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

Stroke is a leading cause of morbidity and disability, with limited data on in-hospital mortality from low-resource settings. This study aimed to identify predictors of in-hospital mortality among stroke patients at a tertiary care hospital in Nepal. A prospective cohort study was conducted among 120 stroke patients aged ≥ 18 years, enrolled between November 2023 and April 2024. The primary outcome was in-hospital mortality following admission. Data was analysed using SAS version 9.4. Kaplan-Meier survival analysis and Cox proportional hazards regression were employed to identify predictors of in-hospital mortality. A p-value < .05 was considered statistically significant. The cohort comprised 68.3% ischemic and 31.7% haemorrhagic strokes, with an overall in-hospital mortality rate of 9.0%. Multivariate analysis revealed that a Glasgow Coma (GCS) score < 8 (AHR: 12.36; 95% CI: 2.73-56.00), National Institutes of Health Stroke Scale (NIHSS) ≥12 (AHR: 14.75; 95% CI: 3.01-72.28), moderate to severe disability (mRS ≥ 3; AHR: 9.92; 95% CI: 1.10-89.24), hemiplegia (AHR: 6.70; 95% CI: 1.835-53.748), territorial infarcts (AHR: 26.33; 95% CI: 2.093-331.203), capsuloganglionic infarcts (AHR: 14.6; 95% CI: 1.819-160.877), presence of chronic obstructive pulmonary disease (COPD) (AHR: 2.48; 95% CI: 1.317-45.091), and alcohol use (AHR: 3.87; 95% CI: 1.014-18.478) were significant predictors of in-hospital mortality. Neurological impairment at admission, specific infarct locations, hemiplegia, COPD, and alcohol use are significant predictors of in-hospital mortality among stroke patients. These findings underscore the importance of early neurological assessment, systematic risk stratification, and targeted interventions to improve stroke outcomes in resource-constrained settings.

This study explores how undergraduate health care students in Taiwan observe others' needs and what factors influence their prosocial behavior in the context of priority seating. Using a qualitative descriptive design with thematic content analysis, structured open-ended questionnaires were distributed to 146 students from 3 health-related departments at a college in Taiwan. Thematic content analysis was conducted based on a pre-defined coding framework. Participants' reasoning reflected both normative categories (eg, older adults, pregnant women) and situational judgments based on observed needs (eg, signs of fatigue or injury). Voluntary seat-offering was the most common behavior and was strongly associated with internalized personal values. Decisions were also shaped by the perceived demeanor of the person in need. Visual cross-theme analyses highlighted how these factors interacted in cases involving older adults and people with mobility impairments. Health care students' decisions to offer their seat were influenced by a mix of internal moral orientations, interpersonal cues, and context sensitivity. While cultural norms may inform reasoning, students actively negotiated social expectations with personal judgment. These findings suggest a need for further educational attention to everyday moral decision-making in the development of professional identity.

Site-neutral payment reforms seek to align Medicare reimbursement rates for common outpatient services across care sites. Recent reports have assessed the composite impact of site-neutral payment policies on beneficiaries, federal savings, and the commercial market. This analysis builds on such work, focusing on the potential patient-level savings of site-neutral reform for high-utilizing Medicare beneficiaries facing common chronic cancers. We compiled the outpatient services of standard treatment regimens for a typical lung, ovarian, prostate, and colon cancer patient over their first year of treatment. By simulating scenarios for these patients in which hospital outpatient rates were and were not aligned with those of independent physician offices for the 57 service classifications recommended by the Medicare Payment Advisory Commission (MedPAC), we were able to estimate the effect of site-neutral payments on patient out-of-pocket cancer costs. We found that expanding site-neutral payments for MedPAC's recommended services would greatly reduce Medicare cancer patients' outpatient out-of-pocket share, with certain beneficiaries saving over $1000 in out-of-pocket spending in their first year of cancer treatment. Along with patient savings, site-neutral payment expansion would produce larger Medicare fee-for-service savings that average over $5500 per cancer patient for the 4 standard cancer treatments analyzed. The largest portions of Medicare and patient savings with site-neutral payments for these 4 cancers came in the form of drug administration costs, particularly when chemotherapy was included as a part of treatment. The findings of this analysis suggest that existing regulatory and legislative site-neutral proposals have the ability to save Medicare and its higher-need beneficiaries thousands of dollars per patient when treating typical lung, ovarian, prostate, and colon cancer cases.

In Nepal, community pharmacies serve as the primary source of medical care. The aim of the current study was to evaluate the effect of an educational intervention on knowledge and practice of dispensing, prescription handling and patient counseling among community pharmacists working in 3 districts (Kathmandu, Lalitpur and Bhaktapur) of Nepal. A quasi-experimental pre-post interventional study was conducted in 123 community pharmacies located in Kathmandu, Bhaktapur, and Lalitpur districts of Nepal. The research questionnaire was developed according to national and international good pharmacy practice guidelines. A structured questionnaire with mainly closed-ended and a few open-ended questions, exploring the knowledge and practice of community pharmacists in the 3 areas mentioned previously was prepared. Demographic information was also collected. The pre-tested questionnaires were completed by the community pharmacy in charge from the selected pharmacy. This data was considered as the pre-intervention data. Education sessions on good pharmacy practice were provided to all selected community pharmacists by expert pharmacists. Three weeks following the educational intervention, post-intervention data was collected at the same pharmacies. The percentage of pharmacies chosen were Kathmandu (48.8%), Lalitpur (30.9%), and Bhaktapur (20.3%). Seventy-four percent of respondents were Diploma in Pharmacy, 21.1% were bachelor's in pharmacy. The major problems faced by the pharmacists during dispensing were inadequate instructions (30.1%), followed by missing duration of therapy (24.4%) and unavailable drugs (22.0%). Other problems included dosage form errors (15.4%), illegible prescriptions (13.0%), dosing errors (13.0%), and drug interactions (13.0%). The educational intervention had a positive impact on both knowledge and practice scores among pharmacists, irrespective of their qualification level. The intervention also significantly improved pharmacists' knowledge and practice scores regardless of gender. The educational intervention improved both knowledge and practice scores in counseling, prescription handling and dispensing. Similar studies in other districts and provinces are required.

Although the association between Health Literacy and Mental Health has been explored in previous research, their interplay within digital technology contexts-especially among the aged-remains insufficiently studied. This study aims to explore the association between ICTs usage and the Mental Health of older adults in China and examine the moderating role of Health Literacy in this relationship. This study is a secondary data analysis based on a cross-sectional survey: 2021 Psychological and Behavioral Investigation of Chinese Residents. Descriptive statistical analysis and hierarchical multiple regression analysis were applied. In zero-order correlation analyses, the relationship between ICTs usage and Mental Health was not significant. After controlling for Health Literacy, ICTs usage had a significant negative association with Mental Health (B = -0.129, β = -.16, P < .001). Health Literacy had a positive relationship with Mental Health (B = 0.027, β = .243, P < .001). Further moderation effect analysis showed that introducing the interaction term did not increase the model's explanatory power (ΔR² = .000). Although no moderating effect was found between ICTs usage and Mental Health, Health Literacy may act as a suppressor variable to offset the negative impact of digital technology. Future Mental Health management for the aged should focus on reducing harmful ICTs usage and enhancing Health Literacy levels.

Drug use has emerged as a significant global health concern, contributing to the burden of liver diseases, particularly hepatocellular carcinoma (HCC) and cirrhosis. This study aims to assess the global burden of drug use-related HCC and cirrhosis from 1990 to 2021, using data from the Global Burden of Disease (GBD) study, and to predict future trends up to 2045. Data on drug use-related cirrhosis and HCC were collected from the GBD 2021 database. Joinpoint regression analysis to evaluate temporal trends. Health inequalities were assessed via the slope index of inequality (SII) and the concentration index (CI). Future burden was projected via Bayesian Age-Period-Cohort (BAPC) models. From 1990 to 2021, global mortality and disability-adjusted life-years (DALYs) attributable to drug use-related HCC and cirrhosis increased gradually. The age-standardized death rate (ASDR) for drug use-related HCC increased by 1.96%, whereas the age-standardized DALY rate for HCC increased, with an average annual percentage change (AAPC) of 1.36%. In contrast, the DALY rate for drug use-related cirrhosis declined annually by -0.12%. High socio-demographic index (SDI) regions, particularly high-income North America, presented the highest burden of drug use-related HCC and cirrhosis. The burden of cirrhosis attributable to drug use increased in low-middle-SDI regions. The global burden of liver cancer due to drug use has become more concentrated in high-SDI regions. Future projections indicate that deaths from drug use-related HCC and cirrhosis will continue to increase, with HCC deaths expected to increase by 150.15% and cirrhosis deaths increasing by 43.03% by 2045. The burden of drug use-related cirrhosis and HCC has increased and is projected to continue increasing. This trend highlights the urgent need for targeted public health interventions, improved access to healthcare, and effective drug use prevention strategies, particularly in high-SDI regions.

Food advertising may influence food preferences and consumption. Due to these advertisements' role in health, the present study has updated the data available on television and radio food advertisements in Iran until 2020. Meanwhile, food advertisements on billboards have been analyzed for the first time. All programs broadcast on two TV and radio channels were downloaded and saved 24 h daily for one week (November 10-16th, 2020). Also, on November 15th billboards located on the busy highways of Tehran were photographed. Validated protocols analyzed the advertisements. A total of 6026 advertisements were analyzed, including 4287 on TV, 1545 on radio, and 194 on billboards. The total duration of TV and radio advertising was 48.6 h. Food products were the most displayed advertisements on TV, radio, and billboards (33.6%). Overall, "condiments" and "desserts" were the most frequently advertised food products among all the studied media (20% and 17%, respectively). The most common advertising appeal included "High quality" on TV and billboards and "Stimulation of profiteering and profit-seeking" on the radio. Advertising violation based on Iran's regulations, Nutrient profile model for the marketing of food and non-alcoholic beverages to children in the WHO Eastern Mediterranean Region, and International Network for Food and Obesity / Non-communicable Diseases (NCDs) Research Monitoring and Action Support (INFORMAS) was reported to be 13%, 74%, and 51%, respectively. Food products ranked the highest among all the advertisements. A clear violation of domestic and international advertising regulations was observed which given the high share of food advertising in the studied media, could endanger public health. This study supports the need for stricter regulations and adherence to international standards to improve nutritional status.

We investigate whether the membership of a non-profit hospital's CEO on its board of directors is associated with CEO pay and several measures of hospital performance, including price, operating margin, quality, and service to low-income patients. Although the consequences of CEO board membership for for-profit firms have been studied extensively, the consequences for non-profits in general, and non-profit hospitals in particular, have received less attention. Because most hospitals are non-profit and non-profit hospital prices have increased rapidly over the past 20 years, this gap is important. We use regression models to estimate the association between various measures of hospital performance and CEO board membership, holding constant fixed effects denoting the hospital's county of location, hospital board size, and other hospital characteristics. We find a strong positive association between CEO board membership and non-profit hospital prices, operating margins, and CEO pay, with a weaker positive (negative) association between CEO board membership and quality (service to low-income patients). We conclude that non-profit hospitals' CEO board membership is likely associated with increases in agency costs due to a lack of separation between management and control.

Axillary surgery in breast cancer has evolved from radical dissections to selective de-escalations. Identifying patients who may safely omit sentinel lymph node biopsy (SLNB) can further reduce the surgical burden, post operative complications and financial toxicity associated with breast cancer surgical care. The MD Anderson "Nomogram To Predict Positive Sentinel Lymph Nodes After Neoadjuvant Chemotherapy" is widely available and free of charge to assess SLNB positivity post neoadjuvant chemotherapy (NACT). This study externally validates its accuracy in a sample of Pakistani women and assesses its implications for cost effective breast cancer care in a resource limited setting. Retrospective chart review of 150 women who underwent axillary sentinel lymph node biopsy post NACT at Shaukat Khanum Memorial Cancer Hospital from January 2023 to August 2024. Predicted node probability and observed positivity on histopathology were recorded. Calibration (Hosmer-Lemeshow test) and discrimination (C-index) were calculated. 98% were ductal carcinomas; tumor sub-types showed luminal A (42.7%), luminal B (4.7%), her2neu (H2N) enriched (14%) and triple negative (TNBC; 38.7%). 18% (n = 27) nodes were positive on final pathology closely aligning with the nomogram's predicted probability of 17.1 ± 10.3%. Calibration showed good model fit (P = .89) while C-index (0.64) indicated moderate discrimination. 12.6% of women would avoid costs of SLNB if omitted in the 0% to 5% bracket and 31.3% of women in the 0% to 10% bracket. TNBC demonstrated lowest positivity of 6.89% (P = .01). The MD Anderson Clinical Calculator for predicting positive sentinel lymph nodes post NACT may have a role in tailoring decisions for axillary de-escalation especially in patients with a low probability score between 0% and 10% with decrease in costs of breast cancer care in LMICs. Future studies incorporating safety of axillary surgery omission using the calculator and its economic impact are warranted.

Australians living in rural communities are more likely to experience Domestic violence (DV) than those living in urban areas. Service providers (SP) who provide support to victims of DV in these rural settings encounter some structural barriers at a systems and organizational level that may be useful in improving outreach services. However, few studies have explored SP perspectives surrounding these issues. This study aimed to explore service providers' perspectives on delivering support for DV victims in rural New South Wales (NSW), Australia. This qualitative study utilized structured interviews that were audio recorded and evaluated, using inductive thematic analysis. Ten people from the Central West region of NSW, providing support across DV services, legal services, community centers, medical centers, and the police, were interviewed. Half of the interviewees held roles in organizations that provided DV-specific services. Some service providers noted clients presented with other issues first, before disclosing their experiences with DV. Interviewees described key obstacles, including cultural attitudes, comorbid mental health and substance use disorders, and logistical impediments to leaving relationships and accessing services as barriers for victims. They identified the personal toll of their work and a lack of funding for specialized and multidisciplinary services as challenges to providing effective service delivery. Facilitators such as building trust through community services, using technology for remote support, and community support groups were effective. SP cited DV education in schools as an important avenue for primary prevention. This study highlights the significant barriers and facilitators identified by rural DV service providers in the Central West region of NSW, Australia. Despite the personal toll on providers, supportive networks helped mitigate burnout. The study advocates for increased funding, coordinated multidisciplinary services, and educational programs to address structural and cultural issues in rural DV service delivery at both the systems and organizational levels.