Health Services Insights最新文献

One of the main challenges in breast cancer management is health system literacy to provide optimal and timely diagnosis and treatments within complex and multidisciplinary health system environments. Digitalised patient navigation programs have been developed and found to be helpful in high- and low-resource settings, but gaps remain in finding cost-effective navigation in the public sector in Malaysia, where resources are scarce and unstable. Hence, we set out to develop a virtual patient navigation application for breast cancer patients to enhance knowledge about cancer diagnosis and treatments and provide a tracking mechanism to ensure quality care. This paper identifies the requirement for in-hospital patients' navigational needs for cancer diagnosis, the cancer diagnosis and treatment process's components and pathways, developing the app and usability study on the usefulness of a cancer navigation mobile application in navigating cancer care at the University of Malaya Medical Centre (UMMC). Key features found when designing the in-hospital application are managing the medical appointments, finding the location of each medical department, and providing information to breast cancer patients, healthcare managers and providers to ensure a coordinated care pathway. In future work, we plan to implement the JURNI in-hospital patient navigation and perform usability studies involving the actual patients, physicians and administrators. We are also working towards enhancing data security, adding other local languages and artificial intelligence capabilities to improve the patient's journey.

Background: Inappropriate child feeding practices can have significant negative effects on the well-being and survival of children under two years old. This study was aimed at assessing the minimum acceptable diet (MAD) and associated factors among 6 to 23 months age children in Wondo Genet district, Sidama region, Ethiopia.

Methods: A community-based cross-sectional study was conducted from 1 to 30 July in 2023 among 422 children aged 6 to 23 months. Multi-stage sampling method was applied to select kebeles and study participants. Trained data collectors gathered data using pretested questionnaire. Data was entered into EPI Info 7 and analyzed using IBM SPSS version 26. MAD as a composite indicator was produced based on the proportion of children aged 6 to 23 months who met the minimum meal frequency (MMF) and minimum dietary diversity (MDD) on the previous day. To assess the factors determining adherence to MAD, multi-variable logistic regression analyses were employed. The outputs were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI).

Results: In this study, 419 mothers/caretakers participated with a response rate of 99.3%. The proportion of children who met the MAD were 26.5% (95% CI: 22.29%, 30.71%). Increased odds of meeting MAD were associated with being from food-secured households (AOR = 2.39, 95% CI: 1.48 to 3.86), utilization of growth monitoring services (AOR = 2.05, 95% CI: 1.23 to 3.39), mother attended formal education (AOR = 1.88, 95% CI: 1.15 to 3.08), and being in age range of 12-23 months (AOR = 2.14, 95% CI: 1.26 to 3.63).

Conclusion: The prevalence of MAD was very low. Factors associated with a MAD included maternal education, child age, growth monitoring service utilization, and food security. To enhance MAD provision, it is crucial to strengthen child feeding practices tailored to the local context.

Background: Physician-hospital vertical integration is gaining steam but it is unclear how they affect hospital output.

Objective: To examine the direct impact of vertical integration on hospital output.

Design: A pooled design with 6-year data using linear regressions was used. Then, panel data design with hospital fixed effects was used.

Methods: We linked American Hospital Association data (2016-2021) with AHRQ Comparative Health System Performance Initiative's Compendium (2018, 2020, 2021; 34 987 hospital-year observations) to develop new measures of vertical integration and assess its relationship with several measures of hospital output including annualized total admissions, total number of inpatients days, and total number of emergency department (ED) and outpatient visits.

Results: We find that a hospital's entry into a vertical integration has little or no impact on a broad set of metrics capturing hospital output.

Conclusion: Our findings suggest that vertical integrations as currently structured may not yield meaningful gains in output or productivity and hospitals faced with declining productivity need to carefully consider the expected gains from vertical integration strategies.

Objectives: Residency training is important worldwide and recent studies have put more emphasis on its quality evaluation. This study aims to first explore the impact of educational backgrounds on the quality of gynecology and obstetrics (OB-GYN) standardized resident training (SRT) program in China, which may provide crucial evidence for policy considerations to improve SRT quality.

Methods: A total of 397 OB-GYN resident graduates were enrolled in this retrospective cohort study. They were divided into three groups according to their educational background, that is Bachelor of Medicine (BM), Master of Medicine (MM), and Doctor of Medicine (DM) groups. The characteristics and the results of SRT graduation examination and annual assessment of these residents were collected and compared using one-way analysis of variance or Pearson's chi-square test. A multivariable logistic regression analysis was performed to identify the association between sociodemographic variables and pass rates of SRT graduation examination. Besides, a subgroup analysis on training time for the DM group was performed. Strobe protocol was followed.

Results: The residents were older in DM group than that in BM and MM groups (P < 0.001). There was significant difference of the training length and the proportion taking part in SRT graduation examination among three groups (P < 0.001). Although the written test scores of SRT graduation examination were the lowest in BM group (P = 0.015), there was no significant difference in other results among three groups. No significant variable was found associated with the pass rates of SRT examination. No significant difference was found in the subgroup analysis of DM group.

Conclusion: Overall, the SRT quality of OB-GYN residents with different educational backgrounds was good and comparable. However, residents with BM degrees had lowest written scores and need to be strengthened during training. The training time of residents with DM degrees can be shortened according to their own conditions.

Background: Assessing the financial burden of COVID-19 is important for planning health services and resource allocation to inform future pandemic response.

Objectives: This study examines the changing dynamics in healthcare utilization patterns and costs from a public healthcare perspective during the COVID-19 pandemic in Alberta, Canada.

Design: Population-based descriptive study.

Methods: All adult patients over the age of 18 years who had a laboratory-confirmed COVID-19 diagnosis in Alberta, Canada from March 1, 2020 to December 15, 2021. We described demographic information and community- and hospital-based healthcare utilization and costs. We compared changes in each outcome throughout the first four waves of the pandemic.

Results: Among 255,037 patients, hospitalization incurred significantly higher costs (N = 20,603; aRR = 755.51; marginal cost: $21,738.17 CAD; P < .01). Wave 2 recorded the highest cost for Emergency Department (ED) visits (aRR = 1.10; marginal cost: $79.19 CAD; P < .01). Compared to Wave 1, Waves 2-4 all recorded significantly lower costs for out-patient visits. Wave 2's in-patient cost for patients that required ICU admission was significantly lower than Wave 1 (aRR = 0.75; marginal cost: -$24,142.47 CAD; P = .02).

Conclusion: COVID-19 exerted a heavy toll on healthcare services, and the dynamics of this continue to evolve. Utilization of ED and in-patient services were particularly high. Severe infections requiring hospitalization and ICU admission are more expensive than non-hospitalized and non-ICU hospital admits. Future studies should clarify specific factors, such as sociodemographic determinants, that contribute to evolving patterns of health services consumption and changing trends in cost to holistically inform responses to future pandemics.

Background: Norwegian Municipal Inpatient Acute Care (MIPAC) services were established as part of the 2012 Coordination Reform. The intention was to prevent unnecessary hospital admissions by redirecting and maintaining less urgent patients at the primary care level, which provides inpatient acute healthcare services closer to patients' home. However, the role MIPAC plays in the patient trajectory and how trajectories vary across different units and settings is less clear.

Objective: Therefore, this study aimed to (1) describe the general patient transfer trajectories for MIPAC patients and (2) examine facility and regional variations in MIPAC patients' sources of admission and discharge destinations.

Design: A cross-sectional study using aggregated register data.

Methods: The study involved 36 662 admissions across 185 MIPAC units in 2019. Descriptive statistics were used to describe patient transfer trajectories, and a random-effects multinomial logistic model was applied to assess the association between facility and regional factors and patients' admission sources and discharge destinations.

Results: The findings revealed distinct admission and discharge patterns based on facility and regional factors. Notably, intermunicipal units with 5 and more municipalities collaborating had higher relative risk ratios (RRR) for discharging to hospital (RRR = 1.50, 95%CI: 1.30-1.72) compared with independent MIPAC units. Large MIPAC units with more than 5 beds had increased relative risk ratios of patients admitted from the hospital than from home (RRR = 4.29, 95%CI: 1.56-11.78). Additionally, regional disparities existed, with units in the Central (RRR = 2.29, 95%CI: 1.56-3.38) and Western Norway health authorities (RRR:1.58, 95%CI: 1.22-2.06) displaying higher nursing home discharge rates than units in the South-Eastern Norway health authority.

Conclusions and implications: This study confirms the Norwegian MIPAC services' adherence to admission avoidance policies and identifies significant variations in service delivery across regions and facilities. The Norwegian MIPAC model also has potential to inspire other countries in developing admission avoidance services in the primary care setting.

Background: The Affordable Care Act (ACA) aims to expand coverage and increase access to health insurance. Despite the increase of insured individuals, there are a number of concerns about whether coverage and care are affordable. Prior studies document a growing concern with rising premiums and cost-sharing, including deductibles, particularly for those with chronic conditions.

Objective: Compare the ACA marketplace plan availability and costs across 17 states for individuals with varying diabetic engagement profiles and their related medical needs.

Design: Descriptive Cost Analysis.

Methods: Using Healthcare.gov individual state marketplace websites, we utilized a descriptive cost analysis to compare plan availability and costs for premiums, deductibles, co-payments, and co-insurance for an individual aged 63 years old, who was either a non-diabetic, high-engagement or low-engagement diabetic in urban and rural areas. Using the second lowest monthly premium silver plan (the benchmark plan), we calculated annual costs for premiums, co-insurance, co-payments, and deductibles for these individual profiles. We assessed statistical differences between health care component costs, within and across urban and rural areas, using t-tests.

Results: The findings highlight within and across states, individuals with diabetes, particularly low-engagement diabetics, spend a significantly higher percent of their income on additional health care costs, above their premium, than non-diabetic individuals. In some states, low-engagement diabetic patients spend upwards of 3 times more than high-engagement diabetic patients, highlighting an additional cost burden. For low-engagement diabetics, deductibles are driving health care spending with an average of 59% of health care spending coming from deductible payments. Results do not show statistically different costs across urban and rural diabetic patients.

Conclusion: Despite the ACA's success, results highlight variation in plan availability across states and disproportionate cost burden placed on moderate income individuals, especially related to deductible, and co-payments for those with chronic diseases.

Background: Efficient musculoskeletal care is important for health services and society. Surgical conversion rates are a common measure of efficiency, yet normal values and the impact of referrer type are unclear. This information could assist musculoskeletal care, service benchmarking and redesign.

Methods: A systematic review with meta-analysis was undertaken with PubMed, CINAHL and EMBASE databases searched from inception to 12th of October 2024, to identify studies from which musculoskeletal surgical conversion rates could be extracted. Data were categorised according to the professional group responsible for referral (all doctors, general practitioners, sports physicians, allied-health/physiotherapy-led screening services) and methodology used to define surgical conversion. Meta-analysis of pooled data was undertaken.

Results: Twenty-eight studies with a combined total of 5358 patients were included. Pooled data revealed surgical conversion rates of 23% for referrals from all types of doctors (0.23, 95% CI 0.18-0.27), 28% from general practitioners (0.28, 95% CI 0.12-0.52), 61% from allied health physiotherapy-led screening services (0.61, CI 0.50-0.70) and 70% from sports physicians at (0.70, CI 0.64-0.75). A variety of methodological factors impacted surgical conversion rate reporting and heterogeneity.

Conclusions: Musculoskeletal services seeking to improve efficiency through higher surgical conversion rates, should include sports physician and/or physiotherapy-led models of care for referral generation or management.

Objective: Examination of the impact of the COVID-19 pandemic on rates of antipsychotic medication use, initiation and discontinuation, among newly admitted long-term care residents.

Design: Repeated cross-sectional study.

Settings and participants: Long-term care home residents in Alberta, British Columbia and Ontario, Canada assessed with the Minimum Data Set (MDS) 2.0 assessment. The cohort was segmented according to admission during the pandemic (March 2020/2021) and 2 pre-pandemic (March 2018/2019 and March 2019/2020) periods.

Methods: Multivariable logistic regression models were fit to characterize the association between long-term care admission during the COVID-19 pandemic and the use of antipsychotic medications. A second set of logistic regression models were fit among residents with follow-up assessments to characterize the association between long-term care admission and antipsychotic initiation/discontinuation at follow-up. All models were adjusted for resident characteristics including sex, age group, Aggressive Behaviour Scale score, Cognitive Performance Scale score, and diagnoses of Alzheimer's disease and related dementias, anxiety disorder, depression, and bipolar disorder.

Results: 21 612 residents admitted during the pandemic and over 30 000 in each pre-pandemic period were included. Antipsychotic use increased during the pandemic period among newly admitted residents from both community (adjusted odds ratio [aOR] 1.20-1.29) and hospital settings (aOR 1.21-1.23). Residents admitted during the pandemic period were more likely to have antipsychotic medications initiated (aOR 1.25-1.26) and less likely to have had them discontinued (aOR 0.74-0.76) at the time of follow-up assessment.

Conclusion and implications: Multiple factors contributed to the observed increase in antipsychotic medication use among newly admitted long-term care home residents during the COVID-19 pandemic: increased medication use at the time of admission, increased medication initiation at follow-up, and decreased medication discontinuation at follow-up. A whole-systems approach that extends beyond long-term care into hospital and community settings is necessary to address this prevalent issue.

Background: Digital Health Technologies (DHTs) offer numerous health benefits but raise ethical and security concerns about patient health data among health professionals due to potential security breaches. This study explores the ethical, patient safety, and security issues concerning healthcare professionals using DHTs in hospitals in Ghana.

Methods: The study used a mixed method design, including a descriptive survey and in-depth interviews with health professionals in 3 tertiary hospitals, between July and September 2022, with thematic content analysis using QSR NVivo 12 software. The descriptive survey was analyzed using Stata 15 to produce percentages, means, and standard deviations.

Results: A total of 369 health professionals participated in the study. Disclosure of health data on DHTs without consent from patients 299 (81.03%) was the most frequently mentioned concern. The most often raised concern was the disclosure of the patient. Overall, 298(80.76%) health professionals worried about safety issues relating to the use of the DHTs. On occasion, staff members neglect to log out of the system, which compromises all the security measures in place. Other factors such as system unavailable due to unplanned shutdown affected patient safety.

Conclusion: Health professionals are concerned about patient information confidentiality and security. They believe staff access to patient information should be on a "need-to-know basis," and safety policies be periodically updated to prevent human behavior from compromising security measures.