Frontiers in health services最新文献

Introduction: Hospital discharge is a vulnerable transition for older adults who often leave with limited understanding of their health and care instructions. This study evaluated the implementation and outcomes the Patient-Oriented Discharge Summary (PODS), a one-page co-designed tool to support hospital-to-home transitions.

Methods: Using a hybrid type II design, we combined a quasi-experimental pre-post study with an implementation evaluation in a Swiss acute care unit. Patients aged ≥50 years discharged home were allocated to control (n = 55) or intervention (PODS; n = 56). The primary outcome was perceived quality of care transition measured using the Care Transition Measure (CTM-15). Implementation outcomes were assessed through surveys, focus groups and interviews with healthcare professionals.

Results: PODS participants reported higher CTM-15 scores than controls (74.4 vs. 62.3, p < 0.001). Implementation findings showed that the PODS structured discharge teaching and supported dialogue but its blank, collaboratively completed format led to variable completeness and limited usefulness at home. Persistent barriers included workload, workflow integration, and uneven interprofessional engagement.

Conclusions: PODS improved perceived quality of care transition, primarily through the relational and educational processes it structures rather than the written document alone. While valuable, PODS alone appears insufficient; combining structured tools with contextual and organizational supports may enhance effectiveness.Clinical Trial Registration: clinicaltrials.gov, identifier (NCT06123546).

Background: Leadership underpins nurses' interrelated satisfaction and retention, particularly in military healthcare settings marked by strict hierarchies and high operational demands. In Greece, Navy nurses are integral to military healthcare, yet evidence on their job satisfaction and turnover intentions remains limited. This study offers an initial examination of these factors to inform retention strategies and sustain clinical workforce stability.

Methods: A cross-sectional survey was conducted between January and March 2025 among active-duty Hellenic Navy nurse officers, primarily serving at the Athens Naval Hospital. Data were collected using an anonymous questionnaire incorporating the Job Satisfaction Survey (JSS) and turnover intention items. Analyses employed descriptive statistics and bivariate tests.

Results: Sixty nurse officers participated (response rate: 53.6%). While respondents reported satisfaction with supervision (68.3%) and coworker relationships (31.7%), there was widespread dissatisfaction with extrinsic factors: 90.0% with pay, 85.0% with promotion opportunities, and 83.3% with fringe benefits. Overall, 53.3% of nurses reported low job satisfaction. Turnover intentions were high: 46.7% considered transitioning to civilian nursing, and 31.7% intended to leave both the Navy and the profession. Job satisfaction related to the nature of work (r = 0.36, p < 0.05) and communication (r = -0.33, p < 0.05) significantly correlated with turnover intentions.

Conclusion: Leadership quality, as reflected in supportive supervision, is a key protective factor against job dissatisfaction and turnover intention among Hellenic Navy nurse officers. Strengthening supervisory practices and leadership development, alongside reforms addressing extrinsic rewards and communication, is essential to enhance retention and sustain a resilient military nursing workforce.

Dialysis therapy is a resource-intensive treatment for end-stage kidney disease that remains highly dependent on in-center hemodialysis in Japan. From both economic and environmental perspectives, it is necessary to reduce energy consumption and resource use, and minimize waste generation to achieve sustainable kidney healthcare. The clinic targeted in this study provides hemodialysis in a regional city and launched a resource-saving committee in 2008 to implement initiatives, appoint green champions, and monitor four environmental items (electricity, gas and water consumption, and waste generation) and financial effects. To retrospectively evaluate environmental impact, we calculated the carbon footprint. The median monthly consumption of electricity, gas, and water per hemodialysis patient was approximately 353 kWh, 17 m³, and 9 m³, respectively. These levels of resource consumption were nearly equivalent to those of an average Japanese household in 2022. Switching to a combination of city water and well water reduced both costs and environmental impact. However, the overall financial benefit and initial investment burden, such as for installation of light-emitting diode fixtures and developing the water supply system, were not fully investigated. The resource-saving committee appears to have mitigated both economic and environmental impacts to some extent; however, steady resource-saving efforts were accompanied by surging costs of electricity and medical waste disposal during the study period, indicative of recent general inflation in Japan. To achieve more sustainable dialysis therapy that balances environmental and health considerations, further proactive initiatives are needed to reduce resource use beyond the current scope, such as through individualized dialysate prescriptions.

Backround: The use of generative AI, as represented by ChatGPT, holds promising potential for nursing education. This manifests itself in various areas, including personalized learning, simulation training and teaching process support. However, its integration requires careful consideration of ethical implications, adaptation of curricula and a high level of digital competence on the part of teachers. Only in this way can potential risks, such as the distortion of knowledge, bias and educational inequalities, be avoided.

Methodes: Relevant publications were identified between 2019 and 2025 as part of a comprehensive literature search in the specialist databases PubMed, Embase, CINAHL and Scopus. The search was conducted using combined search terms that included the terms "generative AI", "ChatGPT" and "nursing". After removing duplicates and screening (PRISMA-guided), 140 full texts were analysed and divided into two publications. This rapid overview focuses on the topic of generative AI in nursing education.

Results: As part of the analysis of the included studies, five thematic areas were identified, which were divided into the categories of nursing education, competence development and nursing skills, implementation possibilities, examination quality and ethical considerations, and evaluated. A key theme is the dual potential of this technology: it can enrich learning through features such as virtual tutors and improved exam preparation, but it also requires critical consideration of ethical issues such as plagiarism, data bias and the need for human oversight.

Outlook: In this context, the conclusion emphasises the urgent need to adapt curricula and provide targeted further training for teachers so that GenAI can be used responsibly and effectively-rather than, as is often the case at present, by banning it altogether.

Objectives: This study aimed to explore provider knowledge, barriers, and opportunities for improving chronic disease management in Indonesian primary health care.

Methods: A descriptive cross-sectional mixed methods study was conducted from December 1, 2022 to March 31, 2023 across 14 primary care centers in Jakarta. Multidisciplinary healthcare providers responsible in hypertension and diabetes mellitus (DM) care were involved. Data were collected using a semi-structured, interviewer-administered questionnaire consisting of both closed- and open-ended questions, structured across five domains: referral system knowledge, referral pathway implementation, hypertension management knowledge, DM management knowledge, and delivery of chronic disease care. Quantitative data were complemented with qualitative responses to provide contextual insight.

Results: A total of 59 healthcare providers participated in the study, the majority of whom were female (89.8%). Participants included physicians (42.4%), nurses (35.6%), and midwives (10.2%). Most participants (71.4%) had over three years of practice. Notable knowledge gaps were identified in referral practices, diagnostic criteria, and monitoring protocols. Referrals were often delayed until complications occurred. Implementation of the national chronic disease (PROLANIS) program was suboptimal, particularly in patient selection and defining outcome targets. Screening for kidney complications was limited and medication availability was restricted. Poor adherence to national guidelines, short consultation times, and staffing shortages further hindered care and education efforts. Three major barriers-patient-related, provider-related, and structural-were identified.

Conclusions: Improving chronic disease care in primary settings requires addressing provider knowledge gaps, strengthening referral systems, and enhancing PROLANIS implementation through targeted training and resource allocation.

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.