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

Tennessee registered the second-highest drug overdose mortality rate of any state in 2022; such deaths have grown by 90% from 2019 to 2022. Tennessee has participated in the State Unintentional Drug Overdose Reporting System (SUDORS) since 2018. An abstraction team synthesizes data for SUDORS from death certificates, autopsies, and other sources. The purpose of this study was to engage in a comprehensive qualitative evaluation of our SUDORS process to distill insights that could improve abstraction speed and quality while reducing abstractor burnout. We conducted 2 rounds of interviews and focus groups with all 7 members of the Tennessee abstraction team in late 2023 and early 2024. The researcher asked questions regarding the adequacy of the current project management approach and team communication level, abstractors' stress levels, the need for further training, and whether additional data science-based tools could be deployed to increase the speed and accuracy of abstraction. The study yielded several actionable insights for improving abstraction capacity and lessening stress burdens. Accordingly, we made changes to our project management, team communication, and training approaches; worked to better integrate our extant data science tools; and took steps to improve mental well-being. As a result, the average time it takes for an abstractor to enter a case into the NVDRS platform dropped from 12.2 to 6.5 minutes, and all team members noted a decrease in stress levels. The changes made as a result of the findings of this study will help the State keep pace with a high case load and will support abstractors' mental well-being.

Mothers of premature infants are at high risk of experiencing birth trauma and poor postpartum mental health. However, for some, this experience can lead to personal growth. This study examines Lithuanian women with preterm births, where birth-related PTSD is notably higher despite a lower preterm birth rate. Given the common emotional responses of guilt and shame, we explore whether proneness to these emotions moderates the relationship between birth-related PTSD and post-traumatic growth. A cross-sectional study was conducted using an anonymous e-survey to collect data. Women (N = 79) who experienced a preterm birth during 2020 to 2021 participated in the study at least 2 months postpartum, completing the City Birth Trauma Scale (City BiTS), the Guilt and Shame Proneness Scale (GASP), and the Post Traumatic Growth Inventory (PTGI). The relationship between birth-related post-traumatic stress and post-traumatic growth was assessed using linear regression, while the roles of guilt and shame proneness in this relationship were evaluated using moderated regression. The results showed that higher birth-related post-traumatic stress symptoms were associated with greater post-traumatic growth. However, proneness to shame-related negative self-evaluation weakened this relationship, particularly in women with very preterm births. These findings suggest that trauma models should incorporate the moderating role of shame in recovery outcomes. Women with very preterm births who are prone to shame may require more focused attention from healthcare specialists, with targeted interventions to address these emotional challenges and enhance post-traumatic growth. Additionally, policy initiatives should prioritize support programs tailored to the unique psychological needs of these women.

This study analyzed changes over time in order to identify disparities in health and oral health behaviors among adolescents from multicultural families residing in Korea. This was a cross-sectional analysis of secondary data utilizing raw data from 2011 to 2022 from the Korea Youth Risk Behavior Survey, a statistical dataset provided by the Korea Disease Control and Prevention Agency. The variables included demographic characteristics, socioeconomic characteristics, health behavior (diet, alcohol consumption, smoking), and oral health behavior (toothbrushing behavior, preventive care behavior, oral symptom experience, and school-based oral health education experience). In comparison to non-multicultural adolescents, multicultural adolescents were more likely to perceive their oral health behavior as unhealthy and less likely to engage in toothbrushing after lunch. In addition, multicultural adolescents had higher rates of soda intake and smoking experience than non-multicultural adolescents. During the period between 2011 and 2022, multicultural adolescents had less experience of dental sealants and scaling than non-multicultural adolescents. The disparities in health status and oral health behavior between the 2 groups persisted over a 12-year period. It was necessary to develop active interventions to reduce health and oral health disparities between multicultural and non-multicultural adolescents.

This study examined various factors, including social support as a mediating one, influencing subjective unmet needs (SUN) in Vietnamese older people during the COVID-19 pandemic. Using logistic regression models with a national survey on older persons, we identified determinants of SUN, and then further explored how social support moderated the association between experiencing SUN and chronic diseases. We found that about 25% of Vietnamese older persons experienced SUN during the pandemic, in which more advanced age, living alone, lack of healthcare insurance and having chronic diseases were risk factors, while higher education, better wealth, and stronger social support played as protective factors. Particularly, social support was found a significantly moderated factor between SUN and chronic diseases. Based on these findings, we argued that it would be imperative to strengthen healthcare system at the grassroot level so as to improve accessible and adequate care for older persons, especially those with chronic diseases. Also, enhancing social support via solidary family and community members, particularly in times of crisis, was recommended to address older persons' healthcare needs.

This study explored measures of subjective and objective sleep health and the association with fall occurrence and falls risk for older adults. A longitudinal observational study was conducted with participants in residential aged care (n = 36) and community dwelling (n = 35) settings. At baseline, objective sleep data involved wearing wrist worn accelerometers and measuring falls risk by walking using the Quantitative timed up and go (QTUG) of a simple, cognitive, and motor task. Subjective sleep data was collected by completing sleep diaries using the Karolinska Sleepiness Scale and sleep quality scale, respectively. Longitudinal falls data were collected at baseline, 3, 6, and 9 months. Falls risk was calculated via QTUG. Responses to a fall questionnaire were used to quantify fall occurrence. Independent samples t-test examined differences in objective and subjective sleep variables between settings. Logistic regression explored whether objective or subjective sleep variables could predict an overall fall occurrence. Linear regression determined if a particular sleep variable could predict an overall falls risk. Multiple regression determined if sleep variables could predict falls risk. No significant differences were found between residential and community-dwelling adults in subjective or objective sleep measures. Logistic regression showed no significant associations between most sleep variables and falls risk, except for average awakening length, where each additional minute was associated with a 1.8% increase in fall likelihood (OR = 1.02, 95% CI [1.00-1.03], P = .037). Conversely, higher awakening frequency was associated with reduced falls risk in the simple timed up-and-go task (R² = .21, β = -.69, P = .009, 95% CI [-1.20 to -0.18]). Findings suggest no significant differences in sleep health or falls risk between residential and community-dwelling older adults, though specific sleep disruptions showed minor associations with falls risk.

In 2018, the Ministry of Health and Social Services (MoHSS) introduced acetic acid visual inspection (AAVI) screening program and treatment of cervical precancers with cryotherapy in replacement of Pap smear intervention in Namibia. The study examines the effective use of AAVI-and-cryotherapy treatment on HPV-diagnosed women. Female patients of the reproductive age (20-49 years) group visiting 2 Namibian healthcare facilities for AAVI and cryotherapy treatment were investigated using a cross-sectional approach. The SPSS and coding themes were used to analyze data received through questionnaires and face-to-face interviews from a total of 265 participants. Written informed consent was obtained from participants for treatment and for publication. Among the women that participated in the study, 151 (62%) tested HPV positive, of which 132 (53%) were referred for cryotherapy and 19 (8%) for colposcopy treatments due to Cervical Intraepithelial Neoplasia (CIN I-III) detected. Regardless of the age groups, there was significant evidence of an association between para gravida and HPV positive (χ²(6) = 24.518; P < .001) and HPV negative (χ²(18) = 137.098; P < .001). About 80% of all participants experienced unpleasant pelvic sensations during the examination, with slight abdominal pain during and after the procedure. Ten percent experienced brownish discharges from their pelvis, of which was treated during the cryotherapy treatment. These findings suggest that MoHSS should actively re-evaluate the existing policies to promote AAVI and cryotherapy treatment.

The migratory lifestyle of nomadic communities, combined with the lack of a suitable health-related organizational structure, has made it difficult to provide health care services that can improve their health status. To achieve the concept of justice in health and sustainable development, it is imperative to improve the health status of all citizens in Iran, which consists of the nomadic communities, and urban and rural populations. In this ecological study national health indexes in nomadic tribespeople was Identified and prioritized by expert panel and fuzzy Delphi method. In the first step, the national health indexes were extracted from the literature, and then indexes that can be measured, evaluated and representative of the nomadic communities were extracted and prioritized by using fuzzy Delphi and TOPSIS methods, Questionnaire options were analyzed according to 3 criteria of economic efficiency, measurability, and simplicity in the form of 13 components and their indicators. The analysis of the results of the fuzzy Delphi method shows that the mental health component has the lowest real score in the criteria of measurability, simplicity and economic efficiency. The child care component has the highest real score in terms of economic efficiency and the vaccination component has the highest real score based on the criteria of measurability and simplicity in nomadic communities. The results of the TOPSIS method show that the components of vaccination, maternal care and child care have the highest priority for attention and investigation of their indicators in this segment of the population. In general, by designing and implementing systems to record the information of priority indexes extracted from the present study, it is possible for responsible organizations to make effective decisions and plans for the improvement of the health status of nomadic communities.

As life has become noticeably more comfortable compared to the past, there is a mounting interest in various service sectors, such as healthcare, where growing demand has led to an increase in the number facilities that supply products essential to service provision. Enhancing the service quality is critical to gaining an advantage in the fiercely competitive healthcare environment and is especially important as the outcomes encompass not only the treatment of disease but also patients' emotional and experiential satisfaction. This study presents procedural justice and two dimensions of trust as factors related to physician and patient relationship, investigating their effects on patients' intention to continue the relationship with their healthcare providers. We found that procedural justice had a positive effect on the two dimensions of trust, and the latter had a significant positive effect on the continuity intention. As this study verifies the necessity of procedural justice and trust for patients to continuously experience medical services, it is imperative for the healthcare industry to understand and incorporate these factors into their practices.

Coronavirus disease 2019 (COVID-19), a disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged initially as an isolated illness in December 2019 and later progressed to a global pandemic. Hard-hit areas were lockdown, massively disrupting medical education activities. Tele-education, previously used as a means of long-distance education emerged as a solution in the field of medical education. Tele-rotations for medical students, journal clubs and lectures via Microsoft teams, medical conferences via zoom, residency, and fellowship interviews online, all emerged during this pandemic. Some medical students and trainees found it enjoyable, cost-effective, time saving, feasible, unbiased, and preferred mode of education. Challenges related to supervision, availability, affordability, diminished communication, disturbance of streaming, or distractions due to environment. Tele-education has had a boom in the era of COVID-19. Research is needed further on effective mentoring and supervision of trainees via tele educational teaching models.

In 2018, the US Congress enacted a policy permitting Medicare Advantage (MA) plans to cover telehealth services in a beneficiary's home and through audio-only means as part of the basic benefit package of services, where prior to the policy change such benefits were only allowed to be covered as a supplemental benefit. MA plans were afforded 2 years of lead time for strategizing, negotiating, and capital investment prior to the start date (January 1, 2020) of the new coverage option. Our data analysis found basic benefit telehealth was offered by plans comprising 71% of enrollment in 2020 and increased to 95% in 2021. At the same time, remote access telehealth was offered as a supplemental benefit for 69% of enrollees in 2020, a decrease of 23% compared to 2019. These efforts by MA plans may have enabled traditional Medicare (TM) to leverage an existing telehealth infrastructure as a solution to the access issues created by public health policies requiring sheltering in place and social distancing during the COVID-19 pandemic. The success of this MA policy prompts consideration of additional flexibility beyond the standard basic benefit package, and whether such benefits reduce costs while improving access and/or outcomes in the context of a managed care environment like MA. Subject to oversight, such flexibility could potentially improve value in MA, and facilitate future changes in TM, as appropriate.