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Background The last two decades have seen a growing recognition of the need to expand the impact evaluation toolbox from an exclusive focus on randomized controlled trials to including quasi-experimental approaches. This appears to be particularly relevant when evaluation complex health interventions embedded in real-life settings often characterized by multiple research interests, limited researcher control, concurrently implemented policies and interventions, and other internal validity-threatening circumstances. To date, however, most studies described in the literature have employed either an exclusive experimental or an exclusive quasi-experimental approach. Methods This paper presents the case of a study design exploiting the respective advantages of both approaches by combining experimental and quasi-experimental elements to evaluate the impact of a Performance-Based Financing (PBF) intervention in Burkina Faso. Specifically, the study employed a quasi-experimental design (pretest-posttest with comparison) with a nested experimental component (randomized controlled trial). A difference-in-differences approach was used as the main analytical strategy. Discussion We aim to illustrate a way to reconcile scientific and pragmatic concerns to generate policy-relevant evidence on the intervention’s impact, which is methodologically rigorous in its identification strategy but also considerate of the context within which the intervention took place. In particular, we highlight how we formulated our research questions, ultimately leading our design choices, on the basis of the knowledge needs expressed by the policy and implementing stakeholders. We discuss methodological weaknesses of the design arising from contextual constraints and the accommodation of various interests, and how we worked ex-post to address them to the best extent possible to ensure maximal accuracy and credibility of our findings. We hope that our case may be inspirational for other researchers wishing to undertake research in settings where field circumstances do not appear to be ideal for an impact evaluation. Trial registration Registered with RIDIE (RIDIE-STUDY-ID- 54412a964bce8 ) on 10/17/2014.

Pay-for-performance in health care holds promise as a policy lever to improve the quality and efficiency of care. Although the approach has become increasingly popular in developing countries in recent years, most policy designs do not permit the rigorous evaluation of its impact. Thus, evidence of its effect is limited. In collaboration with the government of Ningxia Province, a predominantly rural area in northwest China, we conducted a matched-pair cluster-randomized experiment between 2009 and 2012 to evaluate the effects of capitation with pay-for-performance on primary care providers' antibiotic prescribing practices, health spending, outpatient visit volume, and patient satisfaction. We found that the intervention led to a reduction of approximately 15 percent in antibiotic prescriptions and a small reduction in total spending per visit to village posts-essentially, community health clinics. We found no effect on other outcomes. Our results suggest that capitation with pay-for-performance can improve drug prescribing practices by reducing overprescribing and inappropriate prescribing. Our study also shows that rigorous evaluations of health system interventions are feasible when conducted in close collaboration with the government. [PUBLICATION ABSTRACT]

Background: Giant cell tumours (GCT) of the spine may be large at presentation and cause severe pain. The current recommended treatment is en bloc excision but it is associated with substantial morbidity and mortality. Denosumab is a monoclonal RANKL inhibitor that may be used neoadjuvantly. The goal of this study was to assess the effect of denosumab on tumour characteristics and symptom relief. Methods: We performed a retrospective review of 10 patients treated with denosumab as neoadjuvant and stand-alone treatment. Tumour measurements were taken before and after treatment, positron emission tomographic (PET) standardized uptake value (SUV) capitation was measured, and patients were interviewed for subjective pain responses. Clinical response was determined by volumetric reduction in tumour size, PET SUV capitation, the Boriani classification and improvement in pain symptoms. Results: Following treatment 70% of patients were pain free, with 50% noting improvement within 48 hours. Mean relative volumetric reduction in tumour volume was 40%. All pathology specimens confirmed elimination of giant cells. Improvement in Bilsky grading occurred in 4 of 10 cases and progression was halted in the remainder. Median baseline SUVmax was 14.7, and median SUVmax after treatment was 6.2. Seventy-eight percent of patients demonstrated intra lesional bone formation following treatment. Conclusion: This study demonstrates that neoadjuvant denosumab facilitates en bloc resection of GCT of the spine, reduces the likelihood of intraoperative morbidity and improves preoperative pain. We recommend routine use when Weinstein-Boriani-Biaginibased criteria are fulfilled for en bloc excision. Assuming that margins are disease free following surgery, we advocate cessation of treatment postoperatively.

The Covid-19 pandemic has exposed and exacerbated weaknesses in the U.S. health care system. Many patients are losing their health insurance when they lose their jobs. Declining revenues are threatening the financial viability of some hospitals and medical practices. The authors propose policy solutions to address these challenges.

IntroductionOne of the ongoing challenges in health care is ensuring patients/families and also health care providers have clear direction and implementation guidance around transitions in care across all care and community settings that includes integration, continuity and coordination. Clearly understanding patient and care provider experiences including what works and where improvements are needed with care transitions across acute and community settings has been an ongoing challenge for most health care systems before COVID-19. During COVID-19, efforts to identify and use experience measures were complicated and impacted because of rapidly enforced restrictions and guidelines for patient/client, family and provider safety.Aims Objectives Theory or MethodsExploring the experiences of patients/clients, families and care providers with their care transitions between acute and community-based care settings prior to and during COVID-19, along with changes in care outcomes, practices, policies and services became the focus of a two-year pilot study within Alberta Health Services (AHS), Canada. We co-designed relevant experience, process and outcome/impact experience indicators/measures with patients/clients, families and care providers regarding care transitions across acute and community settings; and explored the feasibility for transferring measures and lessons learned for practice, policy and service changes as part of follow-up and post COVID new ‘norm’ transformation of care transitions.Highlights or Results or Key FindingsThe study involved the Provincial Seniors and Continuing Care Advisory Council, Continuing Care Quality Committee and eight pilot settings involving community and Transitions in Care programs across the five zones of AHS. Each care setting involved care providers and patient/family advisors in co-designing and implementing the initiative, including survey development, and gathering, analyzing and interpreting client/patient experiences. Findings in each of the eight pilots included more detailed patient/family and care providers experience indicators/measures for transitions in care across settings. Clear themes for what makes transitions in care successful are also identified – e.g. clear communication, navigation and information direction for all stakeholders. The aggregated findings have guided the development of a set of core transition in care measures from across acute points of care including Emergency and care units, to various community-based care settings including Home Care, Long-term or other program and care services/settings – e.g. CHOICE programs.ConclusionsUnderstanding the experiences of patients/clients, families and care providers regarding care transitions between acute and community-based settings are essential to understanding what works well and where there are ‘holes’ in the system leading to failed or unsatisfactory transitions across different care settings. Such findings guide quality and safety improvement.Implications for applicability/transferability sustainability and limitationsThese core measures are being tested for transferability across all care transition settings. As well, practice, policy and service changes involving care transitions resulting from the impact of COVID-19 are noted for how care settings involving specific transition programs will adapt to “new norms”. Further measurement continues.

Collaborative care models are designed to integrate multiple healthcare disciplines to provide comprehensive, patient-centered care. This paper explores the potential benefits of a collaborative approach that combines the expertise of nursing, orthodontics, and social work in achieving optimal patient outcomes. By aligning clinical care with emotional support and social resources, these models create a holistic treatment environment that addresses physical, mental, and socio-economic factors. We will discuss the roles and contributions of each discipline, the benefits of interdisciplinary communication, and the impact on patient satisfaction and health outcomes.