People-centred health care

In recent years, there has been increasing interest in the patient’s perspective of health care and how health systems can better respond to the needs of all health care stakeholders and constituencies in a holistic manner. Previous recommendations of Member States through the WHO Regional Committees for the Western Pacific and South-East Asia reflect the need to pursue work in the following: equity and fairness into policies; the development of programmes firmly grounded in ethical principles; the quality of health care and patient safety; human dignity, patients’ rights and needs, and the role of families, culture and society; the broader psychosocial and cultural determinants of health; and ethics related to medical practice, research and education. These issues have widespread relevance and significance. Improving health care quality and safety and enhancing the people’s experience of care require attention not only to health system design but also to the focus ...

The impact of electronic health records on healthcare quality: a systematic review and meta-analysis

Objective: To assess the impact of electronic health record (EHR) on healthcare quality, we hence carried out a systematic review and meta-analysis of published studies on this topic.

Methods: PubMed, Web of Knowledge, Scopus and Cochrane Library databases were searched to identify studies that investigated the association between the EHR implementation and process or outcome indicators. Two reviewers screened identified citations and extracted data according to the PRISMA guidelines. Meta-analysis was performed using the random effects model for each indicator. Heterogeneity was quantified using the Cochran Q test and I2 statistics, and publication bias was assessed using the Egger’s test.

Results: Of the 23 398 citations identified, 47 articles were included in the analysis. Meta-analysis showed an association between EHR use and a reduced documentation time with a difference in mean of −22.4% [95% confidence interval (CI) = −38.8 to −6.0%; P < 0.007]. EHR resulted also ...

ISQua’s 33rd International Conference on quality and safety in health care

The International Society for Quality in Health Care (ISQua) is delighted to collaborate with the Japan Council for Quality Health Care (JQ) to host the 33rd International scientific meeting on quality and safety in health care in Tokyo, Japan 16 - 19 October 2016. The theme is "Change and Sustainability in Healthcare Quality: the Future Challenges"

For more information, click here: TOKYO 2016.

9th European Public Health Conference

The 9th European Public Health Conference will be held in Vienna with the theme of ‘All for Health, Health for All’. A healthy population is a key requirement for the achievement of society’s goals. Good health for all enhances quality of life, improves workforce productivity, increases the capacity for learning, strengthens families and communities, supports sustainable habitats and environments, and contributes to security, poverty reduction and social inclusion. Increasingly, communities, employers and industries are expecting and demanding strong coordinated government action to promote health in all sectors of society and avoid duplication and fragmentation of actions.

Abstracts can be submitted from 1 February until 1 May 2016 (23:59 Central European Time).

Registration for the 9th EPH Conference opens 1 March 2016.

For more information, click here:9th EPH Conference.

Experiencing Integrated Health: Ontarians’ views of health care coordination and communication

Health Quality Ontario (HQO) has published an analysis using data from the 2014 Commonwealth Fund International Health Policy Survey of Older Adults in order to identify, from a patient perspective, how well different parts of health system are working together.

The HQO extracted a sample with the population from Ontario; Ontarians reported similar results as top-ranking countries in some indicators related to coordination of care; about 80% of Ontarians said they received help from their regular physicians to coordinate their care with other providers.

The sample from Ontario population made able to identify some key points where Canadian Health System can improve in order to get better communication and coordination of care.

Assessing health services delivery performance with hospitalizations for ambulatory care sensitive conditions

Evolving Concepts of Patient-Centered Care and the Assessment of Patient Care Experiences: Optimism and Opposition

This article summarise, a personal view of the author (Paul D. Cleary dean of the Yale School of Public Health), on the available research, concerning measurement of “patient satisfaction” and “patient care experience”. Author argues that patient experiences measurement efforts are being devoted to providing high-quality patient-centered care. Some indicators and surveys are discussed in terms of their reliability, validity and correlation across individuals and settings with other quality indicators.

Special attention is paid to the Consumer Assessment of Healthcare Providers and Systems (CAHPS), launched in 1995 by the Agency for Healthcare Research and Quality (AHRQ). The CAHPS surveys are nowadays tailored to different care settings, so that results can be used to help identify aspects of care that can be targeted to improve patient experiences.

Some contrasting arguments are also discussed on the ability of patients to evaluate the quality of their care. Author proposes a review of currently ...

Continuity of clinical management and information across care levels: perceptions of users of different healthcare areas in the Catalan national health system

The integration of health care has become a priority in most health systems, as patients increasingly receive care from several professionals in various different settings and institutions, particularly those with chronic conditions and multi-morbidities. Continuity of care is defined as one patient experiencing care over time as connected and coherent with his or her health needs and personal circumstances. The objective is to analyse perceptions of continuity of clinical management and information across care levels and the factors influencing it, from the viewpoint of users of the Catalan national health system.

WHO: What is people-centred care?

Globally, 1 in 20 people still lacks access to essential health services that could be delivered at a local clinic instead of a hospital. And where services are accessible, they are often fragmented and of poor quality. WHO is supporting countries to progress towards universal health coverage by designing health systems around the needs of people instead of diseases and health institutions, so that everyone gets the right care, at the right time, in the right place.

WHO: What is people-centred care?

Globally, 1 in 20 people still lacks access to essential health services that could be delivered at a local clinic instead of a hospital. And where services are accessible, they are often fragmented and of poor quality. WHO is supporting countries to progress towards universal health coverage by designing health systems around the needs of people instead of diseases and health institutions, so that everyone gets the right care, at the right time, in the right place.

A scoping review of mentorship of health personnel to improve the quality of health care in low and middle-income countries

Most Low and Middle-Income Countries are facing a crisis in human resources for health which compromises their ability to meet health related targets outline by the Sustainable Development Goals. The crisis is not limited to the availability of health personnel but also the quality of care and the training and development of the workforce. To address these challenges evidence based education strategies are urgently required. 

Progress and outcomes of health systems reform in the United Arab Emirates: a systematic review

The United Arab Emirates (UAE) government aspires to build a world class health system to improve the quality of healthcare and the health outcomes for its population. To achieve this it has implemented extensive health system reforms in the past 10 years. The nature, extent and success of these reforms has not recently been comprehensively reviewed. This paper reviews the progress and outcomes of healht systems reform in the UAE

Approaches towards improving the quality of maternal and newborn health services in South Asia: challenges and opportunities for healthcare systems

South Asia is experiencing a dismal state of maternal and newborn health (MNH) as the region has been falling behind in reducing the levels of maternal and neonatal mortality. Most of the efforts are focused on enhancing coverage of MNH services; however, quality remains a serious concern if the region is to achieve expected outcomes in terms of standardised MNH services within healthcare delivery systems. This research consists of a review of south Asian quality improvement approaches/interventions, specifically implemented for MNH improvement. 

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries

Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available. This paper describes and analyse the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC

Building capacity in primary care rehabilitation clinical practice guidelines: a South African initiative

The large number of South Africans with disability who cannot access good quality rehabilitation presents a public health and human rights challenge. A cost-effective, efficient approach is required to address this. Implementation of high-quality, contextually relevant clinical practice guidelines (CPGs) could be a solution; however, this requires significant investment in innovative capacity-building.

Primary healthcare policy implementation in the Eastern Mediterranean region: Experiences of six countries.

Primary healthcare (PHC) is essential for equitable access and cost-effective healthcare. This makes PHC a key factor in the global strategy for universal health coverage (UHC). Implementing PHC requires an understanding of the health system under prevailing circumstances, but for most countries, no data are available.
This paper describes and analyses the health systems of Bahrain, Egypt, Lebanon, Qatar, Sudan and the United Arab Emirates, in relation to PHC.

Strengthening performance-based financing as a health system approach for quality improvement

Over the last decade, a significant reduction of maternal and child mortality has been achieved in low- and middle-income countries (LMICs). This is largely attributable to the substantial improvement in access to essential reproductive, maternal and child health services. However, in some countries, expansion of health services has not resulted in the expected mortality reduction. Low quality of care (QoC) is an important cause of this discrepancy, and it calls for putting quality improvement on the global health agenda. As an approach to enhance QoC in LMICs, performance-based financing (PBF), which incentivizes health providers based on predetermined indicators, has been piloted or implemented in more than 30 countries. More importantly, PBF has been used as an important vehicle to catalyze health system reforms to enhance service delivery, including quality improvement (QI), in many countries.

This paper takes a system perspective to examine the current practice of PBF in strengthening health ...

Will Disruptive Innovation in Health Care Improve the Health of Populations?

Health care in the United States is long overdue for an upheaval. The mismatch between costs, by far the highest in the world, and health outcomes, among the worst in the high-income world, has long been glaring. Perhaps the good news is that the time for such an upheaval has come. At least 4 forces have been gathering steam, each promising to change the nature of health care and, in so doing, influence population health.

Patient Engagement In Research: Early Findings From The Patient-Centered Outcomes Research Institute

Charged with ensuring that research produces useful evidence to inform health decisions, the Patient-Centered Outcomes Research Institute (PCORI) requires investigators to engage patients and other health care stakeholders, such as clinicians and payers, in the research process. Many PCORI studies result in articles published in peer-reviewed journals that detail research findings and engagement’s role in research. To inform practices for engaging patients and others as research partners, this study analyzed 126 articles that described engagement approaches and contributions to research. PCORI projects engaged patients and others as consultants and collaborators in determining the study design, selecting study outcomes, tailoring interventions to meet patients’ needs and preferences, and enrolling participants. Many articles reported that engagement provided valuable contributions to research feasibility, acceptability, rigor, and relevance, while a few noted trade-offs of engagement. The findings suggest that engagement can support more relevant research through better alignment with patients’ and clinicians’ real-world ...

A compendium of tools and resources for improving the quality of health services

In an attempt to consolidate the work of the WHO Department of Service Delivery and Safety (SDS) on quality improvement, a SDS cross-cut team has produced a compendium of tools and resources on quality improvement, developed within the SDS, that are applicable for country support. It includes resources on IPCHS and community engagement among others. It also includes practical examples of how the tools and resources have been applied in-country, including relevant links with other areas, such as measurement.  Ministries of health, facility quality improvement teams, researchers, development agencies and any organization or individual working to improve the quality of health service delivery can benefit from this compendium.

Strengthening national health research systems in the WHO African Region – progress towards universal health coverage

Health challenges and health systems set-ups differ, warranting contextualised healthcare interventions to move towards universal health coverage. As such, there is emphasis on generation of contextualized evidence to solve local challenges. However, weak research capacity and inadequate resources remain an impendiment to quality research in the African region. WHO African Region (WHO AFRO) facilitated the adoption of a regional strategy for strengthening national health research systems (NHRS) in 2015. This article assessed the progress in strengthening NHRS among the 47 member states of the WHO AFRO.

UN High-Level Meeting on universal health coverage

On 23 September 2019, the United Nations General Assembly will hold a high-level meeting on universal health coverage (UHC). This meeting, held under the theme Universal Health Coverage: Moving Together to Build a Healthier World, aims to accelerate progress towards UHC, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.

The meeting will result in a political declaration on universal health coverage endorsed by Heads of State. Among other key attributes, the declaration recognizes the need for health systems to be integrated and people-centred, with primary health care being the cornerstone of a sustainable health system for UHC and health-related SDGs.

Approval of political resolution on Universal Health Coverage in UN High-Level meeting

World leaders came together for the United Nations High Level Meeting (HLM) on Universal Health Coverage (UHC): Moving Together to Build a Healthier World, held at the UN General Assembly in New York, on Monday, 23 September 2019. This was the first time the UN had called for a HLM devoted to UHC and the encounter provided an unprecedented opportunity to mobilize the global community and secure political commitment from Heads of State and Government to accelerate progress toward achieving UHC by 2030. As a result UN Member States have adopted the most comprehensive set of health commitments ever adopted at this level, the political declaration on UHC. Among other key attributes, the declaration recognizes the need for health systems to be integrated and people-centred, with primary health care being the cornerstone of a sustainable health system for UHC and health-related SDGs.

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Access the political declaration here.

Patients’ perspectives on integrated oral healthcare in a northern Quebec Indigenous primary health care organisation: a qualitative study

Patient-centred care is considered to be an important element in the evaluation of integrated healthcare and has been effective in addressing oral health disparities. This study explored the patients’ perspectives of patient-centred integrated care in oral health services integrated into a primary healthcare organisation serving a northern Quebec Cree population.

Integrated care: a definition from the perspective of the four quality paradigms

The purpose of this paper is to support the ongoing dialogue and shed light on the different views on integrated care. An overarching definition of integrated care is proposed combining the ways of thinking of the four quality paradigms the authors identify. The idea of epistemic fluency offers a way-out of ongoing discussions about “what integration is”.

Variation in Chronic Diseases Across Households, Communities, Districts, and States in India

Globally, chronic noncommunicable diseases are the leading cause of death and accounted for 6 million deaths in India in 2016. However, the extent to which variation in chronic disease can be attributed to different population levels in India is unknown, as is whether variation in individual-level factors explains outcome variation at different population levels.

Integrated care for the inhabitants of the city Leuven: Protocol of the ZORGZAAM Leuven integrated care project

In Flanders, the prevalence of chronic diseases is high and still increasing partially due to aging of the population and partially due to other reasons like surviving acute diseases or cancer. The aim of the Zorgzaam Leuven project is to test the impact of the implementation of a complex intervention based on the principles of integrated care for a well defined population of approximately 100.000 inhabitants in Belgium.

Care coordination in the health-care service delivery: an elderly care perspective

The purpose of this study is to assess the relationship between patient-centricity, care coordination and delivery of quality care for older people with multiple chronic conditions. Care coordination is defined as a process where physicians, nurses and allied professionals work together to clarify responsibilities, care objectives, treatment plans and discharge plans for delivery of unified care. Patient-centricity is defined as an approach of delivering quality care to patients that focuses on creating a positive experience for them.

Exploring improvement plans of fourteen European integrated care sites for older people with complex needs

Integrated care programmes are increasingly being put in place to provide care to older people living at home. However, knowledge about further improving integrated care is limited. In fourteen integrated care sites in Europe, plans to improve existing ways of working were designed, implemented and evaluated to enlarge the understanding of what works and with what outcomes when improving integrated care. This paper provides insight into the existing ways that the sites were working with respect to integrated care, their perceived difficulties and their plans for working towards improvement. 

Using an evidence-based safety approach to develop China’s road safety strategies

Road accidents are a major global public safety and health problem. Presently, many countries such as China urgently need to find better strategies to improve their road safety. This paper has two key objectives, which are: (i) to propose potential solutions to improve China’s road safety, and (ii) to provide China and other countries with helpful evidence for their future road safety.

Non-communicable diseases in sub-Saharan Africa: a scoping review of large cohort studies

Non-communicable diseases (NCDs) cause a large and growing burden of morbidity and mortality in sub-Saharan Africa. Prospective cohort studies are key to study multiple risk factors and chronic diseases and are crucial to our understanding of the burden, aetiology and prognosis of NCDs in SSA. The aim of this study was to identify the level of research output on NCDs and their risk factors collected by cohorts in SSA.

Impact of integrated healthcare: Taiwan’s Family Doctor Plan

Integration of health services has been pursued worldwide. Diversity in integration approaches and in the contexts in which integrated programmes operate, however, hinders comparative analysis of care integration in both high-income countries (HICs) and low- and middle-income countries (LMICs). This study evaluates an HIC programme implemented in a delivery system resembling those of LMICs, especially its weak primary care system. 

Integrating health care in Australia: a qualitative evaluation

With aging populations, a growing prevalence of chronic illnesses, higher expectations for quality care and rising costs within limited health budgets, integration of healthcare is seen as a solution to these challenges. Integrated healthcare aims to overcome barriers between primary and secondary care and other disconnected patient services to improve access, continuity and quality of care. Many people in Australia are admitted to hospital for chronic illnesses that could be prevented or managed in the community. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health has implemented key strategies through the Western Sydney Integrated Care Program (WSICP) to enhance primary care and the outcomes and experiences of patients with these illnesses.

Giving patients a voice: implementing patient and public involvement to strengthen research in sub-Saharan Africa

Patient and public involvement (PPI) is recognised as a valuable tool in improving the quality and relevance of research. Defined as "research being carried out "with" or "by" members of the public rather than "to", "about" or "for" them", PPI is a method of involving patients and the public in the design, conduct and dissemination of research and services that affect them, providing for a more democratic approach and patient empowerment.

Effects of Training Health Workers in Integrated Management of Childhood Illness on Quality of Care for Under-5 Children in Primary Healthcare Facilities in Afghanistan

Training courses in integrated management of childhood illness (IMCI) have been conducted for health workers for nearly one and half decades in Afghanistan. The objective of the training courses is to improve quality of care in terms of health workers communication skills and clinical performance when they provide health services for under-5 children in public healthcare facilities. This paper presents the findings on the effects of IMCI training courses on quality of care in public primary healthcare facilities in Afghanistan.

Driving and Accelerating a ‘One System’ Response: Why COVID-19 has Shone a Spotlight on Integrated Care

Health Networks in Action: The experiences of Argentina, Brazil, Colombia and Mexico

Dioselina is a 54-year-old divorcée who has no children and lives alone in a large city. She has been unemployed for a year and just started receiving welfare six months ago. As for her health, she has long-term obesity, chronic obstructive pulmonary disease, and diabetes. In recent months, she began to develop foot ulcers because her blood sugar was not being monitored properly, which is attributable in part to difficulty accessing healthcare services and getting medications and lab tests. If she does not receive rapid treatment and more specialized care for the ulcers, they could worsen and require hospitalization.

A growing number of people who seek health care have stories like Dioselina’s. Healthcare systems in Latin America and the Caribbean face significant health challenges affecting all age groups, which cause premature death and take a heavy social and economic toll.

Taking cues from the Declaration of Astana, nations ...

Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC)

Integrated Health Service Delivery Networks (IHSDN) based on primary health care (PHC) are the most promising solution for health systems to satisfy the health needs of the population and to address access, efficiency, quality and equity challenges faced by health systems of the world. PHCs essential attributes (people and family centred care, comprehensiveness, continuity, longitudinality) position this approach as one of the key strategies for countries to meet the aspiration of achieving universal health coverage.

Creating care networks has been a common thread running through Latin America and the Caribbean health policy agendas. In terms of actually putting the IHSDN model in action, there is a wide range of interpretations and experiences, with designs, scales, organizational methods, and maturity levels that vary within and between countries.

Health Network in Action, a publication from the Inter-American Development Bank, shares evidence of the progress made in forming and launching IHSDN in Latin ...

Person-centred care and measurement: The more one sees, the better one knows where to look

Determining the quality of a health system is a complex and challenging endeavour. The variety of perspectives needed to determine quality means that increasingly complex measurement frameworks are often employed. Providing the best possible health care has always been a priority for health system leaders, individual professions and individual professionals. But the importance and significance of measuring quality has increased since the evolution of quality-improvement methodologies for health-care quality standardisation in the 1990s.

Audit and feedback systems evolved into quality-control methods with the increased industrialisation of health systems. As the patient voice became increasingly important, with the rise in advocacy groups and patient-representative organisations, the focus on controlling the quality of services through a managerialist ideology was challenged. Broader, more inclusive, approaches to quality were embraced. Quality-improvement methodologies aim to adopt an inclusive approach to ongoing quality enhancement, ensuring that services are continuously developed and improved. This evolutionary context is ...

A vision for primary health care in the 21st century

In 1978 world leaders, international organizations and health authorities gathered in Alma-Ata (now Almaty), Kazakhstan, and released the Declaration of Alma-Ata on Primary Health Care, which remains a landmark document in the history of global health. The Alma-Ata Declaration established a standard of public commitment to making community-driven, quality health care accessible, both physically and financially, for all. This was the forerunner of the Global Strategy for Health for All by the Year 2000 that was pursued by WHO and its partners for the rest of the 20th century, and of Sustainable Development Goal (SDG) 3: “Ensure healthy lives and promote well-being for all at all ages” by 2030.

A Vision for Primary Health Care in the 21st Century provides the rationale for and foundation of the Astana Declaration, with its continued political focus on the right to integrated, quality, personal and population-level primary care; on health as a multisectoral ...