RESUMEN
BACKGROUND: Belize deployed a country-wide fully integrated patient centred health information system with eight embedded disease management algorithms and simple analytics in 2007 for $4 (Cad)/citizen. OBJECTIVES: This study evaluated BHIS uptake by health care workers, and pre and post BHIS deployment mortality in selected areas and public health care expenditures. METHODS: BHIS encounter data were compared to encounter data from required Ministry of Health reports from licensed health care entities. De-identified vital statistics death data for the eight BHIS protocol disease domains and three non-protocol domains were compared from 2005 to 2011. Belize population data came from the Statistical Institute of Belize (2005-2009) and from Belize census (2010) and estimate (2011). Public health system expenditures were compared by fiscal years (2000-2012). RESULTS: BHIS captured over 90% healthcare encounters by year one, 95% by year two. Mortality rates decreased in the eight BHIS protocol domains (each 2005 vs. 2011, all p<0.02) vs. an increase or little change in the three domains without protocols. Hypertension related deaths dropped from 1st cause of death in 2003 to 9th by 2010. Public expenditures on healthcare steadily rose until 2009 but then declined slightly for the next 3 years. CONCLUSION: For modest investment, BHIS was well accepted nationwide and following deployment, mortality in the eight BHIS disease management algorithm domains declined significantly and expenditures on public healthcare stabilized.
Asunto(s)
Registros Electrónicos de Salud/economía , Registros Electrónicos de Salud/estadística & datos numéricos , Costos de la Atención en Salud/estadística & datos numéricos , Sistemas de Información en Salud/economía , Mortalidad/tendencias , Atención Dirigida al Paciente/economía , United States Public Health Service/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Belice , Niño , Preescolar , Sistemas de Información en Salud/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Atención Dirigida al Paciente/estadística & datos numéricos , Integración de Sistemas , Estados Unidos , Adulto JovenRESUMEN
OBJECTIVE: Millennium Development Goal 5A, to decrease the maternal mortality ratio by three quarters between from 1990 to 2015, is proving difficult to achieve in many developing countries, including those in Mesoamerica. In this preliminary report from Belize we describe the major steps taken recently to improve maternal outcomes, leading to the achievement of Millennium Development Goal 5A in 2011, confounding all predictions. METHODS: In mid-2007, Belize deployed the world's first integrated countrywide health information system (BHIS), with eight embedded prevention/management domains. These included one centred on maternal health and covering best practices in prenatal, intrapartum, and postpartum care. The Ministry of Health and local maternal health care leaders used ongoing BHIS maternal data aggressively to detect health care system problems and to intervene to change outcomes. The maternal mortality ratios per 100 000 live births for 2005 to 2011 (i.e., from two years before BHIS deployment to four years after) were calculated from death and live birth data using Belize vital statistics. RESULTS: The maternal mortality ratio fell from 134.1 in 2005 to zero in 2011, with the major sustained drop occurring from 2008 onwards, coincident with implementation of the BHIS. The annual number of live births did not change over this time. CONCLUSION: Exceeding all expectations, Belize achieved Millennium Development Goal 5A in 2011, with a reduction in the maternal mortality ratio of well over three quarters. The drop in maternal mortality ratio was temporally associated with the introduction of the BHIS and its embedded maternal health domain. BHIS data were used aggressively to monitor and continuously improve maternal health care.