Frontiers in health services最新文献

Background: Access improvement is a fundamental component of value-based healthcare as it inherently promotes quality by eliminating chokepoints, redundancies, and inefficiencies which could hinder the provisioning of timely care. The purpose of this review is to present a 12-step framework which offers healthcare organizations a practical, thematic-based foundation for thinking about access improvement.

Methods: This study was designed based on the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. A literature search of prospective peer-reviewed publications was undertaken to identify studies pertaining to healthcare access. Articles published from January 2014 to January 2024 were included. An interpretive synthesis was then presented.

Results: A total of 469 peer-reviewed studies were identified. The most common diseases analyzed were related to general medicine/family practice (N = 75), surgical care (N = 51), health screening (N = 30), mental health (N = 27), cardiovascular disease (N = 17), emergency room/critical care (N = 15), and cancer (N = 7). The remaining 247 studies (53%) did not specifically report on any specialization. The core themes could be broadly categorized into the following: workforce adequacy, patient experience, physical space utilization, template optimization, scheduling efficiency, process standardization, cost transparency, physician engagement, and data analytics. Sixty publications (13%) focused at least in part on equity issues, structural racism, and/or implicit bias; and 25 publications (5%) addressed disparities in education, training, and/or technical literacy. Seventy-three publications (16%) focused either completely or in part on digital health as a means of access improvement.

Conclusion: Based on this systematic review, a 12-step thematically based framework for approaching access improvement in healthcare was developed.

Background: There is a growing international policy focus on involving those affected by healthcare safety incidents, in subsequent investigations. Nonetheless, there remains little UK-based evidence exploring how this relates to the experiences of those affected over time, including the factors influencing decisions to litigate.

Aims: We aimed to explore the experiences of patients, families, staff and legal representatives affected by safety incidents over time, and the factors influencing decisions to litigate.

Methods: Participants were purposively recruited via (i) communication from four NHS hospital Trusts or an independent national investigator in England, (ii) relevant charitable organizations, (iii) social media, and (iv) word of mouth to take part in a qualitative semi-structured interview study. Data were analyzed using an inductive reflexive thematic approach.

Findings: 42 people with personal or professional experience of safety incident investigations participated, comprising patients and families (n = 18), healthcare staff (n = 7), legal staff (n = 1), and investigators (n = 16). Patients and families started investigation processes with cautious hope, but over time, came to realize that they lacked power, knowledge, and support to navigate the system, made clear in awaited investigation reports. Systemic fear of litigation not only failed to meet the needs of those affected, but also inadvertently led to some pursuing litigation. Staff had parallel experiences of exclusion, lacking support and feeling left with an incomplete narrative. Importantly, investigating was often perceived as a lonely, invisible and undervalued role involving skilled "work" with limited training, resources, and infrastructure. Ultimately, elusive "organizational agendas" were prioritized above the needs of all affected.

Conclusions: Incident investigations fail to acknowledge and address emotional distress experienced by all affected, resulting in compounded harm. To address this, we propose five key recommendations, to: (1) prioritize the needs of those affected by incidents, (2) overcome culturally engrained fears of litigation to re-humanize processes and reduce rates of unnecessary litigation, (3) recognize and value the emotionally laborious and skilled work of investigators (4) inform and support those affected, (5) proceed in ways that recognize and seek to reduce social inequities.

Background: Indigenous peoples with substance use disorders (SUD) and intergenerational trauma (IGT) face complex healthcare needs. Therefore understanding Indigenous patient experiences is crucial for enhancing care delivery, fostering engagement, and achieving optimal outcomes, yet few studies explore the motivations for seeking, staying in, and utilizing treatment from an Indigenous perspective. The goal of this study was to understand the patient experience with an abstinence-based treatment model in a residential treatment setting.

Methods: A qualitative thematic study was conducted between April 2018 and February 2020 at Benbowpka treatment centre in Blind River, Ontario, Canada. We evaluated the results of the abstinence-based model intervention from the patient's perspective. The Client Quality Assurance Survey tool was employed to gather this data. The data underwent thematic analysis to derive meaningful insights.

Results: A total of 157 patients were interviewed. The results were categorized into three parts: (1) Critical events that encouraged participants to seeking treatment; (2) Benefits experienced by participants while they were in the program; (3) Participants take-aways and priorities after completing the program. Core themes emerged in each category and each theme is sub-categorized into quadrants of the Medicine Wheel. Firstly, there was a critical juncture that significantly impacted participants' lives that motivated them to seek treatment at the Benbowpka Treatment Centre. Second, during the study, participants admission to the Benbowopka Treatment Centre, the participants benefitted from a holistic program that addresses spiritual, physical, mental and emotional aspects of healing. Third, participants identified tangible ways in which they implement the skills they gained during the program in their daily lives. Overall, study demonstrates that clients benefitted from both the program activities and the traditional healing practices.

Conclusion: This research identified that SUD Indigenous residential treatment programs need to include culture, healing practices, activities and relationships that are part of the treatment process. This study found that the cultural elements and healing practices of the program were highly valued by clients.

Introduction: Clinicians are the conduits of high-quality care delivery. Clinicians have driven advancements in pharmacotherapeutics, devices, and related interventions and improved morbidity and mortality in patients with congestive heart failure over the past decade. Yet, the management of congestive heart failure has become extraordinarily complex and has fueled recommendations from the American Heart Association and the American College of Cardiology to optimize the composition of the care team to reduce the health, economic, and the health system burden of high lengths of stay and hospital charges. Therefore, the purpose of this study was to identify the extent to which specific care team configurations were associated with high length of stay and high-charge hospitalizations of patients with congestive heart failure.

Methods: This study performed a retrospective analysis of data extracted from the electronic health records of 3,099 patients and their hospitalizations from the Arkansas Clinical Data Repository. The data was analyzed using binomial logistic regression in which adjusted odds ratios reflected the association of specific care team configurations (i.e., combination of care roles) with length of stay and hospital charges.

Results: Team configurations that included a nurse practitioner, registered nurse, care manager, and social worker were generally above the median length of stay and median charges when compared to team configurations that did not collectively include all of these roles. Patients with larger configurations (i.e., four or more different care roles) had higher length of stays and charges than smaller configurations (i.e., two to three different care roles). The results also validated the Van Walraven Elixhauser Comorbidity Score by finding that its quartiles were associated with length of stay and charges, an indicator of care demand based on patient morbidity.

Conclusions: Cardiologists, alone, cannot shoulder the burden of improving patient outcomes. Care team configuration data within electronic health record systems of hospitals could be an effective method of isolating and tracking high-risk patients. Registered nurses may be particularly effective in advancing real-time risk stratification by applying the Van Walraven Elixhauser Comorbidity Score at the point of care, improving the ability of health systems to match care demand with workforce availability.

Background: Person-centered care practice has not yet been fully adopted in low- and middle-income nations such as Ethiopia. It focuses on improving several areas of patient-physician interaction. Despite Ethiopia's rapid growth in healthcare facilities, there is insufficient data available on care practices.

Method: A facility-based comparative cross-sectional study was conducted in selected public and private general hospitals in Addis Ababa from May 26 to July 26, 2023. A multistage sampling technique was employed to select the study participants. The data were collected using an interviewer-administered structured questionnaire, entered into Epi Info-7, and exported to SPSS version 27 for analysis. Bivariate and multivariate logistic regression analyses were performed to identify significant factors associated with care practices.

Results: A total of 848 patients were involved, with a response rate of 99.5%. The overall magnitude of good care practice was 52.8%, with 34.8% in public hospitals and 70.9% in private hospitals. Factors associated with good care practices in private hospitals included hospital attractiveness (AOR: 3.2; 95% CI: 1.6-6.5), ease of access to services (AOR: 12.1; 95% CI: 6.2-23.3), and privacy of access and care (AOR: 10.89; 95% CI: 5.60-21.19). In contrast, factors associated with good healthcare practices in public hospitals were perceived intimacy with the provider (AOR: 8.85; 95% CI: 4.50-17.43), privacy in accessing care (AOR: 12.1; 95% CI: 6.62-22.16), and the provision of medication information (AOR: 4.39; 95% CI: 2.40-8.03).

Conclusion: Overall, 52.8% of participants rated person-centered care practices as good, with private hospitals in Addis Ababa (70.9%) demonstrating a higher prevalence of person-centered care practices compared to public hospitals (34.8%). The factors associated with healthcare practices in both public and private hospitals include hospital type, hospital attractiveness, ease of access to services, privacy in accessing care, perceived intimacy with the provider, and the provision of medication information. We recommend targeted improvements in public hospitals to enhance the quality of PCC.

Many students enter medical school with aspirations of expanding healthcare to underserved communities and reducing healthcare access barriers; yet they lack the leadership skills to achieve this goal. This perspective discusses the role of student-run free clinics in developing medical students' leadership abilities-problem-solving, partnership building, planning, decision-making, and resource acquisition-to address the healthcare needs of marginalized patient populations. It also discusses how fostering leadership skills in the context of serving underserved patients also develops medical students' structural competency and thus awareness of how inequities embedded within hierarchies and social institutions shape health outcomes. We use the example of the development of the Coachella Valley Free Clinic, a student-led and community engaged primary care clinic, to illustrate how student-run free clinics create opportunities for medical students to build leadership skills while addressing the healthcare needs of marginalized patient populations. Medical students, working alongside community health workers and federally qualified healthcare centers, devised a "pop-up" clinic model aimed at delivering care that is both culturally sensitive and linguistically appropriate, thereby addressing health disparities rooted in systemic inequality. As we argue, SRFCs create real-world settings where medical students can develop their leadership skills and understanding of inequities in health ultimately contributing to the broader goal of reducing health inequities by improving healthcare access for underserved patient populations.

Background: Healthcare organisations risk harming patients and their families twofold. First, through the physical, emotional and/or financial harm caused by safety incidents themselves, and second, through the organisational response to incidents. The former is well-researched and targeted by interventions. However, the latter, termed 'compounded harm' is rarely acknowledged.

Aims: We aimed to explore the ways compounded harm is experienced by patients and their families as a result of organisational responses to safety incidents and propose how this may be reduced in practice.

Methods: We used framework analysis to qualitatively explore data derived from interviews with 42 people with lived or professional experience of safety incident responses. This comprised 18 patients/relatives, 16 investigators, seven healthcare staff and one legal staff. People with lived and professional experience also helped to shape the design, conduct and findings of this study.

Findings: We identified six ways that patients and their families experienced compounded harm because of incident responses. These were feeling: (1) powerless, (2) inconsequential, (3) manipulated, (4) abandoned, (5) de-humanised and (6) disoriented.

Discussion: It is imperative to reduce compounded harm experienced by patients and families. We propose three recommendations for policy and practice: (1) the healthcare system to recognise and address epistemic injustice and equitably support people to be equal partners throughout investigations and subsequent learning to reduce the likelihood of patients and families feeling powerless and inconsequential; (2) honest and transparent regulatory and organisational cultures to be fostered and enacted to reduce the likelihood of patients and families feeling manipulated; and (3) the healthcare system to reorient towards providing restorative responses to harm which are human centred, relational and underpinned by dignity, safety and voluntariness to reduce the likelihood of patients and families feeling abandoned, de-humanised and disoriented.

Organizations exert influence on the implementation of evidence-based practices and other innovations that are independent of the influence of organizations' individual constituents. Despite their influence, nuanced explanations of organizations' influence remain limited in implementation science. Organization theories are uniquely suited to offer insights and explain organizational influences on implementation. In this paper, we describe the efforts of the Cancer Prevention and Control Research Network's (CPCRN) Organization Theory for Implementation Science (OTIS) workgroup to equip implementation scientists with theory-guided understanding of organizational influences on implementation. We provide a set of recommendations for future efforts to enhance implementation through the use of organization theories and OTIS tools.

Background: The mental health system in Greece faces challenges to complete its transition to a community-oriented model, having significant concerns for child and adolescent care due to lower coverage and service gaps. This component of the mental health system has not been comprehensively evaluated.

Methods: We conducted a review of the mental health care system for children and adolescents in Greece. For a field assessment, we directly collected data from mental health services to map availability and distribution. We analyzed the needs of human resources using professional register data and the national census.

Results: The National Health Care Service (ESY, Εθνικό Σύστημα Υγείας) is the public health system in Greece, characterized by public governance but significant private participation. Although ESY aims for universal care, gaps in population coverage and high user fees create barriers to access. Embedded within ESY, the mental health system is shifting towards a community-oriented structure since the psychiatric reform. For children and adolescents, there is a developing framework for regionalization and community services, including day centers, inpatient facilities, outpatient departments, and school-based psychoeducational facilities. However, services lack coordination in a stepped care model. Patient pathways are not established and primary care rarely involves child mental health, leading to direct access to specialists. Services operate in isolation due to the absence of online registers. There is no systematic performance monitoring, yet some assessments indicate that professional practices may lack evidence-based guidelines. Our mapping highlighted a scarcity of public structures, with an unbalanced regional distribution and many underserved areas. Child and adolescent psychiatrists are predominantly affiliated with the private sector, leading to professional gaps in the public system.

Conclusions: Our assessment identifies an established framework for a community-oriented, universally accessible mental health system, yet several barriers impede its full realization. These include an inconsistent primary healthcare system, a shortage of specialists in the public sector, imbalanced service distribution, lack of coordination among providers, underfunding, and absence of quality monitoring. We propose interventions to promote child and adolescent mental health in primary care, coordinate patient pathways, establish standards of care, and monitor performance.