Israel Journal of Health Policy Research最新文献

Background: Functional Somatic Disorders (FSD) significantly impact patients' quality of life while placing a substantial economic burden on healthcare systems. Identifying which patients achieve reductions in healthcare costs through multidisciplinary care remains crucial for optimizing resource allocation.

Methods: A retrospective analysis examined healthcare utilization and costs during the year preceding and the year following patients' initiation of treatment at a specialized, multidisciplinary clinic in Israel. The clinic combined medical care with mind-body therapies - including cognitive behavioral therapy, hypnotherapy, and physiotherapy. Using baseline characteristics, patients were divided into Diagnostic Classification Groups (DCG). A multivariable analysis was performed to ascertain the impact of DCG on annual, average changes in healthcare utilization and costs after treatment.

Results: Data from N = 685 patients were analyzed. Reduced healthcare utilization and costs were observed among approximately 56% of the population receiving multidisciplinary care. Mean annual cost reductions were 1,367 ILS per patient. Specifically, significant reductions were observed in hospitalizations (-1,723 ILS) and diagnostic procedures (-495 ILS). Patients with simple FSD and stress-exacerbated diseases showed significant cost reductions (P < 0.05), while those with organic disease or difficult FSD did not demonstrate significant changes. Analysis by DCG revealed that baseline diagnostic classification significantly predicted cost reduction.

Conclusion: Healthcare utilization and costs were reduced among FSD patients receiving multidisciplinary treatment, with outcomes varying by diagnostic classification. Baseline diagnostic classification reliably predicted treatment cost-effectiveness, underlining the economic value of collaborative care for patients with simple functional disorders and stress-exacerbated diseases. These diagnostic patterns provide healthcare policymakers with selection criteria for multidisciplinary programs and inform the development of tailored interventions.

Background: This study examines Israel's food system's security, sovereignty, resilience, and sustainability using the Mediterranean Diet (MD) lens. The current global context, marked by supply chain disruptions, climate change impacts, and geopolitical tensions, highlights the critical importance of resilient food systems. We analyzed Israel's food system using FAO Food Balance Sheets (FBS) (2010-2020 trends) and Israel Central Bureau of Statistics (CBS) production and trade data (2021) to assess food availability, import dependency ratios (IDR), and alignment with Mediterranean Diet guidelines.

Methods: A literature search was conducted using PubMed, Semantic Scholar, EBSCO Discovery, and Google Scholar, aiming to agree on the food-based guidelines of MD and their impact on health outcomes. Studies from the past 10 years with the keywords "Mediterranean diet" and "meta-analysis" were included. The Israeli agricultural production data from 2010 to 2020 were drawn from the Central Bureau of Statistics (CBS). Import dependence was calculated by converting product quantities from tonnes to grams per person per day (annual quantity × 10 million people ÷ 365 days).

Results: Israel demonstrates significant import dependency across critical food groups, with 90% of cereals, 87% of fish, 82% of nuts, and 65% of added fats sourced internationally. While nearly self-sufficient in poultry and dairy, chickens and cows grown in Israel depend on imported feed. Moreover, the country's food supply significantly deviates from the MD recommendations. Notably, there is an undersupply of nature-based proteins, including legumes.

Conclusion: The results emphasize the advantages of shifting towards more locally produced, plant-based food and feed, especially in nature-based proteins. Embracing an MD-aligned food system would concurrently tackle the challenges of public health, food security, resilience, and environmental sustainability. These findings hold global significance for countries confronting similar issues in reconciling nutritional recommendations with food security needs. Future strategies should concentrate on policy reforms, agricultural investments, and public involvement to strengthen Israel's food sovereignty and nutritional landscape.

Background: The COVID-19 pandemic created unprecedented challenges for healthcare systems, particularly affecting specialized services like pediatric dental care. This study examined geographic disparities in emergency dental service access for children during the first COVID-19 lockdown in Israel.

Methods: We analyzed data from a major healthcare provider serving 25% of Israel's population, comparing 6,024 emergency dental visits of children under 12 across three time periods: pre-pandemic (March-May 2019), first lockdown (March-May 2020), and post-lockdown (March-May 2021). Using spatial analysis methods, we evaluated the distribution and accessibility of emergency dental services across four main geographic regions through metrics including Load Ratio (LR), Geographic Availability Index (GAI), and Rate of Change in Service Utilization (ROCSU).

Results: During the lockdown, emergency visits decreased by 40.2% compared to the pre-pandemic period, with significant regional variations ranging from 31.2% in the Northern region to 44.8% in the Central region. The mean age of children seeking emergency care during lockdown (6.2 years) was significantly lower than in both pre-pandemic (7.1 years) and post-lockdown periods (6.8 years). Analysis revealed substantial regional disparities in service burden, with the highest Load Ratio in the Central region (1.86) and lowest in the Northern region (1.24), despite the Central region having the highest Geographic Availability Index (2.46). The Jerusalem area had the highest proportion of invasive treatments (40.4%) and swelling/abscess cases (22.4%). Ultra-Orthodox neighborhoods demonstrated distinct utilization patterns, with a lower decrease in emergency visits (29.8-36.8%) compared to the national average (40.2%).

Conclusions: This study identified significant geographic inequities in emergency dental care access during crisis periods, with a paradoxical relationship between service availability and utilization across regions. Our analysis suggests that emergency dental service planning should incorporate strategic facility placement to minimize travel barriers, consideration of population-specific utilization patterns, and balanced resource allocation that maintains proportional service capacity across diverse geographic contexts. These findings provide important insights for health system preparedness to ensure equitable access to essential pediatric dental services during future crises.

Background: Appropriate procurement of blood cultures (BC) is essential for diagnosis of bacteremia and susceptibility testing. This includes (1) adequate preparation of the venipuncture site to minimize contamination; (2) obtaining ≥ two sets with a time interval before starting antibiotics. Although these recommendations are standard since the 1960s, adherence is far less than expected - which may adversely impact on the management of bacteremic patients.

Aims of study: This single-center study conducted in Shaare Zedek Medical Center aimed to decrease the proportion of contaminated BCs and to increase the percentage of obtaining two sets of BC/ blood-culture-taking episode.

Methods: Determination of both markers at baseline, then monthly for one year, then subsequently on a quarterly basis; showing data from all departments in real-time to all department directors; and providing short educative lectures during departmental staff meetings, at baseline and after 1-2 years. These markers were adopted as one of the hospital-wide quality measures.

Results: In the 20-year period 2000-2019 more than 1 million BCs were obtained, of which 70% were from patients ≤ 72 h in hospital. During the 5-year study (2020-2024), the percent of blood-culture-taking episodes from which two culture sets were obtained increased annually by ± 16% from a baseline of 27% (9010/33306) in 2020, to 46% (18462/40191) in 2024 (Incidence Rate Ratios, IRR 1.16 [95%CI 1.13-1.18], p < 0.001). This improvement was observed in almost all departments and was especially profound in the emergency department (ED), starting at a baseline of 19% (1979/10326) and increasing to 53% (5304/9915)(IRR 1.33 [95%CI 1.27-1.39], p < 0.001). During the same period, the annual proportion of false-positive BCs, from which only contaminants were isolated, decreased annually by 18% from 2.4% (1592/65230) in 2020 to 1.3% (895/68991) in 2024 (IRR 0.82 [95%CI 0.77-0.88], p < 0.001). This improvement was observed in all departments: in the emergency department, this rate decreased from 3.3% (676/20529) to 1.56% (272/17459) (IRR 0.79 [95%CI 0.75-0.83], p < 0.001).

Conclusion: A simple educational intervention, combined with meticulous data mining and presentation of each department's results, with comparison of all other departments, led to significant and sustained improvement in measurable markers.