MHA FPX 5028 Assessment 3 Best Practices Report
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MHA-FPX 5028 Comparative Models of Global Health Systems
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Best Practices Report
Prior to 1980, Sickle Cell Disease (SCD) was considered primarily a pediatric ailment, with minimal survival rates into adulthood. Approximately 30% of children born in the United States with sickle cell anemia (SCA) in 1970 died before reaching their fifth birthday (Chaturvedi & DeBaun, 2016). However, significant advancements in screening, treatment, and vaccination have notably enhanced pediatric survival rates. Currently, the median age at death for men and women with SCA in the United States has risen to 42 and 48, respectively (Chaturvedi & DeBaun, 2016). While high-income countries have shown marked improvements in mortality rates and quality of life indicators, developing nations, particularly in Sub-Saharan Africa, continue to face challenges in improving outcomes for SCD patients (Thompson et al., 2023).
Evaluation of Health Care Practices
An area showing promise in enhancing health outcomes and quality of life for SCD patients lies in evaluating healthcare practices in Caribbean nations. These countries exhibit higher rates of sickle cell trait prevalence compared to the United States yet demonstrate superior health outcomes compared to Sub-Saharan Africa. In 2020, the Pan American Health Organization (PAHO) initiated a collaborative effort with the Jamaican Ministry of Health to establish a comprehensive integrated health system delivery network (IHSDN) across primary health centers and hospitals. This initiative aims to manage chronic diseases, emphasizing electronic health records, workforce development, telehealth, health promotion, and medication management (Pan American Health Organization, n.d.).
Scalability Assessment
This report assesses the scalability of PAHO’s agreement with Jamaica to extend best practices to low-income countries, especially in Sub-Saharan Africa. It evaluates shared key performance indicators (KPIs) from both the United States and Jamaica, analyzing consumer and organizational implications, as well as potential provider management challenges in risk-based contracting versus fee-for-service payment strategies.
MHA FPX 5028 Assessment 3 Best Practices Report
Performance Indicators
In 2000, the World Health Organization (WHO) published its first global health ranking report, encompassing various key performance indicators among its member countries. These indicators span life expectancy, maternal and child mortality, disease mortality rates, infrastructure, and vaccination rates. Despite challenges in data collection, the first set of potential SCD quality indicators was published in 2011, comprising 41 metrics distributed across six domains (Oyeku & Faro, 2017). Additional global measures include prevalence data and mortality rates across the life cycle (PAHO, 2023). However, determining the true mortality rate of SCD remains challenging due to associated co-morbidities and complications (Thompson et al., 2023).
Table 1: SCD Key Performance Indicators
KPI |
United States |
Jamaica |
|---|---|---|
Accessibility |
5 hematologists per 100,000 residents (Ramsey et al., 2021) | 4.73 hematologists/100,000 (AAMC, 2017) |
| 5.36 hematologists/100,000 (Ramsey et al., 2021) | ||
Affordability |
Average monthly out-of-pocket costs: $108.33 (NIH, 2022) | Average monthly out-of-pocket medical costs: $15.52 in US dollars (Ramsay et al., 2021) |
Delivery |
Universal Health Care (UHC); 68% of SCD patients covered by Medicaid or Medicare or both (Grady et al., 2021) | 64% of residents (UHC), Sickle Cell Unit (outpatient) and University of West Indies are not covered by UHC (includes labs, prescriptions, imaging, etc.) (Ramsay et al., 2021) |
Mortality |
68% decrease in deaths of SCD in ages 0-3 between 1999-2002 compared to previous 3-year period (Grady et al., 2021) | Average life expectancy 52.6 years in 2022 (Grady et al., 2021); 87% survival rate in children ages 0-5 (Serjeant et al., 2018); Average life expectancy: 58 years for women, 53 years for men (Ramsay et al., 2021) |
Prevalence |
1:365 Black Americans w/SCD; 1:13 Black with SC trait (Thompson et al., 2023) | 1:150 with SCD; 1:10 with SC trait (Thompson et al., 2023) |
Quality |
Influenza vaccination: 25-34% (Payne et al., 2021); Pneumonia vaccination: 80% of children < 12 years (Adamkiewicz et al., 2023) | Influenza vaccination: 98% of all children <18 years; Pneumonia vaccination: 91% of SCD children < 4 years (Serjeant et al., 2018; Hardie et al., 2009) |
Screening |
Universal newborn screening (Thompson et al., 2023) | Universal newborn screening (Thompson et al., 2023) |
Treatment |
Hydroxyurea: 33% of patients between 2015-2017 (Su et al., 2019); Blood transfusions: Discontinued as primary prevention circa 2001 (Shravya et al., 2023) | Hydroxyurea: 23% of patients receive drug (Ryan et al., 2020); 61% of patients receive, but only during crisis (Olujohungbe et al., 2001) |
Conclusion
In conclusion, leveraging best practices from countries like Jamaica offers a pathway to improve outcomes for SCD patients globally. Through collaborative efforts and strategic implementation of cost-effective interventions, the burden of SCD can be alleviated, particularly in regions with limited resources.
References
Azevedo, M. J. (2017). The state of health system(s) in Africa: challenges and opportunities. Historical Perspectives on the State of Health and Health Systems in Africa, Volume II: The Modern Era, 1–73. https://doi.org/10.1007/978-3-319-32564-4_1
Pan American Health Organization. (n.d.) Strengthening health systems & services in Jamaica. https://www.paho.org/en/stories/strengthening-health-systems-services-jamaica
MHA FPX 5028 Assessment 3 Best Practices Report
Schütte, S., Acevedo, P. N. M., & Flahault, A. (2018). Health systems around the world – a comparison of existing health system rankings. Journal of Global Health, 8(1), 010407. https://doi.org/10.7189/jogh.08.010407
Thompson, A.M., McHugh, T.A., Oron, A.P., Teply, C., Lonberg, N., Vilchis-Tella, V.M., … Kassebaum, N.J. (2023). Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000-2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Haematology, 10(8), e585-599. https://doi.org/10.1016/S2352-3026(23)00118-7
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