JSI staff regularly publish their research and results from work in peer-reviewed journals. This section provides a brief abstract with a link to the journal where you can read more and either download or order the article, depending on the journal.
Value-Based Payment Models for Community Health Centers. Time to (Cautiously) Take the Plunge? in Journal of the American Medical Association online May 4, 2017. doi:10.1001/jama.2017.5174
In the current system, community Health centers (CHCs) provide care to all individuals, regardless of insurance status or ability to pay, they are entitled to a set level of reimbursement that is linked to the cost of care for Medicaid patients (standard Medicaid rates are insufficient in many settings). CHCs also receive federal grants to cover care for uninsured patients (but to be eligible, HCs must be federally approved and meet lengthy requirements). Under the current payment model (prospective payment system) because rates are set prospectively, states work with CHCs to determine a flat rate for qualified Medicaid visits, and can also receive supplementary payment from state to cover the difference between managed care payment and prospective payment system rate.
This system is limited by traditional volume-based reimbursement, meaning CHCs have incentives to schedule reimbursable in-person visits for simple issues (some of which could be managed more efficiently by telephone or electronic communication). So the visit volume remains the driving force behind financial stability impeding the evolution of advanced primary care delivery models.
A shift to value-based payment among CHCs could promote higher-quality, more efficient and more patient-centric care. This is an evidence-based strategy for improving health outcomes and slowing cost increases.
Authors: Jay Bhatia, Rachel Tobey, Michael Hochman
Doses per vaccine vial container: An understated and underestimated driver of performance that needs more evidence in Vaccine, 2017 April 19. pii: S0264-410X(16)31137-9.
The widespread use of multidose vaccine containers in low and middle income countries' immunization programs is assumed to have multiple benefits and efficiencies for health systems, yet the broader impacts on immunization coverage, costs, and safety are not well understood. To document what is known on this topic, how it has been studied, and confirm the gaps in evidence that allow us to assess the complex system interactions, the authors undertook a review of published literature that explored the relationship between doses per container and immunization systems. The relationships examined in this study are organized within a systems framework consisting of operational costs, timely coverage, safety, product costs/wastage, and policy/correct use, with the idea that a change in dose per container affects all of them, and the optimal solution will depend on what is prioritized and used to measure performance. Studies on this topic are limited and largely rely on modeling to assess the relationship between doses per container and other aspects of immunization systems. Very few studies attempt to look at how a change in doses per container affects vaccination coverage rates and other systems components simultaneously. This article summarizes the published knowledge on this topic to date and suggests areas of current and future research to ultimately improve decision making around vaccine doses per container and increase understanding of how this decision relates to other program goals.
Authors: Alexis Heaton, Kirstin Krudwig, Tina Lorenson, Craig Burgess, Andrew Cunningham and Robert Steinglass
Maternal characteristics and obstetrical complications impact neonatal outcomes in Indonesia: a prospective study in BMC Pregnancy and Childbirth (2017) 17:100
The authors investigated associations between maternal characteristics, access to care, and obstetrical complications including near-miss status on admission or during hospitalization on perinatal outcomes among Indonesian singletons. Data was collected prospectively on inborn singletons at two hospitals in East Java. Outcomes of interest included low- and very-low birthweight (LBW/VLBW), asphyxia and death.
Referral from a care facility was associated with reduced risk of LBW and VLBW, stillbirth, and neonatal death. Mothers aged less than 20 years increased the risk of VLBW and neonatal death. Mal-presentation on admission increased the risk of asphyxia, still birth, and perinatal death, as did poor prenatal care. Near-miss admission increased the risk of neonatal and perinatal death.
The authors concluded that mothers in labor should be encouraged to seek care early and be taught to identify early danger signs. Adequate prenatal care (PNC) significantly reduced perinatal deaths. Improved hospital management of mal-presentation may significantly reduce perinatal morbidity and mortality. The importance of hospital-based prospective studies helps evaluate specific areas of need in training of obstetrical care providers.
Authors: Trisari Anggondowati, Ayman El-Mohandes, S. Nurul Qomariyah, Michele Kiely, Judith Ryon, Reginald Gipson, Benjamin Zinner, Anhari Achadi and Linda Wright, 2017.
Implementing at-scale, community-based distribution of misoprostol tablets to mothers in the third stage of labor for the prevention of postpartum haemorrhage in Sokoto State, Nigeria: Early results and lessons learned in PLoS ONE 12(2): e0170739.
Postpartum haemorrhage (PPH) is a leading cause of maternal death in Sokoto State, Nigeria, where 95% of women give birth outside of a health facility. Although pilot schemes have demonstrated the value of community-based distribution of misoprostol for the prevention of PPH, none have provided practical insight on taking such programs to scale. A community-based system for the distribution of misoprostol tablets and chlorhexidine digluconate gel to mother-newborn dyads was introduced by state government officials and community leaders throughout Sokoto State in April 2013. A simple outcome form that collected distribution and consumption data was used to assess the percentage of mothers that received misoprostol at labor through December 2014. Mothers' conditions were tracked through 6 weeks postpartum. Verbal autopsies were conducted on associated maternal deaths.
Misoprostol distribution was successfully introduced and reached mothers in labor in all 244 wards in Sokoto State. Community data collection systems were successfully operational in all 244 wards with reliable capacity to record maternal deaths. 70,982 women or 22% of expected births received misoprostol from April 2013 to December 2014.
It was concluded that it is feasible and safe to utilize government guidelines on results-based primary health care to successfully introduce community distribution of life saving misoprostol at scale to reduce PPH and improve maternal outcomes. Lessons from Sokoto State's at-scale program implementation, to assure every mother's right to uterotonics, can inform scale-up elsewhere in Nigeria.
Authors: Nosakhare Orobaton, Jumare Abdulazeez, Dele Abegunde, Kamil Shoretire, Abubakar Maishanu, Nnenna Ikoro, Bolaji Fapohunda, Wapada Balami, Katherine Beal, Akeem Ganiyu, Ringpon Gwamzhi, Anne Austin
Geographic information system for improving maternal and newborn health: recommendations for policy and programs in BMC Pregnancy and Childbirth, (2017) 17:26.
In a letter to the editor of BMC Pregnancy and Childbirth, JSI staff and other authors argue and offer recommendations for how geographic information systems (GIS) applied to maternal and newborn health data could potentially be used as part of the broader efforts for ending preventable maternal and newborn mortality.
The recommendations were generated from a technical consultation on reporting and mapping maternal deaths that was held in Washington, DC from January 12 to 13, 2015 and hosted by the USAID-funded Maternal and Child Survival Program (MCSP). Approximately 72 participants participated in the meeting, which focused on how improved use of mapping could contribute to the post-2015 United Nation’s Sustainable Development Goals (SDGs) agenda in general and to better maternal and neonatal health outcomes in particular.
Researchers and policy makers have been calling for more equitable improvement in maternal and newborn health (MNH), specifically addressing hard-to-reach populations at sub-national levels. Data visualization using mapping and geospatial analyses play a significant role in addressing the emerging need for improved spatial investigation at subnational scale. This correspondence identifies key challenges and recommendations so GIS may be better applied to maternal health programs in resource poor settings. The challenges and recommendations are broadly grouped into three categories: ancillary geospatial and MNH data sources, technical and human resources needs and community participation.
Authors: Yordanos Molla, Barbara Rawlins, Prestige Tatenda Makanga, Marc Cunningham, Juan Eugenio Hernandez Avila, Corrine Warren Ruktanonchai, Kavita Singh, Sylvia Alford, Mira Thompson, Vikas Dwivedi, Allisyn C. Moran, and Zoe Matthews.