Brief Gii Project Follow up

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Today’s talk: An Exploratory Data Analysis

Bugando and Haydom Hospitals in Tanzania

 

 

 

 

 

 

 

 

 

 

 

 

Global gap in neurosurgery workforce

  • Annually, 5 million essential cases not performed due to inadequate personnel

  • In Africa, 1700% increase in workforce is needed

  • Tanzania, w/ population of 58 million, has one accredited neurosurgery training program

 

 

 

 

 

 

 

 

 

 

 

 

Training models for the low resources setting

Train forward model

  • One to one long term mentorship

  • Heavy initial investment

  • Mentee becomes the mentor

 

Back to Back Model

  • Long term pairing

  • Rotating presence

  • Resource intensive throughout

 

 

 

 

 

 

 

 

 

 

 

 

Methods: Location

Haydom Hospital, Tanzania

  • Train forward model

  • 04.2005 - 02.2011

  • 6 months dedicated trainaing

  • 6 months dedicated to “how to teach”

  • 1-2 week top-ups every 6-12 months

 

Bugando Hospital, Tanzania

  • Back to back model

  • 01.2008 - 03.2013

  • Colorado, Brigham, MUSC, FIENS, Barrow

  • 3.5 yr period - 26 trips, 413 training days, $239,518 USD per yr

 

 

 

 

 

 

 

 

 

 

 

 

Methods: Data Collection

 

Variables

  • Demographics (age, gender)

  • Total procedures

  • Procedure type

  • Complication counts

  • Complication type

  • Severe complications = death or re-operation

 

 

 

 

 

 

 

 

 

 

 

 

Results: Haydom

  • Train forward method of teaching

  • Complete data from April 2005 to February 2011

Table 1: Haydom from 2005 to 2011
Haydom
variable 2005 2006 2007 2008 2009 2010 2011
Demographics
Age mean (SD) 21.2 / 23.6 22.8 / 28.3 16.9 / 25.6 19.9 / 24.8 30.2 / 28.8 28.7 / 28.4 19.7 / 28.5
Male N(%) 13 / 72 38 / 79 28 / 44 52 / 63 47 / 59 51 / 70 18 / 75
Clinical volumes
Total Procedures 18 54 74 94 98 80 27
Total Complications (%) 7 / 39 25 / 46 35 / 47 27 / 29 29 / 30 26 / 32 11 / 41
VP Shunt 1 7 14 16 18 16 6
Burr Hole Abscess 5 9 9 11 15 17 6
Spina Bifida Repair 5 8 10 11 6 14 5
Other 2 6 15 17 13 1 2
Craniotomy Evac 2 4 4 13 7 4 2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bugando

  • Back to back method of teaching

  • Complete data from January 2008 to March 2013

Table 1: Bugando from 1-1-2008 to 31-12-2012
Bugando
variable 2008 2009 2010 2011 2012
Demographics
Age mean (SD) 5.1 / 11.9 3.7 / 10.3 4.7 / 11.9 4.5 / 13.2 9.7 / 17.8
Male N(%) 85 / 59 94 / 53 116 / 56 135 / 57 221 / 66
Clinical volumes
Total Procedures 148 180 216 243 357
Total Complications (%) 42 / 28 31 / 17 55 / 25 74 / 30 68 / 19
VP Shunt 79 89 122 129 140
Spina Bifida Repair 19 32 31 47 58
Shunt Revision 8 15 13 17 19
Craniotomy 14 7 9 12 19
Bone Elevation 6 8 8 8 12

 

 

 

 

 

 

 

 

 

 

 

 

Joint analysis

Table 1: Comparison between Haydom and Bugando
Haydom
Bugando
02/2005 - 12/2010 01/2008 - 12/2012
Demographics
Age mean (SD) 23.5 / 27.4 6.3 / 14.4
Male N(%) 247 / 64 678 / 60
Clinical volumes
Total Procedures 445 1183
Total Complications 160 278
VP Shunt 78 575
Spina Bifida Repair 59 191

 

 

 

 

 

 

 

 

 

Take aways

  • Significant heterogeneity in population limits direct comparison

  • Time series data lends itself to ITS, difference in difference, regression discontinuity analyses

  • Both methods increased volume

  • Train forward did so with less overall investment

  • Barrow Global will use both methods to training

 

 

 

 

 

Thank you