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  • 1
    Online Resource
    Online Resource
    Assessing Catastrophic Health Expenditures Among Uninsured People Who Seek Care in US Hospital-Based Emergency Departments
    American Medical Association (AMA) ; 2021
    In:  JAMA Health Forum Vol. 2, No. 12 ( 2021-12-30), p. e214359-
    Details
    In: JAMA Health Forum, American Medical Association (AMA), Vol. 2, No. 12 ( 2021-12-30), p. e214359-
    Type of Medium: Online Resource
    ISSN: 2689-0186
    URL: Article
    DOI: 10.1001/jamahealthforum.2021.4359
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2021
    detail.hit.zdb_id: 3064651-0
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  • 2
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    Estimating health care delivery system value for each US state and testing key associations
    Wiley ; 2022
    In:  Health Services Research Vol. 57, No. 3 ( 2022-06), p. 557-567
    Details
    In: Health Services Research, Wiley, Vol. 57, No. 3 ( 2022-06), p. 557-567
    Abstract: To estimate health care systems' value in treating major illnesses for each US state and identify system characteristics associated with value. Data sources Annual condition‐specific death and incidence estimates for each US state from the Global Burden Disease 2019 Study and annual health care spending per person for each state from the National Health Expenditure Accounts. Study design Using non‐linear meta‐stochastic frontier analysis, mortality incidence ratios for 136 major treatable illnesses were regressed separately on per capita health care spending and key covariates such as age, obesity, smoking, and educational attainment. State‐ and year‐specific inefficiency estimates were extracted for each health condition and combined to create a single estimate of health care delivery system value for each US state for each year, 1991–2014. The association between changes in health care value and changes in 23 key health care system characteristics and state policies was measured. Data collection/extraction methods Not applicable. Principal findings US state with relatively high spending per person or relatively poor health‐outcomes were shown to have low health care delivery system value. New Jersey, Maryland, Florida, Arizona, and New York attained the highest value scores in 2014 (81 [95% uncertainty interval 72‐88], 80 [72‐87] , 80 [71‐86], 77 [69‐84] , and 77 [66‐85], respectively), after controlling for health care spending, age, obesity, smoking, physical activity, race, and educational attainment. Greater market concentration of hospitals and of insurers were associated with worse health care value ( p ‐value ranging from 〈 0.01 to 0.02). Higher hospital geographic density and use were also associated with worse health care value ( p ‐value ranging from 0.03 to 0.05). Enrollment in Medicare Advantage HMOs was associated with better value, as was more generous Medicaid income eligibility ( p ‐value 0.04 and 0.01). Conclusions Substantial variation in the value of health care exists across states. Key health system characteristics such as market concentration and provider density were associated with value.
    Type of Medium: Online Resource
    ISSN: 0017-9124 , 1475-6773
    URL: Issue
    URL: Article
    DOI: 10.1111/hesr.v57.3
    DOI: 10.1111/1475-6773.13676
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2078493-4
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  • 3
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    Trends in burden and risk factors associated with childhood stunting in Rwanda from 2000 to 2015: policy and program implications
    Springer Science and Business Media LLC ; 2020
    In:  BMC Public Health Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Public Health, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: Rwanda has made substantial economic progress over the past two decades. However, evidence suggests that malnutrition among children remains high in spite of this progress. This study aims to examine trends and potential risk factors associated with childhood stunting from 2000 to 2015 in Rwanda. Methods Data for this study come from the 2000 to 2015 Rwanda’s Demographic and Health Surveys (DHS), a cross-sectional, population-based survey that is conducted every 5 years. Following prior work, we define stunting based on age and weight as reported in the DHS. We assess the overall prevalence of stunting among children under the age of 5 in Rwanda and then conduct bivariate analyses across a range of policy-relevant demographic, socioeconomic, and health variables. We then incorporate key variables in a multivariable analysis to identify those factors that are independently associated with stunting. Results The prevalence of stunting among children under the age of 5 in Rwanda declined from 2000 (47.4%) to 2015 (38.3%), though rates were relatively stagnant between 2000 and 2010. Factors associated with higher rates of stunting included living in the lowest wealth quintile, having a mother with limited education, having a mother that smoked, being of the male sex, and being of low-birth weight. Conclusions Though overall stunting rates have improved nationally, these gains have been uneven. Furthering ongoing national policies to address these disparities while also working to reduce the overall risk of malnutrition will be necessary for Rwanda to reach its overall economic and health equity goals.
    Type of Medium: Online Resource
    ISSN: 1471-2458
    URL: Article
    DOI: 10.1186/s12889-020-8164-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041338-5
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  • 4
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    Creating a pathway for public hospital accreditation in Rwanda: progress, challenges and lessons learned
    Oxford University Press (OUP) ; 2020
    In:  International Journal for Quality in Health Care Vol. 32, No. 1 ( 2020-04-21), p. 76-79
    Details
    In: International Journal for Quality in Health Care, Oxford University Press (OUP), Vol. 32, No. 1 ( 2020-04-21), p. 76-79
    Abstract: Weaknesses in the quality of care delivered at hospitals translates into patient safety challenges and causes unnecessary harm. Low-and-middle-income countries disproportionately shoulder the burden of poor quality of hospital care. Initial assessment In the early 2000s, Rwanda implemented a performance-based financing (PBF) system to improve quality and increase the quantity of care delivered at its public hospitals. PBF evaluations identified quality gaps that prompted a movement to pursue an accreditation process for public hospitals. Choice of solution Since it was prohibitively costly to implement an accreditation program overseen by an external entity to all of Rwanda’s public hospitals, the Ministry of Health developed a set of standards for a national 3-Level accreditation program. Implementation In 2012, Rwanda launched the first phase of the national accreditation system at five public hospitals. The program was then expected to expand across the remainder of the public hospitals throughout the country. Evaluation Out of Rwanda’s 43 public hospitals, a total of 24 hospitals have achieved Level 1 status of the accreditation process and 4 have achieved Level 2 status of the accreditation process. Lessons learned Linking the program to the country’s existing PBF program increased compliance and motivation for participation, especially for those who were unfamiliar with accreditation principles. Furthermore, identifying dedicated quality improvement officers at each hospital has been important for improving engagement in the program. Lastly, to improve upon this process, there are ongoing efforts to develop a non-governmental accreditation entity to oversee this process for Rwanda’s health system moving forward.
    Type of Medium: Online Resource
    ISSN: 1353-4505 , 1464-3677
    URL: Article
    DOI: 10.1093/intqhc/mzz063
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2002180-X
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  • 5
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    Medical Student Mobilization During a Crisis: Lessons From a COVID-19 Medical Student Response Team
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Academic Medicine Vol. 95, No. 9 ( 2020-09), p. 1384-1387
    Details
    In: Academic Medicine, Ovid Technologies (Wolters Kluwer Health), Vol. 95, No. 9 ( 2020-09), p. 1384-1387
    Abstract: On March 17, 2020, the Association of American Medical Colleges recommended the suspension of all direct patient contact responsibilities for medical students because of the COVID-19 pandemic. Given this change, medical students nationwide had to grapple with how and where they could fill the evolving needs of their schools’ affiliated clinical sites, physicians, patients, and the community. Approach At Harvard Medical School (HMS), student leaders created a COVID-19 Medical Student Response Team to: (1) develop a student-led organizational structure that would optimize students’ ability to efficiently mobilize interested peers in the COVID-19 response, both clinically and in the community, in a strategic, safe, smart, and resource-conscious way; and (2) serve as a liaison with the administration and hospital leaders to identify evolving needs and rapidly engage students in those efforts. Outcomes Within a week of its inception, the COVID-19 Medical Student Response Team had more than 500 medical student volunteers from HMS and had shared the organizational framework of the response team with multiple medical schools across the country. The HMS student volunteers joined any of the 4 virtual committees to complete this work: Education for the Medical Community, Education for the Broader Community, Activism for Clinical Support, and Community Activism. Next Steps The COVID-19 Medical Student Response Team helped to quickly mobilize hundreds of students and has been integrated into HMS’s daily workflow. It may serve as a useful model for other schools and hospitals seeking medical student assistance during the COVID-19 pandemic. Next steps include expanding the initiative further, working with the leaders of response teams at other medical schools to coordinate efforts, and identifying new areas of need at local hospitals and within nearby communities that might benefit from medical student involvement as the pandemic evolves.
    Type of Medium: Online Resource
    ISSN: 1040-2446
    URL: Article
    DOI: 10.1097/ACM.0000000000003401
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2025367-9
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  • 6
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    Perceived barriers to the development of modern public health in Bulgaria: a qualitative study
    Springer Science and Business Media LLC ; 2011
    In:  International Journal of Public Health Vol. 56, No. 2 ( 2011-4), p. 191-199
    Details
    In: International Journal of Public Health, Springer Science and Business Media LLC, Vol. 56, No. 2 ( 2011-4), p. 191-199
    Type of Medium: Online Resource
    ISSN: 1661-8556 , 1661-8564
    URL: Article
    DOI: 10.1007/s00038-010-0140-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2011
    detail.hit.zdb_id: 2276416-1
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  • 7
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    Healthcare spending in U.S. emergency departments by health condition, 2006–2016
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 10 ( 2021-10-27), p. e0258182-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 10 ( 2021-10-27), p. e0258182-
    Abstract: Healthcare spending in the emergency department (ED) setting has received intense focus from policymakers in the United States (U.S.). Relatively few studies have systematically evaluated ED spending over time or disaggregated ED spending by policy-relevant groups, including health condition, age, sex, and payer to inform these discussions. This study’s objective is to estimate ED spending trends in the U.S. from 2006 to 2016, by age, sex, payer, and across 154 health conditions and assess ED spending per visit over time. Methods and findings This observational study utilized the National Emergency Department Sample, a nationally representative sample of hospital-based ED visits in the U.S. to measure healthcare spending for ED care. All spending estimates were adjusted for inflation and presented in 2016 U.S. Dollars. Overall ED spending was $79.2 billion (CI, $79.2 billion-$79.2 billion) in 2006 and grew to $136.6 billion (CI, $136.6 billion-$136.6 billion) in 2016, representing a population-adjusted annualized rate of change of 4.4% (CI, 4.4%-4.5%) as compared to total healthcare spending (1.4% [CI, 1.4%-1.4%]) during that same ten-year period. The percentage of U.S. health spending attributable to the ED has increased from 3.9% (CI, 3.9%-3.9%) in 2006 to 5.0% (CI, 5.0%-5.0%) in 2016. Nearly equal parts of ED spending in 2016 was paid by private payers (49.3% [CI, 49.3%-49.3%] ) and public payers (46.9% [CI, 46.9%-46.9%]), with the remainder attributable to out-of-pocket spending (3.9% [CI, 3.9%-3.9%] ). In terms of key groups, the majority of ED spending was allocated among females (versus males) and treat-and-release patients (versus those hospitalized); those between age 20–44 accounted for a plurality of ED spending. Road injuries, falls, and urinary diseases witnessed the highest levels of ED spending, accounting for 14.1% (CI, 13.1%-15.1%) of total ED spending in 2016. ED spending per visit also increased over time from $660.0 (CI, $655.1-$665.2) in 2006 to $943.2 (CI, $934.3-$951.6) in 2016, or at an annualized rate of 3.4% (CI, 3.3%-3.4%). Conclusions Though ED spending accounts for a relatively small portion of total health system spending in the U.S., ED spending is sizable and growing. Understanding which diseases are driving this spending is helpful for informing value-based reforms that can impact overall health care costs.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1371/journal.pone.0258182
    DOI: 10.1371/journal.pone.0258182.g001
    DOI: 10.1371/journal.pone.0258182.g002
    DOI: 10.1371/journal.pone.0258182.g003
    DOI: 10.1371/journal.pone.0258182.g004
    DOI: 10.1371/journal.pone.0258182.t001
    DOI: 10.1371/journal.pone.0258182.s001
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
    detail.hit.zdb_id: 2267670-3
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  • 8
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    Addressing the mental health needs of children affected by HIV in Rwanda: validation of a rapid depression screening tool for children 7–14 years old
    Springer Science and Business Media LLC ; 2021
    In:  BMC Pediatrics Vol. 21, No. 1 ( 2021-12)
    Details
    In: BMC Pediatrics, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2021-12)
    Abstract: Depression in children presents a significant health burden to society and often co-exists with chronic illnesses, such as human immunodeficiency virus (HIV). Research has demonstrated that 10–37% of children and adolescents living with HIV also suffer from depression. Low-and-middle income countries (LMICs) shoulder a disproportionate burden of HIV among other health challenges, but reliable estimates of co-morbid depression are lacking in these settings. Prior studies in Rwanda, a LMIC of 12 million people in East Africa, found that 25% of children living with HIV met criteria for depression. Though depression may negatively affect adherence to HIV treatment among children and adolescents, most LMICs fail to routinely screen children for mental health problems due to a shortage of trained health care providers. While some screening tools exist, they can be costly to implement in resource-constrained settings and are often lacking a contextual appropriateness. Methods Relying on international guidelines for diagnosing depression, Rwandan health experts developed a freely available, open-access Child Depression Screening Tool (CDST). To validate this tool in Rwanda, a sample of 296 children with a known diagnosis of HIV between ages 7–14 years were recruited as study participants. In addition to completing the CDST, all participants were evaluated by a mental health professional using a structured clinical interview. The validity of the CDST was assessed in terms of sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Results This analysis found that depression continues to be a co-morbid condition among children living with HIV in Rwanda. For identifying these at-risk children, the CDST had a sensitivity of 88.1% and specificity of 96.5% in identifying risk for depression among children living with HIV at a cutoff score of 6 points. This corresponded with an area under the ROC curve of 92.3%. Conclusions This study provides evidence that the CDST is a valid tool for screening depression among children affected by HIV in a resource-constrained setting. As an open-access and freely available tool in LMICs, the CDST can allow any health practitioner to identify children at risk of depression and refer them in a timely manner to more specialized mental health services. Future work can show if and how this tool has the potential to be useful in screening depression in children suffering from other chronic illnesses.
    Type of Medium: Online Resource
    ISSN: 1471-2431
    URL: Article
    DOI: 10.1186/s12887-020-02475-1
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2041342-7
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  • 9
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    Transitioning to Country Ownership of HIV Programs in Rwanda
    Public Library of Science (PLoS) ; 2016
    In:  PLOS Medicine Vol. 13, No. 8 ( 2016-8-9), p. e1002075-
    Details
    In: PLOS Medicine, Public Library of Science (PLoS), Vol. 13, No. 8 ( 2016-8-9), p. e1002075-
    Type of Medium: Online Resource
    ISSN: 1549-1676
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1371/journal.pmed.1002075
    DOI: 10.1371/journal.pmed.1002075.g001
    DOI: 10.1371/journal.pmed.1002075.t001
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2016
    detail.hit.zdb_id: 2164823-2
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  • 10
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    Learning Valuable Perspectives on Improving the World’s Health Through the Post-2015 Development Agenda: A Response to Recent Commentaries
    Maad Rayan Publishing Company ; 2016
    In:  International Journal of Health Policy and Management Vol. 5, No. 4 ( 2016-01-19), p. 289-290
    Details
    In: International Journal of Health Policy and Management, Maad Rayan Publishing Company, Vol. 5, No. 4 ( 2016-01-19), p. 289-290
    Type of Medium: Online Resource
    ISSN: 2322-5939
    URL: Article
    DOI: 10.15171/ijhpm.2016.04
    Language: English
    Publisher: Maad Rayan Publishing Company
    Publication Date: 2016
    detail.hit.zdb_id: 2724317-5
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