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

The discourse on community violence has expanded over the years, shifting from a focus on interpersonal physical harm to a broader understanding that includes systemic and structural harm. Structural violence, characterized by institutionalized inequities in health, education, and generational wealth, disproportionately impacts marginalized communities and reflects deliberate systems of oppression designed to maintain power imbalances. In community-based violence intervention and prevention (CVIP), identifying how harm can be systematically perpetuated is critical for developing and advancing structurally grounded evaluative measures and training strategies for practitioners. This qualitative study involved interviews and focus groups with community violence intervention (CVI) practitioners (N = 45) from Sacramento, Milwaukee, and Baltimore. We analyzed participants' narratives to explore their understandings of the root causes of community-based firearm violence, with particular attention to the core tenets of structural violence: power, marginalization, oppression, adversity, and trauma. Findings revealed that CVI practitioners hold varying levels of structural violence expertise, ranging from individual-level explanations of violence to critical accounts of how systemic forces cultivate and reproduce structural harm. Participants discussed how government divestment, institutional neglect, and collective and vicarious trauma shape the conditions contributing to community violence. Their reflections underscore the need for standardized training and professional development that embeds structural frameworks into CVIP operations and program evaluations. As key actors in CVIP, CVI practitioners must be equipped with the knowledge and skills to address the structural drivers of community violence. Investing in their capacity for research and advocacy will strengthen the field's effectiveness, scale, and legitimacy in preventing community-based firearm violence through structurally informed practice and evaluation.

Cervical cancer remains the fourth most common cancer among women globally, despite being preventable with the human papillomavirus (HPV) vaccine. However, HPV vaccine uptake remains a challenge in low- and middle-income countries (LMICs), where cervical cancer elimination faces significant delays. The present study aims to identify the social determinants impacting HPV vaccine uptake in LMICs. This systematic review and meta-analysis included studies published between 2010 and 2025, identified through PubMed, Google Scholar, and ScienceDirect. Eligible studies reported HPV vaccine uptake (initiation, completion, or both) among adolescent girls aged 9 to 19 and examined at least 1 individual- or household-level social determinant. Data were thematically synthesized, and a meta-analysis was conducted using the random-effects model, with results expressed as odds ratios (ORs), with 95% confidence intervals (CIs). Eight studies, conducted in Ethiopia, Tanzania, and Uganda, were included. Key determinants assessed included age, religion, residence, parental education, occupation, wealth index, marital status, and household factors. Meta-analyses revealed wealth index (OR = 1.34; 95% CI: 1.05-1.70; P = .02) and parental marital status (OR = 0.86; 95% CI: 0.78-0.95; P < .01) as significant predictors of HPV vaccine uptake among adolescent girls in LMICs. Other factors, such as age, residence, parental education, etc., showed inconsistent effects or no significant association, with high heterogeneity across studies limiting the generalizability of some findings. This review highlights the complex, context-specific individual and household factors influencing HPV vaccine uptake among adolescent girls in LMICs. While wealth index and parental marital status showed consistent associations, other factors varied across studies. Community-based, culturally sensitive, tailored interventions are critical to improve the vaccine uptake. Continued research with standardized mixed-methods is vital to address multilevel factors and ensure equitable HPV vaccine uptake in LMICs.

Age Friendly Health Systems (AFHS) promote geriatric best practices to improve healthcare quality, minimize harms and support older adults' care preferences. AFHS-designated clinics consistently address the Geriatric 4Ms: Mentation, Mobility, Medication, and What Matters Most. The VA Eastern Colorado Health Care System tele-Palliative Care clinic achieved AFHS Level 1 and 2 recognition in 2021, becoming the first AFHS-designated telemedicine clinic in the nation. An interprofessional team and older Veterans guided planning and implementation. Using existing staff and clinic workflows, we consistently addressed the Geriatric 4Ms during visits. Specific metrics include: (1) AFHS Level 1 and 2 recognition, (2) maintenance in addressing Geriatric 4Ms in tele-Palliative Care, (3) number of patients served, (4) travel-miles saved. FY23-24, we conducted 192 AFHS tele-Palliative Care visits, 81% with rural/highly rural Veterans. We served 108 unique patients (FY23:57; FY24:51; percent decrease = 10.5%). Compared to Colorado's Veteran population, Veterans from racial/ethnic minority backgrounds and women were underrepresented; older Veterans were overrepresented. In FY23/FY24, the majority of patients were White (82%/73%), not Hispanic/Latino (83%/73%), male (100%/98%), and ≥65 (90%/89%). All 4Ms were addressed for 86% (FY23) and 76% (FY24) of unique patients. AFHS tele-Palliative Care saved Veterans/caregivers 23 622 (FY23) and 18 632 (FY24) miles of travel. Congruent with AFHS, Palliative Care focuses on physical, emotional, and psychosocial aspects of serious illness. AFHS designation in a tele-Palliative Care clinic is novel nationally. We demonstrated that evidence-based care can be provided to every older adult, regardless of care modality, without expanding staff or changing clinical workflows.

Generative artificial intelligence (genAI) tools are transforming workflows, with growing interest in their potential applications in qualitative research. While the use of genAI in facilitating the systematic review process has been explored, its application in the quality appraisal of qualitative research remains to be understood. This pilot study aims to evaluate the degree to which ChatGPT appraises qualitative research using popular appraisal tools compared to human assessments. Two reviewers applied the Critical Appraisal Skills Program (CASP) and Joanna Briggs Institute (JBI) checklists for qualitative research to studies identified through a previously published review (n = 21). Next, iteratively developed prompts along with a copy of each study were uploaded to ChatGPT to instruct it to appraise each article. Interrater reliability measures and crude agreements were conducted to estimate the level of agreement between human and genAI assessments. Interrater reliability assessments between human and ChatGPT (GPT-5) revealed no agreement to moderate agreement for CASP checklist items (kappa: <.00-.46; crude agreement: 23.8%-100%) and from none to substantial for JBI items (kappa: <.00-.83; crude agreement: 4.8%-95.2%). Agreement was highest for reporting-based elements such as study aims, ethics approval, value of research (CASP), and participant voices and conclusions (JBI). Disagreements were greatest for interpretive and context-dependent items such as research design, researcher-participant relationships, and worldview-methodology congruity. Findings demonstrate that ChatGPT (GPT-5) can reliably identify objective components yet performs inconsistently when assessing items requiring nuance and contextual understanding across both checklists. Currently, any adoption of genAI for quality appraisal of qualitative research must be carefully applied only alongside human assessments and uphold principles of transparency and data privacy.

Healthcare Value Chains (HVCs) describe the full production flow from resource input to service delivery. However, existing literature lacks a clear analytical mechanism to evaluate how Digital Health (DH) transforms these stages. This gap may lead to the misconception that any DH investment automatically enhances efficiency, overlooking the strategic pathways through which DH affects performance. To address this issue, this study proposes a 3-stage production process evaluation framework encompassing Managerial Efficiency, Technical Efficiency and Economic Efficiency to systematically assess the impact of DH on HVCs. Using longitudinal data from 38 Taiwanese hospitals between 2015 and 2021, a non-oriented 3-stage Slack-Based Measure Data Envelopment Analysis (SBM-DEA) model and a Benchmarking Matrix were employed to capture efficiency variations and identify best-performing institutions. The analysis reveals that alliance hospitals with fragmented DH systems underperform, often lagging behind stand-alone hospitals due to insufficient system integration. Conversely, specialised hospitals demonstrate superior Managerial and Technical Efficiency, reflecting the advantages of operational focus and streamlined workflows. The Benchmarking Matrix effectively identifies optimal reference groups, providing actionable insights for alliance hospitals to enhance coordination and functional alignment. This study advances HVC theory by establishing a structured analytical model that elucidates the multi-dimensional effects of DH on healthcare performance. The proposed framework not only clarifies the mechanisms linking DH adoption to efficiency improvement but also offers strategic guidance for enhancing resource utilisation and value creation within healthcare systems.

Community organizations strive to help survivors of intimate partner violence (IPV), stalking, sexual assault and human trafficking address health and safety needs. Hotline, offered by local agencies, is the first line of support for survivors to address needs. Increasingly, hotline is offered in digital formats (chat and text) to meet the emergent needs of survivors. Despite the growing use of digital hotline, little is known about short-term health and safety changes associated with use. Partnering with 2 local agencies in a Southern state, we recruited first-time digital hotline participants to an online baseline and follow-up (6 weeks later) assessment (n = 237) to examine changes in health (e.g. physical health, depression, PTSD) and safety (tools related to safety, perception of safety). Descriptive statistics, paired sample t-tests, chi-square, and regression modeling were used for data analysis. At 6 weeks post-digital hotline use, depression and PTSD symptoms had significantly decreased, and hope and feelings of safety had significantly increased. No changes were observed for physical health. Repeated hotline use after baseline was associated with revictimization, sustained health needs, and reduced perception of internal tools related to safety. Longer-term and expanded study are needed of digital hotline to further examine potential impacts, however these findings suggest that hotline is not merely a conduit to other services, but a potentially impactful intervention into itself.

Isolation facilities are essential to pandemic response, yet the economic trade-offs of repurposing existing hospitals remain poorly characterised. This study quantifies both the operational costs and the revenue foregone from converting Tigoni Level 4 Hospital (TL4H) into Kiambu County's sole COVID-19 isolation centre. Our study focused on estimating recurrent and labour costs, considering only capital costs incurred during the study period. We conducted a cost analysis at the facility level, assessing all expenditures incurred by TL4H between June 2020 and February 2022, using an activity-based costing approach to allocate costs to specific operational activities. Sensitivity analyses, including one-way and 10,000-draw Monte Carlo PSA, estimated uncertainty in total and per-patient costs. The total operational cost of the isolation centre over the 21 months was KES 489,220,113.98 (USD 4,181,011.14). This translates to an annual operating cost of KES 279,554,350.85 (USD 2,389,149.23). The average cost of managing one COVID-19 patient regardless of severity was estimated as KES 337,626.03 (USD 2885.45). The revenue foregone by waiving user fees for COVID-19 patients was KES 160,678,901.00 (USD 1,374,236). Sensitivity analysis indicated that HRH costs (78.9% of total expenditure) had the largest influence: a ±20% change shifted total costs by ±KES 77.6 million (USD 663,191.18). PSA results showed a mean total operational cost of KES 489,212,852 (USD 4,180,949.08; 95% UI: 414,803,680-573,687,849), and a mean cost per patient of KES 337,621.02 (USD 2885.40; 95% UI: 286,268.93-395,919.84). Repurposing TL4H as a COVID-19 isolation centre was resource-intensive, highlighting the importance of strategic budget planning and resource allocation for future preparedness.

The Age-Friendly Health Systems movement has demonstrated remarkable reach, with thousands of health systems now recognized as Age-Friendly. We have served as co-Editors of this Special Issue, which comes at a pivotal time in the Age-Friendly Health System movement. Published in this Special Issue are articles that meaningfully move the field forward by: (1) describing implementation and effects of Age-Friendly adoption across diverse settings of care; (2) contending with the challenge of consistent measurement of the 4Ms of Age-Friendly Care; (3) rigorously evaluating how best to implement and evaluate Age-Friendly care processes; and (4) exploring how policy levers align with Age-Friendly principles. These articles also reveal that while the Age-Friendly Movement has achieved tremendous breadth, the movement must pivot to achieve depth of clinical practice to ensure all older adults receive Age-Friendly care, and depth of research rigor to demonstrate impact and promote sustainability. To make this transition, novel tools are needed to make Age-Friendly care delivery integrated into workflows and the standard of care for older adults. In addition, alignment between payment and policy levers and Age-Friendly implementation must be expanded-including investing in higher levels of recognition that recognize depth of practice, and investment in Age-Friendly Learning Health Systems to encourage both depth of clinical practice and research rigor.

Bundled payment programs aim to align the incentives of acute and post-acute providers during an episode of care. Prior studies of the impact of bundled payments on hospital length of stay (LOS) were mixed, and none evaluated hospital exposure to bundled payments across all payers (public and commercial). In this study, we used the American Hospital Association survey data for 2016 to 2022 to compare the LOS of hospitals that participated in bundled payments to those that did not participate. We used regression analysis with interaction terms to compare the changes in LOS of hospitals that participated in bundled payments with concurrent changes in LOS of hospitals that did not participate in bundled payments. The models included hospital and year fixed effects. We also conducted subgroup analyses by payer type. All-payer LOS was not associated with participation in bundled payment (ATT 0.08 days; 95% CI -0.34, 0.17; P = .54). Participation in bundled payments was associated with slightly longer LOS for stays paid for by Medicare (ATT 0.13 days, 95% CI 0.02, 0.25; P = .03), but not for the other payer types. Bundled payment program participation had a negligible impact on hospital LOS, acknowledging the limitation that the impact might be diminished due to evaluating average LOS across all admissions rather than condition-specific bundled payment programs.

This convergent parallel mixed-methods study examined how a primary care value-based payment (VBP) model affected patient health care use and captured implementation experiences from select clinics. Focusing on outpatient care as a key step to improving outcomes, we used a difference-in-differences model to compare outpatient utilization between PCPM (the VBP model) and non-PCPM clinics, and semi-structured interviews with a subset of participating clinics to explore implementation efforts on the ground. We identified our quantitative study population (cases N = 68 807; control N = 71 695) and outcomes from Oregon's All Payer All Claims (APAC) data system and, qualitatively, we conducted 12 interviews with operational/administrative staff at 7 PCPM clinics. Our findings indicated that PCPM patients experienced greater connection to primary and specialty care-both the proportion who used care and the average amount of care used per member-relative to the control group. Primary care use rose by 4.2 percentage points (95% CI: 3.3%, 5.1%; P < .001), and specialty care by 1.1 points (95% CI: 0.4%, 1.8%; P = .002). Among users, primary care visits increased by 136.9 per 1000 member months (95% CI: 107.2, 166.6; P < .001), and specialty care by 32.1 (95% CI: 10.5, 53.7; P = .004). Qualitative findings added further context: (1) staff communication about PCPM efforts connects directly to improvements in care delivery and patient outcomes; (2) success depends on care team staff being involved in the creation of new workflows and processes; and (3) access to program data helps to identify care gaps and improve patient care delivery. We concluded that care team staff engagement in VBP models is strengthened by making the connection between VBP and direct improvements to patient care. Models that motivate staff can lead to increased connection to primary and specialty care among the clinic's patient population.