This study investigates the possible mechanisms through which modern food markets may affect Vietnamese households’ dietary diversity and diet quality using data from a survey of 1,700 urban households with seven‐day food recall. We calculate Household Dietary Diversity Scores to measure dietary diversity, and use consumption frequencies of micronutrients (vitamin A and heme iron) and a macronutrient (protein) to create a household measure of diet quality. We estimate a Poisson regression model using a two‐step control function approach to address the potential endogeneity of our key explanatory variable, modern market food expenditure shares. Higher modern market food expenditure share is positively and significantly associated with consumption frequency of heme iron, but there are no significant associations with consumption of vitamin A and protein. We further explore indirect linkages between food expenditure shares and dietary diversity, which in turn, may be linked to household diet quality. Results from a system of equations show that the food expenditure share variable has no significant relationship with dietary diversity, but dietary diversity is positively and significantly associated with diet quality. Our results indicate that alone, policies which encourage ‘food market modernisation’ are not enough to improve diet quality in urban Vietnam.
Objective: To examine the association between consumption of western foods purchased and consumed away from home and measures of nutrition quality: average daily caloric intake and macronutrient (carbohydrates, fat and protein) shares, for urban consumers in Vietnam, a country undergoing economic transition. Design: Cross-sectional observational data were collected using household surveys and 24-h food diaries. Outcome variables were individual average daily caloric intake and shares of calories from macronutrients: carbohydrates, fat and protein. The key explanatory variable was individual daily share of calories from western food purchased and consumed away from home. Ordinary least squares and multivariate regression analyses were used to examine the association between the outcome variables: caloric intake and macronutrient shares and the share of calories from western food consumed away from home. Setting: Hanoi and Ho Chi Minh City in Vietnam. Participants: In total, 1685 households and 4997 individuals, including adults (aged $$ \ge $$ 18 years), adolescents (aged 10–17 years) and children (aged 0–9 years). Results: The share of calories from western food away from home was significantly associated with higher caloric intake among male and female adults (P < 0·01), adolescents (P < 0·01) and male children (P < 0·10) and was associated with higher shares of fat for male and female adults (P < 0·01), adolescents (P < 0·01) and male children (P < 0·01). Conclusions: Policymakers must be conscious of the numerous factors associated with poor nutrition quality, especially in younger Vietnamese individuals. Relevant interventions targeting at risk groups are required if nutrition improvement is a long-term goal.
Background Repeated admission to hospital can be stressful for older people and their families and puts additional pressure on the health care system. While there is some evidence about strategies to better integrate care, improve older patients’ experiences at transitions of care, and reduce preventable hospital readmissions, implementing these strategies at scale is challenging. This program of research comprises multiple, complementary research activities with an overall goal of improving the care for older people after discharge from hospital. The program leverages existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. Methods The program of research will take place in South Australia focusing on people aged 65 and over. Three inter-linked research activities will be the following: (1) analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; (2) evaluate the cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; and (3) implement a state-wide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The research is underpinned by an integrated approach to knowledge translation, actively engaging a broad range of stakeholders to optimise the relevance and sustainability of the changes that are introduced. Discussion This project highlights the uniqueness and potential value of bringing together key stakeholders and using a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) for improving health services. The program aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.
Objective We explored the perspectives of professionals working in health and aged care services in South Australia about factors that influenced successful transitions from hospital to home or residential aged care home for older people. We examined successful and recommended strategies that could support safe transitions following hospital discharge and reduce avoidable hospital admissions in South Australia. Methods Nineteen professionals from acute, post‐acute, primary, community and aged care settings in South Australia participated in semi‐structured interviews. Qualitative content analysis was conducted. Results Participants reported that navigating service provision could be difficult, compounded by different funding arrangements for hospitals, community, primary care and aged care services. Some participants felt that there was an over‐reliance on the hospital sector, leaving primary care and community‐based services under‐utilised to support hospital transitions. The importance of good communication between services and sectors was highlighted. Participants described different categories of services that supported safe transitions by supporting older people immediately post‐discharge; services that provided support to stay at home in the weeks and months following discharge; and services that helped the person receive health care at locations other than hospitals or emergency departments when they were unwell. Participants noted that successful programs were not always maintained. Conclusions Division of responsibility of aged and health‐care services between state and national governance contributes to fragmentation of care in South Australia. Careful planning of transitions and coordination of services across sectors is required to ensure older people are supported in the months following discharge from hospital to reduce avoidable rehospitalisations.
IntroductionHospital use increases with age. Older people and their families have reported poor experiences of care at the time of discharge home from hospital. As part of a larger project, we established and evaluated a quality improvement collaborative to address hospital to home transitions for older people.MethodsWe convened an expert panel of 34 stakeholders to identify modifiable issues in the hospital-home transition period. We established a collaborative involving health professionals across a range of agencies working to common goals. Teams were supported by a network manager, three learning sessions and quality improvement methodology to address their identified area for improvement. We used mixed methods to evaluate whether the establishment of the quality improvement collaborative built networks, built capacity in the health professionals and improved the quality of care for older people. Evaluation methods included interviews, surveys, network mapping and case studies.ResultsNine teams (n=41 participants) formed the collaborative and attended all meetings. Mapping showed an increase in networks between participants and organisations at the conclusion of the collaborative. Interview data showed that building relationships across services was one of the most important parts of the collaborative. Survey results revealed that most (77%) believed their quality improvement skills had developed through participation. Advice and regular meetings to progress project work were considered important in ensuring teams stayed focused. In terms of improving the quality of care, some participants indicated that they achieved the stated aims of their project better than expected (21%), most (41%) felt they achieved their aim as expected, 26% got close to their aim and the rest did not know the outcome (13%).ConclusionsEstablishing a quality improvement collaborative was a positive activity in terms of building a network across organisations and progressing quality improvement projects which aimed to achieve the same overall goal.
BackgroundRepeated admission to hospital can be a stressful and negative experience for older people and their families and puts additional pressure on the health care system. While there is evidence about strategies to better integrate care and improve older patients' experiences at transitions of care, thus helping to reduce hospital readmissions, implementing these strategies at scale is challenging. The objective of this project is to improve the pathways of care for older people after discharge from hospital by leveraging existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. MethodsThe project will be undertaken in the state of South Australia and focuses on people aged 65 and over. A mixed methods approach will be adopted, with three inter-linked work packages that aim to: analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; evaluate the effectiveness and cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; implement and evaluate a statewide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The study is underpinned by an integrated approach to knowledge translation, with active engagement of a broad range of stakeholders throughout, to optimize the relevance and sustainability of the changes that are introduced. DiscussionThis project highlights the uniqueness and potential value of a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) to improving health services. The project aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.Trial registrationNot applicable.
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