Health Policy and Technology最新文献

Background

Materials and Methods

Results

Conclusion

Introduction

There remains the need to develop comprehensive organisational care models supported by digital health interventions (DHIs) to manage chronic conditions in primary healthcare.

Objective

this review aimed to identify and map methods, interventions and outcomes investigated regarding the introduction of novel complex integrated care models supported by DHIs in the European primary care setting, as well as the level of integration achieved.

Methods

a scoping review to identify literature from 2013 to 2023 in the European context was conducted across PubMed, Scopus and Web of Science. DHIs description, care models and outcomes were reported using the PRISMA- ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.

Results

A total of 53 studies was included. The models introduced, along with a DHI, at least one innovation in their structure or in the modality of care delivery: either a new figure (44%), interprofessional collaboration (37%), new functions like person-centred care (59%) or population stratification (11%). As regarding the DHIs, 56% implemented monitoring/management platforms and apps for chronic conditions. The most frequent combination of care model-DHI was the introduction of an app/platform, supported by phone calls/texts and electronic health records, paired with the introduction of a new healthcare professional/person centred care/ multidisciplinary team. All the studies reaching statistically significant outcomes introduced, along with one or more DHIs, either a new figure or a multidisciplinary team as part of the organizational change to support the technology.

Conclusions

novel complex integrated care models are focusing on introducing multidisciplinary perspectives and personalization of care, in line with the complex needs of chronic patients. The predominant development of monitoring/management platforms for patients is a further confirmation of this trend. Future research efforts should focus on the investigation of the effectiveness of current complex integrated care models integrating DHIs.

Objective

The purpose of this study was to identify key risk factors and their interrelationships for patient safety in internet hospitals from a system perspective, using mixed methods of qualitative and quantitative analysis.

Methods

This study constructed a comprehensive indicator system of patient safety risk factors in internet hospitals by qualitative analysis using the Patient Safety Systems (SEIPS) model as a framework. Risk factors were initially identified through a literature review and subsequently refined using a Delphi survey involving 24 experts related to internet hospitals in China. The identified indicators were quantitatively analyzed to determine key risk factors and their influencing mechanism using the Decision Making Trial and Evaluation Laboratory (DEMATEL) and Interpretive Structural Modeling (ISM) methods.

Results

The qualitative analysis established a patient safety risk factor indicator system for internet hospitals, comprising 23 elements across six dimensions. Quantitative analysis employing the DEMATEL-ISM approach revealed that risk management has the highest centrality. Among cause factors, task complexity exerts the most significant impact on other factors, while network information security exhibits the highest absolute value among result factors. Risk factors are categorized into three levels: surface, deep, and root factors, with task complexity, legal and regulatory, and guidance policy being the root factors at the foundation of the system.

Conclusions

Our study offered a systemic perspective on analyzing risk factors for patient safety in internet hospitals. Policymakers and managers of internet hospitals should take advantage of the interrelationships among these factors to mitigate patient safety risks by effectively controlling key factors.

Public Interest Summary

In the rapidly evolving landscape of internet hospitals, ensuring patient safety is paramount. This study aimed to comprehensively identify and understand key risk factors influencing patient safety within these digital healthcare platforms. Using mixed methods of qualitative and quantitative analysis, the study examined the intricate interplay of factors affecting patient safety. Our methodology involved constructing a risk factors indicator system based on the Patient Safety Systems (SEIPS) model. By employing the integrated Decision-Making Trial and Evaluation Laboratory along with the Interpretive Structural Modeling method, we unveiled the core risk factors and their intricate relationships. Recognizing the interconnectivity of these factors allows us to develop effective risk mitigation strategies that enhance patient safety in internet hospitals. This study encourages stakeholders to leverage the dynamic relationships among these factors to ensure safer online healthcare experiences for patients.

Background

Expanded services provided at pharmacies show numerous improvements in health outcomes. However, attempts at implementing new services in pharmacies are met with several barriers, among which is the failure to update the pharmacist's role.

Objective

This study aimed to explore pharmacists’ perceptions about the role of pharmacies and the effects of, and barriers to, service expansion.

Methods

Four focus groups were conducted with pharmacists from across Portugal, and an inductive content analysis was applied to the transcribed sessions.

Results

The content analysis results were organized into three main categories: the Role of Pharmacy, Potentialities of Service Innovation, and Service Innovation. The results emphasize the importance of enhancing pharmacists’ training, establishing supportive legal frameworks, prioritizing funding for technological advancements, promoting interprofessional collaboration, and embracing innovative practices to advance healthcare innovation and improve patient outcomes.

Conclusions

The identification of several tasks indicates that, in pharmacists’ perspectives, the Role of Pharmacy ranges from dispensing medication to aiding/monitoring patients at various stages of their health conditions. Expanded services were associated with several emergent Potentialities of Service Innovation, namely, enhancement of health outcomes and help to main healthcare facilities dealing with an increased number of patients. For Service Innovation, several factors emerged that need consideration, such as the conditions and the difficulties found associated with new service implementation. These pertain to pharmacists, legislation, and resources.

Public Interest Summary

Background: Expanded services provided at pharmacies show numerous improvements in health outcomes. However, several barriers should be addressed. Objective: This study sought to explore pharmacists’ perceptions about the role of pharmacies and the effects of, and barriers to, service expansion. Methods: A content analysis was applied to four focus groups conducted with pharmacists from across Portugal. Results: The three main emerging categories were: The Role of Pharmacy, divided into assessment, referrals, therapy monitoring, educating/informing, prescribing, and registering; Potentialities of Service Innovation, divided into proximity, improvement, and competitiveness; Service Innovation, divided into conditions for implementation, implementation difficulties, activation of the new services, and adherence-promoting factors. Conclusion: The pharmacy role goes beyond dispensing medication. Tied to this expanded role, pharmacists identified several advantages that the services could provide and several barriers to Service Innovation. Factors that promote adherence need more extensive study.

Objective

This study describes the application of Experienced-Based Co-Design (EBCD) principles with an embedded implementation technology framework for improving digital health and informatics demand management processes in a multi-hospital healthcare system. The study identified barriers and enablers within the existing demand management system, proposed interventions to address these challenges and engaged in collaborative co-design with stakeholders.

Methods

A multi-method qualitative approach aligning with EBCD principles was used. Framework mapping (Non-adoption, Abandonment, Scale-up, Spread, Sustainability) was applied to barriers and enablers associated with baseline practices. Reflexive thematic mapping and process charts were used to inform stakeholder priorities and co-design. Prototyping was iterative using feedback for continuous improvement with ongoing monitoring.

Results

Fragmentation of information was a technological barrier, decentralized processes and service duplication were organizational barriers, and opportunities to improve clarity of governance policies were identified. Solutions were co-generated and prioritised by stakeholders. The co-design and prototyping phase followed an iterative approach which generated two interventions. For centralizing intake and management, a new workflow process was devised. For improving project portfolio visibility and developing a weighted scoring criterion, a single tool to track projects across the lifecycle and a scoring model based on prioritization techniques were created.

Conclusion

A novel application of an EBCD approach was used to improve demand management processes in a digital health and informatics service context in a large health system. It highlights the value and agility of EBCD to generate flexible and modular solutions for this digital health context and compares favorably to analogous approaches.

Public interest summary

In today's fast-paced digital age, it is vital for hospitals to manage health information innovation efficiently. This study used an Experienced-Based Co-Design design (EBCD) approach to improve how a multi-hospital health system handles and prioritizes digital health projects. We listened to stakeholders, identified challenges, including fragmented information and unclear processes, then co-created solutions. The EBCD produced an implementable streamlined method for managing digital health project requests, including prioritizing and tracking projects from start to finish. This outcome of the exemplar EBCD process is likely to ensure that the most critical health projects are prioritized. For the public, this means better, faster, and more efficient digital health services in the future.

Objective

To investigate trends in Medicare charges, reimbursements, and utilization for ophthalmic and non-ophthalmic procedures.

Methods

We examined all ophthalmic, non-ophthalmic, and the 15 most performed ophthalmic medical/surgical procedures in Medicare Provider Utilization and Payment Data from 2013 to 2019. Monetary values were adjusted for inflation based on the 2019 United States (US) dollar using the Bureau of Labor Statistics Consumer Price Index. We calculated annual procedural utilization by adjusting service counts per million Medicare beneficiaries and examined trends for ophthalmic and non-ophthalmic procedures from 2013-2019 using descriptive statistics.

Results

From 2013-2019, Medicare inflation-adjusted charges and reimbursements changed by -14% and -23%, respectively, for ophthalmic procedures compared to +14% and +5%, for non-ophthalmic procedures, and -24% and -31% for the 15 most common ophthalmic procedures. Utilization of ophthalmic, non-ophthalmic, and common ophthalmic procedures changed by +2%, -15%, and +17%, respectively.

Conclusions

Lower reimbursements likely compensate for higher utilization in ophthalmology, especially since the magnitude of change in charges and reimbursements was larger for the 15 most performed ophthalmic procedures. In future reimbursement deliberations, policymakers should consider the declining reimbursements for procedures in ophthalmology relative to other medical specialties.

Public Interest Summary

Medicare reimbursement rates for common ophthalmic procedures decreased by 31% from 2011-2020. These reductions may lead to lower hospital revenue and, subsequently, higher prices. This shifts the financial burden onto uninsured and underinsured patients and is a potential barrier to care. Additionally, as there are not enough ophthalmologists in the US to adequately meet demand, further reimbursement reductions may influence student interest and contribute to earlier retirements in the existing ophthalmic workforce. This study identifies a decline in charges and reimbursements as utilization concurrently increased for ophthalmic procedures. In contrast, there has been an increase in charges and reimbursements with a decrease in utilization for non-ophthalmic procedures. Policymakers should take these findings into consideration in future decisions on reimbursement changes for ophthalmology.

Objectives

In 2019, the German government established the Hospital Future Fund, allocating 4.3 billion Euros, to support investments in the digital infrastructure of hospitals. The DigitalRadar consortium was commissioned by the German Ministry of Health in 2020 to develop a holistic digital maturity model and evaluate the current state of digitalization and the impact of the funding program. To date, the nationwide digitalization of German hospitals has remained a relatively understudied phenomenon. This study aims to address this gap in knowledge by examining the influence of various factors identified by the DigitalRadar maturity model on the digital maturity of hospitals in Germany. In doing so, it seeks to elucidate the implications these findings have for the development of a digital, patient-centred, safe, and high-quality hospital landscape in the country.

Methods

The model was developed through a scoping review of digital maturity models, requirements set forth in the Hospital Future Act, analysis of components from existing models and feedback from a sounding board. Ultimately, the model includes 234 questions (items) categorized into 7 dimensions of digitalization. It was piloted in 12 hospitals and revised accordingly. 1,624 hospitals (91% of all German hospitals) participated in this self-assessment, as participation was mandatory to receive funding.

Results

The average DigitalRadar score on a 100-point scale is 33. Maturity is comparatively high in the structures and systems dimension, but low in the clinical processes, exchange of information, telemedicine and patient participation dimensions, suggesting that data exchange is hampered by a lack of interoperability. Drivers of digital maturity are teaching status, size, connectivity, and level of emergency services.

Conclusions

The transparency gained allows hospitals and regulators to identify areas for improvement and develop digital strategies. Additionally, it enables researchers to analyse, for example, the correlation between digitalization and the quality of care, as well as the mechanisms of action of large-scale funding programs for hospital digitization.

Objective

Price transparency mandates by the Centers for Medicare and Medicaid Services (CMS) were implemented in 2021 for hospitals and 2023 for health plans. We assessed U.S. patients’ awareness of their estimated out-of-pocket cost (OOPC) and hospital price-estimator tool among outpatients undergoing advanced imaging.

Methods

English-, Spanish-, and Vietnamese-speaking adults receiving a CT, PET/CT, or MRI at a tertiary academic center between 11/2022 and 03/2023 completed a 15-minute survey. We assessed awareness of OOPC estimates prior to imaging and the hospital price-estimator tool, and factors associated with such awareness using multivariable regression analysis.

Results

423 patients were included (mean age: 57.1 ± 15.6; 57.4 % female; 55 % White; 21.8 % Hispanic; 18.9 % Asian). Only 10.7 % and 16.8 % were aware of their OOPC before receipt of imaging and center'shospital price-estimator tool, respectively. No patient used the hospital price estimator tool to obtain their OOPC estimate. Annual household income of $50,000 or more (OR: 30.25, 95 % CI: 1.78, 513.79), and having at least one comorbidity (OR: 4.59, 95 % CI: 1.42, 14.79) were associated with a higher probability of knowing OOPC prior to imaging. Patients who experienced financial hardship were less likely to be aware of their OOPC (OR: 0.29, CI: 0.10, 0.86). No significant factors were associated with awareness of hospital price estimator tool in full regression model.

Conclusion

Our study highlights limited OOPC and price estimator tool awareness, two years post-CMS mandate, with specific demographics more likely to know their OOPC. Our findings emphasize the urgency for targeted interventions to increase price awareness and enhance healthcare decision-making.

Objectives

The study evaluated the digital national waiting time information system from the point of view of oral healthcare managers in Finland in 2021. The information system (IS) was implemented in 2014, primarily to monitor waiting times in public healthcare. The system reported the information on realised waiting times on the Internet.

Methods

We gathered the data using a cross-sectional survey. Evaluating the system was based on a modified IS success model with the dimensions of information quality, system quality, individual impact and organisational impact. We used convenience sampling when including in the study managers working in public primary oral healthcare in the spring of 2021.

Results

The managers (n = 97) perceived it as easy to access the waiting time information on one website, but they evaluated the information as low quality. The information on realised waiting times supported them in the management of current waiting times to a minor degree. The managers associated the information inaccuracy in the national system with dental nurses’ poor data entry in electronic patient ISs in oral healthcare organisations. The inaccuracy meant that waiting time monitoring data was not valid.

Conclusions

Our modified IS success model was sufficient to ascertain that poor information quality likely influenced the effectiveness of managers in information-driven waiting time management. Information must be relevant and accurate to promote the success of ISs. Further research is required to explore how to improve the design of national ISs from the point of view of different stakeholders in healthcare.