Packaging Health Services When Resources Are Limited The Example of a Cervical Cancer Screening Visit 英文参考文献.docVIP

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Packaging Health Services When Resources Are Limited The Example of a Cervical Cancer Screening Visit 英文参考文献.doc

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Packaging Health Services When Resources Are Limited The Example of a Cervical Cancer Screening Visit 英文参考文献

o PL SMEDICINE PackagingHealthServicesWhenResources AreLimited:TheExampleofaCervical CancerScreeningVisit Jane J.Kim1*,Joshua A.Salomon2,Milton C.Weinstein1,Sue J.Goldie1 1 Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, United States of America, 2 Department of Population and InternationalHealth,HarvardSchoolofPublicHealth,Boston,Massachusetts,UnitedStatesofAmerica Funding:Thisstudywassponsored bytheMeritFellowshipfromthe HarvardUniversityGraduateSchool ofArtsandSciences.SJGwas supportedinpartbygrantsfromthe NationalCancerInstitute(R01 CA93435)andfromtheBilland MelindaGatesFoundation(30505). Thefundershadnoroleinstudy design,datacollectionandanalysis, decisiontopublish,orpreparation ofthemanuscript. ABSTRACT Background Increasing evidence supporting the value of screening women for cervical cancer once in theirlifetime,coupledwithmountinginterestinscalingupsuccessfulscreeningdemonstration projects,presentchallengestopublichealthdecisionmakersseekingtotakefulladvantageof thesingle-visitopportunitytoprovideadditionalservices.Wepresentananalyticframeworkfor packagingmultipleinterventionsduringasinglepointofcontact,explicitlytakingintoaccount a budget andscarce human resources, constraints acknowledged assignificant obstacles for provisionofhealthservicesinpoorcountries. CompetingInterests:Theauthors havedeclaredthatnocompeting interestsexist. AcademicEditor:Hans-OlovAdami, InstitutionenforMedicinsk EpidemiologiochBiostatistik, Sweden MethodsandFindings Wedevelopedabinaryinteger programming(IP) modelcapableofidentifying anoptimal packageofhealthservicestobeprovidedduringasinglevisitforaparticulartargetpopulation. InputstotheIPmodelarederivedusingstate-transitionmodels,whichcomputelifetimecosts and health benefits associated with each intervention. In a simplified example of a single lifetime cervical cancer screening visit, we identified packages of interventions among six diseases that maximized disability-adju