Value-based healthcare in Catalonia: challenges and opportunities to contribute to the future

Atenció sanitària basada en el valor; Serveis de salut; Nous models assistencialsAtención sanitaria basada en el valor; Servicios de salud; Nuevos modelos asistencialesValue-based Healthcare; Health services; New healthcare modelsL'atenció sanitària basada en el valor -en anglès Value-Based Healthcare (VBHC)- representa un nou paradigma en la provisió de serveis de salut. L'AQuAS publica aquest treball de reflexió on s'explora la definició d'aquest nou paradigma i es proposa un nou model que permeti incrementar el valor de l'atenció sanitària al sistema de salut de CatalunyaThe health care based on the value -in English Value-Based Healthcare (VBHC) - represents a new paradigm in the provision of health services. Published work explores reflection on the definition of this new paradigm and proposes a new model that would increase the value of health care in the health system of Catalonia.La atención sanitaria basada en el valor -en inglés Value-Based Healthcare (VBHC) - representa un nuevo paradigma en la provisión de servicios de salud. El AQuAS publica este trabajo de reflexión donde se explora la definición de este nuevo paradigma y se propone un nuevo modelo que permita incrementar el valor de la atención sanitaria en el sistema de salud de Cataluña

Com ha anat el primer PERIS d’infermeria?: anàlisi de l'impacte immediat i directe de la recerca infermera del PERIS 2017

Recerca sanitària; PERIS; InfermeriaInvestigación sanitaria; PERIS; EnfermeríaHealth research; PERIS; NurseryLa convocatòria del PERIS del 2017 ha afavorit, per primera vegada, la intensificació en investigació als professionals infermers i infermeres. Durant un període màxim de nou mesos aquesta intensificació ha permès alliberar aquests professionals de les tasques assistencials per desenvolupar activitats de recerca. El present monogràfic recull una anàlisi sistèmica de l’estat de situació indicant el que ha suposat aquesta convocatòria pel que fa a oportunitats per als professionals intensificats i beneficis per al sistema de salut. Això s’ha fet a través de l’anàlisi de text de les Instantànies de Recerca, unes fitxes que van emplenar els beneficiaris dels ajuts al final del període sobre l’experiència, la recerca, els seus resultats i els beneficis obtinguts. Els beneficis per al sistema i les oportunitats que ha suposat per als 61 professionals intensificats es pot resumir en la generació de coneixement divers i heterogeni que ha impactat tant en l’àmbit assistencial com en l’àmbit de recerca, generant valor, reconeixement i visibilitat a la recerca en infermeria, influència en les actituds dels professionals del seu entorn, reforçant relacions professionals i col·laboracions, creant noves competències formals (tesis doctorals) i informals, interaccions amb els usuaris del coneixement (siguin professionals o altres investigadors) i, en última instància, aplicant els resultats als processos assistencials, a les intervencions sanitàries i als programes. Les oportunitats necessiten, tanmateix, un suport sostingut, sobretot perquè molts dels beneficis que aquí es relaten impliquen un canvi cultural per al col·lectiu de professionals de la salut que no es fa en un, dos o tres anys. És doncs important que aquest camí encetat continuï amb un suport institucional com ja s’està fent i també amb un suport mutu i cooperació entre professionals,que les sessions del SARIS van intentar iniciar i reforçar

Women’s pelvic floor muscle strength and urinary and anal incontinence after childbirth: a cross-sectional study

Abstract OBJECTIVE To analyse pelvic floor muscle strength (PFMS) and urinary and anal incontinence (UI and AI) in the postpartum period. METHOD Cross-sectional study carried out with women in their first seven months after child birth. Data were collected through interviews, perineometry (Peritron™), and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). RESULTS 128 women participated in the study. The PFMS mean was 33.1 (SD=16.0) cmH2O and the prevalence of UI and AI was 7.8% and 5.5%, respectively. In the multiple analyses, the variables associated with PFMS were type of birth and cohabitation with a partner. Newborn’s weight, previous pregnancy, UI during pregnancy, and sexual activity showed an association with UI after child birth. Only AI prior to pregnancy was associated with AI after childbirth. CONCLUSION Vaginal birth predisposes to the reduction of PFMS, and caesarean section had a protective effect to its reduction. The occurrence of UI during pregnancy is a predictor of UI after childbirth, and women with previous pregnancies and newborns with higher weights are more likely to have UI after childbirth.AI prior to pregnancy is the only risk factor for its occurrence after childbirth. Associations between PFMS and cohabitation with a partner, and between UI and sexual activity do not make possible to conclude that these variables are directly associated

Understanding factors associated with the translation of cardiovascular research: A multinational case study approach

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.This article has been made available through the Brunel Open Access Publishing Fund.Background: Funders of health research increasingly seek to understand how best to allocate resources in order to achieve maximum value from their funding. We built an international consortium and developed a multinational case study approach to assess benefits arising from health research. We used that to facilitate analysis of factors in the production of research that might be associated with translating research findings into wider impacts, and the complexities involved. Methods: We built on the Payback Framework and expanded its application through conducting co-ordinated case studies on the payback from cardiovascular and stroke research in Australia, Canada and the United Kingdom. We selected a stratified random sample of projects from leading medical research funders. We devised a series of innovative steps to: minimize the effect of researcher bias; rate the level of impacts identified in the case studies; and interrogate case study narratives to identify factors that correlated with achieving high or low levels of impact. Results: Twenty-nine detailed case studies produced many and diverse impacts. Over the 15 to 20 years examined, basic biomedical research has a greater impact than clinical research in terms of academic impacts such as knowledge production and research capacity building. Clinical research has greater levels of wider impact on health policies, practice, and generating health gains. There was no correlation between knowledge production and wider impacts. We identified various factors associated with high impact. Interaction between researchers and practitioners and the public is associated with achieving high academic impact and translation into wider impacts, as is basic research conducted with a clinical focus. Strategic thinking by clinical researchers, in terms of thinking through pathways by which research could potentially be translated into practice, is associated with high wider impact. Finally, we identified the complexity of factors behind research translation that can arise in a single case. Conclusions: We can systematically assess research impacts and use the findings to promote translation. Research funders can justify funding research of diverse types, but they should not assume academic impacts are proxies for wider impacts. They should encourage researchers to consider pathways towards impact and engage potential research users in research processes. © 2014 Wooding et al.; licensee BioMed Central Ltd.RAND Europe and HERG, with subsequent funding from the NHFA, the HSFC and the CIHR. This research was also partially supported by the Policy Research Programme in the English Department of Health

Organitzacions saludables: fem salut, fem ioga

Organitzacions saludables; Ioga; Salut públicaOrganizaciones saludables; Yoga; Salud públicaHealthy organizations; Yoga; Public healthAmb l’objectiu de dissenyar un programa fonamentat en la promoció d’organitzacions saludables a través d’una intervenció específica de ioga, es va crear la Comunitat de Pràctica (CoP) Fem salut, fem ioga. Perquè una organització esdevingui saludable ha de permetre als treballadors conciliar la vida laboral amb la familiar, promoure horaris raonables, difondre la cura de la salut amb l’exemple, facilitar un bon ambient laboral i fer prevaldre el treball en equip inter i multidisciplinari i la cooperació per assolir les fites establertes, en alineació amb els objectius de l’empresa. També ha d’animar els treballadors a participar en obres socials i fer educació en salut, tant per als empleats com per als grups amb què es relaciona. Una de les maneres més habituals de promocionar una organització saludable és crear programes adreçats als treballadors que continguin accions concretes, com pot ser, per exemple, la implementació d’un programa de pràctica de ioga. Les malalties causades pels entorns laborals acostumen a estar relacionades amb problemes osteoarticulars (cervicàlgies, lumbàlgies...) i amb la gestió de l’estrès5,6. La pràctica del ioga pot ajudar a prevenir aquest tipus de problemes o a minimitzar-ne els efectes. Com a resultat final es va definir, implementar i avaluar una intervenció pilot de ioga a l’entorn laboral (en aquest cas, institucions governamentals) per a fomentar organitzacions saludables.Con el objetivo de diseñar un programa fundamentado en la promoción de organizaciones saludables a través de una intervención específica de yoga, se creó la Comunidad de Práctica (CoP) Hacemos salud, hacemos yoga. Para que una organización sea saludable debe permitir a los trabajadores conciliar la vida laboral con la familiar, promover horarios razonables, difundir el cuidado de la salud con el ejemplo, facilitar un buen ambiente laboral y primar el trabajo en equipo inter y multidisciplinar y la cooperación para alcanzar las metas establecidas, en alineación con los objetivos de la empresa. También debe animar a los trabajadores a participar en obras sociales y hacer educación en salud, tanto para los empleados como para los grupos con los que se relaciona. Una de las formas más habituales de promocionar una organización saludable es crear programas dirigidos a los trabajadores que contengan acciones concretas, como puede ser, por ejemplo, la implementación de un programa de práctica de yoga. Las enfermedades causadas por los entornos laborales suelen estar relacionadas con problemas osteoarticulares (cervicalgias, lumbalgias...) y con la gestión del estrés5,6. La práctica del yoga puede ayudar a prevenir este tipo de problemas o minimizar sus efectos. Como resultado final se definió, implementó y evaluó una intervención piloto de yoga en el entorno laboral (en este caso, instituciones gubernamentales) para fomentar organizaciones saludables.In order to design a program based on the promotion of organizations health through a specific yoga intervention, the Community of Practice (CoP) We do health, we do yoga. For an organization to be healthy, it must allow workers to reconcile work and family life, promote reasonable hours, disseminate health care by example, facilitate a good work environment, and prioritize inter and multidisciplinary teamwork and cooperation. to achieve the established goals, in alignment with the objectives of the company. It should also encourage workers to participate in social projects and health education, both for employees and for the groups with which they are related. One of the most common ways to promote a healthy organization is to create programs aimed at workers that contain specific actions, such as, for example, the implementation of a yoga practice program. Illnesses caused by work environments are usually related to osteoarticular problems (neck pain, low back pain...) and stress management5,6. The practice of yoga can help prevent these types of problems or minimize their effects. As a final result, a pilot yoga intervention was defined, implemented and evaluated in the work environment (in this case, government institutions) to promote healthy organizations

A global call for action to include gender in research impact assessment

Global investment in biomedical research has grown significantly over the last decades, reaching approximately a quarter of a trillion US dollars in 2010. However, not all of this investment is distributed evenly by gender. It follows, arguably, that scarce research resources may not be optimally invested (by either not supporting the best science or by failing to investigate topics that benefit women and men equitably). Women across the world tend to be significantly underrepresented in research both as researchers and research participants, receive less research funding, and appear less frequently than men as authors on research publications. There is also some evidence that women are relatively disadvantaged as the beneficiaries of research, in terms of its health, societal, and economic impacts. Historical gender biases may have created a path dependency that means that the research system and the impacts of research are biased towards male researchers and male beneficiaries, making it inherently difficult (though not impossible) to eliminate gender bias. In this commentary, we – a group of scholars and practitioners from Africa, America, Asia, and Europe– argue that gender-sensitive research impact assessment could become a force for good in moving science policy and practice towards gender equity. Research impact assessment is the multidisciplinary field of scientific inquiry that examines the research process to maximise scientific, societal, and economic returns on investment in research. It encompasses many theoretical and methodological approaches that can be used to investigate gender bias and recommend actions for change to maximise research impact. We offer a set of recommendations to research funders, research institutions, and research evaluators who conduct impact assessment on how to include and strengthen analysis of gender equity in research impact assessment and issue a global call for action

A systematic review of non-invasive modalities used to identify women with anal incontinence symptoms after childbirth

© 2018, The International Urogynecological Association. Introduction and hypothesis: Anal incontinence following childbirth is prevalent and has a significant impact upon quality of life (QoL). Currently, there is no standard assessment for women after childbirth to identify these symptoms. This systematic review aimed to identify non-invasive modalities used to identify women with anal incontinence following childbirth and assess response and reporting rates of anal incontinence for these modalities. Methods: Ovid Medline, Allied and Complementary Medicine Database (AMED), Cumulative Index of Nursing and Allied Health Literature (CINAHL), Cochrane Collaboration, EMBASE and Web of Science databases were searched for studies using non-invasive modalities published from January 1966 to May 2018 to identify women with anal incontinence following childbirth. Study data including type of modality, response rates and reported prevalence of anal incontinence were extracted and critically appraised. Results: One hundred and nine studies were included from 1602 screened articles. Three types of non-invasive modalities were identified: validated questionnaires/symptom scales (n = 36 studies using 15 different instruments), non-validated questionnaires (n = 50 studies) and patient interviews (n = 23 studies). Mean response rates were 92% up to 6 weeks after childbirth. Non-personalised assessment modalities (validated and non-validated questionnaires) were associated with reporting of higher rates of anal incontinence compared with patient interview at all periods of follow-up after childbirth, which was statistically significant between 6 weeks and 1 year after childbirth (p < 0.05). Conclusions: This systematic review confirms that questionnaires can be used effectively after childbirth to identify women with anal incontinence. Given the methodological limitations associated with non-validated questionnaires, assessing all women following childbirth for pelvic-floor symptomatology, including anal incontinence, using validated questionnaires should be considered

Participatory design of impact indicators for nursing research

As the Catalan research assessment agency, we designed and implemented an ongoing, ex-post and impact assessment system in the area of health system (SARIS), which includes a crucial pillar: engagement. We developed an approach that combines the co-creation with the stakeholders in order to define topics of interests, with the formulation of preliminary indicators to assess the impact of nursing research. Therefore, a 2-phase approach was developed. First, discussion groups with the main purpose of identifying topics of interest in relations to the impact of nursing research were developed. Nurses from different settings, territories and disciplines made emerge four topics of interest: ‘advancement of knowledge’, ‘results dissemination’, ‘nurse training and networks’ and ‘results application’. Second, the suggested ideas from the focus groups were analysed and discussed in order to elaborate 30 preliminary indicators. Next steps will include a consensus in order to assess the relevance of these indicators. In the current context, where research in nursery care has not been measured before, co-creation with stakeholders might be a win-win strategy to reach three objectives: 1) obtaining a meaningful and measurable set of indicators, 2) raising awareness on the transformative potential of nursery care research, and 3) in motivating researchers in nursery care to maximize the impact