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

Patient safety indicators are core measures for improving healthcare. We aimed to conceptualize the prioritization of such indicators and the requirements for developing a core set of nationwide, valid, low-bureaucracy patient safety indicators. We also aimed to develop a decision aid for adapting the core set to strengthen the resilience of healthcare provision with respect to crisis situations and to identify factors related to successful implementation. A hybrid focus group design of 4 guided online focus group interviews was used by combining a semi-structured discussion and supporting materials, including questionnaires. The data were analyzed using content and descriptive analysis. A framework for prioritizing patient safety indicators for core set development and adaptation was developed. Indicator prioritization is guided by the aim of the core set, considering stakeholders' needs, potential for improvement, context of use, scientific quality, and implementability criteria. Together with the requirement criteria, such as patient safety dimensions, the breadth and depth of the indicator set can be defined. The developed decision aid for crisis events was deemed suitable for maintaining patient safety. A modular system is recommended for the adaptation of the core set to address several different indicator measurement scenarios. The developed framework and decision aid allow context-(in)dependent prioritization on the basis of the criteria for prioritizing patient safety indicators for a core indicator set and for indicator decision-making in adapting the core set for crisis events. Further real-world validation of the framework and decision aid and the associated criteria is recommended.

Heat acclimation is a critical strategy for preventing heatstroke in military personnel, but traditional heat acclimatization relies on natural environments, unfeasible for military training. This study aimed to establish mobile cabin-type thermal rooms in basic-training troops and evaluate the effects of active and passive heat acclimation training in new soldiers. Mobile cabin-type thermal rooms were constructed in basic-training troops. New soldiers underwent heat tolerance tests, and those identified with poor heat tolerance were randomized into active or passive training groups. Following heat acclimation training, participants were re-evaluated, and physiological responses were compared between groups. A total of 1326 male new soldiers participated in the heat tolerance test; 134 (10.1%) were identified with poor heat tolerance. Among them, 70 were assigned to the active training group and 64 to the passive group. All participants completed training and subsequently passed the heat tolerance test. Both groups showed significant improvements in core physiological and stress indices (P < .05), with no statistical differences between groups (P > .05). However, the rise in core temperature and heart rate occurred faster in the passive group, while a higher proportion of soldiers reported comfort in the active group (P < .05). Mobile cabin-type thermal rooms provide a reliable, rapid method for screening and training heat tolerance in basic-training troops. Both active and passive heat acclimation improved heat tolerance, but active training offered better subjective comfort. This approach enables safe and effective preparation for military personnel in hot environments.

Medicare Advantage (MA) enrollment has grown significantly over the last 2 decades while Medicare program spending per capita has moderated over that same period. An open question is how the growth in MA enrollment has impacted Medicare program spending. The objective of this study is to estimate the association between MA penetration (ie, the percentage of Medicare beneficiaries enrolled in MA) and total Medicare spending per capita. We estimated linear regression models that examine the relationship between county-level MA penetration and total Medicare spending per capita. The study used county-level Medicare spending and enrollment data-including MA, Medicare Fee-for-Service, and Part D-from the Centers for Medicare & Medicaid Services from 2012 to 2021. The study included counties from all 50 states and Washington, D.C. 3045 counties were included in the analysis, which represents 97% of U.S. counties. We found that counties with higher MA penetration showed lower standardized Medicare spending per capita. Specifically, 10 percentage point higher annual MA penetration was associated with $194 lower (P < .001) total Medicare spending per capita, representing 1.5% lower spending. After adjusting risk scores to reflect the Medicare Payment Advisory Commission's estimates of higher coding intensity in MA, 10 percentage point higher annual MA penetration was associated with $146 lower (P < .001) total Medicare spending per capita, representing 1.1% lower spending. If these associations are causal in nature, then higher MA enrollment over the last 2 decades may have moderated total Medicare program spending over the same period.

This study aimed to evaluate the impact of a simulation-based Advanced Life Support (ALS) training programme on the self-efficacy and communication of health personnel. The research focussed on whether such training could enhance both technical and non-technical skills, particularly in managing cardiopulmonary resuscitation (CPR) situations. A quasi-experimental pre- and post-intervention study was conducted in primary care centres across Andalusia, Spain. A total of 106 health personnel (doctors and nurses), aged 21 to 65 years, participated in the study. Participants completed questionnaires measuring self-efficacy and communication styles before and after a 27-hour blended ALS training programme, which incorporated high-fidelity simulation exercises. Communication was assessed across several dimensions, including expressiveness, preciseness, impression manipulativeness, and emotionality. Post-intervention analysis revealed significant changes in communication styles. Specifically, doctors exhibited a reduction in "impression manipulativeness," while nurses showed an increase in "expressiveness." Although self-efficacy scores improved slightly after the training, the changes were not statistically significant. Correlational analyses indicated that higher self-efficacy was positively associated with "expressiveness" and "preciseness," and negatively associated with "emotionality." In conclusion, simulation-based ALS training led to improved communication among health personnel, with distinct patterns emerging between doctors and nurses. While the simulation training did not significantly increase self-efficacy, the trends observed suggest potential benefits. These findings support the inclusion of simulation in continuing professional development programmes to strengthen non-technical skills essential for effective CPR performance.

Balance impairment is a major motor symptom of Parkinson's disease (PD), leading to falls, reduced mobility, and lower quality of life. Despite advances in pharmacological and rehabilitation approaches, postural instability often persists, requiring effective adjunctive interventions. Vibration therapy (VT) is a non-invasive, drug-free method that may enhance neuromuscular and balance control. However, evidence remains inconsistent due to methodological heterogeneity and small samples. This protocol describes a systematic review and meta-analysis designed to evaluate the effects of VT on balance in individuals with PD. Following PRISMA-P 2015 and Cochrane Handbook guidelines, the protocol is registered in PROSPERO (CRD420251124173). Searches will include PubMed, EMBASE, MEDLINE, Web of Science, and Cochrane Library for English-language, peer-reviewed randomized and non-randomized controlled studies comparing VT (WBV, FMV, or SRT) with control interventions. Risk of bias will be assessed using RoB 2 and ROBINS-I tools. A 3-level random-effects meta-analysis will address within-study dependencies, followed by subgroup and meta-regression analyses. Certainty of evidence will be rated using GRADEpro. This review will synthesize available evidence on the effects of vibration therapy on balance and postural outcomes in individuals with Parkinson's disease. Pooled effect sizes will be estimated, and potential sources of heterogeneity will be examined through predefined subgroup analyses and multilevel meta-regression based on clinical and intervention-related factors. This review will clarify the therapeutic potential of VT for balance in PD and guide evidence-based rehabilitation strategies.Systematic review registration: PROSPERO CRD420251124173.

Disability is a major public health concern affecting about 16% of the global population. It results from the interaction of health condition and/or impairments with various contextual personal and environmental factors. All people need access to sexual and reproductive health (SRH) services, but young people with disabilities (YPWDs) need it even more. In Ethiopia, evidence indicates that YPWDs experience substantially limited access to SRH services. This study aimed to systematically identify, appraise, and summarize existing evidence on SRH service utilization and associated factors among YPWDs in Ethiopia. Eight electronic databases were searched for studies published between 2010 and 2024. Microsoft Excel and STATA software were used for data extraction and analysis, respectively. A random-effect model of meta-analysis was conducted. Heterogeneity was assessed using Cochrane's Q and I² statistics and a funnel plot was used to identify whether there is a publication bias among included studies. Findings are reported according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Out of 2105 studies, 9 studies with 4066 YPWDs were included. The pooled prevalence of SRH service utilization among YPWDs in Ethiopia is 36.56% [95% CI: 29.58, 43.55], with P-value < .001 and I² = 95.76%. Good knowledge of SRH services was significantly associated with service uptake (OR 4.84, [1.16, 20.24], with P-value < .001 and I² = 87.3%). This study shows that SRH service utilization among YPWDs in Ethiopia remains low, with only 36.56% accessing the service. The significant association between knowledge of SRH and service uptake underscore the need for inclusive SRH strategies tailored to young people with disabilities through adapted communication and service delivery approaches.

The rapid integration of artificial intelligence (AI) into healthcare presents a double-edged nature, making systematic assessment of users' benefit-risk perceptions critical. However, a unified, multidimensional framework for such measurement is currently lacking. This review aims to systematically identify and synthesize existing measurement instruments for users' benefit-risk perceptions of AI in healthcare, and to propose an integrated framework based on the evidence. Guided by Arksey and O'Malley's 5-stage framework, we retrieved quantitative studies describing measurement dimensions for users' benefit-risk perceptions regarding AI in healthcare. The search covered 8 Chinese and English databases from their inception to December 6, 2025. Two reviewers independently performed study screening and data extraction, with subsequent synthesis and visual presentation of findings. Based on a synthesis of 49 eligible studies, we developed a measurement framework encompassing 5 benefit and 6 risk dimensions, where technological attributes often exhibit a dual nature. Current measurement instruments consistently emphasize functional benefits, cost benefits, and privacy risks across diverse healthcare contexts, user groups, and geographical regions. In contrast, social benefits and capability development risks generally receive less consideration. Furthermore, variations in instrument design are primarily reflected at the subdimension level. This framework extends classical technology acceptance theories. It provides a theoretical basis for standardized instrument development and offers guidance for the clinical implementation of AI in healthcare. Future research should explore how perceptions evolve with advancing AI maturity and clinical integration to support responsible adoption.

Labor induction (IOL) is a common obstetric intervention to stimulate uterine contractions before the spontaneous onset of labor, with the goal of achieving vaginal delivery. It is indicated for various reasons, including post-term pregnancy, premature rupture of membranes (PROM), maternal medical conditions, and fetal growth restriction. This study aims to evaluate the prevalence of labor induction, its indications, and the associated maternal and fetal outcomes in Ethiopia. A comprehensive search for relevant articles was conducted using widely recognized databases such as Google Scholar, Cochrane, PubMed, HINARI, Web of Science, African Online, and institutional repositories from Ethiopian universities. Data were extracted using the standard format provided by the Joanna Briggs Institute. The Cochran Q test and I² statistics were employed to assess the heterogeneity of the studies. Publication bias was evaluated using a Funnel plot and Egger's test. A Forest plot was used to present the pooled prevalence of labor induction in Ethiopia. This systematic review and meta-analysis revealed that the overall pooled prevalence of induction of labor in Ethiopia was 14.4% (95% CI: 11.09-17.70; I² = 95.7%, P < .01). The primary indications for labor induction included premature rupture of membranes (33.91%), intrauterine fetal death (8.8%), intrauterine growth restriction (4.85%), post-term pregnancy (21.49%), oligohydramnios (12.2%), and hypertensive disorders (30.7%). Maternal complications related to induction of labor included postpartum hemorrhage (9.47%), cesarean section (28.68%), instrumental delivery (18.82%), and vaginal tears (14.45%). Adverse fetal outcomes included low Apgar scores at 1 min, fetal death, and neonatal intensive care unit (NICU) admission, with respective rates of 48.2%, 6.11%, and 15.5%. According to this systematic review and meta-analysis, the estimated overall prevalence of induction of labor in Ethiopia is 14.4%. The indications for induction of labor include premature rupture of membranes (PROM), intrauterine fetal death (IUFD), intrauterine growth restriction (IUGR), post-term pregnancy, oligohydramnios, and hypertensive disorders. Maternal complications of labor induction include postpartum hemorrhage (PPH), cesarean section, instrumental delivery, and vaginal tear. Adverse fetal outcomes associated with induction of labor include a low first-minute Apgar score, fetal death, and admission to the neonatal intensive care unit (NICU). Careful consideration and balancing of risks are essential when deciding to induce labor. Additionally, clear national protocols and follow-up on induction of labor are crucial to mitigate these risks. Registration number: reviewregistry2051.

Commercial interests have increasingly engaged in scientific research, particularly as the European Health Data Space (EHDS) allows access to electronic health records for such studies. Normative legal research was conducted to examine EU Member States' effective medical research legislation and landmark cases. Eleven EU Member States' legislation do not reference commercial medical research. Regarding the others, some adopt stricter rules for commercial research. Others prioritize incentives for non-commercial research. Related legislation primarily regulates research based on funding sources, diverging from the multi-actor and multi-interest nature of health data research. Both the GDPR and ethical guidelines generally exempt anonymized data from oversight, creating a governance gap. Low marginal costs and the black-box nature of data-driven approaches further intensify funding biases, potentially undermining public trust. Member States also differ in data subjects' right to opt out of scientific research. Such regulatory fragmentation undermines EHDS implementation and creates opportunities for regulatory arbitrage. Commercial scientific research should be understood as a type of research conducted by profit-driven actors through ongoing business operations. Special measures should be applied to commercial scientific research within the EHDS, including mandatory consideration reflecting data market pricing, tiered data dividends, compulsory health data access body ethical review, conflicts of interest declaration, and opt-out rights for data subjects. Rules for providing data access are tailored to the stage of research and require a balancing test between research interests and trade secrets. Raw data should be made accessible. Processed data should be made available when classified as essential. Research results should always be provided. A centralized EU platform is recommended to reduce administrative burdens.