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

There are few validated contextual measures predicting adoption of evidence-based programs. Variation in context at clinical sites can hamper dissemination. We examined organizational characteristics of Veterans Affairs hospitals implementing STRIDE, a hospital walking program, and characteristics' influences on program adoption. Using a parallel mixed-method design, we describe context and organizational characteristics by program adoption. Organizational characteristics included: organizational resilience, implementation climate, organizational readiness to implement change, highest complexity sites versus others, material support, adjusted length of stay (LOS) above versus below national median, and improvement experience. We collected intake forms at hospital launch and qualitative interviews with staff members at 4 hospitals that met the initial adoption benchmark, defined as completing supervised walks with 5+ unique hospitalized Veterans during months 5 to 6 after launch with low touch implementation support. We identified that 31% (n = 11 of 35) of hospitals met adoption benchmarks. Seven percent of highest complexity hospitals adopted compared to 48% with lower complexity. Forty-three percent that received resources adopted compared to 29% without resources. Thirty-six percent of hospitals with above-median LOS adopted compared to 23% with below-median. Thirty-five percent with at least some implementation experience adopted compared to 0% with very little to no experience. Adopters reported higher organizational resilience than non-adopters (mean = 23.5 [SD = 2.6] vs 22.7 [SD = 2.6]). Adopting hospitals reported greater organizational readiness to change than those that did not (mean = 4.2 [SD = 0.5] vs 3.8 [SD = 0.6]). Qualitatively, all sites reported that staff were committed to implementing STRIDE. Participants reported additional barriers to adoption including challenges with staffing and delays associated with hiring staff. Adopters reported that having adequate staff facilitated implementation. Implementation climate did not have an association with meeting STRIDE program adoption benchmarks in this study. Contextual factors which may be simple to assess, such as resource availability, may influence adoption of new programs without intensive implementation support.

This narrative review paper contrasts the professional prospects of psychologists in Japan and the U.S., discussing how divergent training, licensing, and practice standards appear to influence psychologists' profession in each country. Licensed psychologists in the U.S. practice with significant autonomy, which can be seen as a reflection of rigorous training requirements. In contrast, certified public psychologists in Japan complete a shorter-duration training regimen yet encounter more restrictive professional standards and greater financial challenges. These varying standards often create barriers to professional practice that impact psychologists on a global scale. Limited international mobility restricts opportunities for psychologists to learn abroad, exchange knowledge, and deliver culturally sensitive care to diverse populations, despite the need for such services among foreign individuals or immigrants in both countries. Furthermore, these disparities impede broader collaborative efforts to address global mental health challenges. Aligning training and licensing standards globally could enhance psychologists' international mobility, ensure consistent quality of care, and foster global collaboration. This alignment could improve access to culturally sensitive psychological services and help bridge the mental health care gap worldwide. This review emphasizes the necessity of further cross-cultural comparisons to understand the impact of training and licensing standards on clinical practice quality and accessibility. By presenting this comparative analysis, the study aims to inspire similar efforts, promoting global licensing reciprocity and the integration of professional psychology in an increasingly interconnected world.

Time of labor or time of emergency is not the time to decide what to do, instead it is time to seek care from skilled health care providers. Birth preparedness and complication readiness is the process of planning for a normal birth and anticipating the action needed in case of an emergency, which helps to minimize obstetric complications. Even though birth preparedness and complication readiness reduce maternal and newborn morbidity and mortality, the practice of birth preparedness and complication readiness is still low in Ethiopia. This study aimed to assess the practice of birth preparedness and complication readiness and its associated factors among pregnant women who attended antenatal care in the public health facilities of Debre Tabor town, northwest, Ethiopia. A health facility-based cross-sectional study was conducted from August 1/2022 to September 15/2022 among 397 pregnant mothers. The study was collected using a systematic random sampling technique and the collected data were entered and analyzed using SPSS version 25.0. Bivariate and multivariate logistic regression analyses were employed to estimate the crude and adjusted odds ratio and considered significant at a confidence interval of 95% and a P-value of less than .05. The proportion of birth preparedness and complication readiness practice was found to be 32.2%. Having formal education, primigravida, starting antenatal care contact in the first trimester of pregnancy, having knowledge of danger signs of labor and delivery, and birth preparedness and complication readiness were significantly associated with the practice of preparedness and complication readiness. In this study area, the practice of birth preparedness and complication readiness was low. Therefore, it is important to strengthen counseling on the advantage of starting antenatal care contact early and creating awareness of birth preparedness and complication readiness.

To investigate clinical nurses' perception of adverse event risk and to analyze its influencing factors. A proportional stratified random sampling method was applied to recruit nurses from a hospital in Shiyan City, Hubei Province, China. The Nursing Adverse Event Risk Perception Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout scale was used to investigate 1084 nurses. Univariate analysis, Pearson correlation analysis, and multiple linear regression analysis were used to analyze the influencing factors. The scores of the Nurses' Risk Perception of Adverse Nursing Event Scale, Organizational Support Questionnaire, Nurse Manager Leadership Behavior Questionnaire, Nursing Safety Behavior Questionnaire, and Burnout Scale were 14.98 ± 5.39, 52.57 ± 10.00, 88.98 ± 21.08, 56.42 ± 5.03, 30.90 ± 21.49, respectively. According to the correlation analysis, nurses' perception of adverse nursing events was positively correlated with the sense of organizational support (r = .457, P < .01), head nurses' leadership behavior (r = .348, P < .01), and nurse safety behavior (r = .457, P < .01), and negatively correlated with the level of burnout (r = -.384, P < .01). According to the Regression analysis, nurses' departments (β = .226, P < .001), daily working hours (β = 1.122, P < .001), adverse events experience (β = -1.505, P < .001), organizational support (β = .105, P < .001), head nurses' leadership behavior (β = .072, P < .001), and burnout (β = -.052, P < .001) held an influence on nurses' risk perception of adverse nursing event. These factors explained 42.5% of the total variation. Nurses' risk perception of adverse nursing events needs to be improved. Nursing managers need to strengthen organizational support for nurses, change the leadership behavior of nurse managers, reduce nurses' burnout, improve nurses' risk perception of adverse nursing events, prevent adverse events, and ensure patient safety.

Dementia is a progressive condition and an umbrella term used to describe a set of symptoms that affects many older adults. Older adults living with dementia often experience social stigma, which can impact their quality of life. Most people with dementia need the assistance of a caregiver in order to enhance their health. The present study seeks to explore the perspective of nurses as the primary caregivers of people living with dementia in Saudi Arabia, focusing on the challenges faced by nurses and their reactions to these challenges. A descriptive qualitative approach using semi-structured interviews with 10 nurses with experience caring for people living with dementia from 2 hospitals in Jeddah, Saudi Arabia. Using thematic analysis, 4 main themes were identified: (1) types of support, (2) challenges when caring for people living with dementia, (3) society's views on people living with dementia, and (4) nurses' perceptions of dementia. The nurses stated that people living with dementia do not receive sufficient support from their families. Most participants believed that public awareness about dementia is insufficient. Increased efforts to raise public awareness about dementia could include harnessing social norms around family structure and respect for elders to improve care provided to people living with dementia.

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

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

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

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

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