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Public health tools - Coggle Diagram
Public health tools
Describing/ evaluating a health system
Health system frameworks
System frameworks
Building blocks (WHO, 2007)
Health system dynamics framework (Van Olmen, 2010)
"Control Knobs" framework (Roberts, World bank & Harvard, 2008)
Framework w/ special focus on governance (Mikkelson-Lopez, 2011)
Health systems performance framework (Murray, 2000)
Health systems in transition (HIT) framework (Mossialos, European Observatory on Health Systems and Policies, 2007)
Triple Aim framework (Berwick, Institute for Healthcare Improvement, 2008)
Systems thinking framework (De Savigny, 2009)
Investment framework (Shakarishvili, 2011)
Sub-system frameworks
Healthcare utilization
Framework for health service utilization (Andersen, 1973)
Access to care
Framework for access to health services (Peters, 2008)
Framework for access to healthcare (Levesque, 2013)
Supra-system frameworks
Identifying gaps
Entire cascade of care
Retrospective (registries, medical records)
Prospective
Access to care
Demographic and health surveys (identify people with poor access)
Prevalence surveys (interview people who were otherwise not diagnosed to ask if they sought care etc)
Patient pathway analysis
Structured interview to ask about pathway/events before hospitalization
ART coverage may be an indicator of access to care
Diagnosis
Patient pathway analysis (whether their pathway aligns with diagnostic capacity)
Laboratory capacity
Laboratory test availability through lab reports (Bahati 2022)
Burden/ prevalence
TB Prevalence surveys
Delphi process (Jodie Schildkraut)
Modelling based on surveillance data/meta-analyses (Dodd 2021)
Serosurvey (Nagy, 2022 West Nile virus)
TB notifications (as a proxy) - adjusted by a standard factor to account for underreporting, overdiagnosis and underdiagnosis
National inventory studies that measured the level of underreporting of detected TB cases
Case notification data combined with expert opinion about case-detection gaps
Evaluation tools
Monev
PRISM framework (Performance of Routine Information System Management) (Aqil, 2009)
Program evaluation
Framework for programme evaluation in public health (CDC, 1999)
Integration of interventions/ improvements
See green branch
Evaluation of health system performance
Framework for health systems performance measures, Kruk (2008,analyzing processes and outcomes)
Identifying factors/barriers/enables related to healthcare use
Overarching methodology/ design
Health needs assessment (Rutherford, 2013)
Process documentation and analysis (Mohr-Holland, 2019)
Situational analysis, gap analysis (Hill, 2011)
Qualitative study on specific element (Lisboa 2020)
Tools
Qualitative
Focus group discussions
In-depth interviews
Observation
Quantitative
Surveys/questionnaires
National/regional registries
Medical records
Cost-effectivenes studies
Modelling of health survey data to find individual and community-level factors associated with early initiation of care (Appiah 2022)
Measure specific factors
Patients
KAP questionnaires (see healthcare providers)
Surveys of patient satisfaction
Pathways
Patient pathway analysis -> alignment with diagnostic capacity
Interviewing patients with long delays (as proxy for people who have no access)
Prevalence surveys --> interview people who were otherwise not diagnosed to ask why they didn't or did seek care etc.
Perception of social status using ladder scale (MacArthur Scale of Subjective Social Status) (Goodman, 2001)
Patient OOP costs
Unmet needs surveys
COMPASS: COMprehensive Problem And
Symptom Screening (developed for cancer care)
Holistic Needs Assessment (developed for cancer care)
Post-treatment
SUNS & SF-SUNS (developed for post-treatment cancer)
CaSUN (developed for post-treatment cancer)
Health literacy
Patient preferences
Discrete choice experiments to quantify patient preferences and to understand decision-making processes (for instance for certain treatments)
Healthcare providers
KAP surveys
A guide to developing knowledge, attitude and practice surveys (WHO, 2008) (can also be applied to other groups of people)
Health system factors
Diagnosis
Diagnostic evaluation studies
Health economics
Financing incidence analysis
Cost-effectiveness
Capacity
Reports/registries about nr of labs, clinics etc.
Time-and-motion studies: measure efficiency of service utilization,human resources etc (Tampi 2019)
Neighbourhood
Geocoded multilevel analyses to identify neighbourhood risk factors in TB recurrence
Finding & selecting solutions
Methodology
Option analysis (Hill, 2011)
"Plan, Do, Study, Act" cycles (Mohr-Holland, 2019)
Analytical framework to select appropriate interventions for access barriers (Jacobs, 2011)
Priority setting
Multi-criterion decision analysis (MCDA)
A4R
Cost-effectiveness
Measuring impact of interventions
Knowledge-based
Systematic review
Meta-analysis
Observational
Before-after studies
Controlled before after studies (CBA)
Time-series analyses (TSA)
Real life evaluations
Randomised
Stepped wedge
RCT
Cluster-RCT
Mathematical modelling
Evaluating integration of interventions
Framework for analysing integration of targeted health interventions into health systems (Atun, 2019)
Flottorp (2013) - Checklist for identifying determinants of practice that may hinder or facilitate improvements in healthcare practice
Comparative effectiveness research
Reducing gaps (interventions)
Access/ case-finding
Active case finding
Focus on high-risk groups
Household contacts
HIV
Geographic hotspots
Community-wide case finding (
Longitudinal follow-up of previous TB patients
Care seeking behavior
Public education strategies
Interactive text messages to reduce pre-diagnosis loss to follow up
Contact tracing
Surveillance
Decentralization of diagnostic services
Diagnosis
Rapid tests
Upscale Xpert
Diagnostic algorithms
MDR-TB: sequencing
Linkage to care
Automated text messages or other reminder devices
Improved patient contact registration in medical records
Patient navigators (i.e. individuals tasked with helping patients reach next steps in care)
Patient tracking interventions
Drop-out follow up
Integrated TB services
Peer support/counselling
Treatment adherence
DOT
Addressing specific risk factors for poor treatment adherence (e.g. nutritional supplements, support groups, social protection schemes)
Shorter treatment regimens
Home delivery of medication
Quality improvement of care
QI-driven improvement of care (Naidoo 2022)
Using patient and public involvement (Bergerum 2022)
Describing/ evaluating quality of care
Standardized patients
(described as best method)
Direct observation of providers (Hawthorne effect?)
Surrogates
Diagnostic delays
Patient pathways
See other branches (gaps/barriers etc)
Specific subparts of quality
Knowledge-assessment questionnaires
Availability of equipment
Definition: patient-centered, accessible, timely, safe, effective, efficient, equitable
Standards/ guidelines TB
International Standards of TB care