Health system performance assessment in small countries: The case study of Latvia

Managing the complexity that characterizes health systems requires sophisticated performance assessment information to support the decision‐making processes of healthcare stakeholders at various levels. Accordingly, in the past few decades, many countries have designed and implemented health system performance assessment (HSPA) programmes. Literature and practice agree on the key features that performance measurement in health should have, namely, multidimensionality, evidence‐based data collection, systematic benchmarking of results, shared design, transparent disclosure, and timeliness. Nevertheless, the specific characteristics of different countries may pose challenges in the implementation of such programmes. In the case of small countries, many of these challenges are common and related to their inherent characteristics, eg, small populations, small volumes of activity for certain treatments, and lack of benchmarks. Through the development of the case study of Latvia, this paper aims at discussing the challenges and opportunities for assessing health system performance in a small country. As a result, for each of the performance measurement features identified by the literature, the authors discuss the issues emerging when adopting them in Latvia and set out the potential solutions that have been designed during the development of the case study

Lowest Q^2 Measurement of the gamma*p -> Delta Reaction: Probing the Pionic Contribution

To determine nonspherical angular momentum amplitudes in hadrons at long ranges (low Q^2), data were taken for the p(\vec{e},e'p)\pi^0 reaction in the Delta region at Q^2=0.060 (GeV/c)^2 utilizing the magnetic spectrometers of the A1 Collaboration at MAMI. The results for the dominant transition magnetic dipole amplitude and the quadrupole to dipole ratios at W=1232 MeV are: M_{1+}^{3/2} = (40.33 +/- 0.63_{stat+syst} +/- 0.61_{model}) (10^{-3}/m_{\pi^+}),Re(E_{1+}^{3/2}/M_{1+}^{3/2}) = (-2.28 +/- 0.29_{stat+syst} +/- 0.20_{model})%, and Re(S_{1+}^{3/2}/M_{1+}^{3/2}) = (-4.81 +/- 0.27_{stat+syst} +/- 0.26_{model})%. These disagree with predictions of constituent quark models but are in reasonable agreement with lattice calculations with non-linear (chiral) pion mass extrapolations, with chiral effective field theory, and with dynamical models with pion cloud effects. These results confirm the dominance, and general Q^2 variation, of the pionic contribution at large distances.Comment: 6 pages, 3 figures, 1 tabl

Short-range correlations in low-lying nuclear excited states

The electromagnetic transitions to various low-lying excited states of 16O, 48Ca and 208Pb are calculated within a model which considers the short-range correlations. In general the effects of the correlations are small and do not explain the required quenching to describe the data.Comment: 6 pages, 2 postscript figures, 1 tabl

Measurements of the \gamma * p --> \Delta(1232) reaction at low Q2

We report new p$(\vec{e},e^\prime p)\pi^\circ$ measurements in the $\Delta^{+}(1232)$ resonance at the low momentum transfer region utilizing the magnetic spectrometers of the A1 Collaboration at MAMI. The mesonic cloud dynamics are predicted to be dominant and appreciably changing in this region while the momentum transfer is sufficiently low to be able to test chiral effective calculations. The results disagree with predictions of constituent quark models and are in reasonable agreement with dynamical calculations with pion cloud effects, chiral effective field theory and lattice calculations. The reported measurements suggest that improvement is required to the theoretical calculations and provide valuable input that will allow their refinements

International comparison of spending and utilization at the end of life for hip fracture patients.

ObjectiveTo identify and explore differences in spending and utilization of key health services at the end of life among hip fracture patients across seven developed countries.Data sourcesIndividual-level claims data from the inpatient and outpatient health care sectors compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC).Study designWe retrospectively analyzed utilization and spending from acute hospital care, emergency department, outpatient primary care and specialty physician visits, and outpatient drugs. Patterns of spending and utilization were compared in the last 30, 90, and 180 days across Australia, Canada, England, Germany, New Zealand, Spain, and the United States. We employed linear regression models to measure age- and sex-specific effects within and across countries. In addition, we analyzed hospital-centricity, that is, the days spent in hospital and site of death.Data collection/extraction methodsWe identified patients who sustained a hip fracture in 2016 and died within 12 months from date of admission.Principal findingsResource use, costs, and the proportion of deaths in hospital showed large variability being high in England and Spain, while low in New Zealand. Days in hospital significantly decreased with increasing age in Canada, Germany, Spain, and the United States. Hospital spending near date of death was significantly lower for women in Canada, Germany, and the United States. The age gradient and the sex effect were less pronounced in utilization and spending of emergency care, outpatient care, and drugs.ConclusionsAcross seven countries, we find important variations in end-of-life care for patients who sustained a hip fracture, with some differences explained by sex and age. Our work sheds important insights that may help ongoing health policy discussions on equity, efficiency, and reimbursement in health care systems

Measurements of the Generalized Electric and Magnetic Polarizabilities of the Proton at Low Q2 Using the VCS Reaction

The mean square polarizability radii of the proton have been measured for the first time in a virtual Compton scattering experiment performed at the MIT-Bates out-of-plane scattering facility. Response functions and polarizabilities obtained from a dispersion analysis of the data at Q2=0.06 GeV2/c2 are in agreement with O(p3) heavy baryon chiral perturbation theory. The data support the dominance of mesonic effects in the polarizabilities, and the increase of beta with increasing Q2 is evidence for the cancellation of long-range diamagnetism by short-range paramagnetism from the pion cloud

Measurement of the Partial Cross Sections s(TT), s(LT) and [s(T)+epsilon*s(L)] of the p(e,e' pi+)n Reaction in the Delta(1232) Resonance

We report new precision p(e,e' pi+})n measurements in the Delta(1232) resonance at Q2 = 0.127(GeV/c)2 obtained at the MIT-Bates Out-Of-Plane scattering facility. These are the lowest, but non-zero, Q2 measurements in the pi+ channel. The data offer new tests of the theoretical calculations, particularly of the background amplitude contributions. The chiral effective field theory and Sato-Lee model calculations are not in agreement with this experiment

Investigation of the conjectured nucleon deformation at low momentum transfer

We report new precise H$(e,e^\prime p)\pi^0$ measurements at the $\Delta(1232)$ resonance at $Q^2= 0.127$ (GeV/c)$^2$ using the MIT/Bates out-of-plane scattering (OOPS) facility. The data reported here are particularly sensitive to the transverse electric amplitude ($E2$) of the $\gamma^* N\to\Delta$ transition. Analyzed together with previous data yield precise quadrupole to dipole amplitude ratios $EMR = (-2.3 \pm 0.3_{stat+sys} \pm 0.6_{model})$ and $CMR = (-6.1 \pm 0.2_{stat+sys}\pm 0.5_{model})$ and for $M^{3/2}_{1+} = (41.4 \pm 0.3_{stat+sys}\pm 0.4_{model})(10^{-3}/m_{\pi^+})$. They give credence to the conjecture of deformation in hadronic systems favoring, at low $Q^2$, the dominance of mesonic effects.Comment: 4 pages, 1figur

Relativistic effects and two-body currents in 2H(e⃗,e′p)n^{2}H(\vec{e},e^{\prime}p)n using out-of-plane detection

Measurements of the ${^2}H(\vec{e},e^{\prime}p)n$ reaction were performed using an 800-MeV polarized electron beam at the MIT-Bates Linear Accelerator and with the out-of-plane magnetic spectrometers (OOPS). The longitudinal-transverse, $f_{LT}$ and $f_{LT}^{\prime}$, and the transverse-transverse, $f_{TT}$, interference responses at a missing momentum of 210 MeV/c were simultaneously extracted in the dip region at Q$^2$=0.15 (GeV/c)$^2$. On comparison to models of deuteron electrodisintegration, the data clearly reveal strong effects of relativity and final-state interactions, and the importance of the two-body meson-exchange currents and isobar configurations. We demonstrate that these effects can be disentangled and studied by extracting the interference response functions using the novel out-of-plane technique.Comment: 4 pages, 4 figures, and submitted to PRL for publicatio

Measurement of the Transverse-Longitudinal Cross Sections in the p (e,e'p)pi0 Reaction in the Delta Region

Accurate measurements of the p(e,e?p)pi0 reaction were performed at Q^2=0.127(GeV/c)^2 in the Delta resonance energy region. The experiments at the MIT-Bates Linear Accelerator used an 820 MeV polarized electron beam with the out of plane magnetic spectrometer system (OOPS). In this paper we report the first simultaneous determination of both the TL and TL? (``fifth" or polarized) cross sections at low Q^{2} where the pion cloud contribution dominates the quadrupole amplitudes (E2 and C2). The real and imaginary parts of the transverse-longitudinal cross section provide both a sensitive determination of the Coulomb quadrupole amplitude and a test of reaction calculations. Comparisons with model calculations are presented. The empirical MAID calculation gives the best overall agreement with this accurate data. The parameters of this model for the values of the resonant multipoles are |M_{1+}(I=3/2)|= (40.9 \pm 0.3)10^{-3}/m_pi, CMR= C2/M1= -6.5 \pm 0.3%, EMR=E2/M1=-2.2 \pm 0.9%, where the errors are due to the experimental uncertainties.Comment: 10 pages, 3 figures, minor corrections and addition