Call for Abstracts: Special Issue International Comparisons of High-Need, High-Cost Patients

Special Issue: International Comparisons of High-Need, High-Cost Patients: New Directions in Research and Policy

Sponsored by: The Health Foundation

Submission deadline: November 30, 2020

Health Services Research (HSR) and the International Collaborative on Costs, Outcomes and Needs In Care (ICCONIC) are partnering to publish a Special Issue on International Comparisons of High-Need, High-Cost Patients: New Directions in Research and Policy.

Health systems around the world have similar goals: maximizing quality of care for their populations, offering services that are responsive to patient needs and providing value for money. International comparisons can be a useful tool to provide national policy makers and clinical leaders with a benchmark that helps determine whether countries are achieving their goals. However, due to the inherent gaps in data, underdeveloped analytic methodologies and lack of consideration of key structural differences across health systems, poor comparisons can lead to unwarranted policy interpretations with adverse consequences for policy makers. Properly conducted cross-national comparisons can provide a rich source of data to learn from and inform health policy.

One key challenge facing many health systems is how to best design services to provide care to a small number of high-need, high-cost individuals. These patients are expensive and often the most vulnerable to experiencing the ill effects of poor quality care. In recent years, policy makers and clinical leaders have increased their efforts to understand how best to care for this heterogeneous group of patients with a diverse set of needs stemming from multiple physical conditions, mental and behavioural health issues and complex social problems. However, despite the enormous importance of this population, there are limited data on how different nations and health systems manage these patients.

Therefore, the goal of this Special Issue is to highlight cutting-edge work that showcase the potential to learn from international comparisons of high-need, high-cost individuals. A portion of the Special Issue will feature the work of the International Collaborative on Costs, Outcomes and Needs in Care (ICCONIC). ICCONIC consists of 12 partners from North America, Europe and the Pacific who use national and regional patient-level datasets to explore variations in the utilization and costs of health services for particular types of high-need individuals. The rest of the Special Issue will consist of invited submissions that examine areas related to the delivery of care for high-need, high cost-individuals.

Key dates proposed:

  • November 30, 2020: Submission deadline for abstracts for the Special Issue.
  • December 21, 2020: Notification sent to authors of manuscript invitation for Special Issue.
  • March 1, 2021: Submission deadline of manuscripts for the Special Issue.
  • October 1 2021: Notification of assignment of accepted manuscripts to the Special Issue.
  • December, 2021: Print Publication Date for Special Issue.

Questions can be directed to Kristen Riley at kriley@hsph.harvard.edu

An Interview with Vamba Lolleh, Partners In Health

Vamba Lolleh is no stranger to using digital health tools for infectious disease response and contract tracing. As an electronic health officer for Partners In Health (PIH), Sierra Leone, he and his organization were instrumental in responding to the 2014 Ebola outbreak. Yet as COVID-19 spreads, Vamba filled us in on how many of the lessons learned haven’t been as seamless to carry out as hoped.

Early in the COVID-19 response, Sierra Leone, alongside other West African countries, implemented infection control measures that were used during Ebola. Successful programs to stop the spread of misinformation through the use of radio and TV were quickly adapted for COVID-19. An aptly named policy called ‘less touching,’ aimed at reducing contact points between people was resurrected, and ‘selective quarantine’ was put in place for high-risk individuals. Yet as the government took steps to mitigate the spread of COVID-19, unprecedented challenges emerged.

According to Vamba, contact tracing, for example, has proved more difficult. During Ebola, it was one of the most effective strategies for identifying and controlling new cases. Through the use of CommCare, a digital platform developed by Dimagi, Vamba and his team were able to collect, store, and manage critical data in real-time. The tool was lauded as an essential aspect of the response; it was widely used by those on the front lines of the epidemic, and its lack of reliance on internet connectivity meant that it had utility in all parts of the country. 

Yet despite the success of CommCare during the Ebola outbreak, digital engagement hasn’t been as central in the COVID-19 response. According to Vamba, there are no digital tools being used for COVID-19 contact tracing in Sierra Leone.  

The Ministry of Health and Sanitation (MoHS) has taken steps to identify potential digital health solutions for their COVID-19 response, largely through the creation of an E-Health Technical Working Group, which Vamba is participating in. During these meetings, it became clear that the barriers to swift decision making and adoption of a digital contact tracing tool have been high, which is leading to delayed data collection on the ground and incomplete reporting. While the country is currently using a paper-based contact tracing system, Vamba believes that CommCare could still have potential. As he explains, “we have used this tool for five years now, we have over 100 Community Health Workers who know how to use it [CommCare].”

We asked Vamba why the digital response to COVID-19 was so different from that of Ebola. One of the biggest factors, he explained, was that as soon as the Ebola outbreak was controlled, many of the international NGO’s that used digital tools, quickly left Sierra Leone. “All the organizations that came to support the Ebola response, they brought lots of good programs and tools. But when they left, the programs were not handed over to the MoHS. The tools that existed during Ebola are not here anymore,” he noted. While Vamba believes the MoHS should be the organization leading the pandemic response, he acknowledges that they were left to start from scratch. “There are a lot of lessons that were learned during the Ebola response that could help with COVID-19 but those lessons were not shared with the Ministry,” Vamba said.  

As the government tries to get a handle on the burgeoning health crisis, a lack of essential resources is hampering their efforts. Sierra Leone continues to battle shortages in personal protective equipment and testing-kits, and their laboratory diagnostics capabilities are limited. Healthcare personnel have gone on strike, a situation that mirrors difficulties faced during Ebola. The pandemic has only exacerbated healthcare challenges that existed before the crisis; including a weak healthcare infrastructure, limited funding for the health sector, and a shortage in medical personnel.

While organizations like PIH continue to carry out their existing programs while supporting the COVID-response, Vamba says they are eager to continue to work with MoHS on a shared mission of reducing suffering and saving lives. Collaboration, both regionally and within government agencies, was critical in ending the Ebola outbreak; a lesson that can and should be applied to fight the COVID-19 pandemic. Vamba’s biggest takeaway after working and living through Ebola and now COVID-19? “The sustainability of the programs is what is actually important.” 

To get in touch with Vamba Lolleh, you can email him at: vlolleh@pih.org

To learn more about Partners in Health – Sierra Leone, follow them on Twitter @pihsierraleone

An interview with Mahadia Tunga, Tanzania dLab

“There’s a digital divide being witnessed in Africa,” said Mahadia Tunga, Co-Founder and Director of Capacity Development at the Tanzania Data Lab (dLab). While the divide is not new, the COVID-19 pandemic has highlighted how differential access to the internet can shape who receives access to education, and when. As social distancing restrictions push day-to-day activities online, those who do not have consistent access to the internet and key health information are at risk of being left behind.

Tanzania was on a partial lockdown until the end of June with only 38.7% of the population having access to the internet. While containment measures were markedly less strict than many neighboring states, schools and universities were closed and citizens were encouraged not to leave their homes. Amidst the lockdown, Mahadia and her team looked for innovative ways to overcome this digital divide.

In 2018, Mahadia co-founded the dLab, with a focus on training community members in health data science and disseminating important health information through SMS. The dLab has pivoted to expand their existing online training modules to encourage its students to continue building their data science skills virtually. Yet while online modules have shown great promise by doubling participation, there are limits to who the modules can reach. “We have online materials, but only those who are already empowered with the internet and resources can access them. We are seeing how vulnerable people can become even more vulnerable,” Mahadia noted. 

To address this, Mahadia’s team developed the ‘Smart Girls’ program, which aims to reach young girls in rural settings who do not have the resources to attend in-person data science training. “We specifically targeted schools that might not have power and computers. We would take computers and train the girls, and during the holidays invite them to our organization’s computer lab.” This program encouraged girls who typically lack access to computer education, or a data science curriculum, the skills to pursue future careers in science, technology, engineering, and mathematics (STEM). 

Yet the restrictions put in place in response to the COVID-19 pandemic have essentially stripped the dLab’s access to these young girls; and in turn, has limited their ability to continue their data science education. Mahadia feels that not being able to reach these girls when they have even more time than normal to devote to their data science training is a huge missed opportunity.

While Mahadia’s team is still seeking a way to provide training to participants of the ‘Smart Girls’ program, the dLab has successfully adapted some of their other programs in the face of COVID-19. The ‘Code Like a Girl’ program, for example, which also teaches young girls coding and data science skills, has been able to thrive due to a partnership with telecommunications provider, Vodacom Tanzania. With their support, the dLab is able to provide free internet bundles and access to online learning modules. 

Another program the dLab has successfully pivoted is ‘Talk To Data’(#Sema_Na_Data), which provides targeted messaging and partners with social media influencers to disseminate information to young men who are vulnerable to HIV/AIDS. With the onset of COVID-19, Mahadia knew that staying connected to this at-risk population was not only more important than ever but presented an opportunity. “People living with preconditions are more vulnerable to COVID… when COVID hit, we said ‘let’s find a way to be relevant.’” Now, Mahadia’s team has integrated COVID-19 messaging into their existing work, encouraging more young men to get tested for HIV so that they can know their status and take necessary precautions against the virus.

While Mahadia has been challenged to reorient her work due to the COVID-19 pandemic, the essence of it remains unchanged. “We are trying to share an evidence-based message. Analyzing the data and digesting it in a simple way so that people can understand the impact of COVID.” “But most importantly,” Mahadia continued, “we are telling a story that people can relate to their own activity, their own work, their own health. We are trying to get those big numbers into a level that everyone in the community can understand.” The messages may have changed since the start of the pandemic, but Mahadia remains committed to reaching the most vulnerable in her community.

To learn more about the Tanzania dLab, follow them on Twitter @dLabTz and Facebook