Criteria for vaccine introduction: results of a DELPHI discussion among international immunisation experts on a stepwise decision-making procedure

Background: Based on a model of a stepwise approach for decision-making on vaccine introduction, this study aimed to reveal unpublished decision aids, to assess cut-off limits or thresholds for vaccine introduction that have already been used, and to discuss the comprehensiveness and feasibility of our suggested model. Methods: Forty international immunisation experts were invited to a DELPHI discussion, 14 finally participated. Experts received a questionnaire and were asked for comments on other experts’ opinions and specification of their previously given answers in the second DELPHI round. We did not intend to develop a consensus document. Results: Though most of the DELPHI participants were not aware of decision aids other than the five that had been used for the development of our model, the international discussion revealed four additional national documents that define decision-making criteria. Except for one example with a cost-utility ratio, no defined thresholds or cut-off limits have been used in vaccine introduction decisions so far. The majority of experts believe that a stepwise approach could enhance the feasibility of decision aids. The experts agreed that the influence of each single criterion of our model should be at least “important” for decision-making. The most often mentioned possible negative consequence that could arise from a rigid stepwise procedure, was a delay of the vaccine introduction process. Conclusions: The suggested stepwise procedure provides a systematic and evidence-based standardised way to support public health immunisation policy decisions. A framework could be a common starting point

Diagnosis and Treatment of Cystinosis - Systematic Review Protocol for a Clinical Practice Guideline

The aim of this systematic review is to search, select, and critically assess the evidence on diagnosis and treatment of cystinosis and generate evidence profiles to support decision making of the guideline developers

Hebammenberatung im Rahmen des Mutter-Kind-Passes

Seit 2013 wird Schwangeren im Rahmen des Österreichischen Mutter-Kind-Pass Programms die optionale Leistung einer kostenlosen Beratung durch Hebammen angeboten. Der Evaluierung dieser Beratungsleistung liegen insbesondere Fragestellungen nach Erfassungsgrad, Inanspruchnahme, Charakteristika der Mütter bzw. Geburten sowie deren Unterstützungsbedarf zugrunde. Darüber hinaus sollten Inanspruchnahme und Verbesserungsbedarf des Online-Tools zur webbasierten Dokumentation der Beratungen analysiert werden. Für die Evaluierung wurden sowohl die Datenbank des Hebammengremiums Österreich als aktuell datenhaltende Stelle der Dokumentation als auch spezifische Auswertungen aus dem Geburtenregister Österreich herangezogen und um statistische Vergleichsdaten, u. a. von Statistik Austria, ergänzt. Österreichweit wurde im Jahr 2016 für rund 22 Prozent aller Geburten eine kostenlose Beratung durch eine Hebamme im Rahmen des Mutter-Kind-Passes abgerechnet, 84 Prozent dieser Beratungen wurden dokumentiert, wobei der Dokumentationsgrad zwischen den Bundesländern schwankt. Frauen, die eine Hebammenberatung in Anspruch nehmen, weisen einen besseren sozioökonomischen Status auf (z. B. höherer Bildungsgrad) und schneiden in Bezug auf schwangerschaftsrelevante Variablen (z. B. Rauchen in der Schwangerschaft) positiver ab. Deutlich mehr Erstgebärende und vermutlich auch Frauen mit speziellen Fragen/Vorgeschichten nehmen die Beratung in Anspruch. Die Auswirklungen der Beratung auf Schwangerschaft und Geburt können auf Basis der vorliegenden Daten nicht abschließend beurteilt werden. Aufgrund der bisherigen Analysen wird empfohlen, künftig gezielt Frauen zur Beratung zu motivieren, die bislang eher unterrepräsentiert sind (z. B. Frauen mit geringer Schulbildung, erwerbslose Frauen, Migrantinnen). (...

Study on Cross-Border Cooperation: Capitalising on existing initiatives for cooperation in cross-border regions Final report

The study investigates past achievements and potential future developments in the field of cross-border healthcare collaboration. The findings are based on a mapping of EUfunded cross-border healthcare initiatives, foresight modelling for cross-border healthcare in 2030, a systematic literature review on fraud and fraud mitigation in crossborder healthcare and an evaluation of take-up of the Joint Action on Patient Safety and Quality of Care (PaSQ). The study also provides practical tools to assist stakeholders, including local and regional authorities, who intend to start a cross-border healthcare collaboration project. The study enhances an in-depth understanding of cross-border healthcare collaborations and provides new knowledge to the field on different aspects of cross-border healthcare research. Seven lessons are summarised in the following: 1. Cross-border healthcare initiatives are more effective in regions where ease of cooperation is already established, e.g. due to similar welfare traditions or close historical ties. 2. Support should be given to key players such as regional policy-makers or hospital managers to reduce transaction costs of cross-border healthcare. The toolbox developed in this study can provide help1. 3. There are several scenarios for future cross-border healthcare, one of the most realistic ones being one which builds regional networks oriented towards addressing local and regional needs. 4. Regional networks are likely to represent a low-cost option, but the downsides are that they are likely to remain small-scale and they may create inequities by not benefiting all regions equally. 5. Top categories of cross-border healthcare initiatives to receive EU-funding over the past 10 years are 1) knowledge sharing and management, and 2) shared treatment & diagnosis of patients. 6. Collaborations such as high-cost capital investments and emergency care tend to have more discernible economic and social benefits, but require more formalised terms of cooperation. 7. Although information on the effectiveness and sustainability of current cross-border healthcare initiatives is scarce, funding of CBHC projects could help achieve these aim