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

The Age-Friendly Health System (AFHS) movement has spread widely in recent years, with nearly 5000 healthcare organizations across the country recognized as Age-Friendly. Despite this broad recognition, there is little focus on how AFHS are implemented and the impact of implementation. The objectives of this study were to describe the strategies employed to support AFHS implementation in outpatient settings and to identify the measures used to evaluate implementation and effectiveness. We conducted a systematic review of literature from multiple databases spanning 2015 to March 2024, identified eligible studies using predefined inclusion/exclusion criteria, and extracted key data (eg, study design, study population, implementation strategies, outcomes/measures). We identified ten eligible studies from primary care clinics (N = 8), convenient care clinics (N = 1) and a cancer center (N = 1). The studies employed over 65 implementation strategies and 98 outcomes or measures. The vast majority of measures mapped to components of the 4Ms (Mobility, Mentation, Medication, What Matters), with up to ten measures per M category. Five of ten studies had reporting discrepancies and four did not fully define outcomes. The ten included studies serve as clear examples for the need for more evidence to support AFHS implementation in outpatient settings. Existing research lacks strategy specification and standardization of measures. We present gaps and opportunities to advance from AFHS "recognition" to impact.

Despite extensive global research on second-hand smoking (SHS) exposure, there is a noticeable lack of studies focusing on the knowledge and attitudes of university students in Bangladesh. This cross-sectional study aimed to address this gap by assessing the levels of knowledge and attitudes towards SHS exposure among university students in Bangladesh. Utilizing a convenience sampling technique, data were collected from 383 university students, encompassing socio-demographic information, as well as knowledge and attitude-related inquiries. Statistical analyses were conducted using SPSS software, including independent t-tests and analysis of variance (ANOVA) and multiple linear regression. The findings revealed that participants exhibited a moderate level of knowledge and attitude towards SHS exposure. Multiple linear regression identified age, gender, mother's education, and self-rated health status as significant predictors of knowledge, explaining 12.9% of its variance (R² = 0.129, F = 6.117, P < .001). Furthermore, age, gender, and living with parents emerged as significant predictors of attitude, explaining 14.7% of its variance (R² = 0.147, F = 7.165, P < .001). The study highlights the need for interventions aimed at enhancing awareness and fostering positive attitudes towards SHS exposure among university students in Bangladesh. It is recommended that university authorities organize seminars and implement health education initiatives targeting vulnerable populations to address the findings and promote a smoke-free environment on campus.

The global nursing shortage poses challenges to healthcare accessibility, clinical outcomes, and patient safety. Researchers have explored factors that influence nursing attrition, and the Nurses' Perceived Professional Benefits (NPPB) is one such factor that has gained attention. This cross-sectional study aims to assess the NPPB among registered nurses in Macao, a multicultural city with a unique healthcare system. A 33-item online questionnaire was used to collect data from 279 nurses. The questionnaire measured NPPB across 5 dimensions: positive occupational perception, personal enhancement, recognition from family and friends, decent nurse-patient relationships, and team belongingness. This study indicated that Macao nurses had a moderate level of NPPB. Nurse-patient relationships, income, and job stability received the most positive responses, while team belongingness received the lowest scores. These findings suggest that improvements are needed in team building, providing more opportunities for specialized training, and offering more career advancement opportunities.

Promoting healthy ageing would benefit from an understanding of what this means to stakeholders. We explored healthy ageing perceptions in rural and peri-urban Ugandan communities. Community dialogues, focus group discussions with older persons, community members, community-based organization leaders, key informant interviews with Ministries of Gender (2), Health (1), non-governmental organizations (3) and elderly representatives (5) were held. Thematic content analysis framework was used. Physical perceptions of ageing healthy included physical fitness, absence of health challenges, good physical appearance and looking younger. Emotional perceptions were a stress-free life with children's care, a balanced diet, basic needs and activity involvement. Socio-economic included financial stability, medical accessibility, future planning and network engagement. Spirituality, ageing with dignity and knowledge of body changes were others. The study provides insight into physical, emotional, and socio-economic perceptions of healthy ageing. Additional research in other settings would inform the UN Decade of Healthy Ageing.

Hospital mergers have increased significantly since 2010, driven by factors such as healthcare policy changes, reimbursement, economies of scale, and quality improvement goals. However, limited evidence exists about how these mergers affect the quality of care and cancer outcomes. We conducted a difference-in-differences analysis to assess the impact of hospital consolidation on cancer outcomes. Using data from the Surveillance, Epidemiology, and End Results (SEER) program, we identified cancer patients diagnosed between 2008 and 2016, then used the Health Cost Institute's Healthy Marketplace Index to assess hospital consolidation as measured by the Herfindahl-Hirschman Index (HHI). The HHI is a measure of market concentration and competition between firms in a given industry. We found that increases in hospital consolidation were associated with a higher likelihood of early-stage cancer diagnosis compared to control areas (-1.1%, 95% confidence interval (CI) -2.3 to 0.0%), and improved overall survival (hazard ratio 0.94, CI 0.90-0.98). These improvements were restricted to cancers with screening recommendations. Our study suggests that hospital consolidation may have some benefits for cancer patients. However, these benefits may not be evenly distributed across all cancer types. Further research is needed to confirm these findings and to understand the mechanisms by which hospital consolidation affects cancer outcomes.

Physical activity is recommended for older adults; however, the benefits of previous active engagement in physical activity that can be sustained after one becomes inactive remain to be determined. This study investigated the longitudinal associations between physical activity engagement patterns and older adults' well-being. This population-based cohort study used data from the China Health and Retirement Longitudinal Study between 2015 and 2020. People aged 60 years and above were included, and they were categorized as active engagers if they reported engaging in at least 10 min of moderate and/or vigorous exercise consecutively per week in each survey year. Older adults' well-being was evaluated using the healthy aging score, and geographical variations were visualized. The generalized estimating equations model was adopted to examine the differences between various physical activity engagement patterns and older adults' well-being. Among the 3300 older adults (50.5% men; age 66.9 ± 5.7 years) during the five years of follow-up, engagement in physical activity increased from 31.7% to 59.6%. However, their well-being decreased gradually, especially among those who were inactive engagers (beta = -0.20 to -0.21). Physical activity engagement patterns appeared to slow decline in well-being. Geographical variations were noted, with more favorable healthy aging scores observed in northern China than in southern China. As older adults age, well-being deteriorates, and disengagement of physical activity accelerates the rate of decline. Re-engagement in physical activity can slow the rate of decline in well-being. Early identification of and intervention in inactive engagement in physical activity reduce the detrimental effects on older adult's well-being. A national health initiative is an effective strategy to create a supportive environment for older adults to continue and engage in physical activity. The participation of healthcare professionals and community parties is important to encourage and engage older adults in physical activity.

Supplement use is influenced by personal factors such as sex, knowledge, health status, and sociocultural factors. Korean women with musculoskeletal disease commonly use dietary supplements for purposes such as symptom relief. This study aimed to identify the differences in demographics, health status, and functional health literacy depending on the use of dietary supplements in Korean women with musculoskeletal disease. A cross-sectional study and secondary data analysis were designed using a representative, multilevel stratified cluster sample from the 8th wave (2019) of the National Health and Nutrition Examination Survey, a national statistical survey encompassing health status, health behaviors, and food and nutrient consumption. Data on 804 women aged 20 years or older with musculoskeletal disease were included. A complex samples χ²-test was conducted to compare all variables such as demographics, health status, and functional health literacy. As results, significant differences were found between the dietary supplement user and non-user groups in terms of age (χ² = 12.21, P = .009), type of health insurance (χ² = 4.01, P = .049), education level (χ² = 42.86, P < .001), and presence of diabetes mellitus (χ² = 9.16, P = .005). Functional health literacy was higher in the user group than in the non-user group (χ² = 5.48, P = .050). We found that younger individuals with health insurance, higher educational levels, and functional health literacy, and who do not have diabetes are likely to use dietary supplements. Healthcare providers should continue to monitor the use of dietary supplements among women with musculoskeletal diseases to ensure their safe and effective use.

The Japanese health care system provides universal coverage with relatively low cost sharing and patients have a free choice of providers. Although Japan's government price controls have helped to restrain the growth in health care spending, the country's rapidly growing elderly population and adoption of new drugs and technologies have placed increased fiscal pressures on its health care system. Additionally, the Japanese health care system does not have the infrastructure in place to restrain utilization, which may be a key driver of increases in health care spending. Although the US health care system has many shortcomings, such as the highest health care prices among developed countries and a significant uninsured population, it has been able to manage utilization by using various tools, such as prior authorization and gatekeeping. The US health care system might be able to offer Japan some lessons on ways to reduce unnecessary utilization and supply to create greater value in its health care system.

Adolescence is characterized by heightened emotion dysregulation, impulsivity, and engagement in high-risk behaviors, such as substance use, violence, and unprotected sexual activity. Dialectical Behavioral Therapy for Adolescents (DBT-A) is an evidence-based intervention that targets emotion regulation and impulsivity among adolescents, proven effective at decreasing high-risk behaviors. However, limited research exists on adolescents' perceptions of DBT-A, particularly in schools. The current study aimed to understand adolescents' perspectives on a DBT-A skills group delivered within urban high schools in a midwestern state. The study sample of 18 youth (mean age 14.7; 66.7% male; 38.9% Black) completed individual semi-structured qualitative interviews assessing their perspectives on the DBT-A skills group. Interview topics included the program's impact on youths' daily lives, risk-taking behaviors, skill acquisition, and general feedback about the group. Fifteen of the eighteen participants (86%) reported acceptability of the program, expressing that they enjoyed the content and would recommend the group to peers. Participants observed positive impacts on their daily lives, including self-reported enhanced ability to regulate their emotions, communicate with teachers, effectively adapt their mindsets and motivations, and make healthy relationship decisions. Additionally, some noted an increased feeling of connection to their peers following the group. Delivering the DBT-A skills group in schools was shown to have high rates of acceptability among youth and resulted in improved emotion regulation and reduced impulsivity. Further research is needed to assess long-term effects of this program and to identify best training practices for school staff to implement and sustain the program long-term.

While telegenetic counseling has increased substantially since the start of the COVID-19 pandemic, previous studies reported concerns around building rapport, nonverbal communication, and the patient-counselor relationship. This qualitative evaluation elicited feedback from genetic counselors, referring clinicians, and patients from a single healthcare organization to understand the user-driven reasons for overall satisfaction and experience. We conducted 22 in-depth, semi-structured interviews with participants from all 3 groups between February 2022 and February 2023. Interview recordings were transcribed and analyzed using a pragmatic thematic approach. Participants across all groups felt the style and content of the genetic counseling visit lent itself perfectly to telegenetics specifically because of no physical exam component. Most patient and counselor participants expressed having the genetic counseling over phone or video had no impact on the patient-counselor relationship or the amount of trust and emotional connection they were able to achieve remotely. Preference for visit type can be influenced by in-person masking requirements impeding full facial expressions or expressing strong emotions over phone. All respondents expressed strong support for all modalities going forward. Counselors with broad experience across platforms should be the focus of future recruitment as should patient education around the nature of the genetic counseling visit and the accuracy of various testing options. Telegenetic programs should consider perspectives from all 3 groups to ensure that specific needs of each are addressed.