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Relative Impact of Different Strategies for Allocating Federal Funds for Syphilis Prevention.

ABSTRACT: BACKGROUND:Improvements in resource allocation can increase the benefits of federally funded sexually transmitted disease (STD) prevention activities. The purpose of this study was to illustrate how different strategies for allocating federal funds to subnational districts for syphilis prevention might affect the incidence of syphilis at the national level. METHODS:We modeled syphilis rates by district and year using an equation based on a previous analysis of state-level syphilis elimination funding and syphilis case rates from 1998 to 2005 in the United States. We used the model to illustrate the potential impact of 3 different strategies for allocating supplemental federal funds to subnational districts to support syphilis prevention activities a hypothetical country with 18 subnational districts. The 3 strategies were based on each district's (1) population size, (2) syphilis incidence rate, or (3) number of syphilis cases. The hypothetical country was similar to the United States in overall population and syphilis burden. RESULTS:Without the supplemental federal funds, there would be an estimated 48,600 incident infections annually in the hypothetical country. With the supplemental federal funds, the annual number of infections would be reduced to 27,800 with a population-based allocation of funding to each district, 26,700 with a rate-based allocation, and 24,400 with a case-based allocation of funding. CONCLUSIONS:Allocating federal STD prevention funds to districts based on burden of disease can be an efficient strategy, although this efficiency may be reduced or eliminated when high-burden districts have less ability to provide adequate STD prevention services than lower-burden districts.

SUBMITTER: Chesson HW

PROVIDER: S-EPMC6745686 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

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Relative Impact of Different Strategies for Allocating Federal Funds for Syphilis Prevention.

Chesson Harrell W HW Owusu-Edusei Kwame K

Sexually transmitted diseases 20180901 9S Suppl 1

<h4>Background</h4>Improvements in resource allocation can increase the benefits of federally funded sexually transmitted disease (STD) prevention activities. The purpose of this study was to illustrate how different strategies for allocating federal funds to subnational districts for syphilis prevention might affect the incidence of syphilis at the national level.<h4>Methods</h4>We modeled syphilis rates by district and year using an equation based on a previous analysis of state-level syphilis ...[more]

PMID: 29465641

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Project description:IntroductionIntegrated care is viewed widely as a potential solution to some of the major challenges faced by health and social care systems, such as those posed by service duplication, fragmentation and poor care coordination, and associated impacts on the quality and cost of services. Fragmented models of allocating funds to and across sectors, programmes and providers are frequently cited as a major barrier to integration and countries have experimented with different models of allocating funds to enhance care coordination among service providers and to reduce ineffective care and avoid costly adverse events. This scoping review aims to assess published international experiences of different models of allocating funds to facilitate integration and the evidence on their impacts.Methods and analysisWe will adopt a scoping review methodology due to the potentially vast and multidisciplinary nature of the literature on different models of allocating funds in health and social care systems, as well as the scarcity of existing knowledge syntheses. The framework developed by Arksey and O'Malley will be followed that entails six steps: (1) identifying the research question(s), (2) searching for relevant studies, (3) selecting studies, (4) charting the data, (5) collating, summarising and reporting the results and (6) and conducting consultation exercises. These steps will be conducted iteratively and reflexively, making adjustments and repetitions when appropriate to make sure the literature has been covered as comprehensively as possible. To ensure comprehensiveness of our literature review, we also search a wide range of sources.Ethics and disseminationAn integrated knowledge translation strategy will be pursued by engaging our knowledge users through all stages of the review. We will organise two workshops or policy roundtables/policy dialogues in Alberta and British Columbia with participation of diverse knowledge users to discuss and interpret the findings of our review and to draw out policy opportunities and lessons that can be applied to the context of these two provinces.

Project description:ObjectivesTo develop a formula for allocating resources for commissioning hospital care to all general practices in England based on the health needs of the people registered in each practiceDesignMultivariate prospective statistical models were developed in which routinely collected electronic information from 2005-6 and 2006-7 on individuals and the areas in which they lived was used to predict their costs of hospital care in the next year, 2007-8. Data on individuals included all diagnoses recorded at any inpatient admission. Models were developed on a random sample of 5 million people and validated on a second random sample of 5 million people and a third sample of 5 million people drawn from a random sample of practices.SettingAll general practices in England as of 1 April 2007. All NHS inpatient admissions and outpatient attendances for individuals registered with a general practice on that date.SubjectsAll individuals registered with a general practice in England at 1 April 2007.Main outcome measuresPower of the statistical models to predict the costs of the individual patient or each practice's registered population for 2007-8 tested with a range of metrics (R(2) reported here). Comparisons of predicted costs in 2007-8 with actual costs incurred in the same year were calculated by individual and by practice.ResultsModels including person level information (age, sex, and ICD-10 codes diagnostic recorded) and a range of area level information (such as socioeconomic deprivation and supply of health facilities) were most predictive of costs. After accounting for person level variables, area level variables added little explanatory power. The best models for resource allocation could predict upwards of 77% of the variation in costs at practice level, and about 12% at the person level. With these models, the predicted costs of about a third of practices would exceed or undershoot the actual costs by 10% or more. Smaller practices were more likely to be in these groups.ConclusionsA model was developed that performed well by international standards, and could be used for allocations to practices for commissioning. The best formulas, however, could predict only about 12% of the variation in next year's costs of most inpatient and outpatient NHS care for each individual. Person-based diagnostic data significantly added to the predictive power of the models.

Project description:Innovations in decision-making practice for allocation of funds in health research are emerging; however, it is not clear to what extent these are used. This study aims to better understand current decision-making practices for the allocation of research funding from the perspective of UK and international health funders. An online survey (active March-April 2019) was distributed by email to UK and international health and health-related funding organisations (e.g., biomedical and social), and was publicised on social media. The survey collected information about decision-making approaches for research funding allocation, and covered assessment criteria, current and past practices, and considerations for improvements or future practice. A mixed methods analysis provided descriptive statistics (frequencies and percentages of responses) and an inductive thematic framework of key experiences. Thirty-one responses were analysed, representing government-funded organisations and charities in the health sector from the UK, Europe and Australia. Four themes were extracted and provided a narrative framework. 1. The most reported decision-making approaches were external peer review, triage, and face-to-face committee meetings; 2. Key values underpinned decision-making processes. These included transparency and gaining perspectives from reviewers with different expertise (e.g., scientific, patient and public); 3. Cross-cutting challenges of the decision-making processes faced by funders included bias, burden and external limitations; 4. Evidence of variations and innovations from the most reported decision-making approaches, including proportionate peer review, number of decision-points, virtual committee meetings and sandpits (interactive workshop). Broadly similar decision-making processes were used by all funders in this survey. Findings indicated a preference for funders to adapt current decision-making processes rather than using more innovative approaches: however, there is a need for more flexibility in decision-making and support to applicants. Funders indicated the need for information and empirical evidence on innovations which would help to inform decision-making in research fund allocation.

Project description:IntroductionThe Special Supplemental Nutrition Program for Women, Infants and Children (WIC) required major revisions to food packages in 2009; effects on nationwide low-income household purchases remain unexamined.MethodsThis study examines associations between WIC revisions and nutritional profiles of packaged food purchases from 2008 to 2014 among 4,537 low-income households with preschoolers in the U.S. (WIC participating versus nonparticipating) utilizing Nielsen Homescan Consumer Panel data. Overall nutrients purchased (e.g., calories, sugar, fat), amounts of select food groups with nutritional attributes that are encouraged (e.g., whole grains, fruits and vegetables) or discouraged (e.g., sugar-sweetened beverages, candy) consistent with dietary guidance, composition of purchases by degree of processing (less, moderate, or high), and convenience (requires preparation, ready to heat, or ready to eat) were measured. Data analysis was performed in 2016. Longitudinal random-effects model adjusted outcomes controlling for household composition, education, race/ethnicity of the head of the household, county quarterly unemployment rates, and seasonality are presented.ResultsAmong WIC households, significant decreases in purchases of calories (-11%), sodium (-12%), total fat (-10%), and sugar (-15%) occurred, alongside decreases in purchases of refined grains, grain-based desserts, higher-fat milks, and sugar-sweetened beverages, and increases in purchases of fruits/vegetables with no added sugar/fats/salt. Income-eligible nonparticipating households had similar, but less pronounced, reductions. Changes were gradual and increased over time.ConclusionsWIC food package revisions appear associated with improved nutritional profiles of food purchases among WIC participating households compared with low-income nonparticipating households. These package revisions may encourage WIC families to make healthier choices among their overall packaged food purchases.

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Relative Impact of Different Strategies for Allocating Federal Funds for Syphilis Prevention.

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Relative Impact of Different Strategies for Allocating Federal Funds for Syphilis Prevention.

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