Pub Date : 2024-03-07DOI: 10.1101/2024.03.05.24303817
Gindo Tampubolon
The world is ageing with unprecedented momentum, and large global south nations are ageing at higher speed than their northern peers. They have grown old while they have not grown rich, straining their health systems' ability to deliver financial protection. This work aimed to assess whether Indonesia's health insurance scheme, seven years on, has delivered equal protection for families with older members (over 60 years) as for other families. Methods Before-and-after observation study is designed to estimate how much difference the Scheme made to probabilities of catastrophic payment and financial impoverishment for the two family types. As in recent assessments, two national socioeconomic surveys were used (2013, 2021). Two level observations came from 622,125 families residing in 514 districts across the archipelago. Financial protection indicators against catastrophic payment and impoverishment were constructed following recent works. I estimated two level probit models, then plotted marginal probabilities of financial protection. A sensitivity analysis was conducted with the standard financial protection indicator. Findings After the Scheme, financial hardship for all family types has reduced by 19%. But families with older members (compared to other families) have an additional 0.7% risk of incurring catastrophic payment or financial impoverishment. And social and spatial inequalities in health persist. Discussion While the Scheme has markedly improved financial protection for all, families with older members remain at higher risk of being unprotected. The global south can prepare for an ageing world by monitoring financial protection and its social determinants and systematically distinguishing families with older members.
{"title":"Fit for growing old? Financial protection before and after Indonesia's national health insurance scheme - a repeated cross-section study","authors":"Gindo Tampubolon","doi":"10.1101/2024.03.05.24303817","DOIUrl":"https://doi.org/10.1101/2024.03.05.24303817","url":null,"abstract":"The world is ageing with unprecedented momentum, and large global south nations are ageing at higher speed than their northern peers. They have grown old while they have not grown rich, straining their health systems' ability to deliver financial protection. This work aimed to assess whether Indonesia's health insurance scheme, seven years on, has delivered equal protection for families with older members (over 60 years) as for other families. Methods\u0000Before-and-after observation study is designed to estimate how much difference the Scheme made to probabilities of catastrophic payment and financial impoverishment for the two family types. As in recent assessments, two national socioeconomic surveys were used (2013, 2021). Two level observations came from 622,125 families residing in 514 districts across the archipelago. Financial protection indicators against catastrophic payment and impoverishment were constructed following recent works. I estimated two level probit models, then plotted marginal probabilities of financial protection. A sensitivity analysis was conducted with the standard financial protection indicator. Findings\u0000After the Scheme, financial hardship for all family types has reduced by 19%. But families with older members (compared to other families) have an additional 0.7% risk of incurring catastrophic payment or financial impoverishment. And social and spatial inequalities in health persist. Discussion\u0000While the Scheme has markedly improved financial protection for all, families with older members remain at higher risk of being unprotected. The global south can prepare for an ageing world by monitoring financial protection and its social determinants and systematically distinguishing families with older members.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140057641","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}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.04.24303279
Merideth A. Addicott, Josephine Hinds, Vita Mithi, George Kypriotakis, Wura Jacobs, Sydney Martinez, Rachel Denlinger-Apte, Lilianna Phan, Douglas Levy, Olatokunbo Osibogun, Kavita Mosalpuria, Danusha Kumar, Lauren Czaplicki, Andy Tan
The Society for Research on Nicotine and Tobacco (SRNT) Health Equity Network (HEN) Evaluation Subcommittee members conducted an open-ended survey regarding what should be considered authentic health disparity/equity (HD/E) research and how the SRNT community defines this term. Anonymous surveys were emailed to over 300 SRNT HEN members, and invitees were asked to complete the survey if they conducted HD/E research or engaged in HD/E research in some other way. A total of 26 usable survey responses were collected and qualitatively coded. Respondents were asked to describe authentic HD/E research, challenges in their field, and indicators of good and poor quality HD/E research. Respondents expressed that authentic HD/E research investigates disparities/inequalities in health outcomes or access to healthcare services that are specific to communities defined by a social or demographic characteristic. Challenges included lack of funding, a slow rate of recruiting minority populations, and an under-valuation of HD/E research among funders and scientific journals. Indicators of good quality HD/E research were community involvement and a social justice context. Respondents also expressed concerns that poor quality HD/E research could inadvertently harm minoritized communities. As this field grows, we feel it is necessary for experts to set standards for the appropriate conduct of HD/E research, set benchmarks for success, and voice their concerns about the potentially negative impacts of poorly conducted HD/E research.
{"title":"SRNT Health Equity Network Survey on Authentic Health Disparity/Equity Research","authors":"Merideth A. Addicott, Josephine Hinds, Vita Mithi, George Kypriotakis, Wura Jacobs, Sydney Martinez, Rachel Denlinger-Apte, Lilianna Phan, Douglas Levy, Olatokunbo Osibogun, Kavita Mosalpuria, Danusha Kumar, Lauren Czaplicki, Andy Tan","doi":"10.1101/2024.03.04.24303279","DOIUrl":"https://doi.org/10.1101/2024.03.04.24303279","url":null,"abstract":"The Society for Research on Nicotine and Tobacco (SRNT) Health Equity Network (HEN) Evaluation Subcommittee members conducted an open-ended survey regarding what should be considered authentic health disparity/equity (HD/E) research and how the SRNT community defines this term. Anonymous surveys were emailed to over 300 SRNT HEN members, and invitees were asked to complete the survey if they conducted HD/E research or engaged in HD/E research in some other way. A total of 26 usable survey responses were collected and qualitatively coded. Respondents were asked to describe authentic HD/E research, challenges in their field, and indicators of good and poor quality HD/E research. Respondents expressed that authentic HD/E research investigates disparities/inequalities in health outcomes or access to healthcare services that are specific to communities defined by a social or demographic characteristic. Challenges included lack of funding, a slow rate of recruiting minority populations, and an under-valuation of HD/E research among funders and scientific journals. Indicators of good quality HD/E research were community involvement and a social justice context. Respondents also expressed concerns that poor quality HD/E research could inadvertently harm minoritized communities. As this field grows, we feel it is necessary for experts to set standards for the appropriate conduct of HD/E research, set benchmarks for success, and voice their concerns about the potentially negative impacts of poorly conducted HD/E research.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140075215","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}
Pub Date : 2024-03-07DOI: 10.1101/2024.03.06.24303875
Oscar Thompson, Mioara Cristea, Monica Tamariz
The global fight against the COVID-19 pandemic has underscored the critical importance of widespread vaccination to mitigate the impact of the virus on public health. The current study aimed to investigate which social influences might be most important for predicting attitudes towards COVID-19 vaccination and vaccine uptake among young students in the UK. We focused on the cultural evolution and social transmission aspects, i.e., parent-to-child versus peer-to-peer, of attitudes and vaccine uptake during the COVID-19 pandemic. A sample of 192 UK students (aged 18 to 35 years old) filled in an online survey including measures for attitudes towards COVID-19 vaccination and vaccine uptake and/or intention, age, and gender. Participants were also asked about their mother’s, father’s, and best friend’s attitudes towards COVID-19 vaccination and vaccine uptake. Finally, they provided a subjective measure of the quality relationship with their parents. Overall, our results suggest that both parents and very close friends are important agents in understanding the students’ attitudes towards COVID-19 vaccination and vaccine uptake. More specifically, our findings suggest the mother’s vaccine uptake as the most salient predictor of students’ attitudes towards COVID-19 vaccination and vaccine uptake, particularly when the students disclose having a positive relationship with their parents. In cases where students’ experience negative relationship with their parents, the best friend’s vaccine uptake may supersede the mother’s influence. Despite these nuances, a general trend emerges from our data suggesting that vaccine uptake could be primarily guided by vertical transmission (i.e., parent to child). Our results have the potential to influence public health strategies, communication campaigns, and targeted interventions to enhance vaccination uptake. Identifying key social predictors can enable policymakers and health authorities to tailor vaccination promotion efforts towards mothers’ and peers’ vaccine uptake to increase overall positive attitudes and vaccine uptake among young people.
{"title":"The importance of mothers: The social transmission of COVID-19 vaccination attitudes and uptake","authors":"Oscar Thompson, Mioara Cristea, Monica Tamariz","doi":"10.1101/2024.03.06.24303875","DOIUrl":"https://doi.org/10.1101/2024.03.06.24303875","url":null,"abstract":"The global fight against the COVID-19 pandemic has underscored the critical importance of widespread vaccination to mitigate the impact of the virus on public health. The current study aimed to investigate which social influences might be most important for predicting attitudes towards COVID-19 vaccination and vaccine uptake among young students in the UK. We focused on the cultural evolution and social transmission aspects, i.e., parent-to-child versus peer-to-peer, of attitudes and vaccine uptake during the COVID-19 pandemic. A sample of 192 UK students (aged 18 to 35 years old) filled in an online survey including measures for attitudes towards COVID-19 vaccination and vaccine uptake and/or intention, age, and gender. Participants were also asked about their mother’s, father’s, and best friend’s attitudes towards COVID-19 vaccination and vaccine uptake. Finally, they provided a subjective measure of the quality relationship with their parents. Overall, our results suggest that both parents and very close friends are important agents in understanding the students’ attitudes towards COVID-19 vaccination and vaccine uptake. More specifically, our findings suggest the mother’s vaccine uptake as the most salient predictor of students’ attitudes towards COVID-19 vaccination and vaccine uptake, particularly when the students disclose having a positive relationship with their parents. In cases where students’ experience negative relationship with their parents, the best friend’s vaccine uptake may supersede the mother’s influence. Despite these nuances, a general trend emerges from our data suggesting that vaccine uptake could be primarily guided by vertical transmission (i.e., parent to child). Our results have the potential to influence public health strategies, communication campaigns, and targeted interventions to enhance vaccination uptake. Identifying key social predictors can enable policymakers and health authorities to tailor vaccination promotion efforts towards mothers’ and peers’ vaccine uptake to increase overall positive attitudes and vaccine uptake among young people.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140054386","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}
Pub Date : 2024-03-04DOI: 10.1101/2024.03.01.24303596
Meng Zhang, Shuchuan Zhao, Mingfang Li, Yue Liu, Hu Li, Peng Su, Guangmin Xu
Objective:This study investigated the effects of ultrasound-guided erector spinal muscle plane block (ESPB) and quadratus muscle block (QLB) on the quality of analgesia and recovery after laparoscopic nephrectomy.Design:randomized, controlled, double-blind study.Setting: A single tertiary care academic medical center,include anesthesia preparation room, operating room, anesthesia recovery room and ward.Patients:Aged 18-70years,ASA grades I-III,elective laparoscopic partial nephrectomy or radical nephrectomy and 54 patients were included in the statistical analysis.Interventions:All included patients were randomassigned to the erector spinal muscle plane block or the quadratus block,and all patients underwent morphine pump controlled analgesia.Results:The study found that ultrasound-guided ESPB had a higher incidence of hypotension than QLB at the T1 time point, but it did not significantly increase the intraoperative dose of the vasoactive drug used. Patients in the ESPB group showed significant improvement in resting NRS pain scores at 0.5h,number of morphine pumps at 6h and 24h, cumulative morphine equivalent consumed 6h after surgery, and QOR-15 score at 24 h after surgery, and shortened hospital stay.Conclusions:Compared with QLB,ESPB has certain advantages in analgesia and recovery quality after laparoscopic nephrectomy, and shows opioid frugality effect at individual postoperative time points.
{"title":"Comparison of ultrasound-guided erector spinal muscle plane block and quadratus block for laparoscopic renal cancer resection:A single-center,double-blind, randomized controlled trial.","authors":"Meng Zhang, Shuchuan Zhao, Mingfang Li, Yue Liu, Hu Li, Peng Su, Guangmin Xu","doi":"10.1101/2024.03.01.24303596","DOIUrl":"https://doi.org/10.1101/2024.03.01.24303596","url":null,"abstract":"Objective:This study investigated the effects of ultrasound-guided erector spinal muscle plane block (ESPB) and quadratus muscle block (QLB) on the quality of analgesia and recovery after laparoscopic nephrectomy.Design:randomized, controlled, double-blind study.Setting: A single tertiary care academic medical center,include anesthesia preparation room, operating room, anesthesia recovery room and ward.Patients:Aged 18-70years,ASA grades I-III,elective laparoscopic partial nephrectomy or radical nephrectomy and 54 patients were included in the statistical analysis.Interventions:All included patients were randomassigned to the erector spinal muscle plane block or the quadratus block,and all patients underwent morphine pump controlled analgesia.Results:The study found that ultrasound-guided ESPB had a higher incidence of hypotension than QLB at the T1 time point, but it did not significantly increase the intraoperative dose of the vasoactive drug used. Patients in the ESPB group showed significant improvement in resting NRS pain scores at 0.5h,number of morphine pumps at 6h and 24h, cumulative morphine equivalent consumed 6h after surgery, and QOR-15 score at 24 h after surgery, and shortened hospital stay.Conclusions:Compared with QLB,ESPB has certain advantages in analgesia and recovery quality after laparoscopic nephrectomy, and shows opioid frugality effect at individual postoperative time points.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140032479","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}
Pub Date : 2024-03-01DOI: 10.1101/2024.02.28.24303459
Leslie Smith, Lisa A Carricaburu, Jonathan R Genzen
In October 2023, the U.S. Food and Drug Administration (FDA) released a proposed rule to regulate laboratory-developed tests (LDTs) as medical devices. While approximately 6,700 public comments were submitted during the open comment period, there is not a reliable mechanism to quantify how clinical laboratorians as a sector perceive the proposed rule. To solicit quantifiable feedback on the FDA's proposed rule, a ten-item questionnaire was developed and submitted to clinical laboratory customers of ARUP Laboratories, a national nonprofit clinical laboratory of the University of Utah Department of Pathology. Of 503 clinical laboratory respondents, only 41 (8.2%) support the FDA's proposed rule. 66.9% of respondents work in laboratories that perform LDTs and were therefore asked additional questions regarding the proposed rule. 83.9% of these respondents believe that the proposed rule will negatively impact their laboratories, while only 3.0% believe that they have the financial resources to pay for FDA user fees. 60.9% of respondents anticipate removing tests from their laboratory menus if the proposed rule is enacted, while an additional 33.2% indicated that they do not yet know. Only 11.2% of respondents believe that they would pursue FDA submissions for all of their existing LDTs if the final rule is enacted. The vast majority of respondents (>80%) were either 'extremely concerned' or 'very concerned' about the impact of the proposed rule on patient access to essential testing, financial and personnel resources to comply, innovation, the FDA's ability to implement the proposed rule, and send-out costs and test prices. Respondents indicated that they would rely heavily on reference laboratory partners for advocacy against the proposed rule, testing options, education, and consultation if the rule was enacted. Thematic analysis of open comments revealed strong opposition to the proposed rule and significant concern regarding negative impacts to patient care across clinical laboratory settings.
{"title":"The FDA's Proposed Rule on Laboratory-Developed Tests: Impacts on Clinical Laboratories and Patient Care","authors":"Leslie Smith, Lisa A Carricaburu, Jonathan R Genzen","doi":"10.1101/2024.02.28.24303459","DOIUrl":"https://doi.org/10.1101/2024.02.28.24303459","url":null,"abstract":"In October 2023, the U.S. Food and Drug Administration (FDA) released a proposed rule to regulate laboratory-developed tests (LDTs) as medical devices. While approximately 6,700 public comments were submitted during the open comment period, there is not a reliable mechanism to quantify how clinical laboratorians as a sector perceive the proposed rule. To solicit quantifiable feedback on the FDA's proposed rule, a ten-item questionnaire was developed and submitted to clinical laboratory customers of ARUP Laboratories, a national nonprofit clinical laboratory of the University of Utah Department of Pathology. Of 503 clinical laboratory respondents, only 41 (8.2%) support the FDA's proposed rule. 66.9% of respondents work in laboratories that perform LDTs and were therefore asked additional questions regarding the proposed rule. 83.9% of these respondents believe that the proposed rule will negatively impact their laboratories, while only 3.0% believe that they have the financial resources to pay for FDA user fees. 60.9% of respondents anticipate removing tests from their laboratory menus if the proposed rule is enacted, while an additional 33.2% indicated that they do not yet know. Only 11.2% of respondents believe that they would pursue FDA submissions for all of their existing LDTs if the final rule is enacted. The vast majority of respondents (>80%) were either 'extremely concerned' or 'very concerned' about the impact of the proposed rule on patient access to essential testing, financial and personnel resources to comply, innovation, the FDA's ability to implement the proposed rule, and send-out costs and test prices. Respondents indicated that they would rely heavily on reference laboratory partners for advocacy against the proposed rule, testing options, education, and consultation if the rule was enacted. Thematic analysis of open comments revealed strong opposition to the proposed rule and significant concern regarding negative impacts to patient care across clinical laboratory settings.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140011434","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}
Pub Date : 2024-02-29DOI: 10.1101/2024.02.28.24303432
Judit Katalin Csontos, Deborah Edwards, Elizabeth Gillen, Juliet Hounsome, Meg Kiseleva, Mala K Mann, Abubakar Sha'aban, Ruth Lewis, Alison Cooper, Adrian Edwards
Abstract: It is estimated that one in four people will experience poor mental health throughout their lifetimes. However, ethnic minority groups, refugees and asylum seekers experience more barriers accessing mental health services and have poorer mental health outcomes than those from non-ethnic minority groups. Evidence suggests that interventions that improve access and engagement with mental health services may help reduce disparities affecting ethnic minority groups, refugees and asylum seekers. Thus, the aim of this rapid evidence summary was to explore the literature on what works to support better access to mental health services for ethnic minority groups, refugees and asylum seekers to reduce inequalities. The review included interventions that were developed or assessed to improve equity in access, engagement, utilisation, or provision of mental health services. Research Implications and Evidence Gaps: There is limited review evidence regarding the effectiveness of interventions to improve access to mental healthcare across ethnic minority groups. Review evidence regarding interventions to support refugees and asylum seekers access to primary healthcare or specialised clinics (for example pregnancy and postpartum) is available, but the findings related to mental health care cannot be extracted.
{"title":"What works to support better access to mental health services (from primary care to inpatients) for minority groups to reduce inequalities? A rapid evidence summary.","authors":"Judit Katalin Csontos, Deborah Edwards, Elizabeth Gillen, Juliet Hounsome, Meg Kiseleva, Mala K Mann, Abubakar Sha'aban, Ruth Lewis, Alison Cooper, Adrian Edwards","doi":"10.1101/2024.02.28.24303432","DOIUrl":"https://doi.org/10.1101/2024.02.28.24303432","url":null,"abstract":"Abstract:\u0000It is estimated that one in four people will experience poor mental health throughout their lifetimes. However, ethnic minority groups, refugees and asylum seekers experience more barriers accessing mental health services and have poorer mental health outcomes than those from non-ethnic minority groups. Evidence suggests that interventions that improve access and engagement with mental health services may help reduce disparities affecting ethnic minority groups, refugees and asylum seekers. Thus, the aim of this rapid evidence summary was to explore the literature on what works to support better access to mental health services for ethnic minority groups, refugees and asylum seekers to reduce inequalities. The review included interventions that were developed or assessed to improve equity in access, engagement, utilisation, or provision of mental health services.\u0000Research Implications and Evidence Gaps:\u0000There is limited review evidence regarding the effectiveness of interventions to improve access to mental healthcare across ethnic minority groups. Review evidence regarding interventions to support refugees and asylum seekers access to primary healthcare or specialised clinics (for example pregnancy and postpartum) is available, but the findings related to mental health care cannot be extracted.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140002587","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}
Background: The Japanese Ministry of Health, Labour and Welfare (MHLW) released a list of public and municipal hospitals (hereinafter "the list") that are subject to reevaluation for hospital function. First, this study describes the functional differentiation status of Japanese hospital beds. Second, it evaluates the impact of the list release on the number of admissions in the listed hospitals. Methods: Firstly, the number of hospitals and beds by the function of listed and non-listed hospitals in 2019 and 2021 were described using the bed function report. The Controlled Interrupted Time Series (CITS) analyses were subsequently conducted using Diagnosis Procedure Combination (DPC) data. Hospitals were divided near the cutoff point of the list. The outcomes were the number of admissions for gastrointestinal cancer surgery, those admitted via ambulance, or with a femoral fracture per 1,000 admissions. The exposure point was the week when the list was released. Results: A decrease in the total number of beds was observed in 18.9% of the listed hospitals and 10.2% of others. Changes in bed functions were observed in 19.9% of the listed hospitals and 12.5% of others. CITS analyses showed that the rate ratio of admissions for gastrointestinal cancer surgery, those admitted via ambulance, and those with a femoral fracture in the listed hospital group after the list's release were 1.001 (95% CI: 0.998-1.004, p = 0.619), 1.001 (95% CI: 0.998-1.004, p = 0.548), and 0.998 (95% CI: 0.998-1.002, p = 0.313), respectively. Conclusion: More prominent trends of functional differentiation of hospital beds were observed in the listed hospitals. The release of the list did not impact the number of hospital admissions for gastrointestinal cancer surgery, those admitted via ambulance, or those with a femoral fracture per 1,000 admissions in the listed hospitals.
{"title":"How were Hospitals Affected by the Ministry's Release of Hospital Names to be Potentially Reorganized?","authors":"Hiromichi Takahashi, Jung-ho Shin, Susumu Kunisawa, Kiyohide Fushimi, Yuichi Imanaka","doi":"10.1101/2024.02.27.24302544","DOIUrl":"https://doi.org/10.1101/2024.02.27.24302544","url":null,"abstract":"Background: The Japanese Ministry of Health, Labour and Welfare (MHLW) released a list of public and municipal hospitals (hereinafter \"the list\") that are subject to reevaluation for hospital function. First, this study describes the functional differentiation status of Japanese hospital beds. Second, it evaluates the impact of the list release on the number of admissions in the listed hospitals.\u0000Methods: Firstly, the number of hospitals and beds by the function of listed and non-listed hospitals in 2019 and 2021 were described using the bed function report. The Controlled Interrupted Time Series (CITS) analyses were subsequently conducted using Diagnosis Procedure Combination (DPC) data. Hospitals were divided near the cutoff point of the list. The outcomes were the number of admissions for gastrointestinal cancer surgery, those admitted via ambulance, or with a femoral fracture per 1,000 admissions. The exposure point was the week when the list was released.\u0000Results: A decrease in the total number of beds was observed in 18.9% of the listed hospitals and 10.2% of others. Changes in bed functions were observed in 19.9% of the listed hospitals and 12.5% of others. CITS analyses showed that the rate ratio of admissions for gastrointestinal cancer surgery, those admitted via ambulance, and those with a femoral fracture in the listed hospital group after the list's release were 1.001 (95% CI: 0.998-1.004, p = 0.619), 1.001 (95% CI: 0.998-1.004, p = 0.548), and 0.998 (95% CI: 0.998-1.002, p = 0.313), respectively.\u0000Conclusion: More prominent trends of functional differentiation of hospital beds were observed in the listed hospitals. The release of the list did not impact the number of hospital admissions for gastrointestinal cancer surgery, those admitted via ambulance, or those with a femoral fracture per 1,000 admissions in the listed hospitals.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140002673","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}
Pub Date : 2024-02-28DOI: 10.1101/2024.02.27.24303457
Najmaddin A. H. Hatem, Mohamed Izham Mohamed Ibrahim, Seena A. Yousuf
The integration of artificial intelligence (AI) in healthcare has emerged as a transformative force, promising to enhance medical diagnosis, treatment, and overall healthcare delivery. Hence, this study investigates the university students perceptions toward using AI in healthcare. A cross-sectional survey was conducted at two major universities using a paper-based questionnaire from September 2023 to November 2023. Participants' views regarding using artificial intelligence in healthcare were investigated using 25 items distributed across five domains. The Mann-Whitney U test was applied for the comparison of variables. The response rate for the survey was 75%, with a sample size of 279. More than half of the participants (52%, n = 145) expressed their belief in AI's potential to reduce treatment errors in the future. However, about (61.6%, n = 172) of participants fear the influence of AI that could prevent doctors from learning to make correct patient care judgments, and it was widely agreed (69%) that doctors should ultimately maintain final control over patient care. Participants with experience with AI, such as engaging with AI chatbots, significantly reported higher scores in both the "Benefits and Positivity Toward AI in Healthcare" and "Concerns and Fears" domains (p = 0.024) and (p = 0.026), respectively. The identified cautious optimism, concerns, and fears highlight the delicate balance required for successful AI integration. The findings emphasize the importance of addressing specific concerns, promoting positive experiences with AI, and establishing transparent communication channels. Insights from such research can guide the development of ethical frameworks, policies, and targeted interventions, fostering a harmonious integration of AI into the healthcare landscape in developing countries.
{"title":"Yemeni university students public perceptions toward the use of artificial intelligence in healthcare: A cross-sectional study","authors":"Najmaddin A. H. Hatem, Mohamed Izham Mohamed Ibrahim, Seena A. Yousuf","doi":"10.1101/2024.02.27.24303457","DOIUrl":"https://doi.org/10.1101/2024.02.27.24303457","url":null,"abstract":"The integration of artificial intelligence (AI) in healthcare has emerged as a transformative force, promising to enhance medical diagnosis, treatment, and overall healthcare delivery. Hence, this study investigates the university students perceptions toward using AI in healthcare. A cross-sectional survey was conducted at two major universities using a paper-based questionnaire from September 2023 to November 2023. Participants' views regarding using artificial intelligence in healthcare were investigated using 25 items distributed across five domains. The Mann-Whitney U test was applied for the comparison of variables. The response rate for the survey was 75%, with a sample size of 279. More than half of the participants (52%, n = 145) expressed their belief in AI's potential to reduce treatment errors in the future. However, about (61.6%, n = 172) of participants fear the influence of AI that could prevent doctors from learning to make correct patient care judgments, and it was widely agreed (69%) that doctors should ultimately maintain final control over patient care. Participants with experience with AI, such as engaging with AI chatbots, significantly reported higher scores in both the \"Benefits and Positivity Toward AI in Healthcare\" and \"Concerns and Fears\" domains (p = 0.024) and (p = 0.026), respectively. The identified cautious optimism, concerns, and fears highlight the delicate balance required for successful AI integration. The findings emphasize the importance of addressing specific concerns, promoting positive experiences with AI, and establishing transparent communication channels. Insights from such research can guide the development of ethical frameworks, policies, and targeted interventions, fostering a harmonious integration of AI into the healthcare landscape in developing countries.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140011210","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}
Pub Date : 2024-02-23DOI: 10.1101/2024.02.21.24303177
Mohamed Taha, Mamoon Habib, Victor Lomachinsky, Peter Hadar, Joseph P Newhouse, Lee H. Schwamm, Deborah Blacker, Lidia M.V.R. Moura
Background: The National Institutes of Health Stroke Scale (NIHSS) scores have been used to evaluate Acute Ischemic Stroke (AIS) severity in clinical settings. Through the International Classification of Diseases, Tenth Revision Code (ICD-10), documentation of NIHSS scores has been made possible for administrative purposes and has since been increasingly adopted in insurance claims. Per CMS guidelines, the stroke ICD-10 diagnosis code must be documented by the treating physician, but ICD-10 NIHSS scores can be documented by any healthcare provider involved in the patient's care. Accuracy of the administratively collected NIHSS compared to expert clinical evaluation as documented in the Paul Coverdell registry is however still uncertain. Methods: Leveraging a linked dataset comprised of the Paul Coverdell National Acute Stroke Program (PCNASP) clinical registry and probabilistically matched individuals on Medicare Claims data, we sampled patients aged 65 and above admitted for AIS across nine states, from 2016 to 2019. We excluded those lacking documentation for either clinical or ICD-10 based NIHSS scores. We then examined score concordance from both databases and measured discordance as the absolute difference between the PCNASP and ICD-10-based NIHSS scores. Results: Among 66,837 matched patients, mean NIHSS scores for PCNASP and Medicare ICD-10 were 7.26 (95% CI: 7.20 - 7.32) and 7.40 (95% CI: 7.34 - 7.46), respectively. Concordance between the two scores was high as indicated by an intraclass correlation coefficient of 0.93. Conclusion: The high concordance between clinical and ICD-10 NIHSS scores highlights the latter's potential as measure of stroke severity derived from structured claims data.
{"title":"Evaluating the Concordance between ICD-10 and Stroke Severity as Measured by the NIHSS","authors":"Mohamed Taha, Mamoon Habib, Victor Lomachinsky, Peter Hadar, Joseph P Newhouse, Lee H. Schwamm, Deborah Blacker, Lidia M.V.R. Moura","doi":"10.1101/2024.02.21.24303177","DOIUrl":"https://doi.org/10.1101/2024.02.21.24303177","url":null,"abstract":"Background: The National Institutes of Health Stroke Scale (NIHSS) scores have been used to evaluate Acute Ischemic Stroke (AIS) severity in clinical settings. Through the International Classification of Diseases, Tenth Revision Code (ICD-10), documentation of NIHSS scores has been made possible for administrative purposes and has since been increasingly adopted in insurance claims. Per CMS guidelines, the stroke ICD-10 diagnosis code must be documented by the treating physician, but ICD-10 NIHSS scores can be documented by any healthcare provider involved in the patient's care. Accuracy of the administratively collected NIHSS compared to expert clinical evaluation as documented in the Paul Coverdell registry is however still uncertain.\u0000Methods: Leveraging a linked dataset comprised of the Paul Coverdell National Acute Stroke Program (PCNASP) clinical registry and probabilistically matched individuals on Medicare Claims data, we sampled patients aged 65 and above admitted for AIS across nine states, from 2016 to 2019. We excluded those lacking documentation for either clinical or ICD-10 based NIHSS scores. We then examined score concordance from both databases and measured discordance as the absolute difference between the PCNASP and ICD-10-based NIHSS scores. Results: Among 66,837 matched patients, mean NIHSS scores for PCNASP and Medicare ICD-10 were 7.26 (95% CI: 7.20 - 7.32) and 7.40 (95% CI: 7.34 - 7.46), respectively. Concordance between the two scores was high as indicated by an intraclass correlation coefficient of 0.93. Conclusion: The high concordance between clinical and ICD-10 NIHSS scores highlights the latter's potential as measure of stroke severity derived from structured claims data.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139949494","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}
Pub Date : 2024-02-21DOI: 10.1101/2024.02.21.24301090
Vera P. van Druten, Margot J. Metz, Jolanda J.P. Mathijssen, Dike van de Mheen, Marja van Vliet, Bridey Rudd, Esther de Vries, Lenny M.W. Nahar - van Venrooij
Introduction Using the positive health perspective has emerged in general healthcare. Conceptual similarities exist with the recovery perspective in mental healthcare. Both concepts are multidimensional and focus on capability. The My Positive Health (MPH) and Individual Recovery Outcomes Counter (I.ROC) tools were developed for dialogues. These tools might be useful for quantitively measuring the positive health construct for monitoring and scientific purposes as well. We aimed to investigate this. Method An observational cross-sectional study was conducted in a representative general Dutch population (the LISS panel) to investigate factor structures and internal consistency from the 42-items MPH and 12-items I.ROC. After randomly splitting the dataset, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied. Spearman correlation coefficient between both tools total scores was calculated. Results 2,457 participants completed the questionnaires. A six-factor structure was extracted for MPH (PH42) and a two-factor structure for I.ROC (I.ROC12). Explained variances were 68.1% and 56.1%, respectively. CFA resulted in good fit indices. Cronbach alphas were between 0.74 to 0.97 (PH42) and 0.73 to 0.87 (I.ROC12). Correlation between the total scores was 0.77. Conclusion Both PH42 and I.ROC12 are useful to quantitatively measure positive health aspects which can be summarised in sum scores in a general population. The dimensions found in this study and the corresponding item division differed from the dimensions of the original dialogue tools. Further research is recommended focussing on item reduction for PH42, factor structure of I.ROC and assessment of construct validity (in a general population) in more depth.
{"title":"Measuring positive health using the My Positive Health (MPH) and Individual Recovery Outcomes Counter (I.ROC) dialogue tools: a panel study on measurement properties in a representative general Dutch population","authors":"Vera P. van Druten, Margot J. Metz, Jolanda J.P. Mathijssen, Dike van de Mheen, Marja van Vliet, Bridey Rudd, Esther de Vries, Lenny M.W. Nahar - van Venrooij","doi":"10.1101/2024.02.21.24301090","DOIUrl":"https://doi.org/10.1101/2024.02.21.24301090","url":null,"abstract":"Introduction\u0000Using the positive health perspective has emerged in general healthcare. Conceptual similarities exist with the recovery perspective in mental healthcare. Both concepts are multidimensional and focus on capability. The My Positive Health (MPH) and Individual Recovery Outcomes Counter (I.ROC) tools were developed for dialogues. These tools might be useful for quantitively measuring the positive health construct for monitoring and scientific purposes as well. We aimed to investigate this.\u0000Method\u0000An observational cross-sectional study was conducted in a representative general Dutch population (the LISS panel) to investigate factor structures and internal consistency from the 42-items MPH and 12-items I.ROC. After randomly splitting the dataset, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were applied. Spearman correlation coefficient between both tools total scores was calculated.\u0000Results\u00002,457 participants completed the questionnaires. A six-factor structure was extracted for MPH (PH42) and a two-factor structure for I.ROC (I.ROC12). Explained variances were 68.1% and 56.1%, respectively. CFA resulted in good fit indices. Cronbach alphas were between 0.74 to 0.97 (PH42) and 0.73 to 0.87 (I.ROC12). Correlation between the total scores was 0.77.\u0000Conclusion\u0000Both PH42 and I.ROC12 are useful to quantitatively measure positive health aspects which can be summarised in sum scores in a general population. The dimensions found in this study and the corresponding item division differed from the dimensions of the original dialogue tools. Further research is recommended focussing on item reduction for PH42, factor structure of I.ROC and assessment of construct validity (in a general population) in more depth.","PeriodicalId":501386,"journal":{"name":"medRxiv - Health Policy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139928404","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}
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