Dear CHIFA and HIFA colleagues,
This Commentary by CHIFA member Mike English concludes: 'we need study designs and research platforms that deal with complex systems'. While the focus is on child health, the issues raised are applicable to all facility-based healthcare.
CITATION: Improving emergency and admission care in low-resource, high mortality hospital settings—not as easy as A, B and C
Health Policy and Planning, Volume 37, Issue 6, June 2022, Pages 808–810, https://doi.org/10.1093/heapol/czab128
Strategies to provide emergency care training and promote use of clinical guidelines targeting common severe illness in newborns and children are available but there remain few studies testing the consequences of introducing these through multifaceted interventions.
Unlike studies that compare two quite specific treatments (e.g. drug A vs drug B) interventions that target improvement in delivery of emergency care and multiple guidelines require many changes in the organization and behaviour of multiple health workers (e.g. so that a team follows the key A, B and C steps of an emergency protocol and then continues to offer correct care over hours or days).
Some approaches to evaluating such multi-faceted interventions try and specify the complicated but logical sequence of changes or steps in care that need to be achieved so that patient outcomes including mortality are improved. These approaches may also recognize the complicated set of contextual factors that may influence implementation itself and patient outcomes. In principle, good study designs and analytic models might then account for all such influential factors to provide good evidence of effect for decision makers.
There are concerns that even very carefully designed studies that treat health care delivery as a complicated problem, especially those focused on organizations as the unit of study, may not in the end provide the evidence needed. Instead, we need study designs and research platforms that deal with complex systems.
Best wishes, Neil
Coordinator, WHO-HIFA project on Learning for Quality Health Services