Frontiers in health services最新文献

Background: This study evaluates the effectiveness of AI-enhanced "One Body Two Wings" pharmacovigilance models in China, focusing on improving medication safety and risk management. As the pharmaceutical landscape grows more complex, integrating AI into pharmacovigilance offers the potential to enhance adverse drug reaction (ADR) detection and monitoring.

Methods: A nationwide cross-sectional survey was conducted from June 25 to August 10, 2024, involving 1,000 participants from pharmacovigilance centers, hospitals, corporations, and the general public. Participants were recruited through stratified convenience sampling to ensure a broad geographical and professional representation. Data were collected through a validated questionnaire and analyzed using ANOVA, regression analysis, decision tree models, and random forest algorithms. To ensure the validity of the predictive models, resampling (SMOTE) and class weighting techniques were employed to address significant class imbalance in the outcome variable.

Results: The survey revealed that 43% of participants were hospital staff and 46% had more than 10 years of experience, with these expert groups expressing strong support for AI's role. Path analysis indicated that AI's effectiveness in processing ADR reports was strongly related to enhanced monitoring capabilities (standardized path coefficient: 0.85). Furthermore, logistic regression identified the perceived effectiveness of information systems as a significant predictor of positive attitudes toward the model (odds ratio: 1.703). Crucially, a random forest model, adjusted for class imbalance, confirmed that information systems effectiveness was the most significant predictor of the model's success (mean importance: 0.53 ± 0.05), achieving robust performance with a weighted F1-score of 0.94 and an AUC-ROC of 0.89.

Conclusion: The findings confirm AI's potential to enhance pharmacovigilance, especially in ADR monitoring. However, the study concludes that successful AI integration is predicated on a robust information systems infrastructure, which the data identified as the most critical foundational element. Therefore, optimizing pharmacovigilance in China requires prioritized investment in both this foundational IT and supportive organizational frameworks.

Introduction: Implementing evidence-based interventions for tobacco use disorder (TUD) in community mental health agencies is critical, given the low adoption rates of these interventions and the high rates of TUD among patients, contributing to the high morbidity and shortened lifespan of this population. Implementation efforts require enhancing organizational preparedness to integrate these evidence-based interventions.

Purpose: When the Addressing Tobacco Through Organizational Change (ATTOC) model was evaluated in a cluster-randomized trial (with 13 clinics, 610 clients, and 222 staff) and compared with an education-only intervention, ATTOC proved to be better at having more TUD treatment, policies, and staff skills. This paper presents a secondary analysis focusing only on the ATTOC sites, examining whether clinic-level preparedness is associated with increased implementation activities and estimating the combined direct and indirect impact on patient referrals to evidence-based TUD interventions.

Methods: Seven sites applied the ATTOC model over 9 months, with the ATTOC Environmental Scan (ES) conducted at baseline and 3, 6, and 9 months to assess the following: (1) the environment inside and outside the building, (2) staff training and personal tobacco use, (3) clinical TUD services and documentation, and (4) tobacco policies. Summary statistics are provided, and generalized linear mixed model analyses for repeated measures were used to assess time trends and relationships among composite preparedness, activities, and number of referrals.

Results: Over the 9-month period, significant improvements were observed in ES composite preparedness (p < 0.001) and individual ES areas (p < 0.001 for each). Eight out of 11 ATTOC Dashboard items showed significant changes, including increased number of patients treated (p = 0.002); tobacco discussions (p = 0.022); provision of educational brochures (p = 0.034); referrals to a Nicotine Anonymous group (p < 0.001), an in-house wellness or tobacco group (p < 0.001), and state quitline (p = 0.012); and documentation in treatment plans (p = 0.008). Both composite preparedness (p = 0.006) and composite activities (p < 0.001) were significantly associated with the number of composite referrals.

Conclusion: Significant TUD intervention uptake was found over time through the ATTOC model organizational change intervention and tracking tools.

Objective: To explore nurse role reconstruction under the implementation of no-attendant care services in Shanghai hospitals, and to identify challenges and strategies for optimization.

Methods: A phenomenological qualitative design was adopted. From June 1 to July 1, 2025, semi-structured face-to-face interviews were conducted with 14 registered nurses from no-attendant care wards in three tertiary hospitals in Shanghai. Data were transcribed verbatim and analyzed using Colaizzi's seven-step method. Two researchers independently coded, discrepancies were resolved through discussion and methodological arbitration, and results were validated through member checking to ensure rigor.

Results: Four main themes and eleven subthemes were extracted: (1) Expanded Responsibilities and Intensified Workload: Significant Increase in Work Intensity; New Challenges in Professional Competence; Multidimensional Accumulation of Occupational Stress. (2) Positive Impacts on Patients and Families: Effective Relief of Family Care Burden; Enhanced Perceived Value of High-Quality Nursing. (3) Challenges in the Implementation Process: Blind Spots in Patient Safety Management; Need to Improve Nurse-Patient Communication Efficiency; Inadequate Mechanisms for Accountability. (4) Optimization Strategies: Establish a Legal Safeguard System; Improve Insurance Payment Coordination Mechanism; Strengthen Training Mechanisms for Nursing Assistants. A few minority or dissenting perspectives were incorporated as contextual modifiers.

Conclusion: No-attendant care improves patient experience and alleviates family caregiving burden, but simultaneously places heavier physical, risk, and relational demands on nurses, highlighting the complexity of role reconstruction. This study demonstrates the essential features of nurses' lived experiences under this model and emphasizes the need for systemic support, such as legal frameworks, insurance coverage, and workforce training, to optimize care delivery and sustain professional resilience.

Objective: Globally adopted as a contemporary hospital management methodology, DRG payment systems aim to improve cost-efficiency, advance clinical service quality, and maintain treatment safety. Through empirical analysis of lung cancer inpatient data, this study quantifies the policy's effects on medical expenditure patterns and efficiency metrics, offering evidence-based insights for optimizing healthcare resource management.

Methods: Using ITS analysis, we developed a segmented regression model to evaluate the longitudinal effects of DRG-based payment reform on healthcare expenditure and LOS for lung cancer patients at a regional tertiary hospital in Northwest China.

Results: The analytical cohort comprised 1,076 consecutively admitted lung cancer patients. ITS analysis revealed: (1) No significant immediate changes in total hospitalization costs (β ₂ = -1,365.532, P = 0.684), treatment expenses [(β ₂ = +147.512, P = 0.524)], or LOS [(β ₂ = -0.104 days, P = 0.944)], with stable longitudinal trends post-implementation; (2) Material expenses showed no reduction [(β ₂ = -1,433.072, P = 0.426)]; (3) Diagnosis expenses exhibited a significant immediate increase [(β ₂ = +1,953.740, P < 0.001)] and progressive monthly escalation [(β ₃ = +72.184, P = 0.035)], while drug costs showed a pronounced policy-induced surge [(β ₂ = +4,963.668, P < 0.001)] with accelerated growth [(β ₃ =+147.378 per month, P = 0.001)].

Conclusion: While DRG reform serves as an essential resource allocation mechanism, our findings reveal paradoxical outcomes. The implementation showed limited efficacy in reducing aggregate costs and LOS while provoking structural cost shifts marked by escalated diagnostic and pharmaceutical expenditures. These unintended economic consequences may distort clinical practices, potentially compromising both pharmacoeconomic efficiency and service quality.

Objectives: Patient-reported outcomes (PROs) are an essential component in the implementation of value-based health care. Up to now, no consensus exists on the appropriateness of PROs used across diseases, e.g., to allow for comparability or to assess disease impact. The aim of this study was to develop an international, multi-stakeholder consensus on a generic PRO set applicable for different stakeholders and diseases within of the Health Outcomes Observatory (H2O) project funded by the EU Innovative Medicines Initiative.

Methods: To begin, a literature review was conducted to identify the most frequently utilized generic PROs followed by a three-round Delphi consensus procedure. The resulting outcome set was then cross-referenced with disease-specific outcome sets for lung and metastatic breast cancer, diabetes, and inflammatory bowel diseases to identify overlaps and gaps. Lastly, the identified generic outcome domains were mapped to the Max Neef's human needs model to explore the degree to which the generic domains address a general concept of wellbeing.

Results: The literature search resulted in 2357 articles from which 190 PROMs and their measured domains were extracted. The Delphi consensus procedure reduced these to 10 core domains (mental, physical and social wellbeing, overall health status, fatigue, pain, sleep quality, sexuality, self-efficacy, treatment satisfaction). In comparison to the human needs model, needs such as identity and leisure were disregarded.

Conclusions: The H2O generic outcome set presents a disease-generic, domain-centered PRO framework building the groundwork for health data spaces and supporting consistency in treatment outcomes across different sites, settings, and patient populations.

This community case study outlines the conceptualization, development, implementation, and commercialization of the Alberta Family Integrated Care (Alberta FICare) model, offering insights into a unique way of sustaining patient-oriented innovations through social enterprise. Our team developed the Alberta FICare model to include families as partners in care in neonatal intensive care units (NICUs). Research phases of our model showed improved outcomes for neonates (shorter hospital stays), their families (greater caregiving self-efficacy, reduced psychosocial distress), and the health system (cost avoidance). Despite co-development of the model with families, providers, and leaders, rigorous testing (cluster randomized controlled trial), and province-wide scale-up (now standard of care in all 14 Alberta NICUs) efforts to sustain the model stalled due to shifting health system priorities. To address this challenge, we incorporated a social enterprise (Liminality Innovations Inc.) to sustain the model of care and support broader dissemination of family integrated care practices in NICUs beyond Alberta. While this strategy fostered sustainment and growth of our model, it also raised challenges. Some of these challenges included tackling perceptions within the research and practice communities that commercialization undermines research integrity. We share our experiences to highlight the potential of ethical, mission-driven commercialization through social enterprise to support innovation in learning health systems through ongoing interest holder engagement, responsible stewardship, and improving learning health system outcomes as the central goal.

Background: Child and youth mental health care is of varying quality across the WHO European Region, with many settings being low-resourced. To improve and standardize quality of care, WHO Regional Office for Europe is developing quality standards for child and youth mental health services. This research aims to develop evidence informed methods to develop these quality standards.

Methods: Desk reviews of grey literature aimed to understand what approaches have been used or recommended to develop quality standards for child and youth mental health/health for use across a range of different countries, and consultation was sought from an expert steering group. A thematic approach was used to synthesize relevant themes. The methods were developed based on the results of these steps.

Results: Desk reviews identified variation in approaches used and recommended to develop quality standards, with limited available guidance applicable across different resource settings. Nine key themes from stakeholder consultations were highlighted. Based on these results, a seven-step methodology was created to develop the quality standards for child and youth mental health which prioritizes using an evidence-based approach and inputs from a wide range of stakeholders.

Discussion: The methods taken to develop quality standards need to be rigorous to ensure that standards accurately define high-quality care for a service. There is a need to develop a unified approach to developing quality standards. It is hoped that this paper will provide inspiration for others developing quality standards for child and youth mental health services and spark research in this area.

Introduction: Ulcerative colitis is an inflammatory bowel disease that is limited to the colon. First-line treatment consists of rectally administered suppositories, foam or enema. Adherence to rectal treatment is very low in people with ulcerative colitis. We aimed to explore modifiable factors influencing adherence to rectal treatment among patients, healthcare providers (HCP), and pharmaceutical companies, and to delineate new approaches to improve adherence to rectal medicines.

Methods: We recruited people using rectal treatment, community and clinical pharmacists, gastroenterologists, inflammatory bowel diseases (IBD) nurses, and representatives of pharmaceutical companies specialised in the production of rectal therapies. We performed semi-structured one-to-one interviews tackling the three pivotal topics knowledge and beliefs, product characteristics, and communication. We started with patient interviews whose statements served to inform the other interviews. All interviews were the subject of a keyword protocol, audio-recorded, and transcribed. Thematic analysis was used with inductive approach for the patients, and deductive approach for all other interviewees. Identified themes were compared and agreements and divergences were compiled.

Results: We interviewed eight patients (22-77 years old, 3 women) in spring 2023, and stakeholders from the hospital (3 gastroenterologists and 2 IBD nurses), ambulatory setting (4 community pharmacists) and pharmaceutical companies (2 representatives) in 2024, all in the region of Basel (Switzerland). Overall, people with ulcerative colitis often feel left alone to cope with the challenges associated with their therapies. Pretreatment concerns and difficulties experienced by these people following their first attempts at use are not adequately addressed by HCPs. Training sessions for clinicians and pharmacists, patient-oriented demonstration materials, visual aids, and tips and tricks the application of rectal treatment could help improve the use of rectal medicines by people with ulcerative colitis.

Conclusion: This study identified a detailed knowledge of the proper use of rectal treatment and frank communication between patients and HCPs as crucial for the adherence to rectally administered medicines. While these factors are broadly recognised in the literature, this study highlights their common priority among all stakeholders. In addition, solutions for future development and tailored interventions are proposed.

While there is evidence of humans' harmful impact on the environment, translating such evidence into changes is challenging. Implementation science can facilitate a shift from a reactive to proactive approach in tackling environmental sustainability. This article aims to spur further discussion among implementation scientists to incorporate environmental sustainability within their research, while also offering concepts relevant to environmental science researchers seeking to apply implementation science principles.