BMC Health Services Research最新文献

Background: Quality assurance in hospitals is essential for ensuring patient safety, quality of care and efficiency. The nursing profession is a key contributor to healthcare quality, yet, a comprehensive overview and comparison of the role and scope of nursing as part of accreditation and certification schemes has been lacking. The aim was to identify if and to what extent international accreditation or certification schemes focus on nursing, and to compare their conceptual models and outcome indicators.

Methods: A scoping review was conducted. A search strategy was developed together with a librarian and carried out in January 2024 in Medline, CINAHL, Web of Science Core Collection, Cochrane Reviews and Google Scholar. Additionally, authoritative websites of accreditation/certification holders were searched. Inclusion criteria were studies on international accreditation or certification schemes for hospital settings with relevance to nursing published in English or German. Screening and data analysis adhered to the Joanna Briggs Institute's methodology, with reporting following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline (PRISMA-ScR).

Results: The search identified 17.315 records. After removing duplicates and screening of titles/abstracts, 336 full-texts remained. A total of 124 studies were included, identifying seven international accreditation/certification schemes: European Foundation for Quality Management, Evaluation and Quality Improvement Program, International Organization for Standardization 9001, Joint Commission International^®, Magnet Recognition Program^®, Pathway to Excellence^® Program, Qmentum^®. The different schemes ranged from nursing-specific to having no specific focus on, but relevance for, nursing and varied in their topics, focus on structure, process and outcome quality and structure and content of requirements. Additionally, outcome indicators varied, with differences in the extent to which indicators were nurse-sensitive, compulsoriness of data collection, and use of external benchmarking.

Conclusions: The seven international schemes show large conceptual variations as to their focus on nursing and differences in the degree of nurse-specific outcome indicators. Hospital and nursing managers, policymakers, patients and the public need to understand the content and outcome dimensions of the schemes when making decisions or assessing hospital quality data.

Background: Electronic patient-reported outcome (ePRO)-based symptom management improves cancer patients' outcomes. However, implementation of ePROs is challenging, requiring technical resources for integration into clinical systems, substantial buy-in from clinicians and patients, novel workflows to support between-visit symptom management, and institutional investment.

Methods: The SIMPRO Research Consortium developed eSyM, an electronic health record-integrated, ePRO-based symptom management program for medical oncology and surgery patients and deployed it at six cancer centers between August 2019 and April 2022 in a type II hybrid effectiveness-implementation cluster randomized stepped-wedge study. Sites documented implementation strategies monthly using REDCap, itemized them using the Expert Recommendations for Implementation Change (ERIC) list and mapped their target barriers using the Consolidated Framework for Implementation Research (CFIR) to inform eSyM program enhancement, facilitate inter-consortium knowledge sharing and guide future deployment efforts.

Results: We documented 226 implementation strategies: 35 'foundational' strategies were applied consortium-wide by the coordinating center and 191 other strategies were developed by individual sites. We consolidated these 191 site-developed strategies into 64 unique strategies (i.e., removed duplicates) and classified the remainder as either 'universal', consistently used by multiple sites (N = 29), or 'adaptive', used only by individual sites (N = 35). Universal strategies were perceived as having the highest impact; they addressed eSyM clinical preparation, training, engagement of patients/clinicians, and program evaluation. Across all documented SIMPRO strategies, 44 of the 73 ERIC strategies were addressed and all 5 CFIR barriers were addressed.

Conclusion: Methodical collection of theory-based implementation strategies fostered the identification of universal, high-impact strategies that facilitated adoption of a novel care-delivery intervention by patients, clinicians, and institutions. Attention to the high-impact strategies identified in this project could support implementation of ePROs as a component of routine cancer care at other institutions.

Trial registration: ClinicalTrials.gov. NCT03850912. February 22, 2019. https://clinicaltrials.gov/ct2/show/NCT03850912?term=hassett&draw=2&rank=1.

Background: Although telemental health can make suicide prevention treatments more scalable and accessible, limited evidence demonstrates successful reductions in suicidality when interventions are administered through telehealth platforms. To address this limitation, the current work investigated the effects of two suicide prevention treatments - a clinician-guided Crisis Response Plan and a self-guided Safety Planning approach.

Methods: After completing the screening process, 82 participants with high suicide ideation and/or a lifetime history of suicidal behavior were randomly assigned across the two groups. Trained research clinicians administered the interventions using a videoconferencing platform. After the intervention delivery was complete, participants reported the therapeutic alliance they experienced with their clinician using an online survey. Participants also reported their overall suicidality 45 days after receiving the intervention. In addition, participants' perceived usefulness of the received intervention and actual use of the plan were recorded. Linear and logistic regression models predicted how suicidality, perceived utility, and actual use of their intervention protocols varied depending on the high (Crisis Response Plan) versus low (self-guided Safety Planning) level of clinician-led collaboration the two treatments entailed.

Results: Both Crisis Response Plan and self-guided Safety Planning were found to lower suicidality after receiving them via telehealth services. At the same time, those who received the Crisis Response Plan (the more collaborative form of therapy) reported experiencing a stronger therapeutic alliance with the clinician, utilizing the plan more often and perceiving it as more useful. These findings demonstrate the additional benefits of adopting a more collaborative approach because of its effectiveness and perceived utility, which has implications for suicide-related distress reduction in the short and long term.

Conclusions: Evidence from this randomized control trial suggests that Crisis Response Plan is a suitable candidate for delivering suicide prevention via telehealth platform because of its effectiveness in reducing suicidality and its collaborative approach to building a strong therapeutic alliance, perceived usefulness, and actual utility in everyday life.

Trial registration: This paper was part of a registered RCT: https://clinicaltrials.gov/study/NCT04888845 . Registration date: Date: 2021-04-22.

Background: Access to equal health services is a key issue in most European countries. In the coming years, immigrants will constitute an increasing proportion of older adults in Europe, and their need for healthcare services will likely increase. Healthcare services must prepare for such encounters to make them equitable. Older immigrants' hospitalization experiences require elucidation. Their patient experiences can provide important knowledge when the healthcare system is working toward equal and equitable healthcare services.

Methods: This study employed an exploratory qualitative design. Data were collected through narrative interviews with a purposive sample of eight older adult immigrants, aged 61-79 years. Patient narratives were analyzed using thematic analysis with a reflexive approach, as outlined by Braun and Clarke.

Results: The analysis created three themes that shed light on older adult immigrants' experiences as hospital patients. The themes conveyed experiences related to challenging involvement and interaction, notions of what an ideal patient should be like, and participants not feeling valued as a person.

Conclusion: The findings indicate that communication between healthcare professionals and older adult immigrant patients is deficient: older immigrants in this study did not make their voices heard nor were they invited to participate by healthcare professionals. This contributes to limited involvement in assessment, treatment, and care. The older immigrants felt that they were not valued nor met as unique individuals. The findings indicate that health policy goals regarding patient participation and person-centered care are not met when older immigrants are patients. Consequently, the experiences of older adult immigrants in this study indicate that equal health services are at risk.

Introduction: The global burden of injury is huge, falling disproportionately on poorer populations. The benefits of qualitative research in injury care are recognised and its application is growing. We used a novel application of focus group discussions with photovoice to rapidly assess barriers at each of three delay stages; seeking (delay-1), reaching (delay-2) or receiving (delay-3) injury care in Northern Malawi.

Methods: Three community Focus Group Discussions (FGDs) of individuals with (FGD1) and without (FGD2) recent injury experience and community leaders (FGD3) discussed barriers to seeking, reaching or receiving care following injury. Participants from FGD1 subsequently used a digital camera and, following training in photovoice, took photographs illustrating barriers to injury care. Participants reconvened to discuss images which they believed illustrated important barriers. A framework method analysis compared barriers generated to those identified by an earlier Delphi study.

Results: Seven of eight invited adult community members attended each discussion group. Within the FGDs, all prior Delphi derived delay 1 barriers were described. Within delay 2, all but three were discussed by community participants. Those not covered were: 1) "communication" ;2) "prehospital care"; 3) "coordination". Within Delay 3, only "capacity"was not highlighted by participants during the study. Additional health system barriers not identified in the Delphi were inductively derived. Within Delay 1, these were labelled; "religious or other beliefs"; "indecision"; "fear or lacking courage"; and "community/bystander engagement". Within Delay 2, "lack of assistance" was derived. Within Delay 3; "alleged corruption"; "interfacility transfer"; and "police processes" were all identified during analysis. The photovoice group provided 21 photographs evidencing 15 barriers. Delay 1 was the most frequently captured by images (12/21).The individual barriers most frequently described were "transport" and "roads" (6/21 and 5/21, respectively). The photovoice group did not describe any additional barriers not covered in the prior FGDs.

Conclusion: We identified several barriers within this health system. Participants illustrated how some barriers impact on multiple phases of delay. The method was quick, low cost and participants grasped the technique and research question effectively. We recommend this approach for future health system assessments.

Background: Implementation of screening brief intervention and referral to treatment (SBIRT) and medication-assisted treatment for alcohol use disorder (MAUD) remains low in primary care. ANTECEDENT (Partnerships to Enhance Alcohol Screening, Treatment, and Intervention) was a practice-facilitator led implementation study to increase SBIRT and MAUD use in diverse primary care clinics.

Methods: From November 2019 - April 2023, we conducted a convergent parallel mixed methods evaluation. Participants were small and medium-sized primary care clinics in the Northwestern U.S. Clinics received foundational support (i.e., baseline/exit assessment, access to SBIRT Oregon website) and the option for supplemental implementation support (e.g., practice facilitation, expert consultation) over the 15-month intervention to improve SBIRT and MAUD. Qualitative and quantitative data regarding clinic characteristics, implementation strategies, and SBIRT/MAUD outcomes were collected through practice facilitator interviews, periodic reflections and clinic contact logs, interviews, pre-post surveys, and electronic health record (EHR) queries. Quantitative analyses included descriptive statistics, logistic regression, and the Wilcoxon sign-ranked test. Qualitative analysis took an immersion crystallization approach. Data were reviewed in a matrix to evaluate intervention adoption, implementation, and effectiveness.

Results: We recruited 75 unique clinics; 66 participated and 48 (73%) completed the study. Eight participating clinics chose to receive foundational support only (12%) while 58 chose to engage in supplemental support (88%) activities. Clinics that received supplemental support and completed the intervention (n = 42) engaged in practice facilitation (Mean: 293 min, range: 75-550 min); data review (38%), HIT support (31%), expert consultation (19%), and peer-to-peer learning (5%). Pre- and post-intervention assessments showed significant improvement in self-reported SBIRT process outcomes. Performance data improved among the subset of completing clinics able to produce data (n = 17). Clinics described positive experiences with ANTECEDENT support and highlighted remaining barriers to SBIRT and MAUD implementation.

Conclusions: Participating clinics engaged in a diverse range of supportive activities. A flexible approach using practice facilitation and implementation support could be helpful for low-resourced primary care clinics in improving SBIRT and MAUD for unhealthy alcohol use.

Background: The patient's experience of care is critical in determining how satisfied the client is with the quality of health services offered by the health facility. Understanding health needs aids in identifying gaps in service provision as well as potential avenues for planning and improving health care services. The primary goal of this study was to explore the attributes of quality healthcare in South Sudan from the perspective of healthcare recipients. Nonetheless, South Sudan's health system has remained inadequate since the country's independence in 2011, with 85% of deliveries performed by unskilled health personnel, high maternal and child death rates, and a lack of vital lifesaving drugs in health facilities. Political unrest, natural disasters, poor infrastructure, and budgetary limits are among the additional factors impeding the provision of high-quality care services to the population in need. However, the South Sudan government, with the support of international health partners, continues to work towards ensuring that basic health needs are met in accordance with SDG-3 recommendations.

Method: This was a facility-based cross-sectional descriptive study conducted in four selected health facilities in Yambio County, Western Equatoria State, from July 1st to September 30th, 2023. A sample size of 422 was included, and a randomized sampling procedure was used, with 60% of public health facilities supported by non-governmental organizations utilizing the lottery method. Data were collected and entered into SPSS version 25 for descriptive and regression analysis.

Results: A total of 422 participants were solicited for the study, with a response rate of 99.81 percent. Of the 421 responders, 72% (303/421) were female and 28% (118/421) were male. The overall satisfaction with the experience of quality of health care delivered was 84.8%. A preliminary analysis found that the assumption of multicollinearity was met (Age, sex, feeling of having chance to fully explain a problem to care provider, physical examination, provider's technical capacity in diagnosis and treatment, provider attitude, client respect) among others, were all associated with the client's experience of care and satisfaction with the quality of health care.

Conclusion: The clients who sought health care at the public health facilities in Western Equatorial State were quite satisfied with the quality of health services (84.8%). Provider's behaviors, attitudes, and technical skills, among other major factors, were found to be associated with the client's positive experience of care. To uphold health ethics, the study recommends including medical ethics training and client center care into continuing medical educations at health facilities.

Background: It often takes a long time before a rare disease is diagnosed. Without a diagnosis, the right therapy often cannot be carried out and without the right therapy, the patients are denied the opportunity for a cure or relief from their symptoms. In addition, rare diseases can also have economic consequences for those affected. This study aimed to investigate the extent to which a rare disease affects the income and work performance of the patients concerned and whether the use of AI in diagnostics would have the potential to reduce economic losses.

Methods: The work performance and income of 71 patients of the outpatient clinic for rare inflammatory systemic diseases with renal involvement at Hannover Medical School were analyzed during the course of the disease. The WHO Health and Work Performance Questionnaire (HPQ) was used to collect data. During the patient interviews, the questionnaire was completed four times: at the onset of the first symptoms, when a diagnostic decision support system (DDSS) would have suggested the correct diagnosis, at the time of diagnosis and at the current status.

Results: With the onset of the diagnostic odyssey, the monthly net income of the patients under study dropped by an average of 5.32% due to lower work performance or work absenteeism. With the correct diagnosis, the original or even a better income of 11.92% could be achieved. Loss of income due to illness was more massive in patients with a rare disease with joint, muscle and connective tissue involvement than in patients with rare vasculitides. If a DDSS had been used, the loss of income would have been 2.66% instead of the actual 5.32%.

Conclusion: Rare diseases resulted in temporary or existing income losses in 28.17% of the patients. Losses in work performance and income were related to the type of disease and were more pronounced in patients with joint, muscle or connective tissue disease than in patients with rare vasculitides. The use of a DDSS may have the potential to reduce the negative income effects of patients through earlier correct diagnosis.

Trial registration: Retrospectively registered.

Background: Healthcare workers in dental hospitals frequently experience repeated occupational exposures (ROEs). In our study, we aim to analyze these repeated exposures among dental healthcare workers (DHWs), assess the risk levels of different risk factors, and explore the significance of ROE data for infection control in dental hospitals.

Methods: Based on hospital statistical data, we categorized the occupational exposure incidents at West China Hospital of Stomatology over the past seven years into initial and repeated exposures. We analyzed the association of various risk factors, including personnel types, gender, treatment locations, timing of occupational exposure, and pathways of occupational exposure, with the occurrence of repeated exposures. The Statistical Package for Social Sciences (SPSS) 21 was used to conduct chi-square analysis and binary logistic regression analysis, with the significance level set at p < 0.05.

Results: Compared to students, hospital dentists with teaching qualifications exhibited a higher risk of ROEs. The risk of repeated exposure for dental students was 60% lower than that of hospital dentists (P = 0.003). However, gender, treatment locations, timing of occupational exposure, and pathways of occupational exposure did not significantly impact the repeated exposures among DHWs.

Conclusions: Our study demonstrates that the analysis of repeated occupational exposures (ROEs) is meaningful. In our study, hospital dentists with teaching qualifications had the highest risk of ROEs, compared to dental students, hospital dental nurses, and dental nurse students. This means that among individuals who have already experienced occupational exposure, hospital dentists are more likely to experience repeated exposure. Meanwhile, gender, treatment locations, timing of occupational exposure, and pathways of occupational exposure did not have a significant impact on the occurrence of ROEs.