SSM - Health Systems最新文献

The inequitable and insufficient evidence-based allocation of health resources has exacerbated the health disparities in developing nations. Indicators of inadequate accessibility and misuse of health resources include urban-centered health facility site selection and overlapping health service areas. This research employed Service area analysis and the Maximum Covering Location Problem (MCLP) to assess spatial accessibility while considering the operational schedules of basic healthcare providers. Utilizing the motorbike model, the spatial accessibility to basic healthcare facilities amounted to 84%. However, certain facilities did not operate during weekends or around the clock. During the weekends, accessibility decreased to 60%, and for 24-hour accessibility, it dropped to 49%. Consequently, it is evident that the operating hours of healthcare facilities have a significant effect on spatial accessibility. This study proposed the upgrade of strategically positioned healthcare facilities to enhance spatial access and bolster the referral network for the local population.

Purpose

To evaluate the association between health system affiliation and hospitals’ reported responses to the COVID-19 pandemic.

Methods

Between September 14, 2020 and November 20, 2020, we conducted a survey of hospital administrators. We linked these survey results to county-level data on COVID-19 incidence and hospital affiliation data from the Agency for Healthcare Research and Quality Compendium on US Health Systems. We analyzed the association between health system affiliation and hospitals’ reported responses to the COVID-19 pandemic.

Results

We analyzed data from 217 general, short-stay, acute-care hospitals who responded to the survey. Health system affiliated hospitals reported increased adoption of policies to accept fewer patients in transfer (adjusted OR 2.06, 95% CI 1.01 – 4.21, p = 0.047), increased adoption of new ICU telemedicine programs (adjusted OR 4.90, 95% CI 1.09 – 22.1, p = 0.039), and decreased repurposing of medical-surgical units as ICUs (adjusted OR 0.51, 95% CI 0.27 – 0.97, p = 0.041).

Conclusions

Hospitals affiliated with health systems responded differently to the pandemic than non-system affiliated hospitals, including in ways that may have promoted efficient management of critical care demand and supply across hospitals. These findings suggest interhospital coordination may play an important role in disaster and pandemic preparedness.

The Covid-19 pandemic has raised concerns about the resilience of health systems. The aim of this study is twofold: i) to measure and compare the resilience of health system efficiency of OECD countries before and during Covid-19 and ii) to determine the healthcare efficiency drivers (e.g., socio-economic) of health system performance. Using a dataset of 31 OECD countries for 2018 and 2020, we first estimate bias-adjusted efficiency scores, followed by a double bootstrap truncated regression procedure to study the drivers associated with health system efficiency. We find that the health system efficiency overall score decreased among OECD countries during the Covid-19 pandemic compared to before Covid-19. Estonia and Japan retained their full efficiency scoreduring Covid-19. We find a negative association between health system efficiency and unemployment rate, share of health expenditure in GDP, and share of population over 65. Conversely, high vaccination rates contribute positively to health system efficiency during the Covid-19 period.

Networks are an increasingly employed approach to improve quality of care, service delivery, and health systems performance, particularly in low-and-middle income country (LMIC) health systems. The literature shows that networks can improve the provision and quality of services and health system functioning but there is limited evidence explaining how and why networks are established and work to achieve their reported results. We undertook a realist review to explore this. The objective of this realist review was to develop a programme theory outlining the underlying mechanisms and interactions of contexts that explain how and why a network’s set-up and function enable high-quality care and services and improved clinical outcomes in LMIC health systems. We followed Pawson’s five steps for realist reviews. The search strategy was based on a previously published scoping review with additional searches. Literature was selected based on its relevance to the programme theory and rigour. Context-mechanism-outcome configurations were developed from the extracted data to refine the initial programme theory with causal explanations. Theories on social movements and organisations supported the identification of mechanism and brought additional explanatory power to the programme theory. The programme theory explains how networks are initiated, formed, and function in a way that sets them up for network leadership and committed, engaged, and motivated network members to emerge and to change practices, which may lead to improved quality of care, service delivery, and clinical outcomes through the following phases: identify a problem, developing a collective vision, taking action to solve the problem, forming purposeful relationships, linkages, and partnerships, building a network identity and culture, and the creation of a psychological safe space. This deeper understanding of networks formation and functioning can lead to a more considered planning and implementation of networks, thereby improving health system functioning and performance.

The objective of this qualitative research study was to explore system, provider, and patient level factors from the perspective of rural-living citizens in Canada and how these factors influenced their telehealth experiences. Participants were recruited in follow-up to an online survey which asked for interest in participation in focus groups to talk about telehealth experiences. Twenty-two rural citizens participated in one of five focus groups. The qualitative data from the focus groups were thematically analyzed. The overarching theme that described rural participants’ experiences of telehealth during the pandemic was navigating the shifting care model. Two main themes were constructed from the data: shifts in the patient-provider relationship and mismatch between the telehealth requirements and provider and system support. Relational shifts involved a transactional or business-like relationship with their providers, that was reflected in changes in etiquette practices, personalization of care, and communication dynamics. Mismatch in telehealth system requirements and support was reflected in shifting personal and infrastructure technology requirements, blurred boundaries of health data access and privacy, and shifting appointment logistics. Continued use and expansion of technology-enabled healthcare must consider patient perspectives.