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Table 4 Summary of the features of reviewed decision support tools

From: Are there decision support tools that might strengthen the health system for perinatal care in South African district hospitals? A review of the literature

Tool Lives Saved Tool MANDATE model OneHealth Tool Discrete Event Simulation
Purpose Estimate the impact of introducing or increasing coverage of maternal, neonatal and child health interventions on mortality [23, 25,26,27] Guide users to prioritize allocation of resources towards interventions that have greatest impact in reducing maternal, fetal and neonatal mortality [23, 24, 28, 29] Enable users to conduct integrated health system planning and costing for various disease programs [23, 25, 30] Enable users to assess the efficiency of a healthcare delivery system and to forecast the potential impact of implementing changes in the healthcare delivery system [22, 31]
Preloaded Data a) List of maternal, neonatal and child health interventions [23, 26, 32]
b) Estimated baseline coverage of interventions at national level [23, 26, 27, 33, 34]
c) Recent estimate of the effectiveness of interventions that are introduced or scaled up [26, 33]
d) Population risk factors and causes of death relating to maternal, neonatal and child health [26, 34, 35]
a) List of main clinical conditions that contribute to maternal, fetal and neonatal mortality [24, 29]
b) Clinically proven methods to prevent, diagnose and treat maternal, fetal and neonatal conditions [29]
c) Baseline estimates of utilization, penetration and efficacy of interventions at a national or international level [24, 36]
a) Epidemiological and demographic data for various countries [37] Not specified
Required Input a) Geographical region where interventions will be applied [38]
b) Projected coverage of interventions to be assessed [26, 34, 39]
c) Measures of maternal, neonatal and child health status at national level [26]
a) Timeframe of assessment [40]
b) Geographical region where intervention will be applied [40]
c) Intended levels of utilization, penetration and efficacy in different settings, either at home, clinic and or in hospital [40]
a) Geographical region for which integrated planning and costing is conducted [37]
b) Current state of the building blocks of the health system [30, 37]
c) Coverage targets and disease program costs [30]
d) Settings in which interventions will be implemented, whether it is through community based programs, community health centers, hospitals or national level [37, 41]
Current operational state of the health system [22]
a) Number of service stations
b) Number of health professionals available in each service station
c) Medical resources available
d) Arrival rates
e) Service times
Generated output a) Estimated number of lives that could be saved by introducing or by increasing coverage of maternal, neonatal and child interventions [9, 35, 42, 43]
b) Cost implications for prevented deaths [35, 42, 43]
Estimated number of lives saved by increasing utilization and penetration of maternal, fetal and neonatal interventions [24, 29, 36, 44, 45] a) Number of health care professionals needed to implement intervention(s) [30, 37]
b) Medical resources needed for implementation of interventions [30, 37]
c) Expected costs necessary for proper implementation of interventions [25, 30, 37]
d) Number of lives that could be saved by implementing interventions [30, 37]
Performance measures specified by the user such as patient throughput, timeliness of care and resource utilization [22]
Assumptions a) Mortality rates and causes of death would not change considerably from the baseline estimates [23]
b) Estimated impact of interventions on mortality are solely due to the increase in coverage [23, 46]
c) Quality of care is maintained while increasing coverage [47]
Efficacy of interventions is the same in different levels of care (i.e. home, clinic or hospital) [28, 44] Interventions applied in one or more of the following settings:
a) Community
b) Outreach
c) Clinic
d) Hospital [41]
Simulation changes at a discrete time interval [48, 49]
Strengths a) Provides accurate predictions of neonatal and child mortality in diverse geographical settings [35, 50,51,52]
b) Models the impact of a single or integrated interventions [23, 26, 53]
c) Avoids overestimating the impact of interventions by considering multiple potential causes of deaths and risk factors within one group of deaths [23]
a) Evaluates the impact of single and integrated interventions [36]
b) Evaluates the impact of different types of interventions (preventative, diagnostic and treatment) [24, 28, 36, 44, 54]
c) Assesses the impact of transferring mothers and neonates between different levels of care [24, 28, 36, 44]
a) Enables a consolidated analysis across programs while considering financial capacity of the health system [30]
b) Incorporates costing of selected non-health sector factors that may have an impact on health outcomes [37]
a) Shows how processes interact as a whole in the system, providing a macro-level view [22]
b) Models several processes that occur simultaneously in a health care system [55]
c) Effective in allocating scarce resources while minimizing healthcare delivery costs [31]
Limitations Assessment of impact of interventions is limited to the predefined age intervals which do not cover the perinatal period exclusively [26] Output does not distinguish whether neonatal deaths occurred within the first 7 days of life or later, as a result the impact of interventions on perinatal outcomes cannot be measured [40] Output does not distinguish whether neonatal deaths occurred within the first 7 days of life or later, as a result the impact of interventions on perinatal outcomes cannot be measured [37] Not specified
Settings where tool has been applied Low- and middle-income countries [9, 33,34,35, 42, 46, 47, 50,51,52,53, 56,57,58] Low- and middle-income countries [28, 36, 44, 45, 54, 59] Low, middle and high income countries [25, 60,61,62,63] High-income countries [31, 48, 49, 55, 64, 65]
Level of application Country, provincial and district level [9, 33, 34, 42, 46, 47, 50,51,52,53, 56,57,58] National and international [28, 36, 44, 45, 54, 59] National [25, 60,61,62,63] Facility level [31, 48, 49, 55, 64, 65]