Explore the vast range of titles available.

Objectives To explore the roles of patient navigators in different settings and situations for various patient populations and to understand the rationale for implementing lay and professional models of patient navigation in a Canadian context. Methods A qualitative descriptive design was applied, using interviews with 10 patient navigators from eight Canadian provinces, and Braun and Clarke’s six phases of thematic analysis to guide the analysis of interview transcripts. Results Findings indicate that a patient navigator’s personality and experience (personal and work-related) may be more important than their specific designation (i.e. lay or professional). Conclusions Lay and professional navigators in Canada appear to be well suited to provide navigational services across populations. This study has the potential to inform future research, policy, and the delivery of navigation programmes in Canada.

Saskatchewan has implemented care pathways for several common health conditions. To date, there has not been any cost-effectiveness evaluation of care pathways in the province. The objective of this study was to evaluate the real-world cost-effectiveness of a chronic obstructive pulmonary disease (COPD) care pathway program in Saskatchewan. Using patient-level administrative health data, we identified adults (35+ years) with COPD diagnosis recruited into the care pathway program in Regina between April 1, 2018, and March 31, 2019 (N = 759). The control group comprised adults (35+ years) with COPD who lived in Saskatoon during the same period (N = 759). The control group was matched to the intervention group using propensity scores. Costs were calculated at the patient level. The outcome measure was the number of days patients remained without experiencing COPD exacerbation within 1-year follow-up. Both manual and data-driven policy learning approaches were used to assess heterogeneity in the cost-effectiveness by patient demographic and disease characteristics. Bootstrapping was used to quantify uncertainty in the results. In the overall sample, the estimates indicate that the COPD care pathway was not cost-effective using the willingness to pay (WTP) threshold values in the range of $1,000 and $5,000/exacerbation day averted. The manual subgroup analyses show the COPD care pathway was dominant among patients with comorbidities and among patients aged 65 years or younger at the WTP threshold of $2000/exacerbation day averted. Although similar profiles as those identified in the manual subgroup analyses were confirmed, the data-driven policy learning approach suggests more nuanced demographic and disease profiles that the care pathway would be most appropriate for. Both manual subgroup analysis and data-driven policy learning approach showed that the COPD care pathway consistently produced cost savings and better health outcomes among patients with comorbidities or among those relatively younger. The care pathway was not cost-effective in the entire sample.

[...]progress remains insufficient to achieve the necessary reductions in newborn and child mortality to meet the SDG targets by 2030. [...]we place additional emphasis on the follow-up care and support that is needed for survivors of preterm birth and their families. Poverty often limits access to essential services such as prenatal care, proper nutrition, and safe living conditions, which are critical for preventing preterm births and managing complications. Yet, investment in preterm birth prevention and care can unlock more human capital than at any other time across the life course, impacting futures for millions of families and resulting in significant human and economic returns [11, 12]. [See PDF for image] Fig. 1 Navigating Born Too Soon 2012 and 2023 We present updated data and evidence from the 2012 report [6], now examined through a broader lens, including new data on preterm birth rates, trends, risk factors, and advances in measurement globally; maternal health and care relevant to preterm prevention, with an emphasis on sexual and reproductive health and rights; care for small and sick newborns; and implementation learning for systems change, extending beyond preterm care alone.

Progress This paper is a narrative review that takes stock of the progress in addressing preterm birth over the past decade – notably on policies, national plans, innovation, evidence, social mobilisation, and community engagement – to inform future progress on preterm birth. At the global policy level, many countries have strongly supported collective initiatives and resolutions on maternal and newborn health relevant to preterm birth in multilateral fora, most recently through a World Health Assembly resolution calling for a revival amongst the global community on stalled progress for maternal, newborn and child health. Following the adoption of other global plans, like the Every Newborn Action Plan and Strategies for Ending Preventable Maternal Mortality, most countries set corresponding national mortality and coverage targets, and many have national and subnational policies and plans for integrated maternal and newborn health. Adequate financing remains a challenge, and sexual and reproductive health and rights of women and girls are being challenged globally. There have been significant advances in evidence-based interventions for preterm birth prevention and care, reflected in updated World Health Organization guidelines on antenatal, intrapartum and postpartum care, and care for small and sick newborns. The past decade has also seen progress in social mobilisation and community engagement, particularly parent groups and healthcare professional organisations advocating on issues surrounding preterm birth. Polycrisis and vulnerability There are, however, significant challenges that continue to hamper progress on preterm birth. Polycrisis – the interplay of overlapping economic, geopolitical, and environmental crises – compounds existing inequities, especially in places where health systems are already weak. Distinct and overlapping threats from conflict, climate change and the cost-of-living crisis present life-or-death challenges to those already facing extreme vulnerability, particularly women and girls, and small and sick newborns. Preterm birth: a marker of maternal and neonatal health progress in the coming decade The detrimental impacts of preterm birth are felt along the life course and across generations. The success of countries and the global community in preventing preterm births and ensuring high-quality care for mothers and preterm babies serves as a critical measure of progress – or failure – in advancing global efforts to improve maternal and newborn health. Plain language summary Countries have agreed on global plans and resolutions to improve maternal and newborn health. The World Health Assembly recently emphasized the need for renewed efforts in this area. Many countries have set national goals, but implementation remains a challenge as does funding. There have been advances in evidence-based interventions for preterm birth prevention and care, reflected in updated World Health Organization guidelines. Progress has also been made in community engagement, with parent groups and healthcare organisations as leading advocates. However, overlapping crises hinder progress, including conflicts, climate change, pandemics, and the cost-of-living crisis. These crises increase inequities and pose serious risks to women and newborns, especially where health systems are weak. Preterm birth is an important indicator of progress on maternal and neonatal health. How well countries and the global community address preterm birth and provide care for mothers and babies will show their overall success or failure in improving maternal and newborn health more broadly. Key findings • Over the past decade, global and national policy frameworks, targets and plans relevant to preterm birth have been adopted, though significant funding gaps remain. •  Knowledge of ‘what works’ to prevent and delay preterm birth and to care for babies who are born preterm has improved and is reflected in updated World Health Organization technical guidelines. •  The world has flatlined on preterm birth prevention resulting in renewed urgency to learn from and fully leverage knowledge gained over the past decade to accelerate progress in the next decade. •  Overlapping and compounding challenges of climate change, conflict, pandemics and the cost-of-living crisis pose significant direct and indirect risks for pregnant women and preterm babies and must be mitigated. •  Addressing preterm birth is a key component of integrated maternal and newborn health across the continuum of care and along the life course, and a key marker of progress.

Progress needed Preterm birth rates have “flatlined” for a decade with major loss of human capital, hindering progress for many Sustainable Development Goals. Progress on the reduction of maternal, newborn and child mortality needs to accelerate by between 3 and 11-fold to reach national and global targets by 2030. Priorities Actions are required on two tracks: (1) prevention of preterm birth, including better management for women in preterm labour, and (2) provision of high-quality care to vulnerable newborns, including those born into fragile and conflict-affected settings. Together these tracks have potential for high impact in terms of millions of lives saved, and socioeconomic returns on investment. We can and must do more to provide quality and respectful reproductive, antenatal and birth care for all adolescent girls and women, everywhere, and close unacceptable survival gaps for small and sick newborns. New focus is essential on threats beyond the health sector, notably conflict and the climate crisis. Pivots The cost of inaction is too high in every country. Four pivots are central to accelerating action: invest, implement, integrate, and innovate. More specifically these pivots include investments in systems including more skilled human resources; implementation of high-impact interventions with data used for quality improvement and accountability; innovations including new health technologies and also systems and social innovations; plus, integration with levels of the health sector and across sectors and the life-course, with families at the centre. Everyone has a role to play. Increasing speed now, and sustaining progress, requires multi-level leadership including from grassroots movements led by parents and affected people through to heads of state. Some countries provide examples of such change: The United States of America in data identified inequalities by state and ethnicity for preterm birth. Importantly noting drops in donor aid, India has made ambitious investment in the health sector and beyond, and United Republic of Tanzania in multi-level leadership. Changing gears requires the ambition and energy witnessed a generation ago for HIV/AIDS. We have the ability now to ensure that every baby born too soon – and their mothers – can survive and thrive. Our next generation depends on us acting now for more healthy starts and hopeful futures.

IntroductionChildren and youth with complex care needs (CCNs) and their families experience many care transitions over their lifespan and are consequently vulnerable to the discontinuity or gaps in care that can occur during these transitions. Transitional care programmes, broadly defined as one or more intervention(s) or service(s) that aim to improve continuity of care, are increasingly being developed to address transitions in care for children and youth with CCNs. However, this literature has not yet been systematically examined at a comprehensive level. The purpose of this scoping review is to map the range of programmes that support transitions in care for children and youth with CCNs and their families during two phases of their lifespan: (1) up to the age of 19 years (not including their transition to adult healthcare) and (2) when transitioning from paediatric to adult healthcare.Methods and analysisThe Joanna Briggs Institute methodology for scoping reviews (ScR) will be used for the proposed scoping review. ScR are a type of knowledge synthesis that are useful for addressing exploratory research questions that aim to map key concepts and types of evidence on a topic and can be used to organise what is known about the phenomena. A preliminary search of PubMed was conducted in December 2018.Ethics and disseminationEthical approval is not required where this study is a review of the published and publicly reported literature. The research team’s advisory council will develop a research dissemination strategy with goals, target audiences, expertise/leadership, resources and deadlines to maximise project outputs. The end-of-grant activities will be used to raise awareness, promote action and inform future research, policy and practice on this topic.