Ministry of Health Library

Health Improvement and Innovation Digest

Issue 197 - 15 August 2019

Welcome to the fortnightly Health Improvement and Innovation Digest (formerly the HIIRC digest). The Digest has links to key evidence of interest, with access to new content arranged by topic.

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Have you heard about Grey Matter?

We'd like to introduce you to another newsletter that the Ministry of Health Library prepares.  The Grey Matter newsletter provides monthly access to a selection of recent NGO, Think Tank, and International Government reports related to health. Information is arranged by topic, allowing readers to quickly find their areas of interest.  If you'd like to subscribe to Grey Matter, email library@health.govt.nz.

Article access

For articles that aren't open access, contact your DHB library, or organisational or local library for assistance in accessing the full text. If your organisation has a subscription, you may be able to use the icon under full text links in PubMed to access the full article.

Quality Improvement (New Zealand)

A window on the quality of Aotearoa New Zealand's health care 2019 – a view on Māori health equity
This report, by the Health Quality & Safety Commission, highlights a number of areas where change is needed in the health system. The report is divided into three chapters. The first analyses inequity between how Māori and non-Māori access and receive health services, and the effects on equity of improvement activities in our system. The second chapter asks why these inequities exist, and the third chapter addresses opportunities for improvement.

Severe maternal morbidity due to obstetric haemorrhage: Potential preventability
Haemorrhage in pregnancy may be life‐threatening to woman and infant. The impact of severe obstetric haemorrhage can be reduced by detecting high‐risk women, implementing guidelines and treatment plans, early detection of hypovolaemia, and timely appropriate treatment. This study, published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, aims to describe cases of severe maternal morbidity caused by obstetric haemorrhage in New Zealand and investigate the potential preventability of these cases.

Quality Improvement (International)

In-depth comparison of two quality improvement collaboratives from different healthcare areas based on registry data—possible factors contributing to sustained improvement in outcomes beyond the project time
Quality improvement collaboratives (QICs) are widely used to improve healthcare, but there are few studies of long-term sustained improved outcomes, and inconsistent evidence about what factors contribute to success. The aim of the study, published in Implementation Science, was to open the black box of QICs and compare characteristics and activities in detail of two differing QICs in relation to their changed outcomes from baseline and the following 3 years.

Exploring the sustainability of quality improvement interventions in healthcare organisations: a multiple methods study of the 10-year impact of the ‘Productive Ward: Releasing Time to Care’ programme in English acute hospitals
The ‘Productive Ward: Releasing Time to Care’ programme is a quality improvement (QI) intervention introduced in English acute hospitals a decade ago to: Increase time nurses spend in direct patient care; Improve safety and reliability of care; Improve experience for staff and patients; and Make changes to physical environments to improve efficiency. The objective of this study, published in BMJ Quality & Safety, was to explore how timing of adoption, local implementation strategies and processes of assimilation into day-to-day practice relate to one another and shape any sustained impact and wider legacies of a large-scale QI intervention.

Hospital Productivity (International)

Substitution of outpatient hospital care with specialist care in the primary care setting: A systematic review on quality of care, health and costs
Substituting outpatient hospital care with primary care is seen as a solution to decrease unnecessary referrals to outpatient hospital care and decrease rising healthcare costs. This systematic review, published in PLoS ONE, aimed to evaluate the effects on quality of care, health and costs outcomes of substituting outpatient hospital care with primary care-based interventions, which are performed by medical specialists in face-to-face consultations in a primary care setting.

Impact of Integrated Care on Patient-Related Outcomes Among Older People – A Systematic Review
The growing number of older adults with multiple needs increases the pressure to reform existing healthcare systems. Integrated care may be part of such reforms. The aim of this systematic review, published in the International Journal of Integrated Care, was to identify important patient-related outcomes of integrated care provided to older adults.

Shorter Waits for Cancer Treatment (International)

The use of mobile technology and peer navigation to promote adolescent and young adult (AYA) cancer survivorship care: results of a randomized controlled trial.
Adolescent and young adult (AYA) cancer survivors experience unique barriers that compromise receipt of survivorship care; therefore, development of innovative educational interventions to improve rates of AYA survivorship care is needed. This study, published in the Journal of Cancer Survivorship, explores the efficacy of text-messaging and peer navigation interventions was compared to standard-of-care survivorship educational materials to increase AYAs' late effects knowledge and knowledge, attitudes, and self-efficacy towards seeking survivor-focused care.

Shorter Stays In Emergency Departments (New Zealand)

Geographical and population disparities in timely access to prehospital and advanced level emergency care in New Zealand: a cross-sectional study.
Rapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study, published in BMJ Open, aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand and explores national disparities in geographical access to these services.

Shorter Stays In Emergency Departments (International)

Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?
Despite the similarities in the UK’s and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this BMC Emergency Medicine paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands.

How does clinical space utilisation impact patient flow?
Long waiting times in accident and emergency (A&E) departments remain one of the largest barriers to the timely assessment of critically unwell patients. In order to reduce the burden on A&Es, some trusts have introduced ambulatory care areas (ACAs) which provide acute assessment for general practitioner referrals. However, ACAs are often based on already busy acute medical wards and the availability of clinical space for clerking patients means that these patients often face long waiting times too. A cheap and sustainable method to reducing waiting times is to evaluate current space utilisation with the view to making use of underutilised workspace. The aim of this quality improvement project, published in BMJ Open Quality, was to improve accessibility to pre-existing clinical spaces, and in doing so, reduce waiting times in acute admissions.

Cardiovascular Disease and Diabetes (New Zealand)

Understandings of disease among Pacific peoples with diabetes and end‐stage renal disease in New Zealand
Compared with New Zealand Europeans, Pacific peoples in New Zealand develop type 2 diabetes at a higher rate and a younger age, and have 3.8 times higher incidence of end‐stage renal disease (ESRD). The objective of this study, published in Health Expectations, was to investigate contextual factors that shape understandings of disease for Pacific peoples with diabetes and ESRD.

Cardiovascular Disease and Diabetes (International)

Health checks and cardiovascular risk factor values over six years’ follow-up: Matched cohort study using electronic health records in England
The National Health Service (NHS) in England introduced a population-wide programme for cardiovascular disease (CVD) prevention in 2009, known as NHS Health Checks. This research, published in PLoS ONE, aimed to measure the cardiovascular risk management and cardiovascular risk factor outcomes of the health check programme during six years’ follow-up.

Sitting Time and Risk of Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis
Whether physical activity attenuates the association of total daily sitting time with cardiovascular disease and diabetes incidence is unclear. This systematic review and meta-analysis, published in the American Journal of Preventive Medicine, examined the association of total daily sitting time with cardiovascular disease and diabetes with and without adjustment for physical activity.

Primary Health Care (New Zealand)

Community‐acquired invasive Staphylococcus aureus: Uncovering disparities and the burden of disease in Auckland children
Staphylococcus aureus (SA) causes serious invasive disease in children. Large studies have measured the incidence of SA bacteraemia, but there is less information on the total burden of community‐acquired invasive SA (iSA) in children. This study, published in the Journal of Paediatrics and Child Health, explores the burden iSA in Auckland New Zealand.

Primary Health Care (International)

Vitamin D supplementation for women during pregnancy
Vitamin D supplementation during pregnancy may be needed to protect against adverse pregnancy outcomes. The objective of this Cochrane Review was to examine whether vitamin D supplementation alone or in combination with calcium or other vitamins and minerals given to women during pregnancy can safely improve maternal and neonatal outcomes.

Primary Mental Health (International)

Adolescent Mental Health Program Components and Behavior Risk Reduction: A Meta-analysis
Although adolescent mental health interventions are widely implemented, little consensus exists about elements comprising successful models. This meta-analysis, published in Pediatrics, aimed to identify effective program components of interventions to promote mental health and prevent mental disorders and risk behaviours during adolescence and to match these components across these key health outcomes to inform future multicomponent intervention development.

A scoping review of mental health prevention and intervention initiatives for infants and preschoolers at risk for socio-emotional difficulties
This review, published in Systematic Reviews, aimed to report on the landscape of research pertaining to mental health interventions for infants and preschoolers (0–5 years), and their families at risk for socio-emotional difficulties and negative developmental outcomes.

Better Help for smokers to Quit (International)

Motivational interviewing for smoking cessation
Motivational Interviewing (MI) is a directive patient‐centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help people to a make a successful attempt to stop smoking. The objective of this Cochrane Review was to evaluate the efficacy of MI for smoking cessation compared with no treatment, in addition to another form of smoking cessation treatment, and compared with other types of smoking cessation treatment.

Weight Management (New Zealand)

The effect of food price changes on consumer purchases: a randomised experiment
Most evidence on health-related food taxes and subsidies relies on observational data and effects on single nutrients or foods instead of total diet. The aim of this study, published in The Lancet Public Health, was to measure the effect of randomly assigned food price variations on consumer purchasing, where sets of prices emulated commonly discussed food tax and subsidy policies, including a subsidy on fruit and vegetables, a sweetened beverage tax, and taxes on foods according to sugar, sodium, and saturated fat content.

Childhood Obesity (International)

Interventions for preventing obesity in children
Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well‐being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. The objective of this Cochrane Review was to determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children.

Oral Health (International)

Clinical Effectiveness and Cost-Effectiveness of Oral-Health Promotion in Dental Caries Prevention among Children: Systematic Review and Meta-Analysis
The objective of this study, published in the International Journal of Environmental Research and Public Health, was to evaluate the clinical effectiveness and cost-effectiveness of oral-health promotion programs (OHPPs) aiming to improve children’s knowledge of favourable oral health behaviour to lower decayed/-missing/-filled teeth (DMFT) while reducing the financial cost on health institutions.

Health Equity (New Zealand)

Subsequent injuries experienced by Maori: results from a 24-month prospective study in New Zealand.
Māori, the indigenous population of New Zealand, experience a disproportionate burden of injury compared to non-Māori. Injury burden can be exacerbated by subsequent injuries (injuries that occur after, but not necessarily because of, an earlier or 'sentinel' injury). Despite obligations under New Zealand's Treaty of Waitangi, it appears no published studies have investigated subsequent injuries among Māori. This study, published in the New Zealand Medical Journal, aims to describe subsequent injuries experienced by Māori and reported to New Zealand's no-fault injury Accident Compensation Corporation (ACC), and determine: the number and timing of subsequent injury (SI) claims reported to ACC in 24 months following a sentinel injury; the proportions experiencing ≥1 SI; and the nature of SIs.

Key Ministry of Health Publications

Achieving Equity in Health Outcomes – Summary of a discovery process
This report provides a brief summary of phase one of the Achieving Equity Work Programme: The Discovery Phase. The aim of the discovery phase was to identify where practical and coordinated effort could be undertaken to achieve a measurable shift in health equity in the next three to five years.

Sustainability and the Health Sector
This publication aims to support and encourage the health sector to take an active role in incorporating sustainability practices and reducing carbon emissions.  It highlights the wide-ranging benefits of sustainability and provides ideas of how health facilities in New Zealand can reduce their environmental footprints and contribute to the transition to a sustainable, low-emissions world. It also acknowledges that a multi-agency approach is required to effect change, and signals that the Ministry of Health intends to continue to work with District Health Boards and other agencies to create a knowledge base of evidence and expertise to facilitate sustainable thinking throughout the health sector.

The information available on or through this newsletter does not represent Ministry of Health policy. It is intended to provide general information to the health sector and the public, and is not intended to address specific circumstances of any particular individual or entity.