Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?290293345010.15171/ijhpm.2017.144ENGillHarveyAdelaide Nursing School, University of Adelaide, Adelaide, SA, Australia0000-0003-0937-7819JoanneDollardAdelaide Medical School, University of Adelaide, Adelaide, SA, AustraliaAmyMarshallAdelaide Nursing School, University of Adelaide, Adelaide, SA, Australia0000-0002-7084-3690Manasi MurthyMittintyAdelaide Nursing School, University of Adelaide, Adelaide, SA, AustraliaAustralian Research Centre for Population Oral Health, Adelaide Dental
School, University of Adelaide, Adelaide, SA, AustraliaJournal Article20171003<span class="fontstyle0">Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multifactorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. This approach of fixing parts of the system may be akin to shuffling the deckchairs on the Titanic, rather than dealing with the fundamental reasons why the ship is sinking. Attempts to make the ship more watertight need to be firmly centred on the older person, pay close attention to implementation and embrace approaches that promote collaborative working between all the stakeholders involved.</span>https://www.ijhpm.com/article_3450_703957b6dd9e3a7980e040bee50ded65.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Settling Ulysses: An Adapted Research Agenda for Refugee Mental Health294296343610.15171/ijhpm.2017.131ENYuditNamerDepartment of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, GermanyOliverRazumDepartment of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, GermanyJournal Article20170725<span class="fontstyle0">Refugees and asylum seekers arriving in Europe during the 2015/2016 wave of migration have been exposed to war conditions in their country of origin, survived a dangerous journey, and often struggled with negative reception in transit and host countries. The mental health consequence of such forced migration experiences is named the Ulysses syndrome. Policies regarding the right to residency can play an important role in reducing mental health symptoms. We propose that facilitating a sense of belonging should be seen as one important preventive mental healthcare intervention. A refugee mental health agenda needs to take into account the interplay between refugees’ and asylum seekers’ mental health, feeling of belonging, and access to healthcare. We urge for policies to restore individuals’ dignity, and recognize the right for homecoming to parallel the mythology of Ulysses.</span>https://www.ijhpm.com/article_3436_61f2585b0ebcf1f532c4d1ec9a7d51aa.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401An Analysis of the Extent of Social Inclusion and Equity Consideration in Malawi’s National HIV and AIDS Policy Review Process297307339510.15171/ijhpm.2017.87ENMathews JuniorChinyamaCentre for Global Health, Trinity College Dublin, Dublin, IrelandDepartment of
Nutrition, HIV and AIDS, Lilongwe, MalawiMalcolmMacLachlanCentre for Global Health & School
of Psychology, Trinity College Dublin, Dublin, IrelandCentre for Rehabilitation
Studies, Stellenbosch University, Stellenbosch, South AfricaOlomouc
University Social Health Institute, Palacky University, Olomouc, Czech RepublicJoanneMcVeighCentre for Global Health & School
of Psychology, Trinity College Dublin, Dublin, IrelandTessyHussCentre for Global Health & School
of Psychology, Trinity College Dublin, Dublin, IrelandSylvesterGawamadziDepartment of
Nutrition, HIV and AIDS, Lilongwe, MalawiJournal Article20160916Background<br /> Equity and social inclusion for vulnerable groups in policy development processes and resulting documents remain a challenge globally. Most often, the marginalization of vulnerable groups is overlooked in both the planning and practice of health service delivery. Such marginalization may occur because authorities deem the targeting of those who already have better access to healthcare a cheaper and easier way to achieve short-term health gains. The Government of Malawi wishes to achieve an equitable and inclusive HIV and AIDS Policy. The aim of this study is to assess the extent to which the Malawi Policy review process addressed regional and international health priorities of equity and social inclusion for vulnerable groups in the policy content and policy revision process. <br /> <br /> Methods<br /> This research design comprised two phases. First, the content of the Malawi HIV and AIDS Policy was assessed using EquiFrame regarding its coverage of 21 Core Concepts of human rights and inclusion of 12 Vulnerable Groups. Second, the engagement of vulnerable groups in the policy process was assessed using the EquIPP matrix. For the latter, 10 interviews were conducted with a purposive sample of representatives of public sector, civil society organizations and development partners who participated in the policy revision process. Data was also collected from documented information of the policy processes. <br /> <br /> Results<br /> Our analyses indicated that the Malawi HIV and AIDS Policy had a relatively high coverage of Core Concepts of human rights and Vulnerable Groups; although with some notable omissions. The analyses also found that reasonable <br />steps were taken to engage and promote participation of vulnerable groups in the planning, development,implementation, <br />monitoring and evaluation processes of the HIV and AIDS Policy, although again, with some notable exceptions. This is the first study to use both EquiFrame and EquIPP as complimentary tools to assess the content and process of policy.<br /> <br /> Conclusion<br /> While the findings indicate inclusive processes, commitment to Core Concepts of human rights and inclusion of Vulnerable Groups in relation to the Malawi HIV and AIDS Policy, the results also point to areas in which social inclusion and equity could be further strengthened.https://www.ijhpm.com/article_3395_828752f77ada1b8badf688bb8be59f9d.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Measuring Hospital Performance Using Mortality Rates: An Alternative to the RAMR308316340110.15171/ijhpm.2017.94ENChristinePitoccoCollege of Business, Stony Brook University, Stony Brook, NY, USAThomas R.SextonCollege of Business, Stony Brook University, Stony Brook, NY, USAJournal Article20170111Background<br /> The risk-adjusted mortality rate (RAMR) is used widely by healthcare agencies to evaluate hospital performance. The RAMR is insensitive to case volume and requires a confidence interval for proper interpretation, which results in a hypothesis testing framework. Unfamiliarity with hypothesis testing can lead to erroneous interpretations by the public and other stakeholders. We argue that screening, rather than hypothesis testing, is more defensible. We propose an alternative to the RAMR that is based on sound statistical methodology, easier to understand and can be used in large-scale screening with no additional data requirements.<br /> <br /> Methods<br /> We use an upper-tail probability to screen for hospitals performing poorly and a lower-tail probability to screen for hospitals performing well. Confidence intervals and hypothesis tests are not needed to compute or interpret our measures. Moreover, unlike the RAMR, our measures are sensitive to the number of cases treated.<br /> <br /> Results<br /> To demonstrate our proposed methodology, we obtained data from the New York State Department of Health for 10 Inpatient Quality Indicators (IQIs) for the years 2009-2013. We find strong agreement between the upper tail probability (UTP) and the RAMR, supporting our contention that the UTP is a viable alternative to the RAMR.<br /> <br /> Conclusion<br /> We show that our method is simpler to implement than the RAMR and, with no need for a confidence interval, it is easier to interpret. Moreover, it will be available for all hospitals and all diseases/conditions regardless of patient volumehttps://www.ijhpm.com/article_3401_7fcc48d22804dbbe9b66b607d51389d4.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Empirical Study of Nova Scotia Nurses’ Adoption of Healthcare Information Systems: Implications for Management and Policy-Making317327340410.15171/ijhpm.2017.96ENPrincelyIfinedoDepartment of Financial and Information Management, Shannon School of Business, Cape Breton University, Sydney, NSW, CanadaJournal Article20170310Background<br /> This paper used the Theory of Planned Behavior (TPB), which was extended, to investigate nurses’ adoption of healthcare information systems (HIS) in Nova Scotia, Canada.<br /> <br /> Methods<br /> Data was collected from 197 nurses in a survey and data analysis was carried out using the partial least squares (PLS) technique.<br /> <br /> Results<br /> In contrast to findings in prior studies that used TPB to investigate clinicians’ adoption of technologies in Canada and elsewhere, this study found no statistical significance for the relationships between attitude and subjective norm in relation to nurses’ intention to use HIS. Rather, facilitating organizational conditions was the only TPB variable that explained sampled nurses’ intention to use HIS at work. In particular, effects of computer habit and computer anxiety among older nurses were signified.<br /> <br /> Conclusion<br /> To encourage nurses’ adoption of HIS, healthcare administrators need to pay attention to facilitating organization conditions at work. Enhancing computer knowledge or competence is important for acceptance. Information presented in the study can be used by administrators of healthcare facilities in the research location and comparable parts of the world to further improve HIS adoption among nurses. The management of nursing professionals, especially in certain contexts (eg, prevalence of older nursing professionals), can make use of this study’s insights.https://www.ijhpm.com/article_3404_c6b8c8d762da15fa8dbbdfb6baf9e260.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Assessing and Improving Performance: A Longitudinal Evaluation of Priority Setting and Resource Allocation in a Canadian Health Region328335340710.15171/ijhpm.2017.98ENWilliamHallCentre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health
Research Institute, Vancouver, BC, CanadaNealeSmithCentre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health
Research Institute, Vancouver, BC, CanadaCraigMittonCentre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health
Research Institute, Vancouver, BC, CanadaBonnieUrquhartPlanning and Performance
Improvement, Northern Health Authority, Prince George, BC, CanadaStirlingBryanCentre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health
Research Institute, Vancouver, BC, CanadaSchool
of Population and Public Health, The University of British Columbia (UBC),
Vancouver, BC, CanadaJournal Article20161207Background<br /> In order to meet the challenges presented by increasing demand and scarcity of resources, healthcare organizations are faced with difficult decisions related to resource allocation. Tools to facilitate evaluation and improvement of these processes could enable greater transparency and more optimal distribution of resources.<br /> <br /> Methods<br /> The Resource Allocation Performance Assessment Tool (RAPAT) was implemented in a healthcare organization in British Columbia, Canada. Recommendations for improvement were delivered, and a follow up evaluation exercise was conducted to assess the trajectory of the organization’s priority setting and resource allocation (PSRA) process 2 years post the original evaluation.<br /> <br /> Results<br /> Implementation of RAPAT in the pilot organization identified strengths and weaknesses of the organization’s PSRA process at the time of the original evaluation. Strengths included the use of criteria and evidence, an ability to re-allocate resources, and the involvement of frontline staff in the process. Weaknesses included training, communication, and lack of program budgeting. Although the follow up revealed a regression from a more formal PSRA process, a legacy of explicit resource allocation was reported to be providing ongoing benefit for the organization. <br /> <br /> Conclusion<br /> While past studies have taken a cross-sectional approach, this paper introduces the first longitudinal evaluation of PSRA in a healthcare organization. By including the strengths, weaknesses, and evolution of one organization’s journey, the authors’ intend that this paper will assist other healthcare leaders in meeting the challenges of allocating scarce resources.https://www.ijhpm.com/article_3407_dab49080d80c724aad5ebf158d63df41.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Improving the Distribution of Rural Health Houses Using Elicitation and GIS in Khuzestan Province (the Southwest of Iran)336344340810.15171/ijhpm.2017.101ENAliMohammadiDepartment of Health Information Technology, Paramedical School,
Kermanshah University of Medical Sciences, Kermanshah, IranAliValinejadiSocial
Determinants of Health Research Center, Department of Health Information
Technology, School of Allied Medical Sciences, Semnan University of Medical
Sciences, Semnan, Iran0000-0003-4414-2732SaraSakipourHealth Management and Economics Research
Center, Iran University of Medical Sciences, Tehran, IranMortezaHemmatSocial Determinants
of Health Research Center, Saveh University of Medical Sciences, Saveh,
IranJavadZareiDepartment of Health Information Technology, Paramedical School,
Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran0000-0003-2692-7771HesamedinAskari MajdabadiNursing Care
Research Center, Semnan University of Medical Sciences, Semnan, IranJournal Article20170213Background<br /> Rural health houses constitute a major provider of some primary health services in the villages of Iran. Given the challenges of providing health services in rural areas, health houses should be established based on the criteria of health network systems (HNSs). The value of these criteria and their precedence over others have not yet been thoroughly investigated. The present study was conducted to propose a model for improving the distribution of rural health houses in HNSs.<br /> <br /> Methods<br /> The present applied study was conducted in Khuzestan province in the southwest of Iran in 2014-2016. First, the descriptive and spatial data required were collected and entered into ArcGIS after modifications, and the Geodatabase was then created. Based on the criteria of the HNS and according to experts’ opinions, the main criteria and the sub-criteria for an optimal site selection were determined. To determine the criteria’s coefficient of importance (ie, their weight), the main criteria and the sub-criteria were compared in pairs according to experts’ opinions. The results of the pairwise comparisons were entered into Expert Choice and the weight of the main criteria and the sub-criteria were determined using the analytic hierarchy process (AHP). The application layers were then formed in geographic information system (GIS). A model was ultimately proposed in the GIS for the optimal distribution of rural health houses by overlaying the weighting layers and the other layers related to villages and rural health houses.<br /> <br /> Results<br /> Based on the experts’ opinions, six criteria were determined as the main criteria for an optimal site selection for rural health houses, including welfare infrastructures, population, dispersion, accessibility, corresponding routes, distance to the rural health center and the absence of natural barriers to accessibility. Of the main criteria proposed, the highest weight was given to “population” (0.506). The priorities suggested in the proposed model for establishing rural health houses are presented within five zoning levels –from excellent to very poor. <br /> <br /> Conclusion<br /> The results of the study showed that the proposed model can help provide a better picture of the distribution of rural health houses. The GIS is recommended to be used as a means of making the HNS more efficient.https://www.ijhpm.com/article_3408_734e6bfcd358e25ac1db0a4241b95651.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401The No-Destination Ship of Priority-Setting in Healthcare: A Call for More Democracy345348342410.15171/ijhpm.2017.119ENBrayanV. SeixasSchool of Population and Public Health, University of British Columbia, Vancouver, BC, CanadaJournal Article20170811<span class="fontstyle0">In dealing with scarcity of resources within healthcare systems, decision-makers inevitably have to make choices about which services to fund. Setting priorities represents a challenging task that requires systematic, explicit and transparent methodologies with focus on economic efficiency. In addition, the engagement of the general public in the process of decision-making has been regarded as one of the most important aspects of the management of publicly-funded health systems in liberal democracies. In the current essay, we aim to discuss the problematics of public engagement in the process of resource allocation and priority-setting within the context of publiclyfunded health systems. Our central argument is that although there may be a conflict between democratic mechanisms of citizen participation and economic efficiency, in the extra-welfarist sense, expected for/from the system, the solution for this tension does not seem to rely on more or novel authoritative technocratic approaches, but rather on the deepening and betterment of democratic participation.</span>https://www.ijhpm.com/article_3424_71a5c0514ab83382d98154e5a5f9d813.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Providers and Patients Caught Between Standardization and Individualization: Individualized Standardization as a Solution; Comment on “(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare”349352340210.15171/ijhpm.2017.95ENLenaAnsmannInstitute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine,
University of Cologne, Cologne, GermanyHolgerPfaffInstitute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of Medicine,
University of Cologne, Cologne, Germany0000-0001-9154-6575Journal Article20170614In their 2017 article, Mannion and Exworthy provide a thoughtful and theory-based analysis of two parallel trends in modern healthcare systems and their competing and conflicting logics: standardization and customization. This commentary further discusses the challenge of treatment decision-making in times of evidence-based medicine (EBM), shared decision-making and personalized medicine. From the perspective of systems theory, we propose the concept of individualized standardization as a solution to the problem. According to this concept, standardization is conceptualized as a guiding framework leaving room for individualization in the patient physician interaction. The theoretical background is the concept of context management according to systems theory. Moreover, the comment suggests multidisciplinary teams as a possible solution for the integration of standardization and individualization, using the example of multidisciplinary tumor conferences and highlighting its limitations. The comment also supports the authors’ statement of the patient as co-producer and introduces the idea that the competing logics of standardization and individualization are a matter of perspective on macro, meso and micro levels.https://www.ijhpm.com/article_3402_91d0dbfd38d950cb716c4dd26c5da08a.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Making Research Matter; Comment on “Public Spending on Health Service and Policy Research in Canada, the United Kingdom, and the United States: A Modest Proposal”353355340310.15171/ijhpm.2017.97ENDavid J.HunterInstitute of Health and Society, Newcastle University, Newcastle, UK0000-0002-7085-8729JohnFrankUsher
Institute of Population Health Sciences and Informatics, University of Edinburgh,
Edinburgh, UK0000-0003-3912-4214Journal Article20170628We offer a UK-based commentary on the recent “Perspective” published in <em>IJHPM</em> by Thakkar and Sullivan. We are sympathetic to the authors’ call for increased funding for health service and policy research (HSPR). However, we point out that increasing that investment – in any of the three countries they compare: Canada, the United States and the United Kingdom– will ipso facto not necessarily lead to any better use of research by health system decision-makers in these settings. We cite previous authors’ descriptions of the many factors that tend to make the worlds of researchers and decision-makers into “two solitudes.” And we call for changes in the structure and funding of HSPR, particularly the incentives now in place for purely academic publishing, to tackle a widespread reality: most published research in HSPR, as in other applied fields of science, is never read or used by the vast majority of decision-makers, working out in the “real world.”https://www.ijhpm.com/article_3403_898dd88cca7b2f65461bc491dacb9b25.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Best of Both Worlds; Comment on “(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare”356358340510.15171/ijhpm.2017.99ENCatherineNeedhamHealth Services Management Centre, University of Birmingham, Birmingham, UKJournal Article20170616This article builds on Mannion and Exworthy’s account of the tensions between standardization and customization within health services to explore why these tensions exist. It highlights the limitations of explanations which root them in an expression of managerialism versus professionalism and suggests that each logic is embedded in a set of ontological, epistemological and moral commitments which are held in tension. At the front line of care delivery, people cannot resolve these tensions but must navigate and negotiate them. The legitimacy of a health system depends on its ability to deliver the ‘best of both worlds’ to citizens, offering the reassurance of sameness and the dignity of difference.https://www.ijhpm.com/article_3405_be1bc7997695495f756312886f566110.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Competing Logics and Healthcare; Comment on “(Re) Making the Procrustean Bed? Standardization and Customization as Competing Logics in Healthcare”359361340610.15171/ijhpm.2017.100ENMikeSaksUniversity of Suffolk, Ipswich, UKUniversity of Lincoln, Lincoln, UKRoyal Veterinary College, University of London, London, UKUniversity of
St Mark and St John, Plymouth, UKUniversity of Toronto, Toronto, ON, CanadaJournal Article20170617This paper offers a short commentary on the editorial by Mannion and Exworthy. The paper highlights the positive insights offered by their analysis into the tensions between the competing institutional logics of standardization and customization in healthcare, in part manifested in the conflict between managers and professionals, and endorses the plea of the authors for further research in this field. However, the editorial is criticized for its lack of a strong societal reference point, the comparative absence of focus on hybridization, and its failure to highlight structural factors impinging on the opposing logics in a broader neo-institutional framework. With reference to the Procrustean metaphor, it is argued that greater stress should be placed on the healthcare user in future health policy. Finally, the case of complementary and alternative medicine is set out which – while not explicitly mentioned in the editorial – most effectively concretizes the tensions at the heart of this analysis of healthcare.https://www.ijhpm.com/article_3406_32fdab6559cdfa4f167f8c31b9199643.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Additional Insights Into Problem Definition and Positioning From Social Science; Comment on “Four Challenges That Global Health Networks Face”362364341210.15171/ijhpm.2017.108ENKathrynQuissellDepartment of Health Sciences, Sargent College, Boston University, Boston, MA, USAJournal Article20170710Commenting on a recent editorial in this journal which presented four challenges global health networks will have to tackle to be effective, this essay discusses why this type of analysis is important for global health scholars and practitioners, and why it is worth understanding and critically engaging with the complexities behind these challenges. Focusing on the topics of problem definition and positioning, I outline additional insights from social science theory to demonstrate how networks and network researchers can evaluate these processes, and how these processes contribute to better organizing, advocacy, and public health outcomes. This essay also raises multiple questions regarding these processes for future research.https://www.ijhpm.com/article_3412_90f1f4972d133619a60c30f3559ec0c5.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401The Politics and Power of Populism: A Response to the Recent Commentaries365366342310.15171/ijhpm.2017.118ENEwenSpeedSchool of Health and Social Care, University of Essex, Colchester, UK0000-0002-3850-922XRussellMannionHealth Services Management Center, University of Birmingham, Birmingham, UK0000-0002-0680-8049Journal Article20170916https://www.ijhpm.com/article_3423_3d324c2883882b15fa8fbe8f025a3a99.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59397420180401Wind of Change: Brexit and European Rehabilitation367368343710.15171/ijhpm.2017.133ENJorgeHugo VillafañeIRCCS Fondazione Don Carlo Gnocchi, Milan, ItalyPabloHerreroUniversidad San Jorge,
Zaragoza, SpainPedroBerjanoIRCCS Istituto Ortopedico Galeazzi, Milan, ItalyJournal Article20170911https://www.ijhpm.com/article_3437_c2f32522a84d5e6357e6abac087f1b0b.pdf