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An exploration of factors leading to readiness for organizational health literacy change in community-based health organizations. 探讨导致社区医疗机构做好组织健康知识变革准备的因素。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-24 DOI: 10.1177/09514848241295655
Melanie Stone, Ricardo Wray, Jason Rosenfeld, Melissa Valerio-Shewmaker, Teresa Wagner

Introduction: Healthcare systems have a responsibility to improve organizational health literacy (OHL) to increase health equity. This study explored two organizational cultural factors, leadership support and staff buy-in, for organizations planning OHL change.

Methods: Ten community-based health organizations participated in an OHL program. The study design was mixed methods. The qualitative inquiry was interviews with senior leaders to explore awareness of OHL and: impetus to transform, leadership commitment, staff engagement, alignment to organizational goals, and integration of health literacy change with current practices. The quantitative assessment was the Organizational Readiness for Implementing Change (ORIC) questionnaire to assess staff's perceptions about OHL change readiness.

Results: Senior leaders articulated the effects of low health literacy in their patient and client population. Support for OHL change was seen at both leadership and staff levels. Impetus for change was primarily a response to a community need or for quality improvement. Most of the non-clinical organizations had higher ORIC scores than the clinical organizations, indicating a perceived higher level of readiness for OHL change.

Conclusion: Leadership commitment and staff buy-in are important factors of readiness for OHL change. A novel finding is that community-based health organizations are able and willing to engage in OHL change.

导言:医疗保健系统有责任改善组织健康素养(OHL),以提高健康公平性。本研究探讨了计划进行 OHL 变革的组织的两个组织文化因素,即领导支持和员工认同:方法:10 家社区医疗机构参与了 OHL 计划。研究设计采用混合方法。定性调查是对高层领导进行访谈,以探究他们对开放式健康素养的认识,以及:转型的动力、领导的承诺、员工的参与、与组织目标的一致性,以及健康素养变革与当前实践的结合。定量评估是通过组织实施变革准备情况(ORIC)调查问卷来评估员工对开放式健康素养变革准备情况的看法:结果:高层领导明确指出了低健康素养对病人和客户群体的影响。在领导层和员工层面都看到了对改变老年健康素养的支持。变革的动力主要是为了满足社区需求或提高质量。大多数非临床机构的 ORIC 得分高于临床机构,这表明他们对改变开放式流式医疗服务的准备程度较高:结论:领导层的承诺和员工的认同是影响开放式医院变革就绪程度的重要因素。一个新的发现是,社区医疗机构能够并愿意参与开放式医院管理改革。
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引用次数: 0
The (very real) risk of irrelevance, and the great opportunity. 无关紧要的风险(非常现实)和巨大的机遇。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-10-18 DOI: 10.1177/09514848241295480
Federico Lega
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引用次数: 0
Financial management, efficiency, and care quality: A systematic review in the context of Health 4.0. 财务管理、效率和医疗质量:健康 4.0 背景下的系统回顾。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-28 DOI: 10.1177/09514848241275783
Ricardo do Carmo Filho, Pedro Pereira Borges

This article investigates the intersection between innovation, Health 4.0, and financial management in the healthcare industry, emphasizing the importance of operational efficiency and quality of care. The study aims to analyze how financial management processes in healthcare relate to Health 4.0 and enhance care quality. It begins with a thorough theoretical grounding, proposing a framework that connects Health 4.0 with financial management practices. A systematic review of the literature was conducted, identifying trends, challenges, and opportunities in the financial management of Health 4.0. The results highlight selected articles on responsible innovation, Health 4.0 technologies, investments in health, hospital efficiency, performance forecasting, and high-cost patient management. These articles were clustered into "Data Analysis and Machine Learning in Healthcare" and "Health Management and Sustainability," providing a categorized understanding of the topics. The study reveals that Health 4.0 offers significant opportunities for process efficiency and cost reduction without compromising service quality. It highlights strategic advantages in addressing contemporary healthcare challenges by optimizing processes, improving financial projections, and incorporating advanced technologies efficiently. The successful implementation of Health 4.0 can lead to substantial improvements in service quality, adding value to patients and driving local economic development. This article offers valuable insights for healthcare professionals and managers, emphasizing the transformative potential of Health 4.0 and outlining strategies for its effective implementation. The clustering of articles provides a clearer understanding of current research in Health 4.0, contributing significantly to the field and guiding future research directions.

本文研究了医疗保健行业中创新、健康 4.0 和财务管理之间的交叉点,强调了运营效率和医疗质量的重要性。研究旨在分析医疗保健行业的财务管理流程如何与健康 4.0 相关联并提高医疗质量。研究从全面的理论基础开始,提出了一个将健康 4.0 与财务管理实践联系起来的框架。对文献进行了系统回顾,确定了健康 4.0 财务管理的趋势、挑战和机遇。结果突出显示了有关责任创新、健康 4.0 技术、健康投资、医院效率、绩效预测和高成本患者管理的部分文章。这些文章被分为 "医疗保健中的数据分析与机器学习 "和 "健康管理与可持续发展 "两类,以提供对主题的分类理解。研究显示,健康 4.0 为提高流程效率和降低成本提供了重要机会,同时又不影响服务质量。它强调了通过优化流程、改善财务预测和有效采用先进技术来应对当代医疗挑战的战略优势。健康 4.0 的成功实施可大幅提高服务质量,为患者带来更多价值,并推动当地经济发展。本文为医疗保健专业人员和管理人员提供了宝贵的见解,强调了健康 4.0 的变革潜力,并概述了有效实施健康 4.0 的策略。文章的分组使人们对当前的健康 4.0 研究有了更清晰的认识,为该领域做出了重要贡献,并为未来的研究方向提供了指导。
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引用次数: 0
The impact of policy and technology infrastructure on telehealth utilization. 政策和技术基础设施对远程医疗使用的影响。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-28 DOI: 10.1177/09514848241276471
Ying-Chih Sun, Ozlem Cosgun, Raj Sharman

The COVID-19 outbreak resulted in an unprecedented surge in telehealth utilization. However, the effects of policy enactment on utilization remain understudied in the literature. Our research examines the impact of policy mandates relating to federal incentive programs on telehealth utilization across states during the pandemic by considering technology infrastructure, such as broadband penetration and equipment possession. This study also considers the impact of political orientation and control factors, including income attributes, on telehealth utilization. Considering telehealth utilization in the Medicare program as a test case, this study employed the partial least square and structural equation model to analyze data from the Centers for Medicare & Medicaid Services, the American Community Survey, and the Microsoft Airband Project to draw inferences. Our study finds that telehealth legislation, broadband penetration, political orientation, and control factors have a direct significant impact on telehealth utilization, whereas incentive programs and equipment possession have an indirect impact through broadband penetration.

COVID-19 的爆发导致远程医疗的使用率空前激增。然而,文献中对政策颁布对利用率的影响仍然研究不足。我们的研究通过考虑宽带普及率和设备拥有量等技术基础设施,研究了与联邦激励计划相关的政策授权对大流行期间各州远程医疗利用率的影响。本研究还考虑了政治取向和控制因素(包括收入属性)对远程医疗利用率的影响。本研究以医疗保险计划中的远程医疗利用率为测试案例,采用偏最小二乘法和结构方程模型分析了医疗保险与医疗补助服务中心、美国社区调查和微软空中带项目的数据,从而得出推论。我们的研究发现,远程医疗立法、宽带普及率、政治取向和控制因素对远程医疗的使用有直接的重大影响,而激励计划和设备拥有量则通过宽带普及率产生间接影响。
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引用次数: 0
Factors influencing use of eHealth services during and after the COVID-19 pandemic. 影响在 COVID-19 大流行期间和之后使用电子保健服务的因素。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-23 DOI: 10.1177/09514848241275777
Korina Katsaliaki

Objectives: The rapid advancement of information and communication technologies has made eHealth applications increasingly available and accessible. The COVID-19 pandemic has accelerated the need for remote health service provision. This research aims to explore the usage, perceptions, and knowledge of eHealth interventions during and after the COVID-19 pandemic.

Methods: A cross-sectional survey was conducted in 2021 (during the pandemic) and 2023 (post-pandemic) using a structured questionnaire based on the Technology Acceptance Model (TAM) and the eHealth Literacy Scale (eHEALS). The survey, conducted in Greece, included 638 participants in total (277 in 2021 and 361 in 2023). Structural equation modeling was employed to assess the factors influencing eHealth adoption.

Results: The findings indicate a slight increase in positive perceptions of eHealth usefulness, intention to use, and actual usage over the 2 years. However, concerns remain regarding the ease of use and eHealth literacy. eHealth literacy significantly predicts the perceived usefulness and ease of use of eHealth services, both of which predict the intention to use them. Additionally, higher education levels are positively associated with eHealth literacy, while older age is negatively associated with ease of use. Gender did not significantly impact these factors. These findings were consistent across both surveys.

Conclusions: Policy-makers should focus on simplifying eHealth services, removing technical barriers, and enhancing the population's eHealth literacy to promote wider adoption of eHealth services.

目的:信息和通信技术的飞速发展使电子保健应用变得越来越容易获得和使用。COVID-19 大流行加速了对远程医疗服务的需求。本研究旨在探讨 COVID-19 大流行期间和之后电子健康干预措施的使用情况、看法和知识:方法:在 2021 年(大流行期间)和 2023 年(大流行之后)进行了一项横断面调查,采用了基于技术接受模型(TAM)和电子健康素养量表(eHEALS)的结构化问卷。调查在希腊进行,共有 638 人参加(2021 年 277 人,2023 年 361 人)。采用结构方程模型评估了影响采用电子健康的因素:研究结果表明,在这两年中,人们对电子健康的有用性、使用意向和实际使用情况的积极看法略有增加。电子健康素养对电子健康服务的有用性和易用性有显著的预测作用,而这两点都会影响使用意向。此外,较高的教育水平与电子健康素养呈正相关,而较高的年龄则与易用性呈负相关。性别对这些因素的影响不大。这些结果在两次调查中都是一致的:政策制定者应注重简化电子健康服务、消除技术障碍和提高民众的电子健康素养,以促进电子健康服务的广泛采用。
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引用次数: 0
Institutional influences on healthcare service innovation: Lessons from German rehabilitation clinics. 制度对医疗服务创新的影响:德国康复诊所的经验教训。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-20 DOI: 10.1177/09514848241275788
Bettina Kriegl, Herbert Woratschek, Andrea Raab

In view of the growing need for rehabilitation worldwide due to demographic changes and health trends, healthcare organizations are facing increasing pressure to innovate. This study focuses on the institutional dynamics shaping service innovation in orthopedic rehabilitation settings in Germany. Using Scott's framework of institutional pillars and carriers, we conduct a multiple case study analysis. Based on interviews with physicians and managers from six different clinics, conducted in two rounds and supplemented by secondary data analysis, we investigate the influence of regulative, normative, and cultural-cognitive institutions on healthcare service innovation. By distinguishing between the various institutional barriers and facilitators, our research provides valuable insights for healthcare practitioners and managers, equipping them with the necessary knowledge to effectively navigate and utilize the institutional environment.

由于人口结构的变化和健康趋势的影响,全球范围内的康复需求日益增长,医疗机构正面临着越来越大的创新压力。本研究的重点是影响德国骨科康复机构服务创新的制度动力。利用斯科特的机构支柱和载体框架,我们进行了多案例研究分析。基于对六家不同诊所的医生和管理人员进行的两轮访谈,并辅以二手数据分析,我们研究了调节性、规范性和文化认知性制度对医疗服务创新的影响。通过区分各种制度障碍和促进因素,我们的研究为医疗从业者和管理者提供了宝贵的见解,使他们掌握了有效驾驭和利用制度环境的必要知识。
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引用次数: 0
How excellent can centres of excellence be? The impact of prevalence on service quality. 卓越中心能有多卓越?普遍性对服务质量的影响。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-10 DOI: 10.1177/09514848241270844
David Martin Foreman

Centres of Excellence (CEs) are thought to provide better quality services for their speciality than Generic Services (GS). However, clinical test theory suggests this may arise from differences in the prevalence of these specialities' conditions in their referral populations, which affects the services' ability to detect diagnoses accurately, even with similar diagnostic sensitivities and specificities. Furthermore, GS' insensitivity to rarer diagnoses is necessary to avoid serious overdiagnosis despite using skills equivalent to CEs. Good GS can perform as well as CEs for disorders of 15% to 20% or greater prevalence in their referral populations, depending on the Minimal Clinically Important Difference (MCID) decided for their diagnoses' positive predictive values or degree of bias. CEs are necessary for rare disorders and have a role in determining MCIDs and the sensitivity and specificity of new measures. Sensitivity, specificity, positive & negative predictive values, and true diagnostic prevalence should be routine outcome measures.

卓越中心(Centres of Excellence,CE)被认为比通用服务(Generic Services,GS)为其专科提供了更优质的服务。然而,临床检验理论认为,这可能是由于这些专科的疾病在其转诊人群中的流行率不同,从而影响了服务机构准确检测诊断的能力,即使诊断的敏感性和特异性相似。此外,一般事务人员对较罕见的诊断不敏感,这是避免严重过度诊断的必要条件,尽管他们使用的技能与行政主管相当。对于转诊人群中发病率为 15%至 20%或更高的疾病,优秀的 GS 可与 CE 一样出色,这取决于其诊断的阳性预测值或偏倚程度所决定的最小临床重要差异 (MCID)。对于罕见疾病来说,CE 是必要的,它在确定 MCID 以及新措施的敏感性和特异性方面发挥着作用。灵敏度、特异性、阳性和阴性预测值以及真正的诊断流行率应成为常规结果测量指标。
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引用次数: 0
Hospital process performance and the adoption of medical devices: An organization-based view. 医院流程绩效与医疗设备的采用:基于组织的观点。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-05 DOI: 10.1177/09514848241270874
Francesca De Domenico, Guido Noto, Maria Cristina Cinici

Over the past two decades, there has been a growing scholarly interest in the adoption of technology in healthcare. While numerous studies have delved into the effects of specific technologies on the performance of different organizational units and medical specialties, the findings have often been divergent. Unlike the established literature, our approach focuses on the organization's perspective to analyze how technology impacts process performance in hospital settings. More precisely, we compiled a tailored dataset from 56 healthcare organizations in Italy and conducted a comprehensive analysis of panel data from 2016 to 2019, utilizing Ordinary Least Squares (OLS) regression as our main analytical tool. The data shows a clear relationship between an organization's use of medical devices and its overall process performance. Our research highlights the importance of achieving substantial improvements in process performance by strategically integrating new technologies and devices. Policymakers are encouraged to consider introducing incentives to drive hospitals to invest in innovative technologies. Furthermore, monitoring expenditures on new devices could serve as a valuable metric for assessing the extent of technology adoption within clinical practices.

过去二十年来,学术界对医疗保健领域采用技术的兴趣与日俱增。虽然已有大量研究深入探讨了特定技术对不同组织单位和医疗专业绩效的影响,但研究结果往往众说纷纭。与已有文献不同的是,我们的方法侧重于从组织的角度来分析技术如何影响医院的流程绩效。更确切地说,我们从意大利的 56 家医疗机构中编制了一个定制数据集,并利用普通最小二乘法(OLS)回归作为主要分析工具,对 2016 年至 2019 年的面板数据进行了全面分析。数据显示,机构使用医疗设备与其整体流程绩效之间存在明显的关系。我们的研究强调了通过战略性地整合新技术和新设备来大幅提高流程绩效的重要性。我们鼓励政策制定者考虑引入激励机制,推动医院投资创新技术。此外,对新设备支出的监控可以作为评估临床实践中技术应用程度的重要指标。
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引用次数: 0
Competing in the "war for talent" in nursing homes: A quantitative investigation. 养老院的 "人才争夺战":定量调查。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-05 DOI: 10.1177/09514848241270767
Irene Gabutti, Lorena Martini, Daniele Pandolfi, Luigi Apuzzo, Domenico Mantoan

Purpose: This study explores the characteristics of primary care organizations that are likely to attract and retain highly skilled professionals, meeting their expectations and increasing Person-Organization fit. Both "hard" dimensions (ownership) and organizational/managerial traits under the span of control of management are investigated. The objective is to raise awareness on how to mitigate unpopular features of primary healthcare organizations so to effectively compete in the war for talent.

Methods: This study has been carried out based on data extrapolated from a broader study conducted by the Italian National Agency for Regional Health Services and commissioned by the Italian Ministry of Health. Data deriving from Italian nursing homes was extrapolated from the broader public dataset and multiple regressions were carried out to detect associations between managerial variables and staff seniority.

Findings: Several significant associations were detected, suggesting that both physicians and nurses are affected by some investigated variables when deciding where to work and for how long. While some of these are common to the two categories of professionals (e.g., the presence of a nursing director), others are not (e.g., the presence of internal training programs).

Original value: The implications of this study are related to the need of increasing awareness of managers of nursing homes on those features that are likely to increase their attractiveness and long-lasting appeal to professionals. This is a paramount topic in times in which the war for talent is strong. A lack of attention on this field may lead to the inability to attract and retain staff in primary care settings and, in turn, to implement strategic trends of change healthcare systems are facing in Italy and worldwide.

目的:本研究探讨了基层医疗机构可能吸引和留住高技能专业人员、满足他们的期望并提高 "人-组织 "契合度的特点。研究调查了 "硬 "维度(所有权)和管理层控制范围内的组织/管理特征。目的是提高人们对如何缓解基层医疗机构不受欢迎的特点的认识,从而在人才争夺战中有效竞争:本研究是根据意大利卫生部委托意大利国家地区卫生服务局开展的一项更广泛研究的数据进行的。从更广泛的公共数据集中推断出意大利养老院的数据,并进行多元回归,以检测管理变量与员工资历之间的关联:研究发现了几种重要的关联,表明医生和护士在决定工作地点和工作时间时都会受到一些调查变量的影响。其中一些变量对这两类专业人员具有共性(如是否有护理主任),而另一些变量则不具有共性(如是否有内部培训计划):本研究的意义在于,需要提高疗养院管理者对那些有可能增加疗养院对专业人员的吸引力和持久吸引力的特点的认识。在人才争夺战激烈的时代,这是一个至关重要的课题。如果对这一领域缺乏关注,可能会导致无法吸引和留住基层医疗机构的员工,进而无法实施意大利乃至全球医疗系统所面临的战略变革趋势。
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引用次数: 0
Insights into how universal, tax-funded, single payer health systems manage their waiting lists: A review of the literature. 洞察由税收资助的全民单一支付医疗系统如何管理候诊名单:文献综述。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-08-01 Epub Date: 2023-07-02 DOI: 10.1177/09514848231186773
Francesco Amigoni, Federico Lega, Elena Maggioni

Background: A conspicuous consequence of gatekeeping arrangements in universal, tax-funded, single-payer health care systems is the long waiting times. Besides limiting equal access to care, long waiting times can have a negative impact on health outcomes. Long waiting times can create obstacles in a patient's care pathway. Organization for Economic Co-operation and Development (OECD) countries have implemented various strategies to tackle this issue, but there is little evidence for which approach is the most effective. This literature review examined waiting times for ambulatory care. Objective: The aim was to identify the main policies or combinations of policies universal, tax-funded, and single-payer healthcare systems have implemented to improve the governance of outpatient waiting times. Methods: Starting from 1040 potentially eligible articles, a total of 41 studies were identified via a 2-step selection process. Findings: Despite the relevance of the issue, the literature is limited. A set of 15 policies for the governance of ambulatory waiting time was identified and categorized by the type of intervention: generation of supply capacity, control of demand, and mixed interventions. Even if a primary intervention was always identifiable, rarely a policy was implemented solo. The most frequent primary strategies were: guidelines implementation and/or clinical pathways, including triage, guidelines for referral and maxim waiting times (14 studies), task shifting (9 studies), and telemedicine (6 studies). Most studies were observational, with no data on costs of intervention and impact on clinical outcomes.

背景:在由税收资助的全民单一付费医疗系统中,把关安排的一个显著后果就是漫长的候诊时间。除了限制平等获得医疗服务的机会外,漫长的等候时间还会对健康结果产生负面影响。漫长的候诊时间会给病人的治疗路径造成障碍。经济合作与发展组织(OECD)国家已实施了各种策略来解决这一问题,但几乎没有证据表明哪种方法最有效。本文献综述研究了非住院治疗的候诊时间。目的:旨在确定全民医疗保健系统、税收资助医疗保健系统和单一支付者医疗保健系统为改善门诊病人候诊时间管理而实施的主要政策或政策组合。方法:从 1040 项可能符合条件的政策中筛选出 1040 项:从 1040 篇可能符合条件的文章中,经过两步筛选,共确定了 41 项研究。研究结果尽管该问题具有相关性,但文献却很有限。研究确定了 15 项门诊候诊时间管理政策,并按干预类型进行了分类:创造供应能力、控制需求和混合干预。即使总能找到主要干预措施,但很少有政策是单独实施的。最常见的主要策略是:实施指南和/或临床路径,包括分流、转诊指南和最长等候时间(14 项研究)、任务转移(9 项研究)和远程医疗(6 项研究)。大多数研究都是观察性的,没有关于干预成本和对临床结果影响的数据。
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引用次数: 0
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Health Services Management Research
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