Browsing by Author "Silimperi, Diana"

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    Achieving value: A case study of the One Family Health care delivery model in the Context of Rwanda’s Vision for Universal Health Coverage
    (2021) Kalapurakkel, Sreeja

    Background: Healthcare systems such as that of Rwanda face barriers in terms of infrastructural, financial, human, and technical resources. The value-based care framework offers an approach to examining health delivery systems facing resource-constraints and to highlight areas for greater progression towards maximizing impact on health outcomes given resource limitations. Methods: A qualitative approach was used to explore One Family Health’s care delivery model and its challenges and successes using value-based care as an underlying analytic framework. Primary data in the form of 8 qualitative semi-structured interviews were combined with secondary data from 14 previously conducted semi-structured interviews. Thematic analysis was applied to analyze the data. Results: Successes indicate OFH contribution to expanding access to care in Rwanda and challenges of the OFH health post model point to financing model and its relation to Rwanda’s recent financing changes. Quality of service delivery at the OFH health post approximately indicate strengths in patient-centeredness and equity and weaknesses in safety and efficiency. An anecdotal exploration of health outcomes suggest that individual patients improve as a result of visiting the health post and that the health post contributes to community wellbeing particularly in terms of health education and reducing the burden on health centers. Barring a small and biased sample, OFH nurses seem to be satisfied with the health post model, though their experience could be improved with routine training and increased supervision. Insights in integration and alignment in the context of the public-private partnership were also discussed. Conclusions: The One Family Health qualitative case study utilizing the value-based care framework offers several lessons for One Family Health, Rwanda Ministry of Health as it continues to contract with private sector entrepreneurs, and for further research that involves the application of the value-based care framework. These lessons include aligning its financial model with the aims of government financing initiatives, providing infrastructural and financial supports, and routine monitoring of health outcomes centered on patients as well as provider satisfaction and support.

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    Bringing Care to Patients: Evaluation and Implications of an Outreach Mobile Clinic Model in Rural North Carolina
    (2024-04-08) Haddad, Nicholas
    The goal of the DGHI and Hope Clinic partnership has evolved over time but has centered around understanding the services Hope Clinic offers to its patients, especially those with chronic conditions, and their access to care. Hope Clinic is a free and charitable clinic in Bayboro, NC that serves about 300 patients. Following previous studies that have highlighted the clinic’s current building constraints and patients’ transportation difficulties, an outreach care pilot was developed. This model rests on two pillars: “outreach locations” (six community sites where patients could go for clinic appointments) and community health workers. Using patient geospatial and clinical data, Duke students identified six community sites that would theoretically reduce the travel burden patients with chronic conditions currently face in making it to Bayboro. Second, a partnership with a now defunded community health worker program aimed to provide personalized check-ins for patients outside of clinic hours (e.g., calling to ensure that patients are taking their medications). The community health worker program lost its funding before this pilot began in its entirety; while specific data and implications from this portion of the program won’t be considered, the incorporation of community health workers will be considered in recommendations and when addressing current gaps in care that emerge from this analysis. Over the course of 2023, Hope Clinic has been holding quarterly clinics at five outreach locations. A joint pilot evaluation plan was developed at the forefront of this project. This study aims to evaluate this pilot from January 2023 through December 2023 by: analyzing qualitative and quantitative patient satisfaction data (survey and interview data from 2023), demographic and diagnosis data taken from the clinic’s health records (from 2023), clinic encounter and appointment adherence data (from 2022 and 2023), and interview data from other free and charitable clinics (collected November and December 2023); future implications of a program like this for similar clinics and recommendations for Hope Clinic’s existing program will be offered. Collected data includes patient encounter statistics (e.g., completed appointments, cancellations, and no-shows), pertinent demographic data (e.g., gender, age, race/ethnicity) pulled from Hope Clinic’s electronic health records system, conversations with patients and providers (e.g., satisfaction, travel time to locations, qualitative suggestions). This data paints a vivid picture of who is coming to outreach locations, their health status (e.g., vital signs, hypertension and/or diabetes diagnosis, frequency of appointments, prescription status), and how the program is impacting adherence to appointment times and patient maintenance of health conditions. Interviews with other free and charitable clinics are used to better understand their strategies addressing barriers to health care access for their most vulnerable clients with an eye towards identifying possible solutions for Hope Clinic. Overall, findings from Hope Clinic’s first year of piloting their outreach care model are overwhelmingly positive. With higher completion rates, fewer cancellations and no-shows, and shorter travel times to outreach sites than to the normal Bayboro location, staff have reduced barriers to access that patients have previously expressed in interviews. Talking to other free and charitable clinic leadership across the state has highlighted similar transportation and resource constraints that make it difficult for patients to receive care and has showcased strategies used to address those challenges. While implementation of this model has led to reductions in the number of completed patient appointments (down roughly 6% from 2022), the benefits of this model seem to outweigh this challenge, and recruiting another provider (given space exists at community sites) may increase capacity.
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    Scaling malaria interventions: bottlenecks to malaria elimination.
    (BMJ global health, 2023-11) Mao, Wenhui; Cooke, Rianna; Silimperi, Diana; Urli Hodges, Elina; Ortiz, Ernesto; Udayakumar, Krishna
    The slow progress in malaria control efforts and increasing challenges have prompted a need to accelerate the research and development (R&D), launch and scaling of effective interventions for malaria elimination. This research, including desk research and key informant interviews, identified the following challenges along the end-to-end scale-up pathway of malaria interventions. Underinvestment in malaria R&D persists, and developers from low-resource settings are not commonly included in the R&D process. Unpredictable or unclear regulatory and policy pathways have been a hurdle. The private sector has not been fully engaged, which results in a less competitive market with few manufacturers, and consequently, a low supply of products. Persistent challenges also exist in the scaling of malaria interventions, such as the fragmentation of malaria programmes. Further efforts are needed to: (1) Strengthen coordination among stakeholders and especially the private sector to inform decisions and mobilise resources. (2) Increase engagement of national stakeholders, particularly those in low-income and middle-income countries, in planning for and implementing R&D, launching and scaling proven malaria interventions. (3) Use financial incentives and other market-shaping strategies to encourage R&D for innovative malaria products and improve existing interventions. (4) Streamline and improve transparency of WHO's prequalification and guidelines processes to provide timely technical advice and strategies for different settings. (5) Increase effort to integrate malaria services into the broader primary healthcare system. (6) Generate evidence to inform policies on improving access to malaria interventions.