillance and informing road safety policies. Unless these are addressed, significant reductions in RTC fatalities cannot be achieved in India.9 page(s

Variations in catastrophic health expenditure estimates from household surveys in India

OBJECTIVE: To assess the comparability of out-of-pocket (OOP) payment and catastrophic health expenditure (CHE) estimates from different household surveys in India. METHODS: Data on CHE, outpatient and inpatient OOP payments and other expenditure from all major national or multi-state surveys since 2000 were compared. These included two consumer expenditure surveys (the National Sample Survey for 2004-05 [NSS 2004-05] and 2009-10 [NSS 2009-10]) and three health-focused surveys (the World Health Survey 2003 [WHS 2003]; the National Sample Survey on Morbidity, Health Care and the Condition of the Aged 2004 [NSS 2004]; and the Study on Global Ageing and Adult Health 2007-08 [SAGE 2007-08]). All but the NSS 2004-05 and the NSS 2009-10 used different questionnaires. FINDINGS: CHE estimates from WHS 2003 and SAGE 2007-08 were twice as high as those from NSS 2004-05, NSS 2009-10 and NSS 2004. Inpatient OOP payment estimates were twice as high in WHS 2003 and SAGE 2007-08 because in these surveys a much higher proportion of households reported such payments. However, estimates of expenditures on other items were half as high in WHS 2003 as in the other surveys because a very small number of items was used to capture these expenditures. CONCLUSION: The wide variations observed in CHE and OOP payment estimates resulted from methodological differences. Survey methods used to assess CHE in India need to be standardized and validated to accurately track CHE and assess the impact of recent policies to reduce it.10 page(s

Analysis of evaluations of health system/policy interventions in India

BACKGROUND. Analysis of the scope and quality of evaluations of health system/policy interventions done in India is not available. Such analysis can help in conducting more useful evaluations. METHODS. We accessed evaluation reports of health system/ policy interventions aimed at improving population health in India, reported during 2001-08, which were available in the public domain through extensive internet searches. We developed and used a classification system for the type of evaluation, commissioning agency, health system/policy area covered and methodology used, and a method for assessing the quality of evaluation reports. RESULTS. Of the 219 total evaluation reports in the public domain, 6% assessed needs, 22% process, 42% outcome and 30% impact. Seventy-six per cent evaluations were commissioned by international agencies. Among health system components, services were the focus of evaluation in 74.9% of reports, with human resources, financing, drugs/products, information system and governance having little representation. Only 21% of evaluation reports were rated as good quality. Among evaluations based mainly on health system data, 42% were poor quality compared with 20% that were based on population data. Seventy-two per cent of the outcome/impact evaluations presented only basic tabulations and just 12% attempted multivariate analysis. Eighty-two per cent of the outcome/impact evaluations had no controls, among which 42% were poor quality versus 17% poor quality among outcome/impact evaluations with controls. Among the 54% evaluations in which the intervention implementer was involved, only 1% reported negative conclusion about the intervention compared with 37% among evaluations in which the implementer was not involved. CONCLUSION. This analysis of health system/policy intervention evaluation reports from India identifies specific areas that need improvement. We recommend that Indian agencies should commission more evaluations as international agencies currently dominate, involvement of intervention implementer in the evaluation needs scrutiny as potential bias is suggested by our analysis, and health system components other than services need more attention. Outcome/impact evaluations need to incorporate controls in design and multivariate techniques more often in their analysis to achieve higher quality robust evaluations in India.6 page(s