Israel Journal of Health Policy Research最新文献

Background: Efficient hospital-to-home transitions for older adults and their informal caregivers are hampered by current fragmented care systems, resulting in communication and coordination lapses when people move between hospital-to-home settings. Such fragmentation often leads to suboptimal hand-overs of information and care, medication errors, and overlooked follow-up appointments, which, in turn, contribute to adverse health outcomes for the elderly population. This study aims to answer the question: "What policy interventions can improve the transitions from hospital to home for older adults and their informal caregivers" Thus the study focuses on delineating policy recommendations at the micro, meso, and macro levels to facilitate smoother and more beneficial hospital-to-home transitions for older adults and their informal caregivers.

Methods: As part of the European Union Transitional Care Program (TRANS-SENIOR), this qualitative descriptive study leverages a multiple perspectives approach through in-depth interviews with older adults and informal caregivers. The goal is to pinpoint critical intervention zones of policy recommendations based on a holistic understanding of older adult and caregiver recommendations for improving hospital-to-home transitions.

Results: Findings show strategies that strengthen patient and caregiver engagement on the micro level. These include implementing personalized care plans and improving communication channels between healthcare providers and their recipients. The meso level targets healthcare organizations and systems, promoting the adoption of streamlined care coordination, enhanced discharge planning, and bolstered support services for caregivers. Such interventions are designed to smooth the transition process, ensuring that care continues seamlessly from hospital to home. At the macro level, our findings urge policy reforms to address broader systemic issues, such as the allocation of resources, the introduction of funding mechanisms, and the expansion of healthcare workforce capacity. These policy recommendations aim to create an enabling environment for effective care transitions, addressing underlying challenges that impede seamless care transitions.

Conclusion: This paper presents a set of policy recommendations for policymakers, healthcare professionals, and stakeholders. These recommendations aim to tackle the multifaceted challenges associated with hospital-to-home transitions to enhance care experience and outcomes for older adults and their caregivers by addressing individual, organizational, and systemic issues.

Background: Enhancing security and dependability of health systems necessitates resource allocation, a well-defined infrastructure, and a steadfast commitment to ensuring its safety and stability over time. This study aimed to assess changes in patient safety culture over time (2014-2022) within a network of private hospitals in Brazil and to examine its association with the hospital accreditation process. The study utilized the Hospital Survey on Patient Safety Culture (HSOPSC) to measure healthcare professionals' perceptions of patient safety culture.

Methods: The HSOPSC questionnaire was distributed to 71 hospitals between 2014 and 2022 with 259,268 responders. Hospitals were classified as accredited (AH) or non-accredited (NAH). A linear mixed-effects regression model was used to analyze the trend of dimension scores over time, accounting for both fixed and random effects to accommodate within-hospital correlations and variations across time points.

Results: Out of 12 dimensions analysed, 11 significantly improved, and one ("frequency of reported events") remained unchanged over time (p = 0.84). Two dimensions had < 50% positive responses: "communication openness" (47.13% [38.19-58.73]) and "nonpunitive response to errors" (41.24% [34.13-51.98]). Safety culture improved among AH across all, but "frequency of reported events" (p = 0.12), dimensions. Among NAH, "frequency of reported events" decreased over time (p = 0.008) while other dimensions remained unchanged.

Conclusion: Our results suggest an improvement in patient safety culture within this network of private hospitals in Brazil from 2014 to 2022. While accreditation appears to be associated with fostering a culture of safety over time, our study does not establish a causal relationship. Additionally, non-accredited hospitals tended to report fewer adverse events, which may indicate underreporting and missed opportunities for healthcare system improvement through adverse event analysis.

Background: Preventive medicine is one of the core elements of primary care physicians' (PCPs) work. This includes screening for cancer (such as Mammography and fecal occult blood test (FOBT) for breast and colon cancer) and also screening for chronic conditions (like bone density scans (DEXA scans) for osteoporosis). In recent years, especially since the COVID-19 pandemic, the use of telemedicine increased dramatically. This study aimed to identify the rate of preventative medicine referrals and performance in individuals who mostly had face-to-face encounters compared to those who mostly had remote encounters.

Methods: This retrospective cohort study is based on the electronic medical records of one healthcare maintenance organization (HMO) in Israel. We followed all individuals eligible for at least one of the screening tests in 2020 and 2021 and evaluated whether they received referrals to screening tests (mammography, FOBT, and DEXA scans) and performed them. Each individual was assigned to the face-to-face group (more than 60% of their encounters were face-to-face), the remote group (more than 60% of their encounters were remote), and the mixed group, which included the rest of the cohort.

Results: For mammographies and FOBT, the referral rates were lower in the face-to-face group compared to remote and mixed groups (mammographies: 27.3% vs. 29.8% and 32.9%, p-value < 0.001; FOBT: 55.6% vs. 60.3% and 58.7%, p-value < 0.001, respectively). However, for all three tests, the performance rates were the lowest in the remote group compared to face-to-face and mixed (for mammographies, 68.2% vs. 76.3% vs. 78.1; for FOBT, 44% vs. 56.8% vs. 54.3%; for DEXA 9.2% vs. 22.9% vs. 20.7%, respectively). A referral from the PCP increased the odds of performing the test for mammographies OR-1.55, 95% CI 1.52-1.58, and for FOBT OR-1.96, 95% CI 1.93-1.99.

Conclusion: Although PCPs referred their patients to screening tests in remote visits, the performance rate of individuals who mainly used telemedicine was lower than those who mostly had face-to-face visits. A referral for a screening test from the PCP increased the odds of performing it. Understanding individuals' health behaviors using telemedicine is crucial to maintaining adherence to preventing medicine.

Minority populations in many countries, including Israel and the US, experience significant health disparities compared to the majority population. A health workforce that reflects the characteristics of the population including race/ethnicity, language and socioeconomic backgrounds, can help address these disparities. Over the years, Isreal and the US have implemented a variety of programs and policies to promote greater representation of minority populations in medicine and other health professions. This paper compares some of the efforts and outcomes in the 2 countries to support a more diverse health workforce. While progress has been made in both countries, they now face significant challenges which are likely to put recent progress at risk.

Background: Social disparities in health persist in Israel despite universal health care. Few studies have focused on the impact of neighborhood disadvantage on health in a representative sample of the Israeli population while accounting for multiple socioeconomic factors. The objective of this study was to assess the independent association between perceived neighborhood disadvantage and self-reported poor chronic health.

Methods: Self-reported poor chronic health was defined as (1) reported not very good/poor health, and (2) having a chronic health/physical problem for > = 6 months disrupting daily life activities. Neighborhood disadvantage was based on self-reported measures of residential environment (scale of dissatisfaction with transportation, parks, cleanliness, waste removal, noise, pollution, safety, and walkability) and social problems (dissatisfaction related to neighbors, and neighbors interacting to improve the environment). High levels of neighborhood problems were defined as top 25th percentile of dissatisfaction scales. Logistic regression models included incremental adjustment for sex, age, ethnicity/religion, immigration status, peripheral region and then income, education and employment status.

Results: A total of n = 7,020 participants with non-missing data were included. High levels of neighborhood environmental and social problems were independently associated with poor chronic health even after adjustment for sex, age, ethnicity/religion, immigration status, and peripheral region, and remained statistically significant after additionally adjusting for income, education, employment and lifestyle factors (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.2-1.9 for environmental problems; OR 1.3, 95% CI 1.1-1.6 for social problems).

Conclusions: Living in areas of perceived disadvantage conferred health risks beyond those related to ethnicity or socioeconomic status. These findings suggest that neighborhood-level factors contribute significantly to health disparities in Israel and should be included in national efforts to evaluate and minimize these health disparities. Future research is needed to also consider objective measures of neighborhood disadvantage, in order to determine the more salient neighborhood measures with respect to health outcomes and to effectively develop targeted interventions to reduce area-level health disparities.

Background: Patient safety during medical treatment is a central issue for health policymakers and medical teams. In this context, both the Israeli and global health systems, are witnessing an increase in the appreciation of the importance of safety indicators for quantitative measurement of treatment safety. Although an important consideration, we did not find any studies of public perception of this important topic. This study was therefore designed to examine the views and opinions of the public concerning patient safety in the Israeli healthcare system with the aim to serve as an important input in determining patient safety goals and policies.

Methods: A digital questionnaire was distributed to 620 Israeli citizens, 18 years of age or older, who were randomly sampled from a pool of 75,000 citizens of Jewish origin stratified by gender, age, and area of residence.

Results: Only 18.8% of the sample considered the healthcare system to be transparent in reporting and dealing with medical errors, while 23.6% reported receiving an explanation of the risks and side effects of medications before prescription. Only 56.4% reported receiving information about the risks related to surgeries and invasive operations, 62.2% claimed to understand the given explanation, and 61.5% reported going through a proper process of patient identification before a test or medical procedure.

Conclusion: Patient safety is a significant concern for the public whose perceptions should be considered when planning improvements to the healthcare system. Healthcare providers must consider patients' perceptions of patient safety issues and remain vigilant in identifying and minimizing risks associated with medical care and in verifying patient comprehension accordingly.

Background: Monitoring breastfeeding rates has important health policy implications, as breastfeeding has significant positive impacts on maternal and child health and healthcare costs. This up-to-date, national, population-based breastfeeding rates study in Israel provides important information for health policy development.

Methods: Breastfeeding rates were determined for the years 2016-2022 by retrospective analysis of Machshava Briah electronic medical records used by many Israeli Maternal and Child Health Clinics. This reflects approximately 70% of Israeli children with a nationwide distribution. Comparisons were conducted measuring breastfeeding rates over time and between different sub-groups.

Results: The dataset consists of 945,437 infant records. The percentages of women with any breastfeeding as well as exclusive breastfeeding have shown a gradual decline annually from 2016 to 2022 and are lower than international goals. Sub-group analyses were conducted for 2022. Breastfeeding rates were higher among multipara mothers (versus primapara). Singleton mothers had much higher breastfeeding rates than twin mothers with the difference even more pronounced in exclusive breastfeeding rates. Mothers of preterm infants (< 37 weeks) and low birthweight infants breastfed less than mothers of full term infants and normal birthweight and were less likely to exclusively breastfeed. Mothers living in urban areas had the highest rates of breastfeeding and those living in rural areas had the lowest. A subanalysis performed at two months postpartum for 2022 found the effect of maternal age with the highest rates of breastfeeding among 20-24 year old mothers. Inter-pregnancy interval also had an effect with the highest rates among those whose last pregnancy was 21-33 months ago and the lowest rates among those with an interval of < 1 year.

Conclusions: The population-based data provides an important baseline marker. This study shows a drop in breastfeeding rates, indicating a need to investigate reasons for discontinuing breastfeeding and identifying possible areas for offering support. This data and similar follow-up studies provide the background evidence to warrant that Ministry of Health policies in the hospitals and in the community, help accomplish their goals.

Background: Monitoring the quality of primary care is essential for improving healthcare services. The National Program for Quality Indicators in Community Healthcare measures various aspects of healthcare quality. A 2010 survey among Israeli primary care physicians (PCPs) found widespread support for the program alongside concerns about its effects on workload and competitiveness. This study assessed the extent to which PCPs' perceptions had changed between 2010 and 2020.

Methods: Cross-sectional survey on PCP's experience with the quality monitoring effort at their health maintenance organizations were conducted in 2010 and 2020 among representative samples of PCPs. Bivariate analysis examined whether the study variables varied between the timepoints. Logistic regression models evaluated the extent to which the participants' characteristics and perceptions contribute to their attitudes toward the program.

Results: The study sample comprised 605 physicians in 2010 and 450 physicians in 2020. Overall, support for the National Program for Quality Indicators was high in both surveys. However, between 2010 and 2020 some decrease in the support for the use of quality indicators was observed among PCPs The greatest decrease in support between 2010 and 2020 was observed in the proportion of respondents who perceived that it is important to a great or very great extent to measure the clinical performance of some quality indicators (88% versus 81%) and in the proportion of respondents who perceived that monitoring contributed to improvement (66% versus 60%). Over half of respondents (58%) perceived to a large or very large extent that the program was associated with increased workload compared to 63% in 2010. Similar proportions of respondents in 2010 and 2020 felt that the program was also associated to a large or very large extent with over-competition (47% and 48%, respectively) and excess managerial pressure (58% and 60%, respectively).

Conclusions: The study indicates that while support for the program in general remains high, it continues to have undesirable side effects. Further use of the program for quality indicators must consider the shortcomings voiced in 2010 which have remained uncorrected as reflected in the results of the 2020 survey: extreme managerial pressures, increased workload and over-competitiveness.

Background: Environmental management in the Israeli health system is driven primarily by safety regulations. Such regulations aim to reduce hazardous exposures to employees, patients, and visitors, as well as some specific aspects of broader environmental toxicity to humans and nature. Most environmental precautions in the system target traditional exposures and do not specifically consider the health system's own impact on climate change. This article aims to justify incorporating climate change mitigation actions into short- and long-term plans in Israeli health organizations and present a schematic strategic roadmap to do so.

Main body: Climate change poses many threats to global health, including risks from severe weather events, changes in vector-borne diseases, increased hazardous air pollutants, food and water shortages, and adverse effects on reproductive health. The most effective effort in climate change mitigation is reducing greenhouse gas emissions to the atmosphere. Ignoring the health sector's emissions contradicts the ancient medical principle: first, do no harm (primum non-nocere). Furthermore, many climate mitigation methods introduce additional health co-benefits. Special attention and medical considerations are needed to safely reduce emissions from the health sector. This article reviews healthcare's most common emission sources, including energy consumption, transportation, food, waste, supplies, and the supply chain. An organizational carbon management strategy should include recognizing the problem and committing to action, estimating the organizational carbon footprint, developing and prioritizing alternative interventions, and developing a carbon management plan with measurable short- and intermediate-term goals.

Conclusion: Climate mitigation in the health sector is encompassed by the moral obligation of the Israeli healthcare system to do no harm. Performance measures to support GHG emission reductions should be adopted into the existing, successful Israeli programs of quality measures in medicine, both in the community and hospitals. In addition, Israel academic institutions for health and medical education should incorporate sustainable health into their curricula for students of health professions and as part of continuous medical education. Such policy actions will contribute to a healthy health system that supports climate change mitigation while providing health co-benefits to the Israeli population.

Background: Disparities in dental health resulting from social and economic inequality are a pressing public health concern. Poor and vulnerable populations bear a higher burden of caries exacerbated by limited access to quality dental care. Recent publications have suggested a possible association between intellectual capability and caries risk, as well as lower compliance with publicly funded healthcare services among populations with lower educational levels. The objective of this study was to explore potential associations between severe dental caries treatment needs (root canal treatments and extractions), socioeconomic factors and intellectual capability.

Methods: Dental records of 21,052 soldiers recruited into Israeli military service between 2019 and 2021 were reviewed, and data on the need for root canal treatments and extractions were retrieved. Sociodemographic information, including age, sex, socioeconomic strata, intellectual capability scores, body mass index, and place of birth, were extracted and analyzed.

Results: The findings from the multivariate generalized linear model indicated that lower intellectual capability scores and socioeconomic strata were associated with a significantly greater requirement for root canal treatments and extractions (p < 0.001). The model also identified male gender and older age as predictors for higher treatment needs. Non-native Israelis were found to be at a greater risk for needing root canal treatments compared to native Israelis. Additionally, a significant positive correlation was observed between intellectual capability scores and socioeconomic strata (p < 0.001).

Conclusions: Groups with lower intellectual capability scores and socioeconomic strata exhibited a greater need for dental treatments, including root canal treatments and extractions. Given their higher likelihood of requiring more invasive treatments, health policy should prioritize intervention plans aimed at improving attendance at preventive care services for these disadvantaged populations under the Israeli free dental care reform.