MHA FPX 5028 Assessment 3 Best Practices Report
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Capella University
MHA-FPX 5028 Comparative Models of Global Health Systems
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Date
Best Practices Report
Introduction
Before 1980, Sickle Cell Disease (SCD) was largely seen as a pediatric condition, with few patients surviving into adulthood. In 1970, about 30% of children born in the United States with sickle cell anemia (SCA) did not live past five years old (Chaturvedi & DeBaun, 2016). However, major improvements in screening, treatment, and vaccination have significantly increased pediatric survival rates. Currently, the median age at death for men and women with SCA in the United States has increased to 42 and 48 years, respectively (Chaturvedi & DeBaun, 2016). While high-income countries have seen substantial progress in reducing mortality rates and enhancing quality of life for SCD patients, developing nations, especially in Sub-Saharan Africa, continue to struggle with these challenges (Thompson et al., 2023).
Evaluation of Health Care Practices
A promising area for improving health outcomes and quality of life for SCD patients involves evaluating healthcare practices in Caribbean countries. These nations have a higher prevalence of sickle cell trait compared to the United States but show better health outcomes than Sub-Saharan Africa. In 2020, the Pan American Health Organization (PAHO) partnered with the Jamaican Ministry of Health to develop a comprehensive integrated health system delivery network (IHSDN) across primary health centers and hospitals. This initiative focuses on managing chronic diseases through electronic health records, workforce development, telehealth, health promotion, and medication management (Pan American Health Organization, n.d.).
Scalability Assessment
This report examines the scalability of PAHO’s agreement with Jamaica to extend best practices to low-income countries, particularly in Sub-Saharan Africa. It evaluates shared key performance indicators (KPIs) from both the United States and Jamaica, analyzing the implications for consumers and organizations, as well as potential provider management challenges in risk-based contracting versus fee-for-service payment models.
Performance Indicators
In 2000, the World Health Organization (WHO) published its first global health ranking report, which included various key performance indicators among its member countries. These indicators covered life expectancy, maternal and child mortality, disease mortality rates, infrastructure, and vaccination rates. Despite challenges in data collection, the first set of potential SCD quality indicators was published in 2011, comprising 41 metrics across six domains (Oyeku & Faro, 2017). Additional global measures include prevalence data and mortality rates throughout the life cycle (PAHO, 2023). However, accurately determining the mortality rate of SCD remains difficult due to associated co-morbidities and complications (Thompson et al., 2023).
MHA FPX 5028 Assessment 3 Best Practices Report
Table 1: SCD Key Performance Indicators
| KPI | United States | Jamaica |
|---|---|---|
| Accessibility | 5 hematologists per 100,000 residents (Ramsey et al., 2021) | 4.73 hematologists per 100,000 (AAMC, 2017) 5.36 hematologists per 100,000 (Ramsey et al., 2021) |
| Affordability | Average monthly out-of-pocket costs: $108.33 (NIH, 2022) | Average monthly out-of-pocket medical costs: $15.52 in US dollars (Ramsay et al., 2021) |
| Delivery | Universal Health Care (UHC); 68% of SCD patients covered by Medicaid or Medicare or both (Grady et al., 2021) | 64% of residents (UHC); Sickle Cell Unit (outpatient) and University of West Indies are not covered by UHC (includes labs, prescriptions, imaging, etc.) (Ramsay et al., 2021) |
| Mortality | 68% decrease in deaths of SCD in ages 0-3 between 1999-2002 compared to previous 3-year period (Grady et al., 2021) | Average life expectancy: 52.6 years in 2022 (Grady et al., 2021); 87% survival rate in children ages 0-5 (Serjeant et al., 2018); Average life expectancy: 58 years for women, 53 years for men (Ramsay et al., 2021) |
| Prevalence | 1:365 Black Americans with SCD; 1:13 Black with SC trait (Thompson et al., 2023) | 1:150 with SCD; 1:10 with SC trait (Thompson et al., 2023) |
| Quality | Influenza vaccination: 25-34% (Payne et al., 2021); Pneumonia vaccination: 80% of children < 12 years (Adamkiewicz et al., 2023) | Influenza vaccination: 98% of all children <18 years; Pneumonia vaccination: 91% of SCD children < 4 years (Serjeant et al., 2018; Hardie et al., 2009) |
| Screening | Universal newborn screening (Thompson et al., 2023) | Universal newborn screening (Thompson et al., 2023) |
| Treatment | Hydroxyurea: 33% of patients between 2015-2017 (Su et al., 2019); Blood transfusions: Discontinued as primary prevention circa 2001 (Shravya et al., 2023) | Hydroxyurea: 23% of patients receive drug (Ryan et al., 2020); 61% of patients receive, but only during crisis (Olujohungbe et al., 2001) |
Conclusion
In conclusion, adopting best practices from countries like Jamaica can significantly improve outcomes for SCD patients worldwide. Through collaborative efforts and strategic implementation of cost-effective interventions, the burden of SCD can be alleviated, particularly in regions with limited resources.
References
Azevedo, M. J. (2017). The state of health system(s) in Africa: challenges and opportunities. In Historical Perspectives on the State of Health and Health Systems in Africa, Volume II: The Modern Era (pp. 1–73). https://doi.org/10.1007/978-3-319-32564-4_1
Pan American Health Organization. (n.d.). Strengthening health systems & services in Jamaica. https://www.paho.org/en/stories/strengthening-health-systems-services-jamaica
Schütte, S., Acevedo, P. N. M., & Flahault, A. (2018). Health systems around the world – a comparison of existing health system rankings. Journal of Global Health, 8(1), 010407. https://doi.org/10.7189/jogh.08.010407
MHA FPX 5028 Assessment 3 Best Practices Report
Thompson, A. M., McHugh, T. A., Oron, A. P., Teply, C., Lonberg, N., Vilchis-Tella, V. M., … Kassebaum, N. J. (2023). Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000-2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Haematology, 10(8), e585-599. https://doi.org/10.1016/S2352-3026(23)00118-7
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