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After all we're only human. 毕竟,我们只是凡人。
IF 2.1 Q2 Medicine Pub Date : 2024-04-23 DOI: 10.1177/09514848241242210
Federico Lega
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引用次数: 0
Design organization and clinical processes around patient characteristics: Evidence from a multiple case study of Hemophilia. 围绕患者特征设计组织和临床流程:来自血友病多病例研究的证据。
IF 2.1 Q2 Medicine Pub Date : 2024-02-14 DOI: 10.1177/09514848241231585
Stefano Villa, Raimondo De Cristofaro, Giovanni Di Minno, Simone Laratro, Flora Peyvandi, Lara Pippo, Sara Villa, Antonio G De Belvis

Background: There is growing evidence of the relevance of designing organization of care around patient characteristics; this is especially true in the case of complex chronic diseases.Purpose: The goal of the paper - that focuses on the analysis of the clinical condition hemophilia in three different centers - is to address two different research questions:1. How can we define, within the same clinical condition, different patient profiles homogeneous in terms of intensity of service required (e.g. number of visits or diagnostics)? 2. What are the conditions to re-organize care around these patient profiles in a multidisciplinary and coordinated manner?Research design: The authors have used a multiple case study approach combining both qualitative and quantitative methodologies; in particularly the semi-structured interviews and the direct observation were aimed to map the process in order to come up with an estimate of the cost of the full cycle of care.Study sample: The research methodology has been applied consistently in three different centers. The selection of the structures has been based on two main different criteria: (i) high standards regarding both organizational and clinical aspects and (ii) willingness from management, nurses and physicians to provide data.Results: The study clearly shows that different patient profiles - within the same clinical condition - trigger a different set of diagnostic and therapeutic activities. It is, thus, important considering patient characteristics in the development and implementation of clinical pathways and this will imply relevant differences in terms of organizational and economic impact.Conclusions: These process-based analyses are very much critical especially if we want to move to a bundled and integrated payment system but, as shown by this study itself, require a lot of time and efforts since our healthcare information systems are still fragmented and vertically designed.

背景:目的:本文重点分析了三个不同中心的血友病临床病症,旨在解决两个不同的研究问题:1.在同一临床病症中,我们如何界定在所需服务强度(如就诊次数或诊断)方面具有同质性的不同患者特征?2.2. 以多学科协调的方式,围绕这些病人特征重新组织护理的条件是什么?作者采用了多种案例研究方法,结合了定性和定量方法;特别是半结构式访谈和直接观察,旨在绘制流程图,以估算整个护理周期的成本:研究样本:研究方法在三个不同的中心得到了一致的应用。研究样本:研究方法一直在三个不同的中心进行,选择这些中心主要基于两个不同的标准:(i) 组织和临床方面的高标准;(ii) 管理层、护士和医生愿意提供数据:研究清楚地表明,在相同的临床条件下,不同的病人情况会引发不同的诊断和治疗活动。因此,在制定和实施临床路径时必须考虑患者的特征,这将意味着在组织和经济影响方面存在相关差异:这些基于流程的分析非常重要,特别是如果我们想转向捆绑式综合支付系统的话,但正如本研究本身所显示的那样,由于我们的医疗信息系统仍然是零散和垂直设计的,因此需要大量的时间和精力。
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引用次数: 0
Reducing the burden of travel and environmental impact through decentralization of cancer care. 通过分散癌症治疗,减轻旅行负担和环境影响。
IF 2.1 Q2 Medicine Pub Date : 2024-02-02 DOI: 10.1177/09514848241229564
Giovanni Fattore, Michela Bobini, Francesca Meda, Benedetta Pongiglione, Luca Baldino, Stefano Gandolfi, Licia Confalonieri, Manuela Proietto, Stefano Vecchia, Luigi Cavanna

Life expectancy, quality of life and satisfaction of oncologic patients highly depend on access to adequate specialized services, that consider their conditions in a holistic way. The present study aims to evaluate the introduction of oncology services in an outpatient setting in a mountain village in Northern Italy. The initiative is evaluated using the three pillars of sustainability (social, economic and environmental) as dimensions that are often overlooked by healthcare policy makers. Using micro data on 18,625 interventions, we estimate the number of kilometers saved by patients (reduction of "travel burden" as indicator of social sustainability), the additional travel costs for the NHS (indicator of economic sustainability) and the implied reduction of CO2 emissions (indicator of environmental sustainability). Over the period July 2016-2021, the decentralized health center delivered 2,292 interventions saving 218,566 km for a corresponding value of €131,140. The additional costs for the NHS was €26,152. The reduction of CO2 emissions was 32.37 Tons (€5,989). Overall, the socio-economic benefit of reducing travel of care for the patients residing in this remote valley was €110,976. This study adds original understanding of the benefits of decentralizing oncologic care and shows its operational feasibility conditions. Given the modest number of similar projects, it provides evidence to policy makers and, especially, managers who are faced with the challenge to implement the decentralization of specialized services.

肿瘤患者的预期寿命、生活质量和满意度在很大程度上取决于能否获得充分的专业服务,这些服务会全面考虑患者的病情。本研究旨在评估在意大利北部一个山村的门诊环境中引入肿瘤服务的情况。本研究利用可持续发展的三大支柱(社会、经济和环境)对该举措进行评估,这三大支柱是医疗政策制定者经常忽视的方面。利用 18625 项干预措施的微观数据,我们估算了患者节省的公里数(作为社会可持续性指标的 "旅行负担 "的减少)、NHS 的额外旅行成本(经济可持续性指标)以及二氧化碳排放量的隐含减少量(环境可持续性指标)。在 2016 年 7 月至 2021 年期间,分散式医疗中心提供了 2292 项干预措施,节省了 218566 公里,相应价值为 131140 欧元。国家医疗服务体系的额外成本为 26 152 欧元。减少的二氧化碳排放量为 32.37 吨(5989 欧元)。总体而言,为居住在这个偏远山谷的病人减少医疗旅行所带来的社会经济效益为 110,976 欧元。这项研究使人们对分散式肿瘤治疗的益处有了新的认识,并显示了其操作的可行性条件。鉴于类似项目为数不多,该研究为政策制定者,尤其是面临专业服务分散化挑战的管理者提供了证据。
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引用次数: 0
High-cost drugs for rare diseases: their expenditure and value based on a regional area-based study. 治疗罕见病的高成本药物:基于地区研究的支出和价值。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-01 Epub Date: 2023-01-10 DOI: 10.1177/09514848231151814
Silvia Manea, Laura Visonà Dalla Pozza, Cinzia Minichiello, Linda Altieri, Monica Mazzucato, Mauro Bonin, Paola De Ambrosis, Elio Borgonovi, Paola Facchin

Background: in the field of rare diseases (RDs) most of the European studies on budget impact analysis of drugs that have been conducted often lay on theoretical assumptions and focus only on Orphan drugs (ODs). Objectives: we aimed to estimate the budget impact of specific drugs for non-oncological RDs, both ODs and non-ODs, using real-world data about patients residing in Veneto Region (Italy) and to describe its expenditure structure and dynamics. Methods: a population-based multi-source observational study was conducted using data from Regional administrative databases; an ad-hoc drugs' list specific for RDs including both ODs and non-ODs and classifying them by ATC codes has been created. Results: In 2019, the total expenditure for drugs specific for RDs was EUR 97.2 million (6.6% of the total Regional budget). The RD drug list included 58 ATC codes, of which 15 ATC had an annual budget impact over EUR 1 million ("blockbuster drugs"). The most expensive treatment was a non-OD drug (Coagulation factor VIII). The two most represented therapeutical areas were the metabolic and the hematological ones. Conclusions: Cost analyses on RD high-cost drugs expenditure should consider any specific RD drug, not only ODs. Expenditure dynamics for RD drugs are peculiar showing "blockbuster drugs". Some therapeutical areas seem to be lacking in the drug research field.

背景:在罕见病 (RD) 领域,欧洲已开展的大多数药物预算影响分析研究往往基于理论假设,且仅关注孤儿药 (OD)。目的:我们旨在利用威尼托大区(意大利)患者的实际数据,估算非肿瘤 RD(包括 OD 和非 OD)特定药物的预算影响,并描述其支出结构和动态。方法:利用大区行政数据库中的数据开展了一项基于人群的多源观察研究;创建了一份专门针对 RD(包括 OD 和非 OD)的临时药物清单,并根据 ATC 代码对其进行了分类。结果:2019 年,RD 专用药物的总支出为 9,720 万欧元(占地区预算总额的 6.6%)。区域局药物清单包括 58 个 ATC 代码,其中 15 个 ATC 的年度预算影响超过 100 万欧元("大片药物")。最昂贵的治疗药物是一种非 OD 药物(凝血因子 VIII)。最具代表性的两个治疗领域是代谢领域和血液领域。结论关于抗逆转录病毒药物高成本支出的成本分析应考虑任何特定的抗逆转录病毒药物,而不仅仅是口服药物。研发药物的支出动态显示出 "大片药物 "的特殊性。药物研究领域似乎缺乏某些治疗领域。
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引用次数: 0
Therapeutic innovation in high-prevalence chronic diseases: Challenges and opportunities for specialist care models. 高发慢性病的治疗创新:专科护理模式的挑战与机遇。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-01 Epub Date: 2022-11-04 DOI: 10.1177/09514848221138406
Valeria D Tozzi, Paola R Boscolo, Gianmario Cinelli, Lucia Ferrara, Francesco Petracca, Angelica Zazzera

Therapeutic innovation is expected to change if not disrupt present care models for several chronic diseases in the coming years, as suggested by recent clinical trials. New drugs that anticipate and possibly delay the full expression of a disease will likely face some common challenges, such as the need of designing and implementing large scale interventions; the necessary engagement of multiple specialties for both diagnosis and treatment; the shift from specialist to non-specialist interventions and secondary prevention. Building on the case of HCV and other innovation in hepatology, we discuss common challenges caused by disruptive change that other chronic conditions faced in the past. The recent history of hepatology shows interesting examples of disruptive innovations that completely reverted traditional treatment approaches. As we learned from the slow early diffusion of antiviral drugs, without a clear information and a prompt design of the appropriate delivery modalities, the effectiveness of new treatments is undermined and care risk to be postponed for long time. This implies the definition of (i) new service models diversified by care phases and patients' target; (ii) horizontal integration: to go beyond the professional boundaries to build solid alliances; (iii) vertical integration between primary and secondary care.

正如最近的临床试验所表明的那样,治疗创新有望在未来几年改变甚至颠覆几种慢性疾病的现有治疗模式。预测并可能延缓疾病全面恶化的新药可能会面临一些共同的挑战,如需要设计和实施大规模干预措施;诊断和治疗需要多个专科的参与;从专科干预到非专科干预和二级预防的转变。以丙型肝炎病毒和肝病学的其他创新为例,我们讨论了过去其他慢性病面临的颠覆性变革所带来的共同挑战。肝病学的近代史展示了完全颠覆传统治疗方法的颠覆性创新的有趣实例。正如我们从抗病毒药物早期缓慢推广的过程中了解到的那样,如果没有明确的信息并迅速设计出适当的治疗模式,新疗法的效果就会受到影响,治疗也有可能被长期推迟。这就意味着要确定:(i) 按护理阶段和病人目标多样化的新服务模式;(ii) 横向一体化:超越专业界限,建立牢固的联盟;(iii) 初级和二级护理之间的纵向一体化。
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引用次数: 0
Assessment of variables determining the health management departments' efficiency with analytical hierarchy process. 利用层次分析法评估决定卫生管理部门效率的变量。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-01 Epub Date: 2023-01-04 DOI: 10.1177/09514848221115089
Gozde Yesilaydin, Menderes Tarcan

This study was conducted to determine the variables that play a role in the efficiency of Health Management departments in Turkey and the ranking of them in order of importance. These variables were determined by systematic analysis. The Prisma method was used in the systematic analysis approach. Input and output variables used in studies assessing the efficiency of higher education institutions in the literature were listed. The ranking of these variables was determined by Analytical Hierarchy Process (AHP) method. The questionnaire used for the AHP analysis and the judgments of 127 academicians working in Health Management Departments in universities in Turkey were assessed. The first three input variables found as a result of the AHP were "the number of registered undergraduate students per faculty member", "the number of faculty members", and "the number of other academic staff". The most important three output variables included "the number of articles searched on SCI, SSCI, SCI-E", "the number of papers presented in international congresses", and "the count of publications published in international peer-reviewed journals". To achieve positive developments in the efficiency of Health Management Departments, it is recommended to carry out studies to increase the number of qualified publications.

本研究旨在确定影响土耳其卫生管理部门效率的变量及其重要性排序。这些变量是通过系统分析确定的。在系统分析方法中使用了 Prisma 方法。列出了文献中高等教育机构效率评估研究中使用的输入和输出变量。通过层次分析法(AHP)确定了这些变量的排序。对用于 AHP 分析的调查问卷和 127 名在土耳其大学健康管理系工作的院士的判断进行了评估。通过 AHP 分析发现,前三个输入变量分别是 "每名教师注册的本科生人数"、"教师人数 "和 "其他学术人员人数"。最重要的三个输出变量包括 "在 SCI、SSCI、SCI-E 上检索到的文章数量"、"在国际大会上宣读的论文数量 "和 "在国际同行评审期刊上发表的论文数量"。为了提高卫生管理部门的效率,建议开展研究,增加合格出版物的数量。
{"title":"Assessment of variables determining the health management departments' efficiency with analytical hierarchy process.","authors":"Gozde Yesilaydin, Menderes Tarcan","doi":"10.1177/09514848221115089","DOIUrl":"10.1177/09514848221115089","url":null,"abstract":"<p><p>This study was conducted to determine the variables that play a role in the efficiency of Health Management departments in Turkey and the ranking of them in order of importance. These variables were determined by systematic analysis. The Prisma method was used in the systematic analysis approach. Input and output variables used in studies assessing the efficiency of higher education institutions in the literature were listed. The ranking of these variables was determined by Analytical Hierarchy Process (AHP) method. The questionnaire used for the AHP analysis and the judgments of 127 academicians working in Health Management Departments in universities in Turkey were assessed. The first three input variables found as a result of the AHP were \"the number of registered undergraduate students per faculty member\", \"the number of faculty members\", and \"the number of other academic staff\". The most important three output variables included \"the number of articles searched on SCI, SSCI, SCI-E\", \"the number of papers presented in international congresses\", and \"the count of publications published in international peer-reviewed journals\". To achieve positive developments in the efficiency of Health Management Departments, it is recommended to carry out studies to increase the number of qualified publications.</p>","PeriodicalId":45801,"journal":{"name":"Health Services Management Research","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10475092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hybridity enabled: A research synthesis of the enabling conditions for hybrid professionalism in healthcare. 实现混合:对医疗保健领域混合职业精神有利条件的研究综述。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-01 Epub Date: 2023-01-18 DOI: 10.1177/09514848231151829
Marco Sartirana, Giorgio Giacomelli

Hybrid professionals in healthcare organizations play a critical role, the characteristics, processes and implications of which have been thoroughly studied by scholars in the field. However, not as much attention has been paid to the conditions under which such roles might be taken by professionals entering the ground of management. This gap results into a lack of conceptual clarity and eventually ends being an obstacle in framing and ameliorating the tools needed to act such a role in its different phases. This is a research area worthy of a finer-grained understanding: the ability of organizations to effectively support role hybridization, in fact, is a requisite for professionals-managers' willingness to stay in the role and cope with the complexity that such a two-fold position entails, no matter what. Based on the results of a scoping literature review, this paper presents the enabling conditions for hybrid professionalism in healthcare, and proposes a classification of them into categories corresponding to different facets of hybrid role-taking: opportunities for interaction with management, tools supporting sense-making, and provision of delegation and autonomy. For each of these categories, organizational and management tools discussed in the literature are presented. The results of the study provide a road-map of the enabling conditions for hybrid professionalism that aims to be of practical convenience for managers and policy-makers in health care. Eventually, suggestions for organizational design and personnel management, as well as directions for further research, are highlighted.

混合型专业人员在医疗保健组织中发挥着至关重要的作用,该领域的学者对其特点、过程和影响进行了深入研究。然而,对于进入管理领域的专业人员在何种条件下可能扮演这种角色,却没有给予那么多的关注。这一空白导致概念不清晰,最终成为制定和改进在不同阶段扮演此类角色所需工具的障碍。这是一个值得深入了解的研究领域:事实上,组织有效支持角色混合的能力是专业人员--管理人员愿意继续担任这一角色并应对这种双重身份所带来的复杂性的必要条件。根据范围性文献综述的结果,本文介绍了医疗保健领域混合职业精神的有利条件,并根据混合角色承担的不同方面提出了分类建议:与管理层互动的机会、支持感性认识的工具以及授权和自主权的提供。针对每个类别,都介绍了文献中讨论过的组织和管理工具。研究结果为混合职业化的有利条件提供了路线图,旨在为医疗保健领域的管理者和政策制定者提供实际便利。最后,强调了对组织设计和人事管理的建议,以及进一步研究的方向。
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引用次数: 0
Framing doctor-managers' resilience during Covid-19 pandemic: A descriptive analysis from the Italian NHS. Covid-19 大流行期间医生管理者的应变能力:意大利国家医疗服务体系的描述性分析。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-01 Epub Date: 2023-03-18 DOI: 10.1177/09514848231165197
Simona Leonelli, Federica Morandi, Romina G Giancipoli, Fausto Di Vincenzo, Maria L Calcagni

With the aim of providing evidence about doctor-managers' resilience during the Covid-19 pandemic, this study analyzes the characteristics of 114 doctor-managers operating within the Italian National Health Service (NHS). During the emergency, doctor-managers had to show adaptive capacities to deal with unexpected situations and develop new paradigms, procedures, and quick responses to patients' needs. This is in line with resilience, and in this perspective, it is crucial to investigate resilience determinants. The paper, therefore, provides an identikit of the resilient doctor-manager. The research was conducted between November and December 2020. Primary data were collected through an online questionnaire consisting of six sections. Participation was voluntary and anonymous. Data were analyzed using quantitative techniques and employing Stata 16. Confirmatory Factor Analysis was employed to test construct validity and scale reliability. Results show that increasing levels of individual resilience are related to increasing levels of managerial identity. Moreover, physicians' individual resilience has a positive association with commitment, knowledge diffusion, and Evidence-Based Medicine adoption. Finally, physicians' individual resilience has a negative association with their role in the university, their specialty, and their gender. The study suggests some practical implications for healtcare organizations. In general, career paths are decided primarily on competency assessment, while an important role should be devoted to behavioral characteristics. Furthermore, organizations should take care of the levels of individual commitment and encourage professional networking because both help doctor-managers cope with uncertainty. The originality of the study relies on a fresh look at all previous work. There are currently few contributions in the literature to explore and investigate resilience elements in doctor-managers during the pandemic era.

本研究分析了意大利国家医疗服务系统(NHS)中 114 名医生管理人员的特点,旨在为医生管理人员在 Covid-19 大流行期间的应变能力提供证据。在紧急情况下,医生管理人员必须表现出适应能力,以应对突发情况,并制定新的范例、程序和快速响应病人的需求。这与复原力是一致的,从这个角度来看,研究复原力的决定因素至关重要。因此,本文提供了一个具有复原力的医生-管理者的识别工具包。研究于 2020 年 11 月至 12 月间进行。原始数据通过一份包含六个部分的在线问卷收集。参与是自愿和匿名的。数据采用定量技术和 Stata 16 进行分析。采用了确认性因子分析来检验建构有效性和量表可靠性。结果表明,个人复原力水平的提高与管理者身份认同水平的提高有关。此外,医生的个人复原力与承诺、知识传播和循证医学的采用呈正相关。最后,医生的个人抗压能力与其在大学中的角色、专业和性别呈负相关。这项研究为医疗机构提出了一些实际意义。一般来说,职业道路主要是根据能力评估来决定的,而行为特征则应发挥重要作用。此外,组织应关注个人的承诺水平,并鼓励建立专业网络,因为这两者都有助于医生管理者应对不确定性。这项研究的独创性在于对以往所有工作的重新审视。目前,很少有文献对大流行病时期医生管理者的复原力要素进行探索和研究。
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引用次数: 0
Patient satisfaction with therapeutic education in oncology: Antecedents, consequences, and the moderating effect of perceived value. 患者对肿瘤治疗教育的满意度:前因、后果以及感知价值的调节作用。
IF 1.6 Q3 HEALTH POLICY & SERVICES Pub Date : 2024-02-01 Epub Date: 2023-01-11 DOI: 10.1177/09514848231151825
Blandine Labbé-Pinlon, Cindy Lombart, Virginie Berger, Didier Louis

This research aims to deepen our understanding of patients' satisfaction with therapeutic patient education (TPE) in oncology. The research model proposed was tested, with structural equation modeling, on 207 French breast-cancer patients who participated in a TPE program. The results confirm that post-TPE empowerment and relational proximity to the TPE team are two major antecedents of patient's satisfaction-and attitude and word-of-mouth toward TPE are two important consequences of this concept of satisfaction. However, the established relationships are moderated by the patients' profiles (i.e., utilitarin believers, passionate followers, or holistic followers) in terms of the perceived value of their own experience of patient education. These results will enable stakeholders to adapt their TPE promotion strategies to the profiles of the patients. The study will also help to demonstrate and highlight the patient benefits of TPE to various stakeholders and thus will favor access to this personalized care practice, which is essential in the management of chronic diseases, but is still limited in oncology.

本研究旨在加深我们对肿瘤患者治疗教育(TPE)满意度的了解。通过结构方程模型,对 207 名参加过 TPE 项目的法国乳腺癌患者进行了测试。结果证实,TPE 后的授权和与 TPE 团队的关系亲近程度是患者满意度的两个主要前因,而对 TPE 的态度和口碑则是这一满意度概念的两个重要结果。然而,就患者对自身患者教育体验的感知价值而言,已建立的关系受到了患者特征(即utilitarin信徒、热情追随者或全面追随者)的调节。这些结果将有助于相关方根据患者的特征调整其 TPE 推广策略。这项研究还将有助于向各利益相关方展示和强调 TPE 对患者的益处,从而促进这种个性化护理实践的普及。
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引用次数: 0
Welcome to the home of health management research. 欢迎来到健康管理研究之家。
IF 2.1 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2023-12-26 DOI: 10.1177/09514848231225542
Federico Lega
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引用次数: 0
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Health Services Management Research
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