Frontiers in health services最新文献

Balancing patient demand with nurse staffing remains a central challenge in inpatient care. In psychiatric settings, patient-side fluctuations create variability that is difficult to reconcile with fixed rosters and limited staffing flexibility. This study quantifies temporal variations in unit capacity utilization in psychiatric inpatient care and explores how unit managers respond to fluctuations and perceive flexible working arrangements. We combined routine inpatient data with a survey of unit managers from Swiss psychiatric hospitals. Routine data were used to describe temporal variability in capacity utilization, while the survey assessed management strategies, causes of workload fluctuations, and attitudes toward flexible working arrangements. Routine data from 116 units across 13 hospitals revealed substantial temporal fluctuations in occupancy. Most unit managers reported maintaining planned staffing levels despite changing demand, relying primarily on individual nurse-level adjustments such as overtime or calling in off-duty staff. Patient-side or structural strategies, including transfers or bed closures, were rarely used. Flexible working arrangements were viewed positively for nurse retention but deemed difficult to implement within shift-based operations. Psychiatric inpatient care illustrates the challenge of aligning fluctuating demand with staffing systems designed for stability. Current responses rely mainly on reactive measures that strain staff and may affect treatment continuity and safety, while opportunities for structural flexibility remain underused. Future research should develop data-driven tools to anticipate workload peaks and evaluate interventions that support flexible staffing and staff well-being. Organizational and policy efforts are needed to strengthen nurse manager capacity, improve working conditions, and support workforce planning that safeguards patient care.

Introduction: Participation in Special Supplemental Nutrition Assistance Program for Women, Infants, & Children (WIC) improves health outcomes for birthing people and their children, including reduced preterm birth and low birth weight, and lower rates of nutritional deficiencies for mothers and children.

Methods: This qualitative descriptive study explored opportunities to increase WIC enrollment in two New England states through community healthcare partnerships. We conducted key informant interviews with a semi-structured interview guide, purposively sampling current WIC participants (N = 10), clinical providers and staff (N = 17), and WIC staff (N = 6). We used a combination of deductive and inductive thematic analysis.

Results: Our study revealed that across multiple perspectives - WIC-eligible participants, healthcare providers, clinical staff, and WIC staff - respondents were supportive of increasing WIC enrollment through community healthcare partnerships. Individual-level barriers included limited or inaccurate understanding of eligibility and benefits and perceived stigma, while organizational-level barriers included inconsistent and inefficient integration of WIC referral in clinical settings, lack of clarity about healthcare and WIC staff roles, and scheduling, communication, and other logistical challenges. Facilitators included trusted relationships with healthcare providers and WIC staff, consistent messaging about WIC benefits, and direct assistance with WIC enrollment. Participants advocated for enhancing patient and provider awareness of and education on WIC services, automating the integration of WIC discussions into clinical workflows, and strengthening coordination between WIC and healthcare organizations.

Discussion: Across participant groups, we identified broad support for improving WIC engagement through community-healthcare partnerships. Through analysis of multi-sector perspectives organized by socio-ecological model domains, our results highlight systemic gaps and corresponding opportunities to improve awareness of WIC services and streamline WIC referrals through healthcare-based interventions at the organizational and community levels.

Background: Less than 10% of pregnant women in Sub Saharan Africa achieve the World Health Organization recommended eight antenatal care (ANC) contacts for optimal pregnancy management. Robust strategies that involve community outreach programmes, integrated service delivery and continuity of care could help improve ANC uptake and quality. Kenya, as other countries, has promoted use of digital health records at the community and facility levels to improve quality and access to data and promote continuity of care. These records, however, are not always linked and access to data does not guarantee its use to drive quality improvement. C-it-DU-it (pronounced "See it, Do it") is a two-arm pragmatic cluster-randomised trial set in Homabay County, Kenya. The trial will implement digital linkage of community and facility electronic patient data (control arm) and assess the impact of having quality improvement teams reviewing and acting on the linked data (intervention arm). While several areas are captured in the community health records, we will focus on uptake of ANC services as a lens.

Methods: Eighteen healthcare facilities (clusters) will be randomly allocated to either the control or intervention arms at a ratio of 1:1. A data linkage module will be deployed in all clusters, enabling digital referral of pregnant women between the community and health facilities. In each intervention cluster, work improvement teams will be established and trained on reviewing these electronic ANC data, identifying problems, developing and deploying context-specific solutions to these problems and evaluating the impact of their interventions. ANC data will be extracted for 1,440 recruited pregnant women. The primary outcome will be the proportion of pregnant women with at least eight ANC contacts. Secondary outcomes will be ANC uptake before 16 weeks gestation, adverse pregnancy outcomes, uptake of required investigations, medication and skilled birth attendance.

Discussion: This trial intends to generate evidence on the benefit of community work improvement teams to review and act on linked digital data to develop and deploy solutions to local problems. This strategy, if successful, will promote antenatal service uptake and quality resulting in improved pregnancy outcomes and progress towards sustainable development goals if appropriately scaled up.Clinical Trial Registration: https://clinicaltrials.gov/study/NCT05929586, identifier NCT05929586.

[This corrects the article DOI: 10.3389/frhs.2025.1695320.].

Background: Specialist nurses represent an important pathway through which registered nurses transition toward advanced practice nurse roles, and their development and clinical practice are essential for addressing contemporary healthcare challenges. However, in countries such as China, substantial gaps remain in the training and practical implementation of specialist nurses. Despite more than two decades of specialist nurse training in China, systemic issues such as unclear role definitions, insufficient designated positions, and limited decision-making authority continue to constrain their clinical practice.

Objective: To investigate healthcare professionals' perceptions and experiences of specialist nurse practice in ICU to identify their roles, impacts, challenges, and suggestions for improvement.

Setting: A 25-bed ICU in a tertiary hospital in central China has been conducting under the specialist nurse practice model for six months.

Participants: A purposive sampling survey recruited 18 nurses (14 ICU registered nurses and 4 specialist nurses) and 3 ICU physicians, all with more than one year of ICU work experience.

Methods: A qualitative descriptive design using semi-structured interviews was adopted.

Findings: Three major themes emerged from the analysis: 1) being a versatile and core force; 2) leading nursing quality and professional transformation; and 3) facing challenges and pursing a path to growth.

Conclusion: Specialist nurses play a pivotal role in ICU nursing, driving quality improvement and professional development. However, systemic barriers such as resource constraints and role ambiguity limit their full potential. Addressing these challenges through workflow optimization, clear role definition, and policy reforms is crucial for advancing specialist nurse practice globally.

Background: Adverse drug reactions (ADRs) remain a major barrier to safe and effective cancer therapy. Existing pharmacovigilance systems predominantly rely on spontaneous reporting, which suffers from underreporting and delays. The Chinese Hospital Pharmacovigilance System (CHPS) provides an opportunity for active monitoring using multidimensional hospital data.

Methods: We conducted a retrospective cohort study, including 500 patients who received chemotherapy, targeted therapy, or immunotherapy. ADRs were identified through CHPS, classified by the Common Terminology Criteria for Adverse Events (CTCAE), and assessed using both active monitoring and spontaneous reporting. Signal detection employed disproportionality analyses (PRR, ROR, IC). Risk factors were analyzed with logistic regression, and predictive models for severe ADRs were evaluated with ROC curve analysis.

Results: The overall ADR incidence was 37.0% (185/500), with 28.1% classified as severe. Hematologic (29.7%), gastrointestinal (26.0%), and skin/mucosal (19.5%) events were most common. Severe ADRs led to hospitalization (34.6%), treatment discontinuation (23.1%), and death (9.6%). Independent risk factors included age ≥65 years, polypharmacy, hepatic/renal dysfunction, and prolonged drug exposure (≥14 days). Signal detection confirmed known associations and identified potential novel signals, including skin hyperpigmentation with PD-1/PD-L1 inhibitors and cardiotoxicity with tyrosine kinase inhibitors. Active monitoring detected more ADRs than spontaneous reporting (160 vs. 50, P < 0.001) and provided earlier detection (mean 4.2 vs. 10.7 days). Predictive modeling demonstrated strong performance of the multivariable model (AUC = 0.82), with active monitoring outperforming spontaneous reporting (AUC = 0.84 vs. 0.72).

Conclusion: CHPS-based active monitoring improves the detection, timeliness, and predictive assessment of ADRs compared with spontaneous reporting. These findings support the integration of active monitoring into hospital pharmacovigilance systems and highlight novel safety signals requiring further validation.

The fast-changing environment for healthcare in all countries calls for new approaches to achieving improvements. This article proposes that improve-mentation is one such approach. Improve-mentation synergistically combines elements of implementation and improvement sciences, as well as experience to carry out change in different settings. One feature is the iteration of the change so as to adapt the change to the evolving context for private and public healthcare in different countries. The article addresses challenges posed by increasing complexity and describes the methods used in four different improve-mentation frameworks, using case examples to illustrate different resolutions to generalisability and other issues.

Introduction: End-stage kidney disease (ESKD) affects many Americans, with higher risks in certain subgroups of the US population. Differential kidney health outcomes may stem from non-medical social drivers of health, cognitive difficulties, and functional limitations. Recommendations for individuals with ESKD are often standardized and may not account for unique challenges and access barriers that individuals face. These challenges lead to preventable differences in access to treatments such as home dialysis and kidney transplantation. This study examines the prevalence of unmet social, cognitive, and functional needs amongst patients receiving dialysis and evaluates the intersection of these barriers to inform strategies to improve kidney health outcomes for all patients.

Methods: In a cross-sectional study, a convenience sample of 962 patients from diverse backgrounds, currently undergoing dialysis from multiple dialysis centers across the United States (aged 21-95 years), were surveyed. Descriptive, Spearman's correlation, logistic regression, and Chi-Square Test analyses conducted.

Results: From our large sample, 45.1% reported memory challenges, 19.6% required assistance with activities of daily living (ADLs), and 51.0% experienced two or more mobility limitations. Additionally, 20.4% reported difficulty accessing healthcare, while 16.3% faced challenges obtaining medications. A subset (12.2%) of participants experienced overlapping social, cognitive, and functional barriers. Unmet needs were disproportionately higher amongst public insurance participants compared to those with private insurance, with 33.0% of Dual-eligible participants reporting three or more unmet needs.

Discussion: This study highlights the significant intersection of social, cognitive, and functional barriers faced by patients receiving dialysis with ESKD, particularly those from vulnerable populations. Addressing these multifaceted needs through person-centered interdisciplinary care models and policy interventions is critical to reducing disparities and improving outcomes in kidney health outcomes.

The persistence of the science to service gap is evidence that evidence is not enough when defining evidence-based programs. Innovations must be developed with attention to the internal and external validity of the innovations themselves so that innovations can be replicated and scaled. This paper outlines the requirements for establishing an innovation, recommends standards for a usable innovation, and describes the usability testing processes to meet those requirements. Usability testing is a systematic process to efficiently and effectively determine the essential components and to develop a fidelity measure for an innovation. Usability testing is the foundation for research to establish the internal validity ("the basic minimum without which any experiment is uninterpretable") and external validity ("asks the question of generalizability") of the innovation itself. Once the essential components of a usable innovation are defined, measured, and linked with outcomes, implementation and scaling of usable innovations with fidelity can narrow the science to service gap.