Pub Date : 2024-09-14DOI: 10.1177/00469580241273148
Songyuan Deng, Kevin Bennett
Introduction:This study aims to examine the association between provider attributes, including network (patient panel size, degree-number of peer connections, and community size- number of a closely connected group of peers) and individual attributes (travel distance, specialties, and rural practice), and a predominant (most visited) provider.Methods:This study utilized South Carolina’s Medicaid claims data during 2014 to 2018, focusing on live births in hospitals. Samples were limited to pregnant women continuously enrolled in Medicaid throughout pregnancy. Predominant providers (total = 2153) were identified for 29 569 pregnancies. Network analyses involved 5520 providers, comprising 3667 antenatal care (ANC) providers and 1853 non-ANC providers. A Cartesian product (n = 45 929 845) combined five annual provider lists with all included pregnancies. Logistic regressions with repeated measures were applied to this retrospective case-control study.Results:The results demonstrated that a medium or large degree were associated with being a predominant provider if the community size was medium or large. A predominant provider was more likely to be located near, rather than far from, the served woman, and in rural areas rather than urban ones. They were also more likely to be specialists, midwives, and nurse practitioners than primary care physicians.Conclusion:The results suggest that both individual and network attributes were significantly associated with being a predominant provider. Policies aimed at addressing access issues for antenatal care should consider both the individual and network attributes of providers, as providers may not be able to alter their individual attributes but can always optimize their social network.
{"title":"Provider’s Individual and Network Attributes in the Selection Process of a Predominant Antenatal Care Provider in South Carolina: A Case-Control Study","authors":"Songyuan Deng, Kevin Bennett","doi":"10.1177/00469580241273148","DOIUrl":"https://doi.org/10.1177/00469580241273148","url":null,"abstract":"Introduction:This study aims to examine the association between provider attributes, including network (patient panel size, degree-number of peer connections, and community size- number of a closely connected group of peers) and individual attributes (travel distance, specialties, and rural practice), and a predominant (most visited) provider.Methods:This study utilized South Carolina’s Medicaid claims data during 2014 to 2018, focusing on live births in hospitals. Samples were limited to pregnant women continuously enrolled in Medicaid throughout pregnancy. Predominant providers (total = 2153) were identified for 29 569 pregnancies. Network analyses involved 5520 providers, comprising 3667 antenatal care (ANC) providers and 1853 non-ANC providers. A Cartesian product (n = 45 929 845) combined five annual provider lists with all included pregnancies. Logistic regressions with repeated measures were applied to this retrospective case-control study.Results:The results demonstrated that a medium or large degree were associated with being a predominant provider if the community size was medium or large. A predominant provider was more likely to be located near, rather than far from, the served woman, and in rural areas rather than urban ones. They were also more likely to be specialists, midwives, and nurse practitioners than primary care physicians.Conclusion:The results suggest that both individual and network attributes were significantly associated with being a predominant provider. Policies aimed at addressing access issues for antenatal care should consider both the individual and network attributes of providers, as providers may not be able to alter their individual attributes but can always optimize their social network.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"1 1","pages":"469580241273148"},"PeriodicalIF":1.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-14DOI: 10.1177/00469580241241268
Iffat Elbarazi, Jamila Al-Balushi, Aisha Al-Dhaheri, Mumtaz Meeran, Mariana Peyroteo, Marília Silva Paulo, Michal Grivna
Community-based intervention (CBI) programs promote lifestyle changes, modify risk factors, and substantially improve public health. Social mobilization and community involvement improve health outcomes, reduce health disparities, and improve access to care and services. Health intervention program evaluations are essential to provide evidence-based strategies that can enhance the design and implementation of successful health promotion programs. Interventions that enable the United Arab Emirates (UAE) community to change and modify unhealthy behaviors were the priority of the last decade and are the health authorities’ objectives. The Department of Health Abu Dhabi launched a wellness program to enable the community to adopt healthy behaviors. The Public Health Ambassadors program is a community-based health intervention program under the Abu Dhabi Public Health Centre, inaugurated in 2019. This paper describes the Public Health Ambassadors CBI conducted in Abu Dhabi. The implementation science framework was used to develop the intervention. The Public Health Ambassadors is one of the UAE’s earliest and most successful CBIs. The program can be used as a model to encourage more health promotion interventions in the country and the region. The role of the program was highlighted during the COVID-19 pandemic. Voluntary community participation and social responsibilities are essential competencies promoted by this program.
{"title":"Public Health Ambassadors: A Novel Participatory Community Health Awareness Program in Abu Dhabi","authors":"Iffat Elbarazi, Jamila Al-Balushi, Aisha Al-Dhaheri, Mumtaz Meeran, Mariana Peyroteo, Marília Silva Paulo, Michal Grivna","doi":"10.1177/00469580241241268","DOIUrl":"https://doi.org/10.1177/00469580241241268","url":null,"abstract":"Community-based intervention (CBI) programs promote lifestyle changes, modify risk factors, and substantially improve public health. Social mobilization and community involvement improve health outcomes, reduce health disparities, and improve access to care and services. Health intervention program evaluations are essential to provide evidence-based strategies that can enhance the design and implementation of successful health promotion programs. Interventions that enable the United Arab Emirates (UAE) community to change and modify unhealthy behaviors were the priority of the last decade and are the health authorities’ objectives. The Department of Health Abu Dhabi launched a wellness program to enable the community to adopt healthy behaviors. The Public Health Ambassadors program is a community-based health intervention program under the Abu Dhabi Public Health Centre, inaugurated in 2019. This paper describes the Public Health Ambassadors CBI conducted in Abu Dhabi. The implementation science framework was used to develop the intervention. The Public Health Ambassadors is one of the UAE’s earliest and most successful CBIs. The program can be used as a model to encourage more health promotion interventions in the country and the region. The role of the program was highlighted during the COVID-19 pandemic. Voluntary community participation and social responsibilities are essential competencies promoted by this program.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"22 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142260093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-30DOI: 10.1177/00469580241248101
Mustapha Immurana, Desmond Klu, Matilda Aberese-Ako, Ibrahim Abdullahi
In Ghana, malaria remains the number 1 reason for outpatient department visits, making it a major public health problem. Thus, there could be significant lost productivity days as a result of malaria morbidity and mortality, which could negatively affect economic output at the macrolevel. Nonetheless, there is a dearth of empirical evidence of the effect of malaria on macroeconomic output in Ghana. This study therefore aims to provide the foremost empirical evidence regarding the effect of malaria prevalence on macroeconomic output in Ghana using a time series design with data spanning the period 1990 to 2019. Gross Domestic Product (GDP), serving as a proxy for macroeconomic output, is the dependent variable, while the prevalence of malaria (overall, among only males and among only females) serves as the main independent variable. The Ordinary Least Square (OLS) regression is used as the baseline estimation technique and the Instrumental Variable Two-Stage Least Square (IV2SLS) regression is employed as the robustness check estimator due to its ability to deal with endogeneity. The IV2SLS regression results show that a percentage increase in the overall prevalence of malaria is associated with a 1.16% decrease in macroeconomic output at 1% significance level. We also find that the effect of malaria in males on macroeconomic output is slightly higher relative to females. The findings from the OLS regression are not qualitatively different from the IV2SLS regression estimates. There is therefore the need to strengthen efforts such as quality case management, larval source management, mass distribution of long-lasting insecticide-treated bed nets, social behavior change, surveillance (both epidemiological and entomological), intermittent preventive treatment of malaria in pregnancy, research among others, which are important toward eliminating malaria.
{"title":"Malaria Prevalence and Macroeconomic Output in Ghana, 1990 to 2019","authors":"Mustapha Immurana, Desmond Klu, Matilda Aberese-Ako, Ibrahim Abdullahi","doi":"10.1177/00469580241248101","DOIUrl":"https://doi.org/10.1177/00469580241248101","url":null,"abstract":"In Ghana, malaria remains the number 1 reason for outpatient department visits, making it a major public health problem. Thus, there could be significant lost productivity days as a result of malaria morbidity and mortality, which could negatively affect economic output at the macrolevel. Nonetheless, there is a dearth of empirical evidence of the effect of malaria on macroeconomic output in Ghana. This study therefore aims to provide the foremost empirical evidence regarding the effect of malaria prevalence on macroeconomic output in Ghana using a time series design with data spanning the period 1990 to 2019. Gross Domestic Product (GDP), serving as a proxy for macroeconomic output, is the dependent variable, while the prevalence of malaria (overall, among only males and among only females) serves as the main independent variable. The Ordinary Least Square (OLS) regression is used as the baseline estimation technique and the Instrumental Variable Two-Stage Least Square (IV2SLS) regression is employed as the robustness check estimator due to its ability to deal with endogeneity. The IV2SLS regression results show that a percentage increase in the overall prevalence of malaria is associated with a 1.16% decrease in macroeconomic output at 1% significance level. We also find that the effect of malaria in males on macroeconomic output is slightly higher relative to females. The findings from the OLS regression are not qualitatively different from the IV2SLS regression estimates. There is therefore the need to strengthen efforts such as quality case management, larval source management, mass distribution of long-lasting insecticide-treated bed nets, social behavior change, surveillance (both epidemiological and entomological), intermittent preventive treatment of malaria in pregnancy, research among others, which are important toward eliminating malaria.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"50 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140835404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-29DOI: 10.1177/00469580241248100
Mariko Nagayoshi, Mika Ogata, Nami Hirai, Jun Kido
A series of 3 direct-type earthquakes with magnitude ≥6 occurred in the Kumamoto Prefecture, located in the western area of Japan, between April 14 and 16, 2016. Children with food allergies (FA) had difficulty procuring allergen-free meals during this period due to the infrastructure shutdown. We investigated the status of children with FA during the 2016 Kumamoto Earthquake and their behavioral changes after the disaster. We conducted a survey of the parents of 59 children with FA (median: 4 years and 1 month old) who were clinically followed up at our institution. They were questioned about their behavior change to allergen removal and using allergen-free foods during the disaster. Forty-seven (79.7%) children with FA were evacuated immediately after the earthquake and returned to their homes after the restoration of lifelines. Most stayed in their cars, while a few took shelter at public evacuation sites. Thirty-eight children (64.4%) had difficulty obtaining allergen-free food, and 29 children with FA (49.2%) did not have a stockpile at home. Thirty-three children with FA (55.9%) consumed allergen-free foods acquired primarily through relief supplies. Forty-seven guardians (79.7%) insisted that stockpiling allergy-friendly foods at home should be a part of future disaster planning. Stockpiles of allergen-free food were not sufficient in most households. Awareness of self-stockpiling allergen-free foods, reassessing public stockpiling, and establishing a system to provide information regarding relief supplies to evacuees outside evacuation centers are important for disaster planning in children with FA.
{"title":"Disaster Preparedness for Children With Food Allergies During the 2016 Kumamoto Earthquake—Observational Study","authors":"Mariko Nagayoshi, Mika Ogata, Nami Hirai, Jun Kido","doi":"10.1177/00469580241248100","DOIUrl":"https://doi.org/10.1177/00469580241248100","url":null,"abstract":"A series of 3 direct-type earthquakes with magnitude ≥6 occurred in the Kumamoto Prefecture, located in the western area of Japan, between April 14 and 16, 2016. Children with food allergies (FA) had difficulty procuring allergen-free meals during this period due to the infrastructure shutdown. We investigated the status of children with FA during the 2016 Kumamoto Earthquake and their behavioral changes after the disaster. We conducted a survey of the parents of 59 children with FA (median: 4 years and 1 month old) who were clinically followed up at our institution. They were questioned about their behavior change to allergen removal and using allergen-free foods during the disaster. Forty-seven (79.7%) children with FA were evacuated immediately after the earthquake and returned to their homes after the restoration of lifelines. Most stayed in their cars, while a few took shelter at public evacuation sites. Thirty-eight children (64.4%) had difficulty obtaining allergen-free food, and 29 children with FA (49.2%) did not have a stockpile at home. Thirty-three children with FA (55.9%) consumed allergen-free foods acquired primarily through relief supplies. Forty-seven guardians (79.7%) insisted that stockpiling allergy-friendly foods at home should be a part of future disaster planning. Stockpiles of allergen-free food were not sufficient in most households. Awareness of self-stockpiling allergen-free foods, reassessing public stockpiling, and establishing a system to provide information regarding relief supplies to evacuees outside evacuation centers are important for disaster planning in children with FA.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"11 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140834927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
During COVID-19 pandemic, telemedicine was a strategy to facilitate healthcare service delivery minimizing the risk of direct exposure among people. In Thailand, the National Health Security Office has included telemedicine services under the Universal Coverage Scheme to support social distancing policies to reduce the spread of COVID-19. This study aimed to determine the patterns of telemedicine service use during major COVID-19 outbreaks including Alpha, Delta, and Omicron in Thailand. We retrospectively analyzed a dataset of telemedicine e-claims from the National Health Security Office, which covers services reimbursed under the Universal Coverage Scheme between December 2020 and August 2022. An interrupted time-series analysis, Pearson correlation analysis and binary logistic regression were performed. Almost 70% of the patients using telemedicine services were over 40 years old. Most patients used services for mental health problems (25.6%) and major noncommunicable diseases, including essential hypertension (12.6%) and diabetes mellitus (9.2%). The daily number of using telemedicine service was strongly correlated with the number of COVID-19 new cases detected. An immediate change in the trend of using telemedicine was detected at the onset of outbreaks along with the surge of infection. The follow-up use of telemedicine services was not substantial among female, older adults patients and those with non-communicable diseases except mental health problems, and infectious diseases. Strategies need to be developed to reinforced healthcare resources for telemedicine during the surge of outbreaks and sustain the use of telemedicine services for chronic and infectious diseases, regardless of the pandemic, and promote the efficiency of healthcare systems.
{"title":"Telemedicine Utilization Patterns and Implications Amidst COVID-19 Outbreaks in Thailand Under Public Universal Coverage Scheme","authors":"Nyi-Nyi Zayar, Nitichen Kittiratchakool, Thanayut Saeraneesopon, Rukmanee Butchon, Saudamini Vishwanath Dabak, Patiphak Namahoot, Tanasak Kaewchompoo, Pritaporn Kingkaew, Yot Teerawattananon, Wanrudee Isaranuwatchai","doi":"10.1177/00469580241246466","DOIUrl":"https://doi.org/10.1177/00469580241246466","url":null,"abstract":"During COVID-19 pandemic, telemedicine was a strategy to facilitate healthcare service delivery minimizing the risk of direct exposure among people. In Thailand, the National Health Security Office has included telemedicine services under the Universal Coverage Scheme to support social distancing policies to reduce the spread of COVID-19. This study aimed to determine the patterns of telemedicine service use during major COVID-19 outbreaks including Alpha, Delta, and Omicron in Thailand. We retrospectively analyzed a dataset of telemedicine e-claims from the National Health Security Office, which covers services reimbursed under the Universal Coverage Scheme between December 2020 and August 2022. An interrupted time-series analysis, Pearson correlation analysis and binary logistic regression were performed. Almost 70% of the patients using telemedicine services were over 40 years old. Most patients used services for mental health problems (25.6%) and major noncommunicable diseases, including essential hypertension (12.6%) and diabetes mellitus (9.2%). The daily number of using telemedicine service was strongly correlated with the number of COVID-19 new cases detected. An immediate change in the trend of using telemedicine was detected at the onset of outbreaks along with the surge of infection. The follow-up use of telemedicine services was not substantial among female, older adults patients and those with non-communicable diseases except mental health problems, and infectious diseases. Strategies need to be developed to reinforced healthcare resources for telemedicine during the surge of outbreaks and sustain the use of telemedicine services for chronic and infectious diseases, regardless of the pandemic, and promote the efficiency of healthcare systems.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"51 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140811266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-26DOI: 10.1177/00469580241248098
Shahzad Rauf, Samar Shah, Zainab Bibi, Rabiya Munir, Hamna Jiskani, Saeed Ahmad, Syed Adil Mir Shah, Aysha Bibi, Hafiz Fasih Ahmad, Kashif Hussain, Shabina Ariff, Gul Ambreen
Apnea and poor respiratory drive increase the risk of extubation failure (EF) and prolonged invasive mechanical ventilation (IMV) in preterm neonates (pre-nates) with respiratory distress. Caffeine citrate (CC) is often prescribed for pre-nates in doses of 5–10 mg/kg in 24 h. This study aimed to evaluate the most effective dosage regimen (5 mg/kg/day vs >5-10 mg/kg/day) to prevent apnea and EF with minimal caffeine-associated potential side effects (CC-APSEs) in pre-nates. This one-year retrospective cohort study included all the eligible neonates admitted to NICU and received CC-therapy till 28 days of life (DOL) or discharge. Based on CC-daily dose formed LD-caffeine-group (5 mg/kg/day) and HD-caffeine-group (>5-10 mg/kg/day). Antenatal, prenatal, and postnatal characteristics, CC-regimen, comorbidities, and CC-APSEs were compared between the groups. Predictors of apnea and EF were analyzed through logistic regression. There were 181 and 72 neonates in the LD and HD-caffeine-groups respectively. In HD-caffeine-group daily CC-dose was 7 to 7.5 mg/kg/day in 93% of neonates and >7.5 to 10 mg/kg/day in only 7%. Significantly fewer neonates experienced apnea and EF in the HD-caffeine-group till 28DOL or discharge. This difference was even greater in the subgroup of ≤28 weeks GA (15.6% vs 40.0%; P < .01). In HD-caffeine-group the incidence of severe/moderate-BPD was significantly lower and the frequency of CC-APSEs was higher. Multivariate analysis showed that; the smaller the GA higher the risk of apnea (AOR = 0.510, 95% CI 0.483-0.999) and EF (AOR = 0.787, 95% CI 0.411-0.997). The HD-caffeine was inversely associated with developing apnea (AOR = 0.244, 95% CI 0.053-0.291) and EF (AOR = 0.103, 95% CI 0.098-2.976). IMV-duration before extubation (AOR = 2.229, 95% CI 1.672-2.498) and severe/moderate-BPD (AOR = 2.410, 95%CI 1.104-2.952) had a high risk of EF. Initiating early HD-caffeine may prevent apnea and extubation failure in preterm neonates. Optimization of caffeine initiation time and dosages can be a safe and feasible approach to decrease the burden of neonatal respiratory morbidities.
呼吸暂停和呼吸动力不足会增加呼吸窘迫的早产新生儿拔管失败（EF）和有创机械通气（IMV）时间延长的风险。本研究旨在评估最有效的剂量方案（5 毫克/千克/天 vs >5-10 毫克/千克/天），以预防早产新生儿呼吸暂停和 EF，同时将咖啡因相关的潜在副作用（CC-APSEs）降至最低。这项为期一年的回顾性队列研究纳入了所有入住新生儿重症监护室并在出生后 28 天（DOL）或出院前接受过 CC 治疗的合格新生儿。根据CC的每日剂量，分为低密度咖啡因组（5毫克/千克/天）和高密度咖啡因组（5-10毫克/千克/天）。比较了各组的产前、产时和产后特征、CC调节、合并症和CC-APSE。通过逻辑回归分析了呼吸暂停和EF的预测因素。LD组和HD咖啡因组分别有181和72名新生儿。在高密度咖啡因组中，93%的新生儿每日CC剂量为7至7.5毫克/千克/天，只有7%的新生儿每日CC剂量为7.5至10毫克/千克/天。在 HD 咖啡因组中，直到 28DOL 或出院时出现呼吸暂停和 EF 的新生儿明显较少。在体重≤28周的亚组中，这一差异更大（15.6% vs 40.0%; P <.01）。在 HD 咖啡因组中，重度/中度 BPD 的发生率明显降低，而 CC-APSE 的发生率较高。多变量分析显示：GA 越小，呼吸暂停（AOR = 0.510，95% CI 0.483-0.999）和 EF（AOR = 0.787，95% CI 0.411-0.997）的风险越高。高清咖啡因与发生呼吸暂停（AOR = 0.244，95% CI 0.053-0.291）和 EF（AOR = 0.103，95% CI 0.098-2.976）呈反向关系。拔管前IMV持续时间（AOR = 2.229，95% CI 1.672-2.498）和重度/中度BPD（AOR = 2.410，95% CI 1.104-2.952）对EF有较高风险。在早产新生儿中尽早开始使用 HD 咖啡因可预防呼吸暂停和拔管失败。优化咖啡因的使用时间和剂量是减少新生儿呼吸系统疾病负担的一种安全可行的方法。
{"title":"Association of Caffeine Daily Dose With Respiratory Outcomes in Preterm Neonates: A Retrospective Cohort Study","authors":"Shahzad Rauf, Samar Shah, Zainab Bibi, Rabiya Munir, Hamna Jiskani, Saeed Ahmad, Syed Adil Mir Shah, Aysha Bibi, Hafiz Fasih Ahmad, Kashif Hussain, Shabina Ariff, Gul Ambreen","doi":"10.1177/00469580241248098","DOIUrl":"https://doi.org/10.1177/00469580241248098","url":null,"abstract":"Apnea and poor respiratory drive increase the risk of extubation failure (EF) and prolonged invasive mechanical ventilation (IMV) in preterm neonates (pre-nates) with respiratory distress. Caffeine citrate (CC) is often prescribed for pre-nates in doses of 5–10 mg/kg in 24 h. This study aimed to evaluate the most effective dosage regimen (5 mg/kg/day vs >5-10 mg/kg/day) to prevent apnea and EF with minimal caffeine-associated potential side effects (CC-APSEs) in pre-nates. This one-year retrospective cohort study included all the eligible neonates admitted to NICU and received CC-therapy till 28 days of life (DOL) or discharge. Based on CC-daily dose formed LD-caffeine-group (5 mg/kg/day) and HD-caffeine-group (>5-10 mg/kg/day). Antenatal, prenatal, and postnatal characteristics, CC-regimen, comorbidities, and CC-APSEs were compared between the groups. Predictors of apnea and EF were analyzed through logistic regression. There were 181 and 72 neonates in the LD and HD-caffeine-groups respectively. In HD-caffeine-group daily CC-dose was 7 to 7.5 mg/kg/day in 93% of neonates and >7.5 to 10 mg/kg/day in only 7%. Significantly fewer neonates experienced apnea and EF in the HD-caffeine-group till 28DOL or discharge. This difference was even greater in the subgroup of ≤28 weeks GA (15.6% vs 40.0%; P < .01). In HD-caffeine-group the incidence of severe/moderate-BPD was significantly lower and the frequency of CC-APSEs was higher. Multivariate analysis showed that; the smaller the GA higher the risk of apnea (AOR = 0.510, 95% CI 0.483-0.999) and EF (AOR = 0.787, 95% CI 0.411-0.997). The HD-caffeine was inversely associated with developing apnea (AOR = 0.244, 95% CI 0.053-0.291) and EF (AOR = 0.103, 95% CI 0.098-2.976). IMV-duration before extubation (AOR = 2.229, 95% CI 1.672-2.498) and severe/moderate-BPD (AOR = 2.410, 95%CI 1.104-2.952) had a high risk of EF. Initiating early HD-caffeine may prevent apnea and extubation failure in preterm neonates. Optimization of caffeine initiation time and dosages can be a safe and feasible approach to decrease the burden of neonatal respiratory morbidities.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"104 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140802260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-26DOI: 10.1177/00469580241249076
Eric W. Christensen, Gregory N. Nicola, Elizabeth Y. Rula, Lauren P. Nicola, Joshua A. Hirsch
Volume increases, inflation, statutory freezes in physician payments, and the budget neutrality requirement for the Medicare Physician Fee Schedule have resulted in persistent inflation-adjusted conversion factor decreases. This study aimed to determine if relative value unit (RVU) volume increases on a per beneficiary basis has counteracted conversion factor decreases and inflation to maintain Medicare reimbursement per beneficiary, overall and across specialties. Using aggregated data for 100% of Medicare part B claims (2005-2021), we computed the percentage change in reimbursement per beneficiary, nominal and inflation-adjusted, by specialty. These trends were then adjusted by separately holding constant RVUs per beneficiary and the conversion factor to demonstrate the impact of budget neutrality. Inflation-adjusted reimbursement per beneficiary increased 9.9% over the 2005 to 2021 period; this trend encapsulated a 64.8% increase in RVUs per beneficiary, offsetting a 33.6% inflation-adjusted conversion factor decline. RVU changes per beneficiary varied widely across clinicians (+45.5% for physicians to +328.2% for non-physician practitioners) and by specialty (−36.1% for cardiac surgery to +1106% for nurse practitioners). Given RVU increases, conversion factor decreases, and inflation combined, reimbursement per beneficiary decreased 2.3% for physicians and increased 16.3% for limited-license physicians and 206.5% for non-physician practitioners. Overall, increased RVU volume per beneficiary has offset conversion factor declines within the budget neutral system. However, substantial redistribution has occurred across provider types, with reimbursement declining slightly for physicians while tripling for non-physician practitioners. Certain physician specialties, particularly procedural specialties, have declined most. Future research should assess the impact of specialty-specific reimbursement changes on patients’ access to care.
{"title":"Medicare Volume Growth and Shift in Payments From Physicians to Non-Physician Practitioners Under Statutory Budget Neutrality","authors":"Eric W. Christensen, Gregory N. Nicola, Elizabeth Y. Rula, Lauren P. Nicola, Joshua A. Hirsch","doi":"10.1177/00469580241249076","DOIUrl":"https://doi.org/10.1177/00469580241249076","url":null,"abstract":"Volume increases, inflation, statutory freezes in physician payments, and the budget neutrality requirement for the Medicare Physician Fee Schedule have resulted in persistent inflation-adjusted conversion factor decreases. This study aimed to determine if relative value unit (RVU) volume increases on a per beneficiary basis has counteracted conversion factor decreases and inflation to maintain Medicare reimbursement per beneficiary, overall and across specialties. Using aggregated data for 100% of Medicare part B claims (2005-2021), we computed the percentage change in reimbursement per beneficiary, nominal and inflation-adjusted, by specialty. These trends were then adjusted by separately holding constant RVUs per beneficiary and the conversion factor to demonstrate the impact of budget neutrality. Inflation-adjusted reimbursement per beneficiary increased 9.9% over the 2005 to 2021 period; this trend encapsulated a 64.8% increase in RVUs per beneficiary, offsetting a 33.6% inflation-adjusted conversion factor decline. RVU changes per beneficiary varied widely across clinicians (+45.5% for physicians to +328.2% for non-physician practitioners) and by specialty (−36.1% for cardiac surgery to +1106% for nurse practitioners). Given RVU increases, conversion factor decreases, and inflation combined, reimbursement per beneficiary decreased 2.3% for physicians and increased 16.3% for limited-license physicians and 206.5% for non-physician practitioners. Overall, increased RVU volume per beneficiary has offset conversion factor declines within the budget neutral system. However, substantial redistribution has occurred across provider types, with reimbursement declining slightly for physicians while tripling for non-physician practitioners. Certain physician specialties, particularly procedural specialties, have declined most. Future research should assess the impact of specialty-specific reimbursement changes on patients’ access to care.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"122 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140802545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Community nurses play a key role in providing continuous home care for patients with chronic diseases. However, a perfect system of responsibilities and requirements has not yet been formed, and nurses cannot provide high-quality nursing services for home-based patients. We attempted to construct an index of the scope of practice for community nurses providing home-based transitional care for patients with chronic diseases and to guide nurses in playing an active role in transitional care work. From March to May 2023, 14 representative community nurses from the Shanghai Community Health Service Center were selected for group interviews and 2 rounds of Delphi consultation. A total of 14 valid questionnaires were collected. The authority coefficients were 0.94 and 0.93, and the Kendall coefficients were 0.56 and 0.59 for the 2 rounds of expert consultation ( P < .05). Finally, an index system, including 6 primary indices (transitional caring provider, patient self-management facilitator, community group intervention organizer, home caregiver supporter, family physician team collaborator and supervisor of home medical equipment use, and medical waste disposal) was constructed for community nurses involved in providing home-based transitional care for patients with chronic diseases. The weight values of the 6 indices were 0.19, 0.17, 0.21, 0.13, 0.14 and 0.16, respectively (CR = 0.035, and the consistency test was passed), and 16 secondary indicators and 42 tertiary indicators were identified. In this Delphi study, an index system that can be used to determine community nurses’ roles in providing home-based transitional and continuous care for patients with chronic diseases was successfully established. The index system is considered reliable and easy to use and will provide a meaningful reference for community nurses and policy-makers.
{"title":"A Delphi Study to Construct an Index of Practice for Community Nurses Providing Transitional Home Care for Patients with Chronic Diseases","authors":"Jinjin Ge, Chunyan Zhao, Jiayun Lu, Xian Zhang, Xiaoling Zhou, Rongxi Wang, Changying Jiang, Wei Sun, Shuqin Ju, Fulan wang, Weiqun Liu, Yuzhong Yan","doi":"10.1177/00469580241246474","DOIUrl":"https://doi.org/10.1177/00469580241246474","url":null,"abstract":"Community nurses play a key role in providing continuous home care for patients with chronic diseases. However, a perfect system of responsibilities and requirements has not yet been formed, and nurses cannot provide high-quality nursing services for home-based patients. We attempted to construct an index of the scope of practice for community nurses providing home-based transitional care for patients with chronic diseases and to guide nurses in playing an active role in transitional care work. From March to May 2023, 14 representative community nurses from the Shanghai Community Health Service Center were selected for group interviews and 2 rounds of Delphi consultation. A total of 14 valid questionnaires were collected. The authority coefficients were 0.94 and 0.93, and the Kendall coefficients were 0.56 and 0.59 for the 2 rounds of expert consultation ( P < .05). Finally, an index system, including 6 primary indices (transitional caring provider, patient self-management facilitator, community group intervention organizer, home caregiver supporter, family physician team collaborator and supervisor of home medical equipment use, and medical waste disposal) was constructed for community nurses involved in providing home-based transitional care for patients with chronic diseases. The weight values of the 6 indices were 0.19, 0.17, 0.21, 0.13, 0.14 and 0.16, respectively (CR = 0.035, and the consistency test was passed), and 16 secondary indicators and 42 tertiary indicators were identified. In this Delphi study, an index system that can be used to determine community nurses’ roles in providing home-based transitional and continuous care for patients with chronic diseases was successfully established. The index system is considered reliable and easy to use and will provide a meaningful reference for community nurses and policy-makers.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"46 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140802221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1177/00469580241248127
Nawal A. Alissa, Mohammed Alwargash
Health promotion and education are collaborative efforts involving patients, healthcare providers, and society, crucial for preventing and managing disease outbreaks. However, in Saudi Arabia, the actual or perceived endeavors of physicians and nurses in health education and promotion are not widely understood, which holds significant implications for those working in the field. This study aimed to evaluate the level of awareness and attitude toward health education and promotion among physicians and nurses in primary healthcare centers in Najran, Saudi Arabia. A descriptive cross-sectional study design was employed, and 187 participants were incorporated into the analysis. Questionnaires were distributed to physicians and nurses at the primary health care centers. Participants completed a face-to-face survey questionnaire about their awareness and attitude toward health education and promotion. One of the authors was physically present at the primary health care centers to assist the participants with answering the questionnaire questions. Saudis and physicians had higher awareness than non-Saudis and nurses, respectively. Work experience and institutional factors did not significantly influence awareness. A positive correlation between awareness and attitude was observed. However, perceived shortcomings in current approaches were identified, including a lack of skills and training, poor communication, and inadequate leadership support. Despite these challenges, healthcare professionals held positive attitudes toward health education, recognizing its importance in behavior change, reducing disparities, and influencing community policies. The study highlights the need for targeted interventions, including research on effective models, training programs, and improved communication and leadership support, to address identified gaps and optimize health education implementation.
{"title":"Awareness and Attitudes toward Health Education and Promotion among Physicians and Nurses: Implications for Primary Health Care","authors":"Nawal A. Alissa, Mohammed Alwargash","doi":"10.1177/00469580241248127","DOIUrl":"https://doi.org/10.1177/00469580241248127","url":null,"abstract":"Health promotion and education are collaborative efforts involving patients, healthcare providers, and society, crucial for preventing and managing disease outbreaks. However, in Saudi Arabia, the actual or perceived endeavors of physicians and nurses in health education and promotion are not widely understood, which holds significant implications for those working in the field. This study aimed to evaluate the level of awareness and attitude toward health education and promotion among physicians and nurses in primary healthcare centers in Najran, Saudi Arabia. A descriptive cross-sectional study design was employed, and 187 participants were incorporated into the analysis. Questionnaires were distributed to physicians and nurses at the primary health care centers. Participants completed a face-to-face survey questionnaire about their awareness and attitude toward health education and promotion. One of the authors was physically present at the primary health care centers to assist the participants with answering the questionnaire questions. Saudis and physicians had higher awareness than non-Saudis and nurses, respectively. Work experience and institutional factors did not significantly influence awareness. A positive correlation between awareness and attitude was observed. However, perceived shortcomings in current approaches were identified, including a lack of skills and training, poor communication, and inadequate leadership support. Despite these challenges, healthcare professionals held positive attitudes toward health education, recognizing its importance in behavior change, reducing disparities, and influencing community policies. The study highlights the need for targeted interventions, including research on effective models, training programs, and improved communication and leadership support, to address identified gaps and optimize health education implementation.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"11 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140802222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-24DOI: 10.1177/00469580241248134
Junhui Park
Null hypothesis significance testing (NHST) in medical research is increasingly being supplemented by estimation statistics, focusing on effect sizes (ESs) and confidence intervals (CIs). This study evaluates the expression of ESs and CIs for binary outcomes. A utilitarian framework is proposed, emphasizing the number of beneficiaries and the impact level. To evaluate clinical significance, minimal clinically important risk difference (MCIRD) is proposed based on event magnitude (EM). Within this framework, risk difference (RD) is introduced as the primary measure. To assess the performance of RD, we compared its statistical power against other measures (risk ratio, RR; odds ratio, OR; Cohen’s h) in individual study scenarios, and visual information conveyance in meta-analysis scenarios. RDs maintain statistical power in comparison to other measures in individual studies. They provide clarity on the true impact of clinical interventions without compromising statistical integrity. Meta-analytic results indicate that using RDs directly enhances transparency, uncovers heterogeneity, and addresses misaligned assumptions. This approach, by quantifying clinical effectiveness under a utilitarian perspective, facilitates the applicability of research to patient care and encourages shared decision-making. The study advocates for reporting baseline risks (BRs) with RDs and recommends a standardized presentation of these statistics. In a utilitarian perspective, adopting RD as the preferred ES can foster a transparent, patient-focused research ethos. This aids in accurately presenting the magnitude and variability of treatment effects, offering a new direction in methodology.
{"title":"A Utilitarian Perspective on Risk Quantification for Clinical Significance in Binary Outcomes","authors":"Junhui Park","doi":"10.1177/00469580241248134","DOIUrl":"https://doi.org/10.1177/00469580241248134","url":null,"abstract":"Null hypothesis significance testing (NHST) in medical research is increasingly being supplemented by estimation statistics, focusing on effect sizes (ESs) and confidence intervals (CIs). This study evaluates the expression of ESs and CIs for binary outcomes. A utilitarian framework is proposed, emphasizing the number of beneficiaries and the impact level. To evaluate clinical significance, minimal clinically important risk difference (MCIRD) is proposed based on event magnitude (EM). Within this framework, risk difference (RD) is introduced as the primary measure. To assess the performance of RD, we compared its statistical power against other measures (risk ratio, RR; odds ratio, OR; Cohen’s h) in individual study scenarios, and visual information conveyance in meta-analysis scenarios. RDs maintain statistical power in comparison to other measures in individual studies. They provide clarity on the true impact of clinical interventions without compromising statistical integrity. Meta-analytic results indicate that using RDs directly enhances transparency, uncovers heterogeneity, and addresses misaligned assumptions. This approach, by quantifying clinical effectiveness under a utilitarian perspective, facilitates the applicability of research to patient care and encourages shared decision-making. The study advocates for reporting baseline risks (BRs) with RDs and recommends a standardized presentation of these statistics. In a utilitarian perspective, adopting RD as the preferred ES can foster a transparent, patient-focused research ethos. This aids in accurately presenting the magnitude and variability of treatment effects, offering a new direction in methodology.","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"44 1","pages":""},"PeriodicalIF":1.7,"publicationDate":"2024-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140802381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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