Amardeep Thind

Cost/DALY averted in a small hospital in Sierra Leone: what is the relative contribution of different services?

A cost-effective analysis (CEA) can be a useful tool to guide resource allocation decisions. However, there is a dearth of evidence on the cost/disability-adjusted life year (DALY) averted by health facilities in the developing world. We conducted a study to calculate the costs and the DALYs averted by an entire hospital in Sierra Leone, using the method suggested by McCord and Chowdhury (Int J Gynaecol Obstet 2003;81:83–92). For the 3-month study period, total costs were calculated to be

Where to deliver? Analysis of choice of delivery location from a national survey in India

369,774. Using the approach of McCord and Chowdhury, we calculated that 11,282 DALYs were averted during the study period, resulting in a cost/DALY averted of

Determinants of Breast Cancer Knowledge Among Newly Diagnosed, Low-income, Medically Underserved Women With Breast Cancer

32.78. This figure compares favorably to other non-surgical health interventions in developing countries. We found that while surgery accounts for 63% of total caseload, it contributes to 38% of the total DALYs averted. Surgical treatment of some common pathologies in developing countries may be more cost-effective than previously thought, and our results provide evidence for the inclusion of surgery as part of the basic public health armamentarium in developing countries. However, these results are highly context-specific, and more research is needed from developing countries to further refine the methodology and analysis.

Rehabilitation impact indices and their independent predictors: a systematic review

BackgroundIn order to reduce maternal mortality, the Indian government has increased its commitment to institutional deliveries. We assess the determinants of home, private and public sector utilization for a delivery in a Western state.MethodsCross sectional analyses of the National Family Health Survey – 2 dataset.SettingMaharashtra state. The dataset had a sample size of 5391 ever-married females between the ages of 15 to 49 years. Data were abstracted for the most recent birth (n = 1510) and these were used in the analyses. Conceptual framework was the Andersen Behavioral Model. Multinomial logistic regression analyses was conducted to assess the association of predisposing, enabling and need factors on use of home, public or private sector for delivery.ResultsA majority delivered at home (n = 559, 37%); with private and public facility deliveries accounting for 32% (n = 493) and 31% (n = 454) respectively. For the choice set of home delivery versus public facility, women with higher birth order and those living in rural areas had greater odds of delivering at home, while increasing maternal age, greater media exposure, and more then three antenatal visits were associated with greater odds of delivery in a public facility. Maternal and paternal education, scheduled caste/tribe status, and media exposure were statistically significant predictors of the choice of public versus private facility delivery.ConclusionAs Indias economy continues to grow, the private sector will continue to expand. Given the high household expenditures on health, the government needs to facilitate insurance schemes or provide grants to prevent impoverishment. It also needs to strengthen the public sector so that it can return to its mission of being the safety net.

Using your electronic medical record for research: a primer for avoiding pitfalls

Among women with breast cancer (BC), greater BC knowledge has been associated with greater participation in treatment decision‐making, patient satisfaction, and survival. The objective of this study was to identify modifiable determinants associated with BC knowledge.

Identifying the determinants of childhood immunization in the Philippines.

Objectives To (1) identify all available rehabilitation impact indices (RIIs) based on their mathematical formula, (2) assess the evidence for independent predictors of each RII and (3) propose a nomenclature system to harmonise the names of RIIs. Design Systematic review. Data sources PubMed and references in primary articles. Study selection First, we identified all available RII through preliminary literature review. Then, various names of the same formula were used to identify studies, limited to articles in English and up to 31 December 2011, including case–control and cohort studies, and controlled interventional trials where RIIs were outcome variable and matching or multivariate analysis was performed. Results The five RIIs identified were (1) absolute functional gain (AFG)/absolute efficacy/total gain, (2) rehabilitation effectiveness (REs)/Montebello Rehabilitation Factor Score (MRFS)/relative functional gain (RFG), (3) rehabilitation efficiency (REy)/length of stay-efficiency (LOS-EFF)/efficiency, (4) relative functional efficiency (RFE)/MRFS efficiency and (5) revised MRFS (MRFS-R). REy/LOS-EFF/efficiency had the most number of supporting studies, followed by REs and AFG. Although evidence for different predictors of RIIs varied according to the RII and study population, there is good evidence that older age, lower prerehabilitation functional status and cognitive impairment are predictive of poorer AFG, REs and REy. Conclusions 5 RIIs have been developed in the past two decades as composite rehabilitation outcome measures controlling premorbid and prerehabilitation functional status, rate of functional improvement, each with varying levels of evidence for its predictors. To address the issue of multiple names for the same RII, a new nomenclature system is proposed to harmonise the names based on common mathematical formula and a first-named basis.

The impact of delays to admission from the emergency department on inpatient outcomes

In Canada, use of electronic medical records (EMRs) among primary health care (PHC) providers is relatively low. However, it appears that EMRs will eventually become more ubiquitous in PHC. This represents an important development in the use of health care information technology as well as a potential new source of PHC data for research. However, care in the use of EMR data is required. Four years ago, researchers at the Centre for Studies in Family Medicine, The University of Western Ontario created an EMR-based research project, called Deliver Primary Health Care Information. Implementing this project led us to two conclusions about using PHC EMR data for research: first, additional time is required for providers to undertake EMR training and to standardize the way data are entered into the EMR and second, EMRs are designed for clinical care, not research. Based on these experiences, we offer our thoughts about how EMRs may, nonetheless, be used for research. Family physician researchers who intend to use EMR data to answer timely questions relevant to practice should evaluate the possible impact of the four questions raised by this paper: (i) why are EMR data different?; (ii) how do you extract data from an EMR?; (iii) where are the data stored? and (iv) what is the data quality? In addition, consideration needs to be given to the complexity of the research question since this can have an impact on how easily issues of using EMR data for research can be overcome.

Return to work in low-income Latina and non-Latina white breast cancer survivors: a 3-year longitudinal study.

A key method of reducing morbidity and mortality is childhood immunization, yet in 2003 only 69% of Filipino children received all suggested vaccinations. Data from the 2003 Philippines Demographic Health Survey were used to identify risk factors for non- and partial-immunization. Results of the multinomial logistic regression analyses indicate that mothers who have less education, and who have not attended the minimally-recommended four antenatal visits are less likely to have fully immunized children. To increase immunization coverage in the Philippines, knowledge transfer to mothers must improve.

Investigating concordance in diabetes diagnosis between primary care charts (electronic medical records) and health administrative data: a retrospective cohort study

BackgroundWe sought to determine the impact of delays to admission from the Emergency Department (ED) on inpatient length of stay (LOS), and IP cost.MethodsWe conducted a retrospective analysis of 13,460 adult (≥ 18 yrs) ED visits between April 1 2006 and March 30 2007 at a tertiary care teaching hospital with two ED sites in which the mode of disposition was admission to ICU, surgery or inpatient wards. We defined ED Admission Delay as ED time to decision to admit > 12 hours. The primary outcomes were IP LOS, and total IP cost.ResultsApproximately 11.6% (n = 1558) of admitted patients experienced admission delay. In multivariate analysis we found that admission delay was associated with 12.4% longer IP LOS (95% CI 6.6% - 18.5%) and 11.0% greater total IP cost (6.0% - 16.4%). We estimated the cumulative impact of delay on all delayed patients as an additional 2,183 inpatient days and an increase in IP cost of

A systematic review of studies reporting multivariable models to predict functional outcomes after post-stroke inpatient rehabilitation

2,109,173 at the study institution.ConclusionsDelays to admission from the ED are associated with increased IP LOS and IP cost. Improving patient flow through the ED may reduce hospital costs and improve quality of care. There may be a business case for investments to reduce emergency department admission delays.