Assessing the Performance of Medical Care Systems: A Method and Its Application

Nutting, Paul A.; Shorr, Gregory; Burkhalter, Barton R.

doi:10.1097/00005650-198103000-00004

Cited by 26 publications

(5 citation statements)

References 17 publications

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“…Our selection of potential predictors of HepB-BD vaccination and development of analytical models drew on the combination of two conceptual frameworks. Andersen’s model of medical care utilization emphasizes the complementary contributions of predisposing factors (such as demographics and social structure) and enabling factors (such as the availability of medical care) [ 13 ]; Nutting’s model of health system performance highlights the sequential nature of health service utilization [ 14 ]. A medical care utilization model is appropriate to conceptualize access to vaccines given at birth that unlike most other Expanded Program of Immunization (EPI) vaccines can be administered by clinical staff who provide obstetric and neonatal services, and as such may be closely correlated with other processes indicative of an accessible and well-functioning clinical care system.…”

Section: Methodsmentioning

confidence: 99%

Coverage, inequity and predictors of hepatitis B birth vaccination in Myanmar from 2011–2016: results from a national survey

Anderson

Richards

Delucchi

et al. 2022

BMC Health Serv Res

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Background Hepatitis B virus birth dose (HepB-BD) vaccination is recommended to reduce mother to infant transmission. We evaluated the HepB-BD status of women who gave birth between 2011 and 2016 (N = 3,583) using the 2015–2016 Myanmar Demographic and Health Survey. Methods Frequency distributions of HepB-BD vaccination across maternal and health system factors, concentration indices, and logistic regression models were used to estimate coverage, inequity, and factors associated with vaccination. Results The majority of participants were younger than 30 years of age, lived in rural areas, and were multiparous. Almost all received antenatal care (ANC), but only 43% received recommended ANC services, and 60% gave birth at home. The overall HepB-BD coverage rate was 26%. Vaccination coverage was higher in urban areas and was inequitably concentrated among children of more educated and wealthier women. HepB-BD coverage was also positively associated with receipt of ANC at non-governmental facilities, and delivery at a facility, skilled provider at birth and Cesarean delivery. After adjusting for sociodemographic and health system factors, receipt of the HepB-BD was positively associated with weekly media exposure, receipt of recommended ANC, and Cesarean delivery, and inversely associated with home delivery. Conclusions Both socioeconomic and health systems factors influenced suboptimal and inequitable vaccination coverage. Improved access to quality ANC and delivery services may increase HepB-BD coverage although targeted approaches to reach home births are likely required to achieve national goals.

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Section: Methodsmentioning

confidence: 99%

Coverage, inequity and predictors of hepatitis B birth vaccination in Myanmar from 2011–2016: results from a national survey

Anderson

Richards

Delucchi

et al. 2022

BMC Health Serv Res

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show abstract

“…This outcome is relevant to primary care because it transcends disease categories and encompasses physical, emotional and social dimensions of health. Inspired by the tracer condition methodology (Nutting et al 1981), we examined the policy and programs through the lens of two patient subgroups: children and youth; and older adults. It is the expectation that policy and programs for these groups will be relevant to other subpopulations that require integration among primary care, social services and community supports.…”

Section: Study Populationmentioning

confidence: 99%

Connecting Health and Social Services for Patients with Complex Care Needs: A Pan-Canadian Comparative Policy Research Program

Haggerty,

Scott,

Couturier

et al. 2023

hcpol

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Comprehensive primary healthcare for patients with complex care needs requires connections to other health services, social services and community supports. This descriptive comparative policy research program used publicly available documents and informant interviews to examine progress toward integrated comprehensive care through the lens of services needed by children and youth (0-25 years) and community-dwelling older adults (≥ 65 years) with high functional health needs. This article describes five projects. The following three findings emerged across all the projects: Canada indeed has multiple health systems; numerous integrated service delivery solutions are being trialled and most focus on medical services; and it is an ongoing challenge for ministries of health to engage physicians and physician associations in integration.

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“…Our evaluation of factors potentially associated with HepB-BD vaccination draws on two conceptual frameworks. Andersen's model of medical care utilization emphasizes the complementary contributions of predisposing factors (such as demographics and social structure) and enabling factors (such as the availability of medical care) [14]; Nutting's model of health system performance highlights the sequential nature of health service utilization [15]. A medical care utilization model is appropriate to conceptualize access to vaccines given at birth that unlike most other Expanded Program of Immunization (EPI) vaccines are administered by clinical staff who provide obstetric and neonatal services, and as such are closely correlated with other processes indicative of an accessible and well-functioning clinical care system.…”

Section: Conceptual Modelmentioning

confidence: 99%

Coverage, Equity and Predictors of Hepatitis B Birth Vaccination in Myanmar from 2011-2016: Results from a National Survey

Anderson

Richards

Delucchi

et al. 2021

Preprint

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Background: Hepatitis B virus birth dose (HepB-BD) vaccination is recommended to reduce mother to infant transmission. We evaluated the HepB-BD status of women who gave birth between 2011 and 2016 (N = 3,583) using the 2015-2016 Myanmar Demographic and Health Survey. Methods: Frequency distributions of HepB-BD vaccination across maternal and health system factors, concentration indices, and logistic regression models were used to estimate coverage, equity, and factors associated with vaccination. Results: The majority of participants were younger than 30 years of age, lived in rural areas, and were multiparous. Almost all received antenatal care (ANC), but only 43% received recommended ANC services, and 60% gave birth at home. The overall HepB-BD coverage rate was 26%. Vaccination coverage was higher in urban areas and was inequitably concentrated among children of more educated and wealthier women. HepB-BD coverage was also positively associated with receipt of ANC at non-governmental facilities, and delivery at a facility, skilled provider at birth and Cesarean delivery. After adjusting for sociodemographic and health system factors, receipt of the HepB-BD was positively associated with weekly media exposure, receipt of recommended ANC, and Cesarean delivery, and inversely associated with home delivery. Conclusions: Both socioeconomic and health systems factors influenced suboptimal and inequitable vaccination coverage. Improved access to quality ANC and delivery services may increase HepB-BD coverage although targeted approaches to reach home births are likely required to achieve national goals.

show abstract

Assessing the Performance of Medical Care Systems: A Method and Its Application

Cited by 26 publications

References 17 publications

Coverage, inequity and predictors of hepatitis B birth vaccination in Myanmar from 2011–2016: results from a national survey

Coverage, inequity and predictors of hepatitis B birth vaccination in Myanmar from 2011–2016: results from a national survey

Connecting Health and Social Services for Patients with Complex Care Needs: A Pan-Canadian Comparative Policy Research Program

Coverage, Equity and Predictors of Hepatitis B Birth Vaccination in Myanmar from 2011-2016: Results from a National Survey

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