Frontiers in health services最新文献

Introduction: The applications of artificial intelligence (AI) in healthcare are very diverse. AI-based systems can assist with diagnosis and decision-making, particularly in intensive care medicine. However, physicians must accept these systems to fully exploit their potential. We investigated attitude and perception toward AI among physicians with intensive care experience.

Methods: A cross-sectional questionnaire survey was conducted between August and October 2024 among 7,475 physicians with intensive care experience. Participants were recruited via the hospital operator Knappschaftskliniken GmbH, the German Sepsis Society and via an address register. The questionnaire collected background information on the participants as well as their attitude toward and perception to AI. Their general attitudes toward AI were assessed using the validated Attari-12 tool. Questions specifically addressing attitude and perception of AI in healthcare were developed independently. Descriptive statistics and subgroup analysis were conducted.

Results: Of the 7,475 physicians initially contacted, 620 returned the questionnaire. Of these, 445 questionnaires were included in the evaluation. Most were male (81.8%) aged over 50 years in leadership positions (92.1%). In both cases, general and health care specific, the attitude toward AI was rather positive. The majority of physicians asked for AI applications that are comprehensible to the treating physicians (87.1%) and agreed that objective values alone are not always sufficient for making medical decisions (87.3%). Furthermore, physicians faced problems in finding reliable information about AI in healthcare (52.6%) and only 21.6% considered communication about AI in the medical community as appropriate. Subgroup analysis revealed few differences for age and gender. The correlation between conscious use of AI in a professional context and attitude toward it was notable.

Discussion: Physicians with intensive care experience generally hold a positive attitude toward AI, particularly in healthcare. However, the sample was predominantly male, older, and in leadership positions, so these findings may not fully reflect the attitudes of younger or female physicians. Several considerations were highlighted: AI outputs should be interpretable, clinical decisions cannot rely solely on objective data, and physicians need reliable information and guidance for further AI education. Leveraging the positive attitude could help make healthcare systems more efficient, effective, and sustainable.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality globally, and rural patients are at higher risk for poor COPD health outcomes. The United States National Institutes of Health (NIH) has issued a call for innovative care delivery models to address this gap in COPD care quality in rural communities. This paper explores the perspective of healthcare teams at two rural VA medical centers sustaining an innovative interprofessional COPD care delivery model, COPD Coordinated Access to Reduce Exacerbations (CARE).

Methods: This qualitative evaluation was conducted at two rural VA medical centers in the Southeast and Midwest regions of the US. Eleven semi-structured interviews with diverse clinical stakeholders were conducted including: facility leaders, hired pharmacists, clinical pharmacists, nurse care managers, primary care providers, and referral champions. The Practical Robust Implementation and Sustainability Model (PRISM) was applied to develop interview guides and informed data analysis. Interviews were transcribed and a mixed inductive-deductive approach was used for data analysis, involving iterative coding and consensus-building among five evaluators to identify emerging themes.

Results: Five overarching themes emerged as key facilitators of COPD CARE sustainment including (1) leadership support, (2) value alignment, (3) service institutionalization, (4) service adaptation, and (5) interprofessional collaboration. Notably, clinical pharmacists were described as filling care gaps in these under-resourced facilities.

Conclusion: This evaluation demonstrated the impact of clinical pharmacists serving as prescribers in improving COPD management in rural settings. The sustainment factors identified can be utilized to inform the expansion of similar, team-based healthcare programs across rural settings.

Background: Myanmar has a longstanding and severe shortage of paediatric neurologists, with only 11 specialists serving an estimated 14 million children, most of whom live in rural areas with limited access to tertiary care. This workforce constraint, combined with high out-of-pocket costs and long travel distances, creates substantial barriers to timely diagnosis, treatment, and follow-up for children with neurological conditions. In response to the growing burden of childhood neurological disorders and persistent inequities in access to specialist services, a blended outreach and telemedicine model was developed to extend paediatric neurology care to underserved regions beyond major urban centres.

Methods: A hub-and-spoke model was implemented, linking paediatric neurologists at Yangon Children's Hospital with general paediatricians in seven regional public hospitals. The model combined quarterly in-person outreach clinics by paediatric neurologists from Yangon supplemented with ongoing virtual support delivered through telemedicine and mobile messaging to support continuity of care. Routinely collected data on clinic activity, diagnoses, and costs from 2017 to early 2020 were analysed to assess service reach, impact, and cost.

Results: Between 2017 and 2020, the programme facilitated 2,603 patient consultations. Epilepsy was the most common diagnosis (54%), followed by cerebral palsy (12%). The blended model enabled more efficient use of limited specialist time, with pre-clinic coordination improving case triage and care consistency. Cost analysis demonstrated substantial reductions in patient-related costs, ranging from 81% to 98% per hospital. The mean cost per patient consultation decreased from US$193 under the standard tertiary referral model to US$7 under the outreach model. The programme also supported local capacity building through continuing medical education, strengthened referral pathways, and enhanced regional clinical networks.

Conclusions: This evaluation demonstrates that a hybrid outreach and telemedicine model can deliver accessible, high-quality, and cost-effective paediatric neurology services in a low-resource setting. By leveraging existing national infrastructure and integrating local providers, the model improved access to specialist care, reduced financial barriers for families, and contributed to the long-term capacity of the system. The approach offers a scalable framework for other specialities and health systems facing similar constraints and supports progress towards universal health coverage.

Negative and stigmatising attitudes towards human rights and mental health exist worldwide. The Ghanaian government has attempted to tackle such discriminatory attitudes and practices to align with a human rights-based approach in mental healthcare through the implementation of the World Health Organisation QualityRights Initiative in Ghana. As part of the initiative, the World Health Organisation has developed a range of capacity building tools on mental health, disability, human rights and recovery. National stakeholders in Ghana completed the WHO QualityRights e-training to build capacity and change attitudes to promote recovery and respect for human rights for people with mental health conditions, psychosocial and intellectual disabilities. Participants completed pre- and post-training questionnaires assessing perceived attitude and practice change. Thematic analysis was conducted on the open-ended questions on the post e-training questionnaires to discover how attitudes were impacted by the e-training. Three themes emerged: "legal capacity and the right to decide", "coercion, violence and abuse" and "equality and community inclusion." Attitudes on the right to make decisions, treatment of individuals with mental health conditions, psychosocial and intellectual disabilities, equality, social inclusion and non-discrimination had improved to be more in line with a human rights-based and recovery-oriented approach to mental health. The QualityRights training shows promise as a scalable intervention to reduce stigma, promote rights, and improve care for individuals with mental health conditions, psychosocial and intellectual disabilities.

Hospitals in Poland's border regions face persistent staffing pressures and rising costs, and the COVID-19 pandemic further disrupted activity. We assessed year-by-year changes in operational and financial efficiency in three regional hospitals (BIA, LOM, SUW) in Podlaskie Voivodeship, on NATO's eastern flank, over 2015-2024. Input-oriented Data Envelopment Analysis with CCR (CRS) and BCC (VRS) models was applied in two domains (operational and financial), and 95% bootstrap confidence intervals were calculated for efficiency scores. Operational efficiency declined during the pandemic and partially recovered thereafter. Before COVID-19, mean TE_CCR ranged from 0.607 (95% CI: 0.571-0.643) in LOM to 0.909 (0.833-0.989) in SUW. In 2020-2021, TE_CCR fell to 0.746 (0.704-0.783) in BIA and 0.399 (0.371-0.410) in LOM, with SUW decreasing to 0.810 (0.731-0.870). Post-pandemic values showed partial rebound: 0.858 (0.781-0.946) in BIA, 0.602 (0.565-0.634) in LOM, and 0.830 (0.758-0.913) in SUW. For LOM, operational TE_CCR dropped as low as 0.399 while financial TE_CCR remained at or above 0.94, illustrating a marked divergence between service delivery and financial performance. Across periods, PTE_BCC remained high, indicating scale efficiency as an important source of inefficiency. Financial efficiency showed a similar trough and recovery. Pandemic-period TE_CCR declined to 0.785 (0.766-0.798) in BIA and 0.951 (0.925-0.967) in SUW, while LOM remained relatively stable at 0.960 (0.947-0.970). Post-pandemic values increased to 0.928 (0.863-0.959) in BIA and 0.949 (0.901-0.979) in SUW, with LOM at 0.940 (0.919-0.958). Several confidence intervals did not include 1.00, indicating persistent inefficiency components. Overall, the decade shows a distinct pandemic-related dip followed by partial normalisation, with between-hospital heterogeneity and recurrent scale-related shortfalls in both domains. These results support routine, domain-specific efficiency monitoring as a tool for transparent performance tracking in strategically sensitive border regions. However, findings are constrained by the very small three-hospital sample, low discriminatory power of annual frontiers and the use of aggregated administrative data. Key methodological constraints are summarised in the Limitations section and should be considered when interpreting the findings.

Background: In the context of medical insurance payment reform in China, Computed tomography (CT), as a key type of large medical equipment, currently faces challenges of over-scanning or under-scanning. This study aims to identify the factors influencing the number of CT scans, perform risk adjustment on the number of CT scans, and evaluate the rationality of the number of CT scans for each major diagnostic category (MDC).

Methods: In the public tertiary general hospital in Sichuan Province, the top 10 MDCs with the highest total number of CT scans in 2023 were selected. A risk-adjusted model was used to estimate the expected number of CT scans. The utilization of CT scans was classified as over-scanning, under-scanning, and rational scanning based on the ratio of observed to expected scan numbers.

Results: The top 10 MDCs included 29,461 encounters and 37,672 CT scans. The number of CT scans varied across different MDCs: five exhibited over-scanning, three showed under-scanning, and two demonstrated rational scanning. The risk-adjusted model revealed that age, admission condition, first-time hospitalization, medical insurance, and length of stay were statistically significant in determining both the decision to perform a CT scan and the number of CT scans conducted.

Conclusions: This study evaluated the rationality of the number of CT scans across the top 10 MDCs, established a methodological framework for hospital to explore the rationality of the number of other medical examinations.

Background: Infection prevention and control (IPC) measures are essential in hemodialysis (HD) units because of the increased risk of healthcare-associated infections (HAIs). Nurses play a central role in the implementation of IPC protocols; however, adherence to these guidelines remains inconsistent, particularly in resource-limited settings like the Gaza Strip.

Objective: This study aimed to evaluate the short-term effects (one-week post intervention) of a structured IPC training program on the knowledge and practices of HD nurses working in governmental hospitals within the Gaza Strip.

Methods: A Quasi-experimental design was adopted, utilizing a census sampling technique to include all 112 HD nurses. Participants were assigned to intervention and control groups using a systematic roster-based allocation method. Data were collected via a validated self-structured questionnaire and observational checklist before and one week after training.

Results: Compared with the control group, nurses in the intervention group exhibited statistically significant post-intervention improvements in IPC knowledge (mean percentage score: 79.91 vs. 49.41, P = 0.001) and practice (overall adherence: 68.9% vs. 47.6%, P = 0.001), representing improvements of 62.68% and 38.63%, respectively.

Conclusion: The IPC training program proved effective in enhancing HD nurses' knowledge and adherence to IPC measures in the short term (one-week post-intervention). However, the study's design limitations and contextual barriers suggest that sustained compliance requires addressing systemic challenges such as resource limitations and high workload. These findings support the need for ongoing structured IPC training in resource-constrained settings.

Background: The nursing ability for medical narrative is essential for patient-focused practice within the bio-psycho-social model of medicine. This study sought to identify influential factors affecting nursing competence in medical narrative skills among practicing nurses in healthcare settings to determine the personal, environmental, relational, and organizational elements that impact this essential competency using grounded theory and constructivist theoretical frameworks.

Methods: A qualitative study design was employed with semi-structured interviews distributed to nurses with expertise in narrative and communication skills. Twenty nurses were selected through purposive sampling to assess: (1) their narrative medicine knowledge and practice; and (2) factors influencing their narrative competency for those with recognized communication expertise in nursing practice. The study used thematic content analysis for data interpretation. Both individual and contextual data were collected.

Results: Twenty nurses participated in this study. Four major categories of influencing factors emerged: personal factors including lack of narrative medicine knowledge, inadequate communication skills, non-standard behaviors, work dissatisfaction, low self-learning capability, and insufficient technical skills; environmental factors including family life situations, relief benefits, working atmosphere, and hospital humanistic culture; relational factors including patient and family interactions; and organizational factors including problematic training models, low emphasis on narrative skills, and ineffective medical processes. These factors demonstrated complex interrelationships affecting overall narrative competency in nursing practice.

Conclusions: The present findings demonstrate that nursing competence in medical narrative is influenced by complex, interlocking factors at multiple levels. Such evidence can be used to support nursing policy and practice improvement through comprehensive strategies including narrative medicine education, incentive-based compensation systems, adequate staffing and supportive environments, primary nursing care models, and integrated organizational approaches for humanistic nursing practice quality.

Background: Patient safety culture (PSC) is a critical component of healthcare quality, particularly in psychiatric settings where unique risks exist. In China, research on PSC within mental health institutions remains underdeveloped, and the factors influencing it are poorly understood.

Methods: This cross-sectional study utilized the Chinese version of the Hospital Survey on Patient Safety Culture (HSOPSC) to assess PSC among 2,524 mental health nurses from multiple Level-2 and Level-3 psychiatric hospitals in China (2021-2023). We specifically examined the impact of hospital level on PSC perceptions. Multivariate regression models were employed to identify predictors of PSC composites.

Results: The overall positive response rate (PPR) across the 12 PSC dimensions was 62.4%, indicating a moderate culture. Strengths were "Teamwork Within Units" (PPR = 83.3%) and "Organizational Learning" (PPR = 82.8%), while critical areas for improvement were "Nonpunitive Response to Error" (PPR = 46.6%) and "Staffing" (PPR = 43.3%). Regression analyses revealed that hospital level was a significant predictor of PSC outcomes, alongside years of experience and daily overtime hours (P < 0.05).

Conclusions: This pioneering national study reveals that the PSC landscape in Chinese psychiatric hospitals is characterized by specific strengths but also critical weaknesses, significantly influenced by hospital level. The findings compel a move away from one-size-fits-all approaches. We recommend stratified interventions: foundational support for Level-2 hospitals and advanced quality initiatives for Level-3 hospitals, with universal prioritization of addressing staffing shortages and fostering a nonpunitive "Just Culture".