Risk Management and Healthcare Policy最新文献

Background: Adequate staffing of primary healthcare workers (PHCWs) is essential for strengthening healthcare systems, yet high turnover intention among these workers presents a significant challenge. While existing strategies primarily target economic incentives and career progression, this study proposes that enhancing organizational justice could offer a novel and impactful approach to retention. Drawing on equity theory and self-determination theory, the study examines how organizational justice influences turnover intention and the mediating roles of both the intensity and type of work motivation.

Methods: This is a cross-sectional study design. A multi-stage cluster sampling method was utilized to administer a questionnaire survey to 1,200 PHCWs from 36 primary health institutions in Shandong Province, China.

Results: Multivariate linear regression analysis revealed that organizational justice significantly reduces turnover intention among PHCWs (β = -0.435, p < 0.001). Among its three dimensions, distributive justice (β = -0.203, p < 0.001) and procedural justice (β = -0.177, p < 0.01) had significant impacts on turnover intention, whereas interactional justice did not. The study also confirmed the mediating role of work motivation, with work motivation type accounting for 18.2% of the total effect, exerting a greater influence than work motivation intensity, which accounted for 13.8% of the total effect.

Conclusion: This study finds that organizational justice, especially distributive and procedural justice, reduces turnover intention among PHCWs in China. Work motivation mediates this effect, with motivation type having a stronger influence than motivation intensity. Enhancing organizational justice through transparent systems for compensation, promotion, and inclusive decision-making can foster the internalization of work motivation, providing a sustainable approach to improving retention and supporting the stability of the primary healthcare workforce.

Objective: Pneumocystis Pneumonia (PCP), primarily affecting individuals with weakened immune systems, is a severe respiratory infection caused by pneumocystis jirovecii and can lead to acute respiratory failure (ARF). In this article, we explore the risk factors of ARF and propose a prognostic model of ARF for PCP patients.

Methods: In this multi-center, retrospective study in 6 secondary or tertiary academic hospitals in China, 120 PCP patients were screened from the Dryad database for the development of a predictive model. A total of 49 patients from Peking University People's Hospital were collected for external validation. Crucial clinical features of these patients are selected applying univariate and multivariate logistic regression analysis. We established an intuitive nomogram. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC) were plotted to evaluate the model's performance.

Results: A cohort of 120 patients formed the training cohort for the development of the model, with 49 patients constituting the test cohort. Univariate and multivariate logistic regression analysis identified five risk factors associated with ARF, which are age, fever, dyspnea, high neutrophil count and use of antibiotics. A nomogram was then proposed based on these factors. The area under the ROC curve (AUROC) in the development group has reached 0.8576, while the validation group has an AUROC of 0.7372, indicating commendable ability for predicting ARF. In addition, results for Hosmer-Lemeshow test indicate the effectiveness of our model. Furthermore, DCA and CIC curves demonstrate excellent clinical benefit.

Conclusion: We present a nomogram for predicting ARF in non-HIV related PCP patients. The prognostic model may provide references in clinical medicine, promote timely treatment and improve therapeutic outcomes of PCP patients.

Purpose: The perception of medical risks is ubiquitous, influencing patients' healthcare experiences, yet the "black box" of this influencing process is seldom explored. This study explores the relationship between medical risk perception, trust, and patient satisfaction while taking shared decision-making as a moderator.

Methods: A stratified random sample of 450 inpatients from a tertiary public hospital in Guangzhou was selected for investigation, from June 2023 to September 2023. A moderated mediation model was tested using the PROCESS program, wherein medical risk perception was linked to patient satisfaction through trust, with shared decision-making acting as the moderating variable.

Results: Medical risk perception had a significant negative predictive effect on patient satisfaction (β = -0.383, p < 0.001), and after introducing the mediating variable, the negative predictive effect of medical risk perception on patient satisfaction remained significant (β = -0.237, p < 0.001). Trust partially mediated the relationship between medical risk perception and patient satisfaction, with the mediating effect accounting for 37.86% of the total effect. The interaction term between medical risk perception and shared decision-making (β = 0.211, p < 0.001) significantly predicted trust.

Conclusion: This study confirmed the mediating and moderating effects of trust and shared decision-making on the relationship between medical risk perception and patient satisfaction. The theoretical model constructed based on the theory of information asymmetry provides strategies and methods for healthcare managers to improve the quality of healthcare services and alleviate tensions in doctor-patient relationship.

Background: Endometrial cancer (EC) is one of the most frequent gynecologic cancers, approximately 20% of patients are regarded as high-risk with poor prognosis. However, more details of patients with second primary endometrial cancer (SPEC) after colorectal cancer (CRC) remain poorly understood. We therefore proposed to construct two nomograms to predict 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates to facilitate clinical application.

Methods: A total of 1631 participants were identified in the SEER database from 1973 to 2020. We constructed and validated the nomograms for predicting OS and CSS. The receiver operating characteristic curves, calibration plot, decision curve analysis, C-index, net reclassification improvement, and integrated discrimination improvement were applied to evaluate the predictive performance. Finally, the Prognostic index was calculated and used for risk stratification of Kaplan-Meier survival analysis based on different treatment options.

Results: Nomograms of OS and CSS were formulated based on the independent prognostic factors utilizing the training set. The 3- and 5- years of OS nomogram demonstrated good discrimination (AUC = 0.840 and 0.829, respectively), well-calibrated power, and excellent clinical effectiveness. Our nomograms of predicting OS and CSS had a concordance index of 0.801 and 0.866 compared with 0.676 and 0.746 for the AJCC staging system, and more importantly, demonstrated a better forecast accuracy. Chemoradiotherapy displayed a significant survival benefit in the high-risk groups, but proceeding to surgery plus chemotherapy showed a favorable survival for the low groups based on all patients.

Conclusion: We developed and internally validated multivariable models that predict OS and CSS risk of SPEC in patients with a CRC to help clinicians make applicable clinical decisions for patients.

Background: Community Health Workers (CHWs) are key to extending health care services, especially to marginalized communities to reduce challenges related to health care access. The study objective was to qualitatively explore the comprehensive role of CHWs in bridging the gap for Medicaid managed care organization (MCO) members' access to health care providers, managed care, and community-based organizations to address health-related social needs (HRSN).

Methods: We conducted a retrospective thematic analysis of narratives developed by CHWs on their role and Medicaid member lives. Three CHWs were embedded in four predominantly Black neighborhoods of Pittsburgh, Pennsylvania, by an MCO for six-months (January-June 2017) to connect its members with the managed care, health care system, and HRSN. In total, 46 MCO members remained throughout the program. The CHWs developed narratives on 13% (n = 6) of MCO members as part of a quality improvement project. These documented narratives became raw data for this study.

Results: The age of MCO members ranged from 25 to 58 years and were Black (n = 6). The narrative had 50% of males and females. Three overarching themes in the narratives about CHWs' role were improving members' access to health care system (providers and medication), helping members with HRSN, and connecting members to managed care case management and member services.

Conclusion: CHWs as MCO staff embedded in communities could help improve its members' health care continuity, care coordination, and HRSN access. Our study demonstrates that CHWs are instrumental in bridging the gap between different systems for Medicaid MCO members. They play a crucial role in connecting the members to primary care providers, specialists, prescription drugs, MCO benefits, case management, and addressing their HRSN such as food, childcare, and housing. Future research should focus on program effectiveness by measuring member experience, health care utilization, health outcomes, and costs in Medicaid managed care settings.

Background: This study aimed to assess the level of readiness among primary school teachers to handle sports injuries in Saudi Arabia.

Methods:  A structured questionnaire was applied to collect information on teachers, training, knowledge, attitudes, and perceived barriers in managing common sports injuries. Descriptive analysis was performed for demographics and baseline information. Pearson's Chi-squared test and Fisher's exact test were used to assess the determinants of first-aid attitude. Multiple logistic regression was also used to evaluate the determinants of first-aid knowledge.

Results: A total number of 535 teachers participated in this study. Most teachers (64.3%) reported an occurrence of sports injury once per month. Only 373 (67.72%) perceived the first aid kit to be readily accessible. The majority (95.89%) of teachers reported familiarity with conducting first aid and 87.38% expressed interest and willingness to learn. Social media was the primary resource of first aid knowledge (57.94%). Logistic regression showed that male sex (OR: 0.51, 95% CI: 0.26, 0.95; p-value = 0.036) and experiencing sports injuries once per month (OR: 0.39, 95% CI: 0.16, 0.84; p-value = 0.024) were associated with negative attitude toward first aid. However, having 10-20 years of experience (OR: 2.46, 95% CI: 1.09, 5.62; p-value = 0.031) or more than 20 years of experience was associated with more positive attitude toward first aid (OR: 6.47, 95% CI: 2.18, 19.8; p-value ≤ 0.001). Furthermore, accessing first aid information from digital media and healthcare professionals compared to books was significantly associated with increased knowledge about first aid. Easy accessibility to first aid was also significantly associated with increased knowledge about first aid.

Conclusion: While many teachers feel prepared, the primary source of their first aid knowledge is unattributed social media content rather than certified training. Certified first aid training programs are needed to help in ensuring the quality emergency management of sports injuries.

Aim: The purpose of this study was to investigate the current situation of the "Internet + nursing service" in Guizhou Province, China, from the perspective of service providers, and to analyze its influencing factors to provide references for further promoting the implementation of related services in the province.

Methods: In this study, a questionnaire survey was conducted among nurses from 55 hospitals in Guizhou Province, China, through convenience sampling from September to December 2023.

Results: The findings showed that 85.45% of the hospitals had not yet carried out the "Internet + nursing service", 97.87% of the nursing staff expressed their willingness to participate in the service, but only 14.55% of the nursing staff actually participated in the service at their hospital. The participation rate of specialist nurses was just 50.00%. The findings also revealed the main issues of current concern, which included the support of relevant policy documents, the security risks of on-site services, and the pricing standards of service projects.

Conclusion: Research data indicate that while most hospitals have not implemented the service, there is a high willingness among nursing staff to participate, yet the actual participation rate is low. The participation rate of specialized nurses is also low, and there are issues related to policy support, safety risks, and pricing standards. It is recommended that Guizhou Province strengthen policy guidance to promote the implementation of "Internet + nursing services". Hospitals at all levels should focus on the training of specialized nursing talents, enhance service promotion, deepen personnel awareness, and optimize the home service system to meet patients' nursing needs.

Background and objective: Incontinence-associated dermatitis (IAD), is a skin injury brought on by protracted exposure to urine or feces in the gluteal, sacral, or perianal regions. Therefore, this study aimed to evaluate nurses' level of knowledge, attitudes, social pressure, and intention to prevent IAD and to explore the factors that explain nurses' intention to prevent incontinence-associated dermatitis.

Methods: A cross-sectional study was conducted among staff nurses from two designated hospitals in Riyadh, Saudi Arabia. The Knowledge, Attitudes, and Practices of the Incontinence-associated Dermatitis Questionnaire with 22 items (KAP-IAD-Q) on a five-agreement rating scale (1=not agreeable to 5=highly agreeable) was used. Also, the intention to use deep vein thrombosis (DVT) preventive measures was rated on a seven-point Likert scale, ranging from 1=strongly disagree to 7=strongly agree.

Results: The participants showed that they had a sufficient knowledge (M= 48.2 ± 9.9) and, a positive attitude toward IAD prevention average score of 6.6 (SD ± 9.9) related to IAD etiology and risk factors. The perceived behavior to prevent IAD average was 5.1 (SD ± 3.9), showing that nurses had confidence and control in preventing IAD. The intention average score was 5.3 (SD ± 3.1), which indicates that nurses had the intention to prevent IAD. Furthermore, knowledge, attitude, social pressure, and perceived behavior to prevent IAD had a positive strong association with intention to prevent IAD (r= 0.547, p < 0.01; r= 0.564, p < 0.01; r= 0.579, p < 0.01; and r = 0.709, p < 0.01) respectively.

Conclusion: The study highlights the critical role of knowledge, attitudes, social pressure, and perceived behavior in shaping nurses' intentions to prevent IAD. The findings demonstrate that nurses generally have a positive attitude and strong intention to prevent IAD, influenced by their level of education, hospital type, and clinical experience.

Background: Coronary heart disease (CHD) is a leading cause of mortality worldwide, with atrial fibrillation (AF) being a common complication. Chronic inflammatory responses play a significant role in the relationship between coronary artery disease and AF. This study aims to investigate the value of the multi-inflammatory index (MII) in predicting the occurrence of atrial fibrillation in patients with coronary heart disease.

Methods: A retrospective analysis was conducted on patients who visited our hospital from January 1, 2020, to December 31, 2023, including a total of 1392 patients. Clinical data and laboratory results were collected. Feature selection was performed using the Boruta algorithm. Five machine learning models were constructed: Logistic Regression, Decision Tree, Elastic Net, Light Gradient Boosting Machine (LightGBM), and Multilayer Perceptron. Model performance was evaluated using five-fold cross-validation. SHAP values were utilized to analyze feature importance and model interpretability.

Results: The study included 1302 patients without AF and 90 patients with AF. Patients with AF had significantly higher MII compared to those without AF (10.02 vs 4.79). Thirteen variables most related to AF occurrence were selected using the Boruta algorithm. The LightGBM model outperformed others, showing the highest accuracy and calibration in both training and test sets. In the training set, LightGBM achieved an AUC of 0.958, accuracy of 0.851, and sensitivity of 0.943, while in the testing set, it achieved an AUC of 0.757 and accuracy of 0.821. SHAP analysis indicated that age, heart rate, and MII were the primary predictors of AF occurrence.

Conclusion: The LightGBM model demonstrated adequate sensitivity and accuracy. The multi-inflammatory index plays a crucial role in predicting atrial fibrillation in patients with coronary heart disease.

Background: Coronary heart disease (CHD) is a significant public health concern affecting an increasing number of young and middle-aged adults. Effective self-management is essential to promote the recovery and quality of life of patients with CHD after percutaneous coronary intervention (PCI), and is closely related to health literacy. However, little is known about the underlying mechanisms of this association.

Objective: This study aimed to investigate the mediating effects of social support and self-efficacy in the relationship between health literacy and self-management behaviors among young and middle-aged patients with CHD after PCI.

Methods: A cross-sectional study was conducted among 360 CHD patients aged 18-59 who after PCI within 1 to 3 months. The data were collected from September 2022 to July 2023 in a tertiary hospital in China. The questionnaires were utilized to gather data on demographic characteristics, social support, self-efficacy, health literacy, and self-management behaviors. The serial mediation model was examined via bootstrapping techniques using SPSS PROCESS v.4.3 macros (Model 6).

Results: Participants health literacy was associated with self-management behaviors both directly (β=0.334, P<0.001) and indirectly through social support (β=0.149, P<0.001) and self-efficacy (β=0.095, P<0.001). Social support and self-efficacy serially mediated the association between health literacy and self-management behaviors (β=0.226, P<0.001), with the total indirect effects accounting for 44.3%, these three mediating paths account for 24.8%, 15.8%, and 3.7% of the overall effect, respectively.

Conclusion: Health literacy influences self-management behaviors that the study's findings suggest were significant. Social support and self-efficacy act as mediators in the relationship between health literacy and self-management behaviors. Our findings provide helpful guidance for the future development of targeted and effective psychosocial interventions to enhance CHD patients' self-management, ultimately improving prognosis and quality of life.