Frontiers in health services最新文献

Background: Addressing high levels of physical strain among Norwegian home care workers is crucial if home care services are to continue to provide cost-effective and high-quality health care for people in their homes. Excessive physical demands may contribute to poor long-term musculoskeletal health and high sick leave rates among home care workers. Based on the Goldilocks Work Principle of redistributing an uneven distribution of physical demands to promote a working environment with a "just right" physical demands conducive to promoting long-term health, the GoldiCare intervention in home care services was conducted. The objective of this qualitative process evaluation study was to gain insights into how the implementation outcomes of acceptability, appropriateness, feasibility, adoption and fidelity, respectively, impacted the implementation of the GoldiCare intervention.

Methods: We conducted ten individual interviews with operations managers and five focus group interviews with home care workers from the intervention units. Interviews were transcribed verbatim and a three step-content analysis was employed to analyze interview material.

Results: Our analysis identified that although the intervention was considered broadly acceptable, there were several challenges corresponding to the dimensions of appropriateness, feasibility, adoption and fidelity. Major barriers were identified in particular with regard to appropriateness, that is underlying ways of measuring physical demands; and feasibility, that is barriers to implementing the tool. Further synthesis of these findings resulted in four core issues that need to be addressed if the GoldiCare intervention is to be successfully implemented in comparable Norwegian home care settings: proxy issues; complexity and unpredictability; organization-level issues; and operational autonomy.

Conclusion: The findings provide valuable insights for future attempts to implement GoldiCare interventions in home care settings, highlighting the need to further integrate GoldiCare and other comparable types of intervention into the political, economic, sociocultural, professional, and technological context of home care services. Performed in the right way, such integration will also allow for more participatory input from those enacting such interventions.

Trial registration: This clinical trial was registered on 08/05/2022 under NCT05 487027.

Introduction: Before implementing a new health care strategy, it is important to assess effectiveness but also to perform an economic evaluation. The goal of the present study was to perform a comparative economic evaluation of a new strategy aimed at using proposed implementation of the Plateletworks guidance (measurement of platelet function) with usual practice (delayed time to surgery) in patients on chronic antiplatelet treatment and scheduled for surgery with neuraxial anaesthesia due to proximal femur fracture.

Methods: This is an economic evaluation carried out alongside a randomised controlled clinical trial at four centres in Spain. Patients were randomised to undergo either early platelet function-guided surgery (experimental group) or delayed surgery (control group). As AFFEcT trial results demonstrated significative difference between groups in the primary efficacy endpoint, the median time to surgery, a cost-effectiveness analysis was performed. Direct costs associated with hospitalisation until one-month post-discharge were considered and measured from a hospital perspective. All costs were reported in euros. Analyses were performed on a per protocol basis. Effectiveness outcome measures were the incremental cost and incremental cost per reduction in days to surgery. A deterministic sensitivity analysis was implemented to quantify uncertainty.

Results: A total of 156 patients were randomized to the two groups (n = 78 per group). A total of 143 patients were included in the per protocol population (75 and 68 patients in the experimental and control groups, respectively). The median time to surgery was 2.30 days (IQR: 1.53-3.73) in the experimental group and 4.87 days (4.36-5.60) in the control group (a reduction of 2.40 days). Total costs during the 1-month study perioperative period were higher in the delayed surgery group (€18,495.19) than for the early surgery group (€16,497.59). The incremental cost was negative (€1,997.60), a statistically significant difference (P < 0.05). As measured by the reduction in time (days) to surgery, the incremental cost-effectiveness ratio (ICER) for early surgery was negative (777.28€/day). Sensitivity analysis demonstrated consistent cost saving.

Conclusion: For patients on chronic antiplatelet treatment scheduled to undergo surgery for proximal femur fracture, an individualised strategy guided by a platelet function testing is a cost-saving and cost-effective strategy.

This review proposes the foundations for an epistemology of resilience in public health, addressing the need for a theoretical framework to guide research and policy. Resilience, often ambiguously defined, is reexamined here as a critical attribute of public health systems, enabling them to adapt, absorb, and respond to routine and extraordinary demands without compromising universal and equitable service delivery. By integrating logical, sociological, historical, and philosophical perspectives, the paper delineates resilience as a structured and measurable concept, distinguishing it from common ambiguities in academic and policy discourse. It further introduces a set of foundational axioms to clarify the boundaries of resilience and support its operationalization within public health. These axioms emphasize the interplay between structural and functional dynamics, responses to internal and external stressors, and the importance of systems-level design over reliance on individual adaptations. This epistemological approach aims to bridge the gap between theory and practice, providing a robust basis for developing evidence-based policies that strengthen public health systems' ability to meet evolving challenges while promoting equity and universality.

Background: Effective nursing management and leadership are essential for the provision of desired patient care that will contribute to the improvement of any country's health indicators. However, nurses' views and experiences on the multitude of personal and organizational factors which may impact their decision-making abilities are often neglected in the literature. The study aimed to assess magnitude of poor decision making and its associated factors among nurse managers in South Wollo Zone Governmental Hospitals, Amhara Regional State, Ethiopia, 2023.

Methods: Non experimental cross-sectional study was conducted among 168 nurse managers in South Wollo Zone Public Hospitals from April 01 2023 to May 15/2023. Participants were selected by using a simple random sampling technique. The data were collected by using structured questionnaire from the study participants. Data were entered using EPI data version 4.6 and exported to SPSS version 26 for analysis. The bi-variable logistic regression analysis model was used to identify the potential predictor variable, with p-value <0.25 was fitted into the multivariable logistic regression analysis model; p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to declare, factors associated with the outcome variable. The model fitness was checked by using the Hosmer and Lemeshow test. Data were presented with frequency tables, graphs, and pie charts.

Results: The study found that the overall magnitude of poor decision-making among nurse managers was 35.7%. Being self-confident [AOR = 0.01, 95% CI: (00.002, 0.05)], receiving feedback [AOR = 0.24, 95% CI: 0.08, 0.76], and getting managerial support [AOR = 0.22, 95% CI: (0.06, 0.81)] were negatively associated with poor decision-making among nurse managers.

Conclusion: Self-confidence, receiving feedback, and getting managerial support were variables significantly associated with poor decision-making. Authors strongly emphasize providing managerial support for nurse managers, increasing their habit of receiving feedback from colleagues, and encouraging them to build their self-confidence.

Introduction: Adults over the age of 65 are at a higher risk for diagnostic errors due to a myriad of reasons. In primary care settings, a large contributor of diagnostic errors are breakdowns in information gathering and synthesis throughout the patient-provider encounter. Diagnostic communication interventions, such as the Agency for Healthcare Research and Quality's "Be the Expert on You" note sheet, may require adaptations to address older adults' unique needs.

Methods: We recruited and partnered with older adult patients (n = 6) in focus group sessions to understand their perspectives on diagnostic communication and the existing AHRQ note sheet. A two-page communication and clinic workflow tool was developed and implemented over a 6-month period using three Plan-Do-Check-Act cycles. Physicians, nurses, staff, and patients were surveyed.

Results: Most older adult patients (n = 31) found the tailored diagnostic communication note sheet to be easy-to-use, helpful for provider communication, and would recommend its use to other patients. Physicians and staff members were satisfied with the note sheet and described few challenges in using it in practice.

Discussion: Our findings contribute to the growing body of evidence around diagnostic safety interventions and patient engagement by demonstrating the feasibility and benefits of actively involving older adult patients in quality initiatives.

Mobile phones have become essential tools for health care workers around the world, but as high touch surfaces, they can harbor microorganisms that pose infection risks to patients and staff. As their use in hospitals increases, hospital managers must introduce measures to sanitize mobile phones and reduce risks of health care-associated infections. But such measures can involve substantial costs. Our objective in this paper was to consider two mobile phone risk mitigation strategies that managers of a hypothetical hospital could implement and determine which involves the lowest cost. The first strategy required all staff to sanitize their hands after every contact with a mobile phone. The second involved the hospital investing in ultraviolet-C-based mobile phone sanitization devices that allowed staff to decontaminate their mobile phones after every use. We assessed each intervention on material and opportunity costs assuming both achieved an equivalent reduction in microbe transmission within the hospital. We found that ultraviolet-C devices were the most cost-effective intervention, with median costs of approximately AUD360 per bed per year compared to AUD965 using hand hygiene protocols. Our results imply that a 200-bed hospital could potentially save AUD1-1.4 million over 10 years by investing in germicidal ultraviolet-C phone sanitizers rather than relying solely on hand hygiene protocols.

The United States healthcare system grapples with a staggering estimated waste of $935 billion, with pricing failure contributing a substantial $240.5 billion. This paper explores an innovative solution to combat rapidly escalating healthcare costs by proposing measures that would complement the mandated disclosure of healthcare prices. The Centers for Medicare and Medicaid Services (CMS) introduced a significant rule for hospital pricing, effective January 1, 2021, aiming to enhance transparency and empower patients to make value-based decisions. However, this rule has faced criticisms on various policy grounds which this examination delves into. To address these concerns and enhance the effectiveness of price transparency, this paper suggests complementary and/or alternative strategies and solutions while also examining the engagement of enrollees in price transparency tools.

Introduction: Family caregivers of people living with serious mental illness such as bipolar disorder, psychosis and schizophrenia, are continuously burdened with caregiving, following the complexities of navigating the mental health system for their loved ones. The aim of the study was to understand the perspectives of caregivers about care coordination for people living with serious mental illness, highlighting the current landscape and new directions across Canada.

Methods: In this co-designed participatory qualitative research, caregivers of people living with serious mental illness, and service providers were engaged and purposively sampled across Canada.

Results: The main findings of the study revealed care coordination as a key strategy to alleviate the burden of caregivers and enhance sustainable support for them. In complement with collaborative mental health care, care coordination can improve service delivery and strengthen the mental health system.

Conclusion: Given the severity of bipolar disorder, psychosis and schizophrenia, it is important that we prioritize care for people living with these illnesses while providing support for their caregivers who bear the brunt of the otherwise fractured mental health system. Ultimately, collaboration between people and systems is how the mental health system can be much improved, and care coordinators serve as resourceful go-betweens in this 'collaborativerse'.

[This corrects the article DOI: 10.3389/frhs.2023.1190357.].