Showing papers on "Health management system published in 2016"

A prospective randomized trial examining health care utilization in individuals using multiple smartphone-enabled biosensors

Abstract: Background. Mobile health and digital medicine technologies are becoming increasingly used by individuals with common, chronic diseases to monitor their health. Numerous devices, sensors, and apps are available to patients and consumers-some of which have been shown to lead to improved health management and health outcomes. However, no randomized controlled trials have been conducted which examine health care costs, and most have failed to provide study participants with a truly comprehensive monitoring system. Methods. We conducted a prospective randomized controlled trial of adults who had submitted a 2012 health insurance claim associated with hypertension, diabetes, and/or cardiac arrhythmia. The intervention involved receipt of one or more mobile devices that corresponded to their condition(s) (hypertension: Withings Blood Pressure Monitor; diabetes: Sanofi iBGStar Blood Glucose Meter; arrhythmia: AliveCor Mobile ECG) and an iPhone with linked tracking applications for a period of 6 months; the control group received a standard disease management program. Moreover, intervention study participants received access to an online health management system which provided participants detailed device tracking information over the course of the study. This was a monitoring system designed by leveraging collaborations with device manufacturers, a connected health leader, health care provider, and employee wellness program-making it both unique and inclusive. We hypothesized that health resource utilization with respect to health insurance claims may be influenced by the monitoring intervention. We also examined health-self management. Results & Conclusions. There was little evidence of differences in health care costs or utilization as a result of the intervention. Furthermore, we found evidence that the control and intervention groups were equivalent with respect to most health care utilization outcomes. This result suggests there are not large short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.

Exploring perceptions of community health policy in Kenya and identifying implications for policy change

Abstract: Background: Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change. Methods: We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before framework analysis. Results: There is widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas for change identified include: lack of clear supervisory structure including provision of adequate travel resources, current uneven coverage and equity of community health services, limited community knowledge about the strategy revision and demand for home-based HIV testing and counselling. Conclusion: This in-depth analysis which captures multiple perspectives results in robust recommendations for strategy revision informed by the Five Wonders of Change Framework. These recommendations point towards a more people-centred health system for improved equity and effectiveness and indicate priority areas for action if success of policy change through the roll-out of the revised strategy is to be realized.

Level of data quality from Health Management Information Systems in a resources limited setting and its associated factors, eastern Ethiopia : original research

Abstract: Background: A Health Information System (HIS) is a system that integrates data collection, processing, reporting, and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. Despite the credible use of HIS for evidence-based decision-making, countries with the highest burden of ill health and the most in need of accurate and timely data have the weakest HIS in the vast majority of world's poorest countries. Although a Health Management Information System (HMIS) forms a backbone for strong health systems, most developing countries still face a challenge in strengthening routine HIS. The main focus of this study was to assess the current HIS performance and identify factors affecting data quality in a resource-limited setting, such as Ethiopian health facilities. Methods: A cross-sectional study was conducted by using structured questionnaires in Dire Dawa Administration health facilities. All unit and/or department heads from all government health facilities were selected. The data was analysed using STATA version 11. Frequency and percentages were computed to present the descriptive findings. Association between variables was computed using binary logistic regression. Results: Over all data quality was found to be 75.3% in unit and/or departments. Trained staff to fill format, decision based on supervisor directives and department heads seek feedback were significantly associated with data quality and their magnitudes were (AOR = 2.253, 95% CI [1.082, 4.692]), (AOR = 2.131, 95% CI [1.073, 4.233]) and (AOR = 2.481, 95% CI [1.262, 4.876]), respectively. Conclusion: Overall data quality was found to be below the national expectation level. Low data quality was found at health posts compared to health centres and hospitals. There was also a shortage of assigned HIS personnel, separate HIS offices, and assigned budgets for HIS across all units and/or departments.

A complexity thinking exploration of the maternal health care system in East New Britain, Papua New Guinea

Abstract: This thesis uses a complexity thinking approach to investigate the implementation of development strategies to improve maternal health taking the province of East New Britain, in Papua New Guinea, as a case study. A key global strategy for improving maternal and neonatal health is that every woman and baby receives assistance from an appropriately qualified and skilled health worker with midwifery skills. However, globally there continues to be a lack of universal care, with one in four births occurring in the absence of skilled assistance. In Papua New Guinea, access to skilled care remains inequitable and, since independence, there has been little reduction in the numbers of women and babies experiencing poor outcomes. Using a qualitative inquiry approach, the thesis employs a range of methods including analysis of historical and contemporary documents, interviews, and observation of clinical and administrative practice, to better understand the maternal health care system. Selected conceptual tools from complexity thinking guide analysis, namely path dependence and system lock-ins; connectivity and nonlinearity; and self-organisation and emergence. This work contributes to building knowledge of implementation of development strategies by highlighting the multiple ways that the maternal health care system intersects with other systems. It argues that these systems are all dynamic constructs shaped by historical, social and political conditions. As such, midwifery and health management practice are constrained by system constructs which do not recognise the importance of the role of midwives in protecting maternal and neonatal health. Constraints include inadequate prioritisation of maternal health to ensure midwives are enabled to provide care across their full scope of practice; non-establishment of maternal health review committees; and little agreement regarding education for cadres of health workers expected to provide women and neonates with midwifery care during pregnancy, labour and birth, and postpartum. In order to ensure all women receive skilled midwifery care, and thus improve maternal and neonatal health, this thesis argues it is crucial for development strategies to remain cognisant of, and engage with, the broader health system and other intersecting social systems. In addition to building technical midwifery capacity, development strategies must constructively disrupt the status quo to generate sufficient endogenous system change to enable the prioritisation of maternal health. This requires a balance between international recommendations, and existing systems realities and endogenous, context-dependent solutions.

Level of data quality from Health Management Information Systems in a resources limited setting and its associated factors, eastern Ethiopia

Abstract: Background: A Health Information System (HIS) is a system that integrates data collection, processing, reporting, and use of the information necessary for improving health service effectiveness and efficiency through better management at all levels of health services. Despite the credible use of HIS for evidence-based decision-making, countries with the highest burden of ill health and the most in need of accurate and timely data have the weakest HIS in the vast majority of world’s poorest countries. Although a Health Management Information System (HMIS) forms a backbone for strong health systems, most developing countries still face a challenge in strengthening routine HIS. The main focus of this study was to assess the current HIS performance and identify factors affecting data quality in a resource-limited setting, such as Ethiopian health facilities. Methods: A cross-sectional study was conducted by using structured questionnaires in Dire Dawa Administration health facilities. All unit and/or department heads from all government health facilities were selected. The data was analysed using STATA version 11. Frequency and percentages were computed to present the descriptive findings. Association between variables was computed using binary logistic regression. Results: Over all data quality was found to be 75.3% in unit and/or departments. Trained staff to fill format, decision based on supervisor directives and department heads seek feedback were significantly associated with data quality and their magnitudes were (AOR = 2.253, 95% CI [1.082, 4.692]), (AOR = 2.131, 95% CI [1.073, 4.233]) and (AOR = 2.481, 95% CI [1.262, 4.876]), respectively. Conclusion: Overall data quality was found to be below the national expectation level. Low data quality was found at health posts compared to health centres and hospitals. There was also a shortage of assigned HIS personnel, separate HIS offices, and assigned budgets for HIS across all units and/or departments.

Adoption of online health management tools among healthy older adults: An exploratory study.

Abstract: As the population ages and chronic diseases abound, overburdened healthcare systems will increasingly require individuals to manage their own health. Online health management tools, quickly increasing in popularity, have the potential to diminish or even replace in-person contact with health professionals, but overall efficacy and usage trends are unknown. The current study explored perceptions and usage patterns among users of online health management tools, and identified barriers and barrier-breakers among non-users. An online survey was completed by 169 computer users (aged 50+). Analyses revealed that a sizable minority (37%) of participants use online health management tools and most users (89%) are satisfied with these tools, but a limited range of tools are being used and usage occurs in relatively limited domains. Improved awareness and education for online health management tools could enhance people’s abilities to remain at home as they age, reducing the financial burden on formal assistance pr...

The Core of Care Management: The Role of Authentic Relationships in Caring for Patients with Frequent Hospitalizations

Abstract: In the movement to improve the health of patients with multiple chronic conditions and vulnerabilities, while reducing the need for hospitalizations, care management programs have garnered wide attention and support. The qualitative data presented in this paper sheds new light on key components of successful chronic care management programs. By going beyond a task- and temporal-based framework, this analysis identifies and defines the importance of "authentic healing relationships" in driving individual and systemic change. Drawing on the voices of 30 former clients of the Camden Coalition of Healthcare Providers, the investigators use qualitative methods to identify and elaborate the core elements of the authentic healing relationship-security, genuineness, and continuity-a relationship that is linked to patient motivation and active health management. Although not readily found in the traditional health care delivery system, these authentic healing relationships present significant implications for addressing the persistent health-related needs of patients with frequent hospitalizations. (Population Health Management 2016;19:248-256).

The Impact of Personalized Preventive Care on Health Care Quality, Utilization, and Expenditures.

Abstract: The objective of this study was to evaluate the impact on health care utilization and expenditure trends over time of a personalized preventive medicine program delivering individualized care focused on lifestyle behavior modification, disease prevention, and compliance with quality-related metrics. MD-Value in Prevention (MDVIP) is a network of affiliated primary care physicians who utilize a model of health care delivery based on an augmented physician-patient relationship and focused on personalized preventive health care. Multivariate modeling was used to control for demographics, socioeconomics, supply of health care services, and health status among 10,186 MDVIP members and randomly selected, matched nonmembers. Health care utilization and expenditure trends were tracked from the pre period prior to member enrollment for a period of up to 3 years post enrollment. MDVIP members experienced reduced utilization of emergency room and urgent care services compared to nonmembers. Program savings ranges indicated that, over time, increasing percentages of members achieved cost savings compared to nonmembers. Older age groups were more likely to realize savings in the early years with preventive activities indicating condition management, and younger age groups were most likely to achieve savings by the third year after enrollment. These results indicate that a primary care model based on an enhanced physician-patient relationship and focused on quality and personalized preventive care within a time frame of 3 years can achieve positive health care expenditure outcomes and improved health management.

Life style improvement mobile service for high risk chronic disease based on PHR platform

Abstract: As IT convergence technique develops, medical technology and apparatus are being modernized opening the era that we can obtain variable information easily anywhere, anytime thanks to wireless communication developed, further. These social changes enabled us to obtain information related to health more efficiently. Modern society is rapidly aging and more people experience chronic diseases because of their wrong eating habit, obesity and insufficient exercise. Thus a demand for health improvement and management at a certain term is increasing rather than complete therapy. Previously, major medical institutions managed personal medical history regarding patients mainly in health management but it is not changing its method to self-utilization and management by individual patient as of now along with medical institutions as fusion technology develops, and individual health record information can easily be checked anywhere, anytime through personal health record (PHR) platform. Unlike developing speed of related technology, however, there is a limitation in expansion, development of individual health record service, personal information security currently. In this paper, we propose mobile service regarding life style improvement targeting high risk chronic diseases based on PHR platform. PHR platform determines high blood pressure, diabetes, hyperlipidemia diseases which are three main chronic diseases using users' data and can monitor chronic diseases in portable mobile device. Also, the service provides by organically, mutually connected form through feedback towards input from health states of users in mobile device. By proposing contents about service based on efficient individual health record through mobile device that maximized transportability based on PHR platform, proposed method will contribute to industry development and activation of application service development of individual health record. Increase in consistency and reliability through standardization of afterwards health management service is expected to contribute to reduction in social cost and improvement of national health being the basis to realize communication activation of health record between medical institutions, efficient management and education of patients, reduction in dual examinations.

Mechanisms of Communicating Health Information Through Facebook: Implications for Consumer Health Information Technology Design.

Abstract: Background: Consumer health information technology (IT) solutions are designed to support patient health management and have the ability to facilitate patients’ health information communication with their social networks. However, there is a need for consumer health IT solutions to align with patients’ health management preferences for increased adoption of the technology. It may be possible to gain an understanding of patients’ needs for consumer health IT supporting their health information communication with social networks by explicating how they have adopted and adapted social networking sites, such as Facebook, for this purpose. Objective: Our aim was to characterize patients’ use of all communication mechanisms within Facebook for health information communication to provide insight into how consumer health IT solutions may be better designed to meet patients’ communication needs and preferences. Methods: This study analyzed data about Facebook communication mechanisms use from a larger, three-phase, sequential, mixed-methods study. We report here on the results of the study’s first phase: qualitative interviews (N=25). Participants were over 18, used Facebook, were residents or citizens of the United States, spoke English, and had a diagnosis consistent with type 2 diabetes. Participants were recruited through Facebook groups and pages. Participant interviews were conducted via Skype or telephone between July and September 2014. Data analysis was grounded in qualitative content analysis and the initial coding framework was informed by the findings of a previous study. Results: Participants’ rationales for the use or disuse of a particular Facebook mechanism to communicate health information reflected six broad themes: (1) characteristics and circumstances of the person, (2) characteristics and circumstances of the relationship, (3) structure and composition of the social network, (4) content of the information, (5) communication purpose, and (6) attributes of the technology. Conclusions: The results of this study showed that participants consider multiple factors when choosing a Facebook mechanism for health information communication. Factors included what information they intended to share, what they were trying to accomplish, attributes of technology, and attributes and communication practices of their social networks. There is a need for consumer health IT that allows for a range of choices to suit the intersectionality of participants’ rationales. Technology that better meets patients’ needs may lead to better self-management of health conditions, and therefore, improve overall health outcomes. [J Med Internet Res 2016;18(8):e218]

Health management system and method based on Internet and big data

Abstract: The invention relates to the technical field of medical treatment and health, and in particular provides health management system and method based on Internet and big data. The health management system based on the Internet and the big data comprises a bag data storage module, a data analysis module, a data management module and a client identity identification card. According to the health management system and method based on the Internet and the big data, provided by the invention, a comprehensive coverage health management system is established by utilizing network information and all-directional health management services are provided for customers; an innovative patient health file platform is established for medical service institutions, and an information interaction channel among the medical service institutions in different regions is established, so that the communication of medical outcomes is promoted, the medical level of one part of institutions is greatly improved, and a statistics platform of product utilization effects is provided for medical equipment manufacturing enterprises. The system has comprehensive functions and is practical, and can be used for greatly promoting the development of medical industry in China.

Physical health and well-being: Experiences and perspectives of young adult mental health consumers.

Abstract: Compromised physical health and raised levels of morbidity and mortality are experienced by young people (16-24 years) with mental illness, and are compounded by psychotropic medication. How this group conceives and experiences physical health is not well understood. We investigated the meanings, beliefs, and endeavours of young people that impact their physical health understandings and behaviours. The present study formed the qualitative phase of a sequential mixed-methods study, and incorporated semistructured interviews with 12 hospitalized young people. Qualitative content analysis was used to analyse data. Participants held a holistic ideal of physical health that they did not meet. Weight change, poor sleep, and limited exercise adversely impacted their lives and self-image. Sedentary behaviour, reduced energy, and limited health literacy compromised effective management of physical health. Young people needed structure and support to assist them in addressing their physical health needs when amotivation overwhelmed their internal resources. Nurses are well placed to help young people increase their competency for health management. Individualized information and methods to promote good physical health are required for this group in jeopardy from physical morbidity and mortality.

A health system perspective on factors influencing the use of health information for decision-making in a district health system

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Utilization of Health Management Information System and Associated Factors in Hadiya Zone Health Centers, Southern Ethiopia

Abstract: Background: Health Information systems are increasingly important for measuring and improving the quality and coverage of health services. Reliable and timely health information is vital for operational and strategic decision making that save lives and enhances health. In Ethiopia information quality and use remain weak, particularly at district health offices and primary health care facilities to facilitate decision making. Therefore this study will be designed to greatly signal the current status of Health Management Information System (HMIS) in study area. Objective: To assess the utilization of health management information systems and associated factors at health centers in Hadiya zone, Southern Ethiopia, 2014. Methods: A cross sectional study was conducted in health institutions by interviewing units/departments of health centers from April to June, 2014. Quantitative data was collected using structured questionnaires, check lists, observation and interview guide by trained data collectors. Data was analyzed using SPSS version 20 and descriptive and logistic regression analysis was carried out. Results: The finding of the study revealed that utilization of health management information was 242(69.3%) in all the study units/departments of health centers. Health center units/department had key indicators (AOR=3.67; 95%CI: 2.11, 6.39), completeness of data format (AOR=3.42; 95%CI: 1.65, 7.08), consistency of data (AOR=1.91; 95%CI: 1.05, 3.48) were found to be significantly associated with utilization of health information system at 95% level of significance. Conclusion: Health center units/departments had key indicators, completeness of data and consistency of data were predictors of utilization of health management information system. Therefore, in-service training and updating of staff involved in Health Management Information System (HMIS) at district, strengthening health information system inputs, timely and concrete feedbacks with establishment of functional Health Management Information System (HMIS).

Health management system based on cloud-computing data analysis

Abstract: The invention discloses a health management system based on cloud-computing data analysis. A detection data collecting unit uploads collected health information to a cloud-computing service platform, the cloud-computing service platform generates a health report by conducting systematic classification on health data, the health report is transmitted to a user mobile terminal through the cloud-computing service platform, and a user inquires health report information through the user mobile terminal. According to the health management system, the user gets rid of a paper report, the health report of the user can be shown on the intelligent terminal of the user through cloud-computing data analysis of the health management system, control over health of the user himself or herself is not limited by time and space any more, the user can check and understand the health condition of his own or her own anytime and anywhere, and the user can understand the variation trend of the health state of a certain phase of his own or her own through the health management system.

Health management system based on novel user authentication and device and information management method

Abstract: The invention provides a health management system based on novel user authentication and a device and information management method. The system is composed of a health management all-in-one machine, an intelligent mobile terminal, a health management cloud platform and a health service team; multiple detection devices and a management terminal are integrated on the front end health management all-in-one machine and can be flexibly arranged in various places such as communities, companies and families, by means of intelligentized user authentication and the device management method on the basis of a mobile internet and a two-dimensional code technology, complete self-service health detection and health management are achieved; a management terminal is used for achieving information management functions such as receiving, displaying and uploading of device management and detection data; the intelligent mobile terminal cooperates with the all-in-one machine management terminal, and user authentication, device binding and measurement data display and health information management functions are achieved; by means of the health management cloud platform, storing and processing of user health data and health archive management are achieved; the health service team provides health status analysis and health consulting services for a user. According to the health management system, the mobile internet, the internet of things and a cloud computing technology are comprehensively utilized, and the advantages of being rich in application and complete in function, achieving self-service health management and the like are achieved.

Meaningful Engagement of ACOs With Communities: The New Population Health Management.

Abstract: Objectives:Population health management (PHM) activities within health care organizations have traditionally focused on coordinating services for populations who present for care in physicians’ offices. With the recent proliferation of Accountable Care Organizations (ACOs), however, the reach of PHM

Travel health management system

Abstract: Systems and methods for providing travel health management include determining that a user will be traveling to a new location that is different from a home location that is associated with the user in a database. Health situation information that is associated with at least one health situation at the new location is then retrieved. The health situation information is compared to a medical profile for the user that is stored in the database to determine a travel health recommendation that includes a health action that will prepare the user for the at least one health situation at the new location. The travel health recommendation is then provided for display to the user. A status of the performance of the heath action by the user may then be tracked, and updates displayed to the user to provide for the management of the travel health of the user.

To what extent do site-based training, mentoring, and operational research improve district health system management and leadership in low- and middle-income countries: a systematic review protocol

Abstract: District health managers play a key role in the effectiveness of decentralized health systems in low- and middle-income countries. Inadequate management and leadership skills often hamper their ability to improve quality of care and effectiveness of health service delivery. Nevertheless, significant investments have been made in capacity-building programmes based on site-based training, mentoring, and operational research. This systematic review aims to review the effectiveness of site-based training, mentoring, and operational research (or action research) on the improvement of district health system management and leadership. Our secondary objectives are to assess whether variations in composition or intensity of the intervention influence its effectiveness and to identify enabling and constraining contexts and underlying mechanisms. We will search the following databases: MEDLINE, PsycInfo, Cochrane Library, CRD database (DARE), Cochrane Effective Practice and Organisation of Care (EPOC) group, ISI Web of Science, Health Evidence.org, PDQ-Evidence, ERIC, EMBASE, and TRIP. Complementary search will be performed (hand-searching journals and citation and reference tracking). Studies that meet the following PICO (Population, Intervention, Comparison, Outcome) criteria will be included: P: professionals working at district health management level; I: site-based training with or without mentoring, or operational research; C: normal institutional arrangements; and O: district health management functions. We will include cluster randomized controlled trials, controlled before-and-after studies, interrupted time series analysis, quasi-experimental designs, and cohort and longitudinal studies. Qualitative research will be included to contextualize findings and identify barriers and facilitators. Primary outcomes that will be reported are district health management and leadership functions. We will assess risk of bias with the Cochrane Collaboration’s tools for randomized controlled trials (RCT) and non RCT studies and Critical Appraisal Skills Programme checklists for qualitative studies. We will assess strength of recommendations with the GRADE tool for quantitative studies, and the CERQual approach for qualitative studies. Synthesis of quantitative studies will be performed through meta-analysis when appropriate. Best fit framework synthesis will be used to synthesize qualitative studies. This protocol paper describes a systematic review assessing the effectiveness of site-based training (with or without mentoring programmes or operational research) on the improvement of district health system management and leadership. PROSPERO CRD42015032351

Do Management and Leadership Practices in the Context of Decentralisation Influence Performance of Community Health Fund? Evidence From Iramba and Iringa Districts in Tanzania.

Abstract: Background In early 1990s, Tanzania like other African countries, adopted health sector reform (HSR). The most strongly held centralisation system that informed the nature of services provision including health was, thus, disintegrated giving rise to decentralisation system. It was within the realm of HSR process, user fees were introduced in the health sector. Along with user fees, various types of health insurances, including the Community Health Fund (CHF), were introduced. While the country’s level of enrolment in the CHF is low, there are marked variations among districts. This paper highlights the role of decentralised health management and leadership practices in the uptake of the CHF in Tanzania. Methods A comparative exploratory case study of high and low performing districts was carried out. In-depth interviews were conducted with the members of the Council Health Service Board (CHSB), Council Health Management Team (CHMT), Health Facility Committees (HFCs), in-charges of health facilities, healthcare providers, and Community Development Officers (CDOs). Minutes of the meetings of the committees and district annual health plans and district annual implementation reports were also used to verify and triangulate the data. Thematic analysis was adopted to analyse the collected data. We employed both inductive and deductive (mixed coding) to arrive to the themes. Results There were no differences in the level of education and experience of the district health managers in the two study districts. Almost all district health managers responsible for the management of the CHF had attended some training on management and leadership. However, there were variations in the personal initiatives of the top-district health leaders, particularly the district health managers, the council health services board and local government officials. Similarly, there were differences in the supervision mechanisms, and incentives available for the health providers, HFCs and board members in the two study districts. Conclusion This paper adds to the stock of knowledge on CHFs functioning in Tanzania. By comparing the best practices with the worst practices, the paper contributes valuable insights on how CHF can be scaled up and maintained. The study clearly indicates that the performance of the community-based health financing largely depends on the personal initiatives of the top-district health leaders, particularly the district health managers and local government officials. This implies that the regional health management team (RHMT) and the Ministry of Health and Social Welfare (MoHSW) should strengthen supportive supervision mechanisms to the district health managers and health facilities. More important, there is need for the MoHSW to provide opportunities for the well performing districts to share good practices to other districts in order to increase uptake of the community-based health insurance.

Routine Health Management Information Use in the Public Health Sector in Tharaka Nithi County, Kenya.

Abstract: Health information systems are foundations of health systems. Despite their essential benefits at facility level, health workers spend 40% or more of their time filling in HIS forms but may make little or no use of information for decision making. Health Information use is determined by multiple factors. This study aimed at establishing the technical, organizational and behavioral factors influencing Health Information use in the public health sector in Tharaka Nithi County. A descriptive cross-sectional study was conducted among 41 respondents in 16 public health facilities in Tharaka Nithi County. Data was collected using researcher administered questionnaires. Lack of staff competence, multiple HIS tools, lack of computers, lack of information use culture promotion, lack of support of staff training in HIS skills, lack of support supervision on information use, lack of staff motivation and recognition for well done job, were the factors influencing Health Information use. The study concludes: provision of technical, organizational and behavioral factors for health information use in fact-based decisions in Tharaka Nithi County.

Building a competent health manager at district level: a grounded theory study from Eastern Uganda.

Abstract: Health systems in low-income countries are often characterized by poor health outcomes. While many reasons have been advanced to explain the persistently poor outcomes, management of the system has been found to play a key role. According to a WHO framework, the management of health systems is central to its ability to deliver needed health services. In this study, we examined how district managers in a rural setting in Uganda perceived existing approaches to strengthening management so as to provide a pragmatic and synergistic model for improving management capacity building. Twenty-two interviews were conducted with district level administrative and political managers, district level health managers and health facility managers to understand their perceptions and definitions of management and capacity building. Kathy Charmaz’s constructive approach to grounded theory informed the data analysis process. An interative, dynamic and complex model with three sub-process of building a competent health manager was developed. A competent manager was understood as one who knew his/her roles, was well informed and was empowered to execute management functions. Professionalizing health managers which was viewed as the foundation, the use of engaging learning approaches as the inside contents and having a supportive work environment the frame of the model were the sub-processes involved in the model. The sub-processes were interconnected although the respondents agreed that having a supportive work environment was more time and effort intensive relative to the other two sub-processes. The model developed in our study makes four central contributions to enhance the WHO framework and the existing literature. First, it emphasizes management capacity building as an iterative, dynamic and complex process rather than a set of characteristics of competent managers. Second, our model suggests the need for professionalization of health managers at different levels of the health system. Third, our model underscores the benefits that could be accrued from the use of engaging learning approaches through prolonged and sustained processes that act in synergy. Lastly, our model postulates that different resource investments and a varied range of stakeholders could be required at each of the sub-processes.

eSeniorCare: Technology for Promoting Well-Being of Older Adults in Independent Living Facilities

Abstract: The aging population (seniors) maintains a strong desire to remain independent as long as possible while maintaining their physical health and emotional well-being. We have witnessed a growth in technological solutions delivered as Apps on mobile devices for health and wellness. However, several challenges remain in their application to assist seniors in the dimensions of health and wellness. They fail to provide sufficient connectivity and a level of usability that is appropriate for seniors. To that end, we are developing a tablet-based application, eSeniorCare, to integrate various components of health and wellbeing targeting successful aging. Our design and development followed an iterative process involving feedback from the participants. We conducted a 31-week study of the application with 16 participants at an independent facility in collaboration with Memorial Hospital of South Bend. Our study found that through the use of the application, participants demonstrated improved technological health management skills and decreased risk for depression, suggesting that eSeniorCare represents an important step toward improving senior care and quality of life.

The impact of a bundled policy intervention on improving the performance of rural healthcare in China

Abstract: The strategy of health policy has been changed for improving the performances to meeting the increasing healthcare demands. However, limited evidences were found to prove that the bundled payment was valid for service delivering in public sector. This study was designed to evaluate the effectiveness of a bundled policy on strengthening the county-village communication and improving the quality of chronic disease management. This is a retrospective cohort study using the data collected in 2011, 2012 and 2014 from the Rural Health Development Project in China. The policy intervention included performance-related contract with health facilities, developing technical guideline for doctors and nurses, routine monitoring of performance, and efforts to increase public awareness about the services. There were two intervention counties in Henan Province, China, while one county with similar characteristics in Henan was selected as control. Funding allocation, work load and salary for health care workers, volume of township-to-village technical assistance were reported before and after the policy was implemented. Our study also examined the policy impacts on improving treatment outcomes of diabetes and hypertension care. There were substantial increases in the provision of the basic package of services including 96.6 % of patients with hypertension, 91.2 % of patients with diabetes under the health management system. After the intervention, there were 34.3 % (hypertension) and 42.0 % (diabetes) increase in regular follow-up visit rates, 24.6 and 17.2 % increase in blood pressure and blood glucose control rates, respectively. The family health records system covered 96 % of the rural families. Technical assistance between township health centres and village clinics were enhanced. Compared with baseline, the monthly training meeting and field supervision & guidance between township health centres and village clinics increased 1.0 meeting, 1.5 field visits, respectively, while the increases in the control county were only 0.3 meeting and 0.3 field visits. At the end of this study, 93.8 % of health workers achieved their performance goals. More patients were referred to appropriate levels of care. This bundled policy intervention effectively improved rural health care delivery. The result of our study can be used for local governments to implement performance-based health system management in developing country.

Utilization of health services in a resource-limited rural area in Kenya: prevalence and associated household-level factors

Abstract: Background and methods Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services. Results and conclusions 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05–0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.

Clinical effectiveness of transdiagnostic health management interventions for older people with multimorbidity: a quantitative systematic review.

Abstract: Aim The aim of this study was to evaluate the clinical effectiveness (improvement in health status and/or functioning and use of health services) of transdiagnostic health management interventions for people aged 65 years and older. Background The care of older people with multimorbidity is of increasing concern for nurses. A transdiagnostic approach to health management interventions (promote self-management or lifestyle) may be apposite for providing older people with the skills to manage symptoms that may or may not be disease-specific. Design Quantitative systematic review. Review methods Cochrane methods using Cochrane's Effective Practice and Organization of Care Methods (EPOC) for assessing risk of bias and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for assessing the weight of evidence. Data sources Medline, CINAHL, PubMed and PsycINFO 1999–2014. Results Twelve studies were included in the review (n = 10,393). All 12 studies provided results for health outcomes (health status and functioning) and six provided results for health outcomes and health service utilization. Ten studies reported statistically significant improvements in health outcomes but of these studies only two were of low risk of bias. Three studies identified some statistically significant reductions in health service utilization. The weight of evidence for the health management interventions included in the review, were low/moderate for improvements in health status and low for improvements in health service utilization. Conclusion While there is some very preliminary evidence suggesting that structured transdiagnostic health management interventions may be clinically effective for older people with multimorbidity the effect sizes are small and the quality of this evidence is generally low.

How do older people with sight loss manage their general health? A qualitative study

Abstract: Purpose: Older people with sight loss experience a number of barriers to managing their health. The purpose of this qualitative study was to explore how older people with sight loss manage their general health and explore the techniques used and strategies employed for health management. Methods: Semi-structured face-to-face interviews were conducted with 30 participants. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Health management challenges experienced included: managing multiple health conditions; accessing information; engaging in health behaviours and maintaining wellbeing. Positive strategies included: joining support groups, clubs and societies; using low vision aids; seeking support from family and friends and accessing support through health and social care services. Conclusion: Healthcare professionals need to be more aware of the challenges faced by older people with sight loss. Improved promotion of group support and charity services which are best placed to share information, provide fora to learn about coping techniques and strategies, and give older people social support to prevent isolation is needed. Rehabilitation and support services and equipment can only be beneficial if patients know what is available and how to access them. Over-reliance on self-advocacy in current healthcare systems is not conducive to patient-centred care. Implications for Rehabilitation Sight loss in older people can impact on many factors including health management. This study identifies challenges to health management and highlights strategies used by older people with sight loss to manage their health. Access to support often relies on patients seeking information for themselves. However, self-advocacy is challenging due to information accessibility barriers. Informal groups and charities play an important role in educating patients about their condition and advising on available support to facilitate health management.

The Information Transparency Effects of Introducing League Tables in the Health System in Malawi

Abstract: League tables are used to compare the performance of different entities in the health systems in developing countries. The aim of this paper is to study the implementation process and its effects related to a computerized league table application in Malawi. Focusing on the health district and using a field experiment research approach, the focus is on the implementation process and how it improves information transparency for health managers. Based on routine health data recording in the health management information system DHIS2, the introduced league table was used by the district health management teams in the pilot districts to rank and compare performance among their health facilities. While the introduction of the league tables was challenging, it also showed its potential through effects including improved visibility of information and accessibility for managers, better understanding of indicators, the identification of data quality issues, skills acquisition in computing and information use and improved communication and collaboration among stakeholders.