BMC Health Services Research最新文献

Background and objective: Tele-ophthalmology is a beneficial technology for providing eye care to diabetic patients, given the ongoing upward trend of this disease across populations. Identifying barriers and facilitators that influence the adoption and implementation of tele-ophthalmology in diabetic eye care is crucial to increasing its utilization. This study aims to elicit and examine these factors using the existing literature to gain a comprehensive understanding of the determinants and to provide solutions that facilitate better adoption of this technology by various healthcare stakeholders, thereby optimizing clinical outcomes of diabetic eye care.

Materials and methods: This scoping review adhered to the PRISMA-ScR checklist. We searched the WoS, PubMed, Scopus, and Google Scholar databases through September 15, 2025, to conduct a comprehensive review of this topic. The study selection process was conducted in accordance with the PRISMA flowchart, and relevant data were extracted using a standardized data extraction form. A qualitative content analysis was conducted to identify the determinants of tele-ophthalmology adoption in diabetic eye care. The results were presented in tables and figures, along with a narrative synthesis of the qualitative data.

Results: After database searches, 257 studies were retrieved. By applying the eligibility criteria and conducting internet and manual searches in accordance with the PRISMA guidelines, seven articles were selected for data extraction and synthesis in this study. Thirty-eight barriers and 68 facilitators of tele-ophthalmology adoption in diabetic eye care were identified through a review of existing literature. The hurdles were classified into three themes: individual, organizational and managerial, and technological determinants. The facilitators were categorized into five themes: individual, organizational and managerial, technological, governmental, and cultural factors.

Conclusion: Identifying and accounting for the factors influencing tele-ophthalmology use is crucial to increasing its adoption among healthcare stakeholders across multiple areas, such as technological and organizational aspects. These factors can be used to develop a roadmap or guideline for stakeholders to enhance the adoption of this technology in healthcare settings.

Background: Transitions from hospital to community are high-risk for older adults. In Denmark, municipal temporary stay (TS) facilities provide short-term, bed-based post-acute support, but determinants of early (re)hospitalization after TS admission are not well described. We estimated baseline risk factors for 30-day and 180-day hospitalization among TS patients.

Methods: We performed a register-based cohort study that includes adults with TS admission in 14 municipalities (2016-2023). Individual-level linkages captured demographics, diagnosis history, healthcare-utilization markers, and characteristics of recent hospitalization episodes. Outcomes were all-cause hospitalization within 30 and 180 days after the index TS admission, with death treated as a competing event. We estimated cumulative incidence using the Aalen-Johansen method and fitted additive competing-risk regression with inverse failure probability weighting, which allows us to directly model absolute risk ratios (ARRs). Discrimination for 30-day risk was assessed with time-dependent c-index and Brier score using 3-fold cross-validation.

Results: Among 11,284 patients (median age 81 years), 26.1% were hospitalized, and 7.6% died within 30 days without prior hospitalization. In adjusted models, male sex (ARR 1.16, 95% CI 1.09-1.24), higher multimorbidity (1-2 vs 0: 1.17, 1.04-1.31; ≥3 vs 0: 1.43, 1.27-1.61), and recent hospitalization (1.24, 1.14-1.34) increased 30-day risk, whereas older age decreased it per 10 years (0.96, 0.93-0.98). Several morbidities were associated with higher 30-day risk (cancer-related morbidities, cirrhosis, chronic kidney disease, chronic heart failure, atrial fibrillation, chronic pulmonary disease, diabetes), while dementia and prior stroke/TIA were associated with lower risk. Healthcare-utilization markers showed dose-response relations (≥4 prior hospitalizations: 1.58; ≥10 medications: 1.28; ≥3 procedures: 1.34). In the recently hospitalized subgroup, a fall-injury primary diagnosis reduced 30-day risk (0.88), recent surgery increased it (1.09), and hospital stays > 14 days conferred higher risk (1.31). The best 30-day model yielded a c-index of 0.623 and Brier score of 0.186.

Conclusions: Early (re)hospitalization after TS admission is common and patterned by sex, multimorbidity, intensive prior healthcare use, and selected morbidities. Although model discrimination was modest, the identified risk factors can inform targeted interventions in transitional care delivered at TS settings.

Clinical trial number: Not applicable.

Background: Interest is growing in whether healthcare professionals from a range of backgrounds can deliver complex behaviour-change interventions effectively. Thus, as part of a wider evaluation of 'REDUCE,' a novel, person-centred, cognitive behavioural intervention targeting the self-care behaviours of individuals with a history of diabetic foot ulcers, we explored whether, how, and why, a diverse group of healthcare professionals developed a sense of competence and confidence as facilitators of behaviour change. Our aim was to generate insights to support the recruitment, training, development and retention of appropriately skilled personnel for this and similar behaviour change-oriented interventions going forward.

Methods: We interviewed 15 healthcare professionals who had been appointed and trained to deliver the REDUCE intervention in the context of a randomised controlled trial. We analysed the resulting data thematically.

Results: Our interviewees described diverse backgrounds, routes into the programme, and motivations, and similarly variegated journeys towards competence and confidence as facilitators. They observed how training provided a solid foundation on which to build, but that subsequent learning - substantially self-directed - also played an important part in their development. Interviewees emphasised the particular contributions of experiential learning and reflective practice, noting the key roles that supervision and group support played in the latter, and highlighting how such arrangements helped them to learn from, rather than be derailed by, challenging cases and interactions. Finally, interviewees talked of the returns and rewards of engaging with the REDUCE programme, and how they had benefited both professionally and personally from investing in their own development as facilitators of behaviour change.

Conclusions: Healthcare professionals involved with this behaviour-change intervention were not passive recipients of training and support. Instead, they were self-directed learners who invested actively in their own development. To enable facilitators to reach their full potential, their agency needs to be recognised and interventions organised in ways which enable them to access appropriate experience and support.

Clinical trial number: Not applicable (the manuscript reports on a qualitative study).

Objective: To systematically evaluate the risk stratification performance of four physiological scoring systems-National Early Warning Score (NEWS), Rapid Acute Physiology Score (RAPS), Glasgow Coma Scale (GCS), and Shock Index (SI)-in prehospital emergency care within resource-limited settings, and to inform evidence-based triage strategies and intervention allocation.

Methods: This retrospective population-based cohort study analyzed 15,720 prehospital emergency cases from Shaodong Emergency Medical Center (2023-2024), a county-level EMS system operating under resource-constrained conditions in southern China. A novel analytical framework, integrating "score stratification × intervention behavior," was designed to assess the predictive consistency and clinical utility of the four scoring systems across four essential prehospital interventions: oxygen therapy, ECG monitoring, intravenous (IV) access, and fluid administration. Statistical methods included trend analysis, nonparametric effect size estimation, generalized linear mixed models (GLMMs), and an XGBoost machine learning algorithm.

Results: NEWS and RAPS demonstrated the strongest dose-response consistency in guiding intervention decisions. Although all effect sizes remained in the weak range (η² < 0.06), NEWS showed the highest trend strength for ECG monitoring (Z = 23.58, P < 0.001) and the largest effect size (η² = 0.0415), with RAPS showing a comparable value (η² = 0.0412). High-risk patients were significantly more likely to receive ECG monitoring than low-risk patients (OR = 2.691, 95% CI: 2.301-3.142). GCS was predictive primarily in patients with severe consciousness impairment (OR = 4.32, P < 0.001), while SI demonstrated minimal discriminatory value (η² < 0.01). In the XGBoost model, disease category (importance = 0.161) and NEWS (0.108) emerged as the most influential predictors of intervention intensity.

Conclusion: In this real-world, resource-constrained EMS cohort, physiological scores exhibited limited discriminatory capacity. Nevertheless, NEWS and RAPS showed more consistent associations with intervention allocation than GCS or SI. Even modest stratification reduced decision variability, supporting an adjunctive role. Multicenter prospective studies are needed to establish actionable thresholds and validate their impact on intervention timeliness and patient outcomes.

Trial registration: Not applicable.