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  1. Article ; Online: Implementing electronic decision-support tools to strengthen healthcare network data-driven decision-making

    Diego Rios-Zertuche / Alvaro Gonzalez-Marmol / Francisco Millán-Velasco / Karla Schwarzbauer / Ignez Tristao

    Archives of Public Health, Vol 78, Iss 1, Pp 1-

    2020  Volume 11

    Abstract: Abstract Background Ministries of health in low- and middle-income countries often lack timely quality data for data-driven decision making in healthcare networks. We describe the design and implementation of decision-support electronic tools by the ... ...

    Abstract Abstract Background Ministries of health in low- and middle-income countries often lack timely quality data for data-driven decision making in healthcare networks. We describe the design and implementation of decision-support electronic tools by the Ministry of Health of the State of Chiapas, in Mexico, as part of Salud Mesoamerica Initiative. Methods Three electronic decision-support tools were designed through an iterative process focused on streamlined implementation: 1) to collect and report health facility data at health facilities; 2) to compile and analyze data at health district and central level; and, 3) to support stratified sampling of health facilities. Data was collected for five composite indicators measuring availability of equipment, medicines, and supplies for maternal and child health. Quality Assurance Teams collected data, evaluated results and supported quality improvement. Data was also analyzed at the central level and health districts for decision-making. Results Data from 300 health facilities in four health districts was collected and analyzed (November 2014—June 2015). The first wave revealed gaps on availability of equipment and supplies in more than half of health facilities. Electronic tools provided the ministry of health officers new ways to visualize data, identify patterns and make hypothesis on root-causes. Between the first and second measurement, the number of missing items decreased, and actions performed by quality improvement teams became more proactive. In the final measurement, 89.7—100% of all health facilities achieved all the required items for each indicator. Conclusions Our experience could help guide others seeking to implement electronic decision-support tools in low- and middle-income countries. Electronic decision-support tools supported data-driven decision-making by identifying gaps on heatmaps and graphs at the health facility, subdistrict, district or state level. Through a rapid improvement process, the Ministry of Health met targets of externally verified indicators. Using available information technology resources facilitated prompt implementation and adoption of technology.
    Keywords Decision-support tools ; Maternal health ; Health information systems ; Decision-making ; Data-driven ; Evidence-based ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2020-06-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Access and use of oxytocin for postpartum haemorrhage prevention

    Ali H Mokdad / Aruna M Kamath / Alexandra M Schaefer / Erin B Palmisano / Casey K Johanns / Alvaro Gonzalez Marmol / Mauricio Dinarte Mendoza / Karla Schwarzbauer / Paola Zúñiga-Brenes / Diego Ríos-Zertuche / Emma Iriarte / Bernardo Hernandez Prado

    BMJ Open, Vol 10, Iss

    a pre-post study targeting the poorest in six Mesoamerican countries

    2020  Volume 3

    Abstract: ObjectivesHaemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of ... ...

    Abstract ObjectivesHaemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoamérica Initiative interventions in the poorest health facilities across Central America.DesignPre-post study.Setting166 basic-level and comprehensive-level health facilities in Belize, Guatemala, Honduras, Mexico, Nicaragua and Panama.ParticipantsA random sample of medical records for uncomplicated full-term deliveries (n=2470) per International Classification of Diseases coding at baseline (July 2011 to August 2013) and at first-phase follow-up (January 2014 to October 2014).InterventionsA year of intervention implementation prior to first-phase follow-up data collection focused on improving access to oxytocin by strengthening supply chains, procurement, storage practices and pharmacy inventory monitoring, using a results-based financing model.Primary and secondary outcome measuresOxytocin availability (primary outcome) and administration (secondary outcome) for postpartum haemorrhage prevention.ResultsAvailability of oxytocin increased from 82.9% to 97.6%. Oxytocin administration increased from 83.6% to 88.4%. Significant improvements were seen for availability of oxytocin (adjusted OR (aOR)=8.41, 95% CI 1.50 to 47.30). Administration of oxytocin was found to be significantly higher in Honduras (aOR=2.96; 95% CI 1.00 to 8.76) in reference to Guatemala at follow-up.ConclusionAfter interventions to increase health facility supplies, the study showed a significant improvement in availability but not administration of oxytocin in poor communities within Mesoamerica. Efforts are needed to improve the use of oxytocin.
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2020-03-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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