Explore the vast range of titles available.

Globally, health systems focus on improving the quality of healthcare services through policy changes. Sub-Saharan African countries have been enacting reforms to strengthen their primary healthcare and referral systems including devolution of authority to healthcare facilities. Devolving health facility financing to primary healthcare providers is a crucial strategy to enhance autonomy in planning, management and resource utilization. In Tanzania, this strategy is called Direct Health Facility Financing (DHFF), and is envisaged to impact on the quality of health services in primary healthcare facilities. This study aimed to determine the effect of DHFF on quality of health services after 3 years of its implementation. This study employed a before-after noncontrolled analysis of the quality scores by considering compliance of public primary health facilities with healthcare quality standards by using star rating assessment data before and after DHFF implementation. Quality scores were established by performance of service areas, namely organization of services, emergencies and referrals; infrastructure, infection prevention and control; clinical services; and clinical support services. Distribution normality of compliance scores was determined through the Shapiro-Wilk test for normal data and were observed to be non-normal. Median change in quality compliance scores were established, Wilcoxon matched pairs sum rank tests estimated probabilities of the change (α = 0.05) and Cohen's d estimator (d) calculated the effect size of DHFF. This study involved 1216 primary healthcare (PHC) facilities from 10 regions of Tanzania's mainland, the majority of which were dispensaries (88.8%) and rurally located (86.3%). Findings showed significant positive median change in compliance with quality standards from 0.53 to 0.57 (P < 0.001). However, effect size of DHFF as an intervention is small (d = 0.27). Direct health facility financing has impacted a small change in quality of health services. As evidenced by several studies, challenges regarding fidelity to its implementation process including lower spending on health commodities, dependence on and delayed disbursement of Health Sector Basket Funds (HSBF), poor facilities' planning capacity and shortage of human resources for health must be addressed for it to yield its intended outcome.

Background Globally, it is known that, there is a close correlation between the concentration of qualified Human Resources for Health (HRH) and key health outcomes. Inadequate numbers with poor skill mix compromise health system functioning that negatively affect delivery of quality healthcare services. Objective This study aims to study the effect of HRH skills and competence mix on the compliance with healthcare quality standards (HCQS) among dispensaries in Tanzania. Methods This is a quantitative secondary data analysis using the Star Rating Assessment (SRA) data collected in the fiscal year 2017/2018 involving 4239 dispensaries majority of which were rural located (81.2%) and public owned (83.6%). Compliance with HCQS was measured by considering service delivery areas of SRA. HRH availability that estimated skill mix status were deduced by considering its recommended number by staffing levels guidelines. Proportions of skill mix status and compliance with HCQS were compared by chi square test while Prevalence Ratios were estimated by Multivariable Poisson Regression with 95% Confidence Interval. Results On average, 36.8% of dispensaries had skill mix. Results indicated that, the higher the skill mix, the more the compliance with HCQS. Dispensaries with optimal skill mix (APR = 2.68, P < 0.001, 95% C.I = 2.00–3.59), Desirable skill mix (APR = 2.41, P < 0.001, 95% C.I = 2.03–2.86) and poor skill mix status (APR = 1.72, P < 0.001, 95% C.I = 1.48–1.99) were more likely to comply with HCQS compared to dispensaries with no skills mix at all. Conclusions This study demonstrates the critical role that HRH skill mix has in ensuring adherence to HCQS. The observed challenge of HRH availability and hence skill mix should be worked on. Given that, over two-thirds of Tanzanians who reside in rural areas rely on dispensaries for accessing healthcare services, to achieve equity in healthcare accessibility, deliberate measures including increasing recruitment budgets and equitable distribution of available HRH should be taken to address the challenge.

Health claims and front-of-pack labels (FoPLs) may lead consumers to hold more positive attitudes and show a greater willingness to buy food products, regardless of their actual healthiness. A potential negative consequence of this positivity bias is the increased consumption of unhealthy foods. This study investigated whether a positivity bias would occur in unhealthy variations of four products (cookies, corn flakes, pizzas and yoghurts) that featured different health claim conditions (no claim, nutrient claim, general level health claim, and higher level health claim) and FoPL conditions (no FoPL, the Daily Intake Guide (DIG), Multiple Traffic Lights (MTL), and the Health Star Rating (HSR)). Positivity bias was assessed via measures of perceived healthiness, global evaluations (incorporating taste, quality, convenience, etc.) and willingness to buy. On the whole, health claims did not produce a positivity bias, while FoPLs did, with the DIG being the most likely to elicit this bias. The HSR most frequently led to lower ratings of unhealthy foods than the DIG and MTL, suggesting that this FoPL has the lowest risk of creating an inaccurate positivity bias in unhealthy foods.

Medicare beneficiaries are increasingly enrolling in Medicare Advantage (MA), which employs a wide range of practices around restriction of the networks of providers that beneficiaries visit. Though Medicare beneficiaries highly value provider choice, it is unknown whether the MA contract quality metrics which beneficiaries use to inform their contract selection capture the restrictiveness of contracts' provider networks. We evaluated whether there are meaningful associations between provider network restrictiveness (across primary care, psychiatry, and endocrinology providers) and contracts' overall star quality rating, as well as between network restrictiveness and contracts' performance on access to care measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Medicare Advantage contracts with health maintenance organization (HMO), local preferred provider organization (PPO), and point of service (POS) plans with available data. A cross-sectional analysis using multivariable linear regressions to assess the relationship between provider network restrictiveness and contract quality scores in 2013 through 2017. Statistical significance in the relationship between network restrictiveness and contract performance on quality measures. Across all study years, we included 562 unique contracts and 2801 contract-years. We find no evidence of consistent relationships between MA physician network restrictiveness and contract star rating. For primary care, psychiatry, and endocrinology, respectively, a 10 percentage point increase in restrictiveness was associated with a 0.02 (95% confidence interval [CI] -0.01 to 0.04), 0.0008 (95% CI, -0.01 to 0.02), and -0.01 (95% CI, -0.01 to 0.001) difference in star rating (p-value > 0.05 for all). Similarly, we find no evidence of consistent relationships between network restrictiveness and access to care measures. Our findings suggest that existing MA contract quality measures are not useful for indicating differences in network restrictiveness. Given the importance of provider choice to beneficiaries, more specific metrics may be needed to facilitate informed decisions about MA coverage.

Purpose In this article we present our tool for assessing the sustainability knowledge of an undergraduate population. Design/methodology/approach Multiple choice questions were developed through soliciting expert input, focus groups, pilot testing, distribution via a large scale online survey, and analysis using item response theory. Findings The final assessment consists of 16 questions from the environmental, economic, and social domains covering foundational concepts within the topic of sustainability. Research limitations/implications This assessment represents an initial effort to quantify knowledge of the broad and abstract concept of sustainability. We plan to continue refining these questions to better differentiate between students with higher levels of knowledge and to replace those with answers that may change over time. Practical implications With knowledge of sustainability concepts becoming increasingly included in institution-wide learning objectives there is a growing demand for a way to measure progress in this area. Our assessment tool can easily be used (via a campus-wide survey or distributed at the classroom level) by institutions to gauge current levels of knowledge, track changes over time, and assess the effectiveness of courses and curricula at meeting sustainability knowledge goals. Originality/value This assessment of sustainability knowledge is the first of its kind to include all three separate domains of sustainability, and we expect it to be useful across a variety of college and university contexts.

On September 7, 2010, Consumers Union (publisher of Consumer Reports ) reported the results of coronary-artery bypass grafting (CABG) procedures at 221 U.S. cardiac surgery programs. 1 The voluntary reporting of risk-adjusted outcomes in approximately 20% of U.S. cardiac surgery programs is a watershed event in health care accountability. The reported ratings derive from a registry developed by the Society of Thoracic Surgeons (STS) in 1989. More than 90% of the approximately 1100 U.S. cardiac surgery programs participate in the registry. Registry data are collected from patients' charts and include key outcomes such as complications and death, the severity of preoperative . . .

Purpose Universidad San Francisco de Quito, USFQ, completed an assessment study to understand its performance in sustainability in 2012. This study aims to recognize the limitations of applying a North American rating system considering relevant criteria to a South American university and to emphasize the importance and lack of benchmarks available in the region. Design/methodology/approach Methodology used for this study is based on the Sustainability Tracking Assessment Rating System (STARS) by AASHE. In December 2013, USFQ joined the Pilot Program that included publicly documenting efforts, sharing feedback and making suggestions for system improvements. Findings Data collected by USFQ in 2012 and 2013 illustrate how the status of USFQ as a non-residential, teaching university in Ecuador in a developing country had several challenges while using an evaluation system established for universities within a North American system. The limits of assessing sustainability in South America are associated to its geographical location, the number of students and staff that commute to University and the lack of environmental services and certifications available in Ecuador. There are applicability issues with the use of STARS without performance reports from regional peers that can guide the development of relevant benchmarks for future comparability. Originality/value Little research has been conducted in the assessment and tracking of sustainability within universities in South America. This paper is one of the first to address the applicability of a North American self-reporting tool to a South American university.

This study examined classroom behavioral outcomes for children with Attention-Deficit/Hyperactivity Disorder (ADHD) following their participation in a manualized, 10-week intervention called Family Skills Training for ADHD-Related Symptoms (Family STARS). Family STARS combined behavioral parent training (BPT) and child-focused behavioral activation therapy (CBAT). Participants were children ages 7–10 diagnosed with ADHD-Combined Type. Pre- and post-treatment teacher ratings of ADHD symptoms were compared using a single group, within-subjects research design. Intervention effectiveness was analyzed using paired-samples t -tests. Results indicated statistically significant classroom improvements for externalizing behaviors and attention problems with medium and large main effects (respectively) for the intervention. Possible implications for combining CBAT with BPT for the treatment of ADHD are discussed as well as the relevance of these results for improving the effectiveness and portability of empirically supported interventions.

If it beats Old Dominion in the championship game, all three of these teams could make the tourney -- thus knocking a team from another conference out of the bracket. [...] many of us relish their suffering.