Frontiers in health services最新文献

Background: Academic hospitals in Saudi Arabia are major providers of specialised healthcare and serve as training centres for future health professionals. With ongoing reforms under Vision 2030, evaluating the quality of care in these institutions is essential. Despite their strategic importance, no recent systematic review has synthesised evidence on their performance.

Aim: The aim of this systematic review is to identify major issues, barriers, and challenges impacting the quality of care in Saudi university-affiliated hospitals and provide evidence-based recommendations for improvement.

Methods: This systematic review followed PRISMA 2020 guidelines. PubMed, Scopus, Web of Science, Embase, and the Saudi Digital Library were searched for empirical studies published between January 2015 and June 2025-a timeframe chosen to update the last available review, which covered literature up to early 2015, and to capture evidence emerging during major healthcare reforms associated with Saudi Vision 2030. Eligible studies included quantitative, qualitative, or mixed-methods research examining any of the Institute of Medicine quality domains in Saudi university-affiliated hospitals. Data were extracted using a standardised form, and study quality was assessed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. Due to heterogeneity across study designs and outcomes, findings were synthesised narratively.

Results: Twenty-eight studies were included. Patient-centredness was most frequently assessed, showing high satisfaction with communication, respect, and clinician interactions, although waiting times and referral delays were common barriers. Effectiveness was evident in paediatric care and pain management, while chronic disease and rehabilitation outcomes were less favourable. Innovative models such as telemedicine and hypofractionated radiotherapy improved both effectiveness and efficiency. Timeliness challenges were identified in emergency and discharge processes, whereas digital health supported faster access. Efficiency concerns included overcrowding and workflow delays, offset by alternative care models. Safety issues included medication errors, infection control gaps, and punitive cultures, though improvements in teamwork and organisational learning were noted. Equity was least studied, with disparities linked to demographics and geography. Most studies were of moderate quality; six were rated high.

Conclusion: Saudi university hospitals demonstrate strengths in patient-centredness, effectiveness, and efficiency, but persistent gaps in timeliness, safety, and equity remain. Targeted improvements are needed to strengthen their role in advancing healthcare quality and achieving Vision 2030 goals.

Background: The objective of this study was to develop a Paediatric Oncology Trigger Tool aimed at facilitating the detection of adverse events and no-harm incidents in the patient process from specialised hospital care to home healthcare in paediatric oncology. The development of the trigger tool addresses the need for enhanced safety knowledge in paediatric oncology, particularly as the field has increasingly transitioned from inpatient admissions to day care and home healthcare settings. Existing trigger tools do not fully meet the specific requirements of paediatric oncology, where care is collaboratively provided by patients, parents and healthcare professionals.

Materials and methods: The study employed a multi-step process, including a literature search, a three-phase modified Delphi process, and the practical application of the trigger tool. All six Swedish paediatric oncology centres were represented in the Delphi process. Medical records were reviewed as part of the national multicentre study Patient Safety in Paediatric Oncology, which included participation from four out of six paediatric oncology centres, covering 64% of the population in Sweden. Data were collected from stakeholders representing the patient process from specialised hospital care to home healthcare in paediatric oncology, as well as from reviewers of medical records, and representatives with patient safety and trigger tool methodology expertise. Data were gathered through virtual meetings and web-based surveys, where the triggers were discussed and rated in terms of clinical relevance, comprehensibility and usefulness. Ratings were made using a four-point Likert scale. A dichotomisation process was used to assess consensus, defined as the proportion of respondents giving the same dichotomised rating.

Result: The key outcome was the development of a Paediatric Oncology Trigger Tool. The final tool consisted of 22 triggers with definitions and decision support information, designed to enhance understanding of patient safety in paediatric oncology.

Conclusions: The application of a multi-step development process resulted in a final context-specific trigger tool, the Paediatric Oncology Trigger Tool, addressing unique patient safety needs. The tool can be used in local safety initiatives aiming to improve safety for children with cancer. Additionally, this paper provides a transparent description of a systematic development process.

Many institutions of higher education recognize the importance of sexual violence prevention efforts. However, often practitioners tasked with offering prevention efforts lack the time and expertise to assess programs. Researcher-practitioner partnerships offer a solution that provides mutual benefits and is reinforced by implementation science. Through our own experiences in a six-year collaboration between a university research center and a small private college's sexual violence prevention team we discovered the value of researcher-practitioner partnerships. Our partnership focused on evaluating a multi-year, required sexual violence prevention curriculum, currently implementing best-practice skill-building and prevention-techniques for college students at a small private college. Robust evaluation efforts, made possible through the researcher-practitioner partnership, have been essential in gaining key insights and making data-informed improvements to ensure effectiveness of the curriculum. The manuscript provides background on the importance of sexual violence prevention on college campuses and how implementation science and effective researcher-practitioner partnerships can address challenges. Findings from the evaluation project will be shared in future publications, allowing this article to focus on best practices, methodology, and lessons learned related to the researcher-practitioner partnership that align with key implementation science constructs. We aim to offer actionable methods and strategies for other researchers, evaluators, and practitioners to strengthen prevention efforts in higher education settings and beyond.

Introduction: County hospitals form the backbone of the rural healthcare delivery system in China, yet they frequently suffer from "patient drain". This behavior exacerbates regional health disparities and undermines the tiered healthcare model. While vertical integration strategies, such as Medical Alliances, have been proposed as a solution, evidence regarding their efficacy-particularly for deep, governance-oriented integration models- remains fragmented. This study aims to evaluate the impact of a "Deep Vertical Integration" strategy on the clinical capacity, operational efficiency, and regional patient flow dynamics of a county-level hospital.

Methods: The setting was Sui Ning County People's Hospital (SNCPH), which formed a deep alliance with a tertiary academic center, The Affiliated Hospital of Xuzhou Medical University (AHXMU). We employed a single-case, quasi-experimental Interrupted Time Series (ITS) design spanning 48 months (January 2021-December 2024), utilizing 72 months of longitudinal administrative data (including pre-intervention baselines) to control secular trends and seasonality. The intervention followed a "Three-Dimensional Strategy": (1) Governance Restructuring (embedded executive leadership and shared financial mechanisms); (2) Technological Empowerment (standardized surgical training and graded authorization); (3) Operational Optimization (DRG-based cost control and AI-assisted quality management). Outcomes were measured using patient-level referral data, surgical complexity grading (Grade IV ratio), and financial structure metrics.

Results: The implementation of deep vertical integration was associated with substantial improvements in hospital performance. The proportion of Grade IV surgeries (complex/critical procedures) increased significantly to 20.0% of all surgical cases by 2024 (P < 0.001), indicating a measurable upgrade in local technical capacity. Concurrently, the model successfully reversed patient outflow: outward referrals to tertiary centers decreased by 64.8% (95% CI [62.1%, 67.5%]), dropping from 1,073 in 2021 to a projected 378 in 2024. ITS analysis confirmed a statistically significant change in the post-intervention trend for patient outflow (P < 0.001) that was robust to autocorrelation testing. Financially, the hospital achieved structural optimization, with medical service revenue increasing by 7.41 percentage points, signaling a shift from drug-reliant to value-based revenue models.

Discussion: Deep vertical integration, characterized by embedded governance and standardized technical mentorship, offers a potent mechanism for strengthening county-level healthcare.

Purpose: Maps out the evidence on AYA's autonomy and decision-making in healthcare settings in the United States to provide a comprehensive and synergistic understanding of the barriers, facilitators, and other salient factors that influence autonomous decision-making.

Methods: This study followed the PRISMA and scoping review methodological frameworks. An electronic database search was performed using Boolean terms based on inclusion/exclusion criteria. Included studies were analyzed using narrative synthesis and thematic analysis techniques.

Results: The final review comprised 31 studies. Half (n = 16; 52%) focused on adolescent autonomy in specialized care, a third focused on sexual and reproductive healthcare (n = 8, 25%), and the remaining studies focused on general healthcare (n = 6; 19%). Most studies defined autonomy as a primary influence in healthcare decision-making (n = 24; 77%). Other conceptual definitions focused on reproductive decision-making and control (n = 5; 16%) or independent functioning (n = 3; 9%). The literature discussed various barriers and facilitators to AYAs' sense of autonomy.

Conclusions: Studies regarding AYA autonomy have historically focused on specific patient populations in specialized healthcare areas. Researchers and practitioners can work towards creating tools to inform and assess interventions to support AYA autonomy in healthcare settings, including programs to improve care for youth.

Background: In Ghana, although free tuberculosis (TB) services are provided at public facilities, the TB case detection rate is still lower than anticipated. To enhance TB case detection, private community healthcare providers and the National Health Insurance Scheme (NHIS) have been involved using a Public-Private Mix (PPM) model, which includes active case finding (ACF) and access to insurance. This study examines the facilitators and barriers to implementing a PPM model that aims to expand ACF and provide health insurance to newly diagnosed TB patients among at-risk populations in two Ghanaian cities.

Methods: This was an exploratory qualitative study based on 54 TB patient exit interviews, key informant interviews from seven sub-metro TB coordinators and 44 facility-level TB coordinators, and six focus group discussions were held, comprising four with health workers (n = 53) and two with volunteers (n = 18). We conducted a thematic content analysis and, based on the key themes identified, we applied the Consolidated Framework for Implementation Research (CFIR) to structure the themes across five domains.

Results: Implementation of the PPM model was facilitated by strong stakeholder collaboration, adaptable screening procedures, adequate diagnostic resources, and effective supervision. However, delays in NHIS reimbursements, limited registration logistics, weak intersectoral communication, and high staff turnover constrained implementation. While community engagement and the integration of TB screening into routine care enhanced uptake, persistent financial and operational barriers limited the program's sustainability.

Conclusion: The PPM model increased TB case detection and expanded insurance coverage but was limited by structural inefficiencies, especially within NHIS operations. Future efforts should address systemic misalignments, support healthcare workers, and improve NHIS-private provider collaboration. Recognizing facilitators and barriers can help policymakers, TB program managers, NHIS officials, and partners plan more effective PPM models to boost active case finding in Ghana and similar settings.

As the United States faces mounting challenges to improving health outcomes, new strategies are needed to address root drivers of health and engage community partners to change the community conditions that impact health and health disparities. Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring model developed in 2003 at the University of New Mexico to disseminate knowledge, share evidence-based care practices, and create communities of learning. The ECHO model has been shown to improve clinical outcomes by training primary care care clinicians to provde care often delegated to specialists. This paper describes modifications to ECHO programming to improve population health through engagement of diverse, community audiences in order to impact non-clinical contributors to health. During these community-facing ECHO courses, participants learn from short didactic sessions, share best practices through case-based presentations, and increase connections between sectors of the community and the health system. Implementation of this novel ECHO program is described using the RE-AIM and CFIR frameworks. Adapting the ECHO model to support collaborative learning to impact upstream drivers of health may be an important innovation for improving population health.

Introduction: This study evaluated a novel strategy to improve accessibility of implementation science to clinicians in a large health network. The strategy, called Accelerating Research Translation (ART), was based on an adaptation of the A3 problem-solving method developed for use in healthcare quality improvement.

Method: An observational pre-post design was used to conduct a 'proof-of-concept' trial of the ART strategy. Clinicians who identified a gap between a clinical practice guideline and usual care were recruited as Project Leads to conduct research translation projects over a 6-month period, supported by a training programme involving a workshop series and mentor. The proportion of patients receiving guideline-consistent care for each project was measured pre- and post-intervention, and results across projects were combined in a planned pooled meta-analysis. Secondary outcomes included changes in confidence in research translation for Project Leads and the degree of evidence of implementation, mapped against Meyer and Goes' stages of healthcare implementation.

Results: Ten projects were completed by 13 Project Leads, involving a diverse range of professional disciplines, clinical specialties, and healthcare settings. Pooled analysis of data from 768 patients suggests the ART programme increased the odds of receiving evidence-based care (logOR 2.52, 95% CI: 0.93-4.11, p < 0.01). Effects were stronger for evidence-practice gaps that could be addressed with changes to local policies and processes than those dependent on changing behaviour or complex systems. Confidence of Project Leads improved, and all reported increases in the level of implementation of evidence.

Conclusion: This novel approach empowered clinicians to tackle evidence-practice gaps within a familiar structure already well-accepted and understood by health service providers. This concept provides a promising mechanism to demystify implementation science and address local evidence-practice gaps at scale.

Background: Effective and cost-effective treatments are not always optimally implemented. The benefit forgone due to sub-optimal implementation is often not considered or estimated. We use the economic concept of "incremental net monetary benefit" (INMB) to demonstrate how this can be valued. This approach can inform decision-making when used to estimate the value for money of potential future quality improvement (QI) programmes. We illustrate these analyses using the case of antenatal magnesium sulphate (MgSO₄), a cost-effective treatment for the prevention of cerebral palsy in preterm births. We estimate the optimal implementation of MgSO₄, the INMB lost due to sub-optimal implementation, and the value of future implementation initiatives to increase the use of MgSO₄.

Methods: We estimated MgSO₄ treatment implementation for babies under 32 weeks' gestation using routine data on its uptake between 2014 and 2022 in England, Scotland, and Wales. The optimal uptake level of MgSO₄ was estimated using clinical judgment. The societal lifetime INMB of MgSO₄ for the prevention of cerebral palsy in preterm births was obtained from the literature. The INMB of sub-optimal implementation over time was estimated as the difference between optimal and actual uptake over time in each country. We estimated the cost-effectiveness of a hypothetical future QI programme based on different scenarios of implementation effectiveness and costs.

Results: The optimal uptake of MgSO₄ was 95%. The INMB forgone associated with sub-optimal MgSO₄ uptake has reduced over time, as uptake has increased. However, in 2022, the societal lifetime INMB forgone was still £18.2 m in England, £3.7 m in Scotland, and £1.0 m in Wales. A future QI programme across all three countries achieving a 5% increase in MgSO₄ uptake over one year, and costing £987,500 to implement, would be cost-effective; generating £7.5 m in INMB. Future implementation initiatives are likely to be cost-effective within a range of different implementation effectiveness and costs.

Conclusions: The case of MgSO₄ treatment for preterm birth illustrates how sub-optimal implementation of evidence-based interventions can be associated with high opportunity costs measured as INMB forgone. This approach provides valuable quantification of the value for money of future QI programmes to improve the implementation of these interventions.