Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

Portugal is one of the European Union countries with the highest rates of people aged 65 or more. The old-age dependency index is the third highest in Europe. Longevity is a remarkable human achievement but without a comprehensive approach to fostering healthy ageing over the life-course, the burden on health and care systems and social services will increase. This issue is compounded as life expectancy rises, but many of these additional years are not lived in good health. Promoting healthy ageing is an essential political and moral strategy for the well-being both of individuals and societies. Concerning this, Portugal endorsed the Lisbon Outcome Statement drawn up based on the 2023 Regional Summit on Policy Innovation for Healthy Ageing and made its commitment for the creation of age-friendly environments. The National Programme for Age-Friendly Cities and Communities in Portugal is one of the first concrete steps to fulfill that endorsement.

This paper aims to establish an intelligent delivery system integrated with track logistics and explores its impact on the clinical transportation of goods. The study analyzed hospital delivery items before and after the implementation of an intelligent delivery system combined with automated track logistics in 2023. Delivery conditions prior to the system's activation served as the control group, while those post-implementation formed the observation group. This research assesses the effects on transportation efficiency, resource allocation, transport safety, and satisfaction among medical staff. The average delivery time of goods significantly decreased following the adoption of the intelligent delivery system combined with automated track logistics (P < .01). The total number of adverse delivery-related events was reduced from 25 to 4 (P < .01). Departmental medical staff reported substantial increases in scores for delivery efficiency, error incidence, and overall satisfaction with the delivery process (P < .01). The integration of the intelligent delivery system with automated track logistics significantly enhances the efficiency of clinical goods transportation, optimizes resource allocation, ensures the safe transport of items, and improves the patient experience and clinical staff satisfaction with delivery operations. Regular system maintenance and adjustments, supported by professional technical personnel, are essential to fully leverage the system's advantages.

The Tailored Activity Program (TAP), an intervention for people living with dementia (PLWD) and their caregivers, has been shown to reduce behavioral symptoms for PLWD and caregiver burden. While TAP is proven as an evidence-based practice (EBP), it has yet to be implemented at scale. The Department of Veterans Affairs (VA) has prioritized the Age-Friendly Health System (AFHS) initiative, providing an opportunity to test implementation of TAP in a complex healthcare system. We conducted semi-structured pre-implementation interviews with leaders and clinicians at 6 VA Medical Centers (VAMCs) to engage key implementation partners and understand their unique implementation contexts. We utilized team-based rapid qualitative analysis to identify themes related to implementation determinants. We interviewed 65 unique informants in 58 interviews (5 VAMC leaders, 36 department leaders, and 17 frontline clinical staff). Informants identified 4 key factors critical to consider prior to implementing TAP: (1) alignment with organizational priorities; (2) perceived value and fit with existing clinical workflows; (3) competition with existing organizational and clinical priorities; and (4) considerations about the effect of caregiver burden on participation. We identified key factors to consider for successful implementation of a multicomponent intervention for PLWD and their caregivers within a complex healthcare system. As the AFHS initiative expands, there is a growing need for EBPs focused on the care of PLWD and their caregivers. These factors can guide clinicians, leaders, and implementation scientists in planning for implementation and sustainment of EBPs to bolster AFHS initiatives.Trial RegistrationRegistered 05 May 2021, at ISRCTN #60,657,985.Reporting GuidelinesThe COnsolidated criteria for REporting Qualitative research (COREQ) checklist was used to ensure proper standards for reporting qualitative studies (see attached).

The 4Ms Framework is the foundation of the Age-Friendly Health System (AFHS) movement. While the framework is based on standalone evidence for each M, there is limited evidence about the impact on outcomes when practiced as a set. A composite measure capturing adherence to the many care processes that comprise the 4Ms is a necessary but complex component of closing the evidence gap. We offer a navigation guide that addresses key considerations for developing a hospital-based composite measure of 4Ms care. The Institute for Healthcare Improvement operationalizes the 4Ms Framework as a minimum set of Assessment and Act On care processes. In developing a composite measure of inpatient 4Ms adherence, we offer a 4 step framework with associated discussion of considerations related to composite measure type (eg, continuous, dichotomous), and synchrony within and across the Ms containing these care processes. Using real-world electronic health record data capturing care process adherence in the 4Ms implementation at a large academic hospital, we illustrate the considerations, and report the implications for sample size and composite measure scoring. We also present our selected composite measure-a dichotomous measure delineating 4Ms care when all encounter-level processes (those needing to be done only once during the hospital encounter) are followed and all day- and shift-level processes are followed for at least 50% of hospital days. While there is no single, standard approach to create a 4Ms composite at this early stage of the AFHS movement, as organizations develop their measure(s), our guide and the considerations we suggest should serve to inform this process and support progress toward meaningful measurement.

Health care price transparency aims to empower patients to make better-informed purchasing decisions. However, the prospective availability of patients' out-of-pocket costs may lead to an increased rate of forgone care. The objective of this study was to examine whether obtaining a prospective out-of-pocket cost estimate is associated with the likelihood of canceling or not arriving at a scheduled outpatient health care appointment. We surveyed adult individuals with scheduled outpatient imaging appointments at a large health care system in Georgia. In this case-control pilot study, we estimated the adjusted association between obtaining an out-of-pocket cost estimate for a scheduled imaging appointment (did not obtain an estimate, did not seek an estimate but received it via an unsolicited phone call from the health care system, and actively sought and obtained an estimate) and not attending the appointment using multivariable logistic regression that controlled for the type of primary health insurance and patient demographics. Actively seeking an out-of-pocket cost estimate was not associated with appointment cancelation or no-show (adjusted odds ratio [aOR] = 0.81, P = .75). Passively receiving an out-of-pocket cost estimate via an unsolicited phone call from the health care system was marginally associated with lower odds of appointment cancelation or no-show (aOR = 0.24; P = .076). This study did not find evidence of an association between prospective exposure of patients to out-of-pocket cost information and the likelihood of health care appointment cancelation or no-show.

The study focuses on the complex interconnection of race, sexuality, and socioeconomic background in shaping the stories of mothers struggling with addiction disorders as they attempt to recover from traumatic experiences. A sample of 45 mothers was employed in the study. Using case study analysis methodologies, the stories of 6 mothers were used as representative cases based on their individual characteristics, community settings, and institutional experiences. Further, the 6 cases were used to describe the difficulties experienced by participants across 3 major life transitions: (1) childhood (2) initiation to drug use and addiction disorders (3) motherhood. Across these life transitions, participants emphasized the relevance of traumatic experiences and mental health disorders as main reasons for their drug addiction. For each theme highlighted in the narrative of each case, a connection to all other participants was made to summarize the findings in the whole sample. The analysis indicates that while most mothers experienced trauma during their lifetime, mothers who identified as members of racial/ethnic minorities and those who identified as lesbians were more likely to report trauma from prejudice and discrimination. Furthermore, the analysis highlights that mothers who identified as members of racial minorities were more likely to have their children placed in foster care. In the study, mothers' involvement with the criminal legal system contributed to the challenges they experienced while renegotiating their relationships with their children. These mothers' lived experiences and the complexity of the dynamics they described-especially their interactions with the legal system-could potentially help other researchers frame new hypotheses that could be tested by larger empirical studies.

The evolving gambling environment, marked by increased accessibility and innovative promotions, has led to rising expenditures globally. Despite this, the relationship between social media use and problem gambling in the Czech Republic remains underexplored. To investigate the association between social media use and problem gambling severity among Czech adults using the Problem Gambling Severity Index (PGSI). Is there a difference in gambling severity based on demographic characteristics? (1); Is there a relationship between social media news consumption and gambling severity? (2); Is there a connection between negative motives for social media use and problematic usage? (3); Is there a link between problematic social media use and gambling severity? (4). Primary research, designed as a cross-sectional study, was conducted in the Czech Republic in November 2024 on a sample of 3093 respondents (48.4% male). All participants were aged 16 years or older. The sample was selected using quota sampling based on multiple identifying quota variables, with minimal differences in the proportions of quota indicators compared to the general population. Non-parametric tests and ordinal logistic regression analyzed relationships between demographics, social media use, and PGSI scores. Higher PGSI scores were found among males, younger participants, those with lower education, and the unemployed or students. Greater social media news consumption correlated with increased gambling severity. Disruptive social media behaviors, such as waking up to check notifications and interrupting activities, were significantly associated with higher PGSI scores. Problematic social media use involving deceit and family conflict substantially heightened the risk of severe gambling problems. These findings highlight the need for targeted prevention initiatives, regulatory policies, and enhanced digital literacy to safeguard vulnerable groups from the risks posed by digital gambling platforms. Addressing both gambling behaviors and problematic social media use is crucial in mitigating potential harms.

The rapid digital transformation in the public healthcare sector demands effective digital leadership to improve organizational performance. This study investigates the impact of digital leadership on employee empowerment and its subsequent effects on techno-work engagement and sustainability performance within public healthcare institutions in Pakistan. A survey-cum questionnaire method was employed for 334 respondents of employees of public healthcare institutions in the Punjab Province of Pakistan. It used structured questionnaires to measure digital leadership, sense of empowerment, techno-work engagement, and sustainability performance. Structural Equation Modeling (SEM) was performed on data to examine the proposed relationships among the variables. The findings of SEM showed that digital leadership positively influences employees' sense of empowerment. Empowerment significantly predicted techno-work engagement and sustainability performance. Techno-work engagement also positively affected sustainability performance. Mediation analysis revealed that the sense of empowerment mediates the relationship between digital leadership and both techno-work engagement and sustainability performance. The findings demonstrate that digital leadership enhances employee empowerment, which in turn boosts techno-work engagement and sustainability performance in the public healthcare sector. Organizations should promote digital leadership practices to empower employees and achieve sustainable outcomes.

This study aimed to determine the association between physical function and edentulism among older adults. The fifth wave of Indonesian Family Life Survey (IFLS-5) data was used. Physical function was evaluated through physical performance, physical capability, and appendicular skeletal muscle mass (ASM). Edentulous was found in 10.96% of 2554 older adults. Low physical performance (OR 2.02, 95% CI 1.32-3.09; P = .001) was shown to be associated with edentulism in the 60 to 69 age group. In the 70 to 79 age group, both low physical performance (OR 1.62, 95% CI 1.04-2.53; P = .033) and 1 dependency in ADL/IADL (OR 1.75, 95% CI 1.02-2.98; P = .04) were significantly associated with edentulism. Two or more dependencies in ADL/IADL (OR 4.02, 95% CI 1.15-13.99; P = .029) demonstrated significant association with edentulism in older adults ≥80 years. These findings highlighted the importance of maintaining natural teeth and improving oral health during the aging process.

Primary health care is the most effective approach to achieving universal health coverage (UHC) and ensuring health security. In this approach, community health workers play a crucial role by delivering a comprehensive array of preventive, promotive, and curative services. Their contributions are vital in addressing health inequities, ensuring that all individuals have access to essential health services. By empowering these workers, we can foster a more equitable health system that meets the diverse needs of communities. African leaders are pursuing a 2 million community health worker agenda, but there are lingering questions about how to set targets of the density of community health workers needed in countries to achieve the sustainable development goals. By examining the implications of empirical estimates and incorporating nuances of working hours of community health workers, we find a wide range of density from 11.2 to 59.5 community health workers per 10 000 population depending on country context and the community health worker's working arrangements. If community health workers are not full-time workers and work between 30% and 65% of their time, the current shortage of community health workers is between 580 000 and 954 500. However, if all the existing community health workers were to be employed full-time, the needs-based shortage of community health workers would shrink significantly to just 210 000. These should be considered ordered guesses and not planning targets for countries. Countries are encouraged to use the available health workforce planning tools to estimate its context-appropriate requirements for community health workers as part of the broader health workforce planning.