Patient pathway analysis

Transcription

1 Patient pathway analysis Methods and Global Findings Christy Hanson Senior Program Officer Bill & Melinda Gates Foundation Mike Osberg Senior Associate Linksbridge, SPC

2 The goal: Meeting patients where they are Reaching all TB patients: To reach all patients and avoid delays in diagnosis, treatment, and cure, TB services must be available where patients seek care. Planning patient-centered care will require knowing more about how patients seek care and aligning the delivery of services to patient preferences. 2

3 Data Sources

4 13-Country Patient Pathway Summary

5 EXAMPLE: EVIDENCE INPUT INTO THE CARE CONTINUUM (1/2) 2017 Patient Pathway Analysis 1 3 Presenting to health facilities, not diagnosed 2 43% of people with TB are likely to visit a health facility with capacity for TB diagnosis on their first visit to the health care system. Even fewer are likely to receive a DR diagnosis on their first visit Diagnosed by non-ntp, not notified 1 3 Over 40% of people initiate their care seeking journey in private (formal or informal) facilities. Diagnostic capacity exists in the private sector, however only notifications from the private sector only account for 13% of the estimated burden. 5

6 STEP 1: DATA GENERATION DRAFT VERSION 1.0 6

7 IDENTIFYING RELEVANT DATA SOURCES Patient Care Seeking TB Prevalence Survey Service Availability Service Availability Assessments Populationbased surveys of health utilization Inventory Studies Published literature Government data and reports

8 Data Sources e.g. Kenya Kenya has a variety of data sources TB Context Barriers to Care Care Seeking Service Availability Additional Context TIBU Case Registry TB cases registered 2015 Annual Report Case notification rate Location of case notifications (public vs private) 2015 Prevalence Survey (preliminary) Prevalence rates 2014 DHS Biggest barriers to care 2014 DHS Care seeking for fever Care seeking for diarrhea Care seeking for HIV test 2013 HHEUS Location of outpatient visits Location of admission visits 2015 Prevalence Survey (preliminary) Care seeking Treatment location 2010 SPA Availability of TB Dx and Tx by facility type Most common methods of TB Dx and Tx by facility type 2014 SARAM TB readiness index Availability of TB tracer items Availability of equipment (e.g. microscopes, x-ray viewers) Health Facility Register Count of all facilities by type, owner and level 2013 HHEUS Health spending per capita Health insurance coverage Kenya Open Data Platform HIV Prevalence

9 Data Standardization: Categories of Health Facilities DRAFT VERSION 1.0 9

10 Data standardization: Health Facility Mapping To allow for comparison across data sources, we mapped the facilities listed from each data source to standardized categories. Public Level 5 DHS SARAM HHEUS Facility Master List Level 4 Level 3 Level 2 Level 1 Microscopy Lab Data Xpert Test Records Private Level 4 Level 3 Level 2 Level 1 10

11 Health Facility Mapping Using health system definitions, we can map variety of data to a standardized view DHS Fever Care Seeking government hospital government health center government dispensary other public cs public cs public private hospital, clinic pharmacy private doctor mission hospital/ clinic cs private other private mobile clinic community health worker shop traditional practitioner relative/friend SPA 2010 Health Facilities national referral hospital provincial hospital district hospital sub-district hospital other hospital health centre clinic dispensary maternity stand-alone vct *Full details of health facility mapping included in the appendix HHEUS 2013 Level Public Hospital Private Hospitals Mission Hospital Public Health Centre Private Health Centre Mission Health Centre Nursing/Maternity Homes All Others SARAM 2014 Levels 1 - Hospital 2 - Health Centres 3 - Dispensaries 4 - Medical Clinics, Stand Alone HTC/VCT & Others Public Level 3 Level 2 Level 1 Level 0 Private Level 2 Level 1 Level 0

12 DATA COMPILATION

13 STEP 2: CALCULATIONS AND VISUALIZATION 13

14 CALCULATIONS

15 VISUALIZATIONS Demo PPA Excel and Tableau Workbooks online: Fig 23 Download the example Tableau workbook

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17 Executive Summary County-Level PPAs

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25 Resources Available Demo PPA Excel and Tableau Workbooks online:

26 PROCESS OF DEVELOPING A PPA FUTURE The tool will require user input, but will substantially decrease the time spent on data analysis and visualization Automated Process for Steps 3 & 4: User: Go to a website and upload data sources Create a health facility mapping lookup table Create a subnational unit mapping lookup table Identify PPA variables from data sources Computer: Summarize raw data Map summary data to health facility sectors and levels per the lookup table Maps subnational units across data sources per the lookup table Calculate PPA metrics Generate PPA visuals Manual Process 1. Prepare to Complete PPA 2. Collect Data Sources 3. Analyze Data 4. Visualize Data 5. Interpret Results Automated Process Bill & Melinda Gates Foundation 26