Yuchen Yang, Yasuhiro Morii, Kensuke Fujiwara, T. Ishikawa, Hiroko Yamashina, Teppei Suzuki, J. Nakaya, K. Ogasawara
Background: Healthcare disparities in China are attracting attention not only in the country but also worldwide. However, few studies have evaluated the changes in equality of healthcare resource distribution among provinces in China. This study was conducted to provide healthcare resource allocation advice to government medical management institutions. We aimed to (I) analyze changes in healthcare disparities in China from 1998 to 2016 through data visualization and (II) determine what factors are related to the changes. Methods: We evaluated healthcare disparities in China by collecting statistical data on healthcare in China from 1998 to 2016 and calculating the Gini coefficient of healthcare resource distribution among the provinces, and comparatively observed the trend of Gini coefficient. Data used in this study were taken from the China Statistical Yearbook (1999–2017). Results: From 2008 to 2016, the Gini coefficient for doctors and nurses dropped by 0.048 (39.4%) and 0.058 (40.9%), respectively. The increase rate of number of nurses is the highest (109.0%), and at the same time, the distribution of nurses is also the most significant. On the other hand, since 2002, the Gini coefficient of healthcare institutions has fluctuated between 0.150 and 0.200. few changes were found in number of medical institutions. Conclusions: Since 2004, the distribution of health human resource has been improving due to the abundance of healthcare resources in China; however, the distribution of healthcare institutions has not been improving. We consider that the enrichment of medical resources has a positive impact on the distribution of human resources, but not on the distribution of physical and financial resources. This situation is considered to be one of the results of several health issues in China, such as the existence of super hospitals with thousands of beds in the inland areas, which interferes with the establishment of China’s hierarchical medical system.
{"title":"Trend of Gini coefficient of healthcare resources in China from 1998 to 2016","authors":"Yuchen Yang, Yasuhiro Morii, Kensuke Fujiwara, T. Ishikawa, Hiroko Yamashina, Teppei Suzuki, J. Nakaya, K. Ogasawara","doi":"10.21037/JHMHP-20-93","DOIUrl":"https://doi.org/10.21037/JHMHP-20-93","url":null,"abstract":"Background: Healthcare disparities in China are attracting attention not only in the country but also worldwide. However, few studies have evaluated the changes in equality of healthcare resource distribution among provinces in China. This study was conducted to provide healthcare resource allocation advice to government medical management institutions. We aimed to (I) analyze changes in healthcare disparities in China from 1998 to 2016 through data visualization and (II) determine what factors are related to the changes. Methods: We evaluated healthcare disparities in China by collecting statistical data on healthcare in China from 1998 to 2016 and calculating the Gini coefficient of healthcare resource distribution among the provinces, and comparatively observed the trend of Gini coefficient. Data used in this study were taken from the China Statistical Yearbook (1999–2017). Results: From 2008 to 2016, the Gini coefficient for doctors and nurses dropped by 0.048 (39.4%) and 0.058 (40.9%), respectively. The increase rate of number of nurses is the highest (109.0%), and at the same time, the distribution of nurses is also the most significant. On the other hand, since 2002, the Gini coefficient of healthcare institutions has fluctuated between 0.150 and 0.200. few changes were found in number of medical institutions. Conclusions: Since 2004, the distribution of health human resource has been improving due to the abundance of healthcare resources in China; however, the distribution of healthcare institutions has not been improving. We consider that the enrichment of medical resources has a positive impact on the distribution of human resources, but not on the distribution of physical and financial resources. This situation is considered to be one of the results of several health issues in China, such as the existence of super hospitals with thousands of beds in the inland areas, which interferes with the establishment of China’s hierarchical medical system.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45299622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Zeng, Elina Pradhan, M. Khanna, Opeyemi Fadeyibi, G. Fritsche, O. Odutolu
Khanna, and assembly of data: W Zeng, Background: Nigeria piloted decentralized facility financing (DFF) and performance-based financing (PBF) programs under the Nigeria State Health Investment Project (NSHIP), funded by the World Bank. It aimed to increase the utilization and quality of MCH services. Although many low- and middle-income countries have launched or piloted DFF and/or PBF like programs and conducted impact evaluation, very few studies related DFF or PBF’s impact to its cost. This study evaluates the incremental cost-effectiveness ratios (ICERs) of facilities with DFF or PBF compared to comparably funded health facilities without it. Methods: This study used a quasi-experimental research design. Local government areas (LGAs) in the three states under NSHIP were randomly assigned to the PBF group, where health facilities received
{"title":"Cost-effectiveness analysis of the decentralized facility financing and performance-based financing program in Nigeria","authors":"W. Zeng, Elina Pradhan, M. Khanna, Opeyemi Fadeyibi, G. Fritsche, O. Odutolu","doi":"10.21037/jhmhp-20-82","DOIUrl":"https://doi.org/10.21037/jhmhp-20-82","url":null,"abstract":"Khanna, and assembly of data: W Zeng, Background: Nigeria piloted decentralized facility financing (DFF) and performance-based financing (PBF) programs under the Nigeria State Health Investment Project (NSHIP), funded by the World Bank. It aimed to increase the utilization and quality of MCH services. Although many low- and middle-income countries have launched or piloted DFF and/or PBF like programs and conducted impact evaluation, very few studies related DFF or PBF’s impact to its cost. This study evaluates the incremental cost-effectiveness ratios (ICERs) of facilities with DFF or PBF compared to comparably funded health facilities without it. Methods: This study used a quasi-experimental research design. Local government areas (LGAs) in the three states under NSHIP were randomly assigned to the PBF group, where health facilities received","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49231041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cynthia J. Sieck, Brian Henriksen, S. Scott, Natasha Kurien, Mark Rastetter
Background: Electronic health records (EHRs) are used across healthcare systems to reduce clinical care errors, improve care team communication, and enhance care coordination and patient safety. However, one criticism is that EHRs increase the provider’s engagement with the computer and decrease engagement with the patient leading to less patient-centered care. Patient-centered care is personalized care tailored to individual patient needs and preferences. Interventions have been suggested to help manage EHR use during visits while balancing computer interaction and patient-centered care. Methods: Using the Resident-as-Teacher: a layered learning intervention, patient care training, patient-centric EHR use and team development of residents is balanced with creating a shared understanding of these processes. New interns serve as scribes for the senior residents, observing how patient care is conducted while taking notes necessary for charting and billing requirements. The intern and senior resident together navigate the EHR to ensure proper documentation. In addition, attending physicians precept every patient, providing the aspect of layered learning. The roles are then reversed and the senior resident becomes the intern’s scribe. The intern is able to focus on patient care without any distractions that would have been present if the intern was fully in charge of the visit. The resident addresses any missed items with the intern before conclusion of each office visit. EHR training in this manner resulted in 15% more patient encounters while building rapport between the residents. Our assessment included an examination of patient visit counts and an open-ended survey administered to all interns and residents. Adapting training to telehealth during COVID-19 highlights adaptations to in-person training that could be implemented in the virtual environment while maintaining connection between the preceptor and resident. For example, use of a “virtual precepting room”, providing the most up to date best practice information and training residents how to provide the best possible care with the limited information received when only seeing the patient virtually. We conducted qualitative interviews with residents approximately one month into the training to assess residents’ perceptions of its impact and support they received. Results: Analysis of the Resident-as-Teacher suggests that it provided more patient interactions for interns and residents, as well as facilitated rapport building on the team. For adapting training to telehealth, interviews with residents noted a few challenges but support from attendings was appreciated. Conclusions: EHRs have been viewed more as a system required in health care and less of a tool to aid in organization and communication. With appropriate training, EHRs can be an asset to clinical care while working in conjunction with patient-centered care. Providers working together during a resident training period can promote
{"title":"Training to improve patient-centered electronic health record (EHR) use","authors":"Cynthia J. Sieck, Brian Henriksen, S. Scott, Natasha Kurien, Mark Rastetter","doi":"10.21037/jhmhp-20-121","DOIUrl":"https://doi.org/10.21037/jhmhp-20-121","url":null,"abstract":"Background: Electronic health records (EHRs) are used across healthcare systems to reduce clinical care errors, improve care team communication, and enhance care coordination and patient safety. However, one criticism is that EHRs increase the provider’s engagement with the computer and decrease engagement with the patient leading to less patient-centered care. Patient-centered care is personalized care tailored to individual patient needs and preferences. Interventions have been suggested to help manage EHR use during visits while balancing computer interaction and patient-centered care. Methods: Using the Resident-as-Teacher: a layered learning intervention, patient care training, patient-centric EHR use and team development of residents is balanced with creating a shared understanding of these processes. New interns serve as scribes for the senior residents, observing how patient care is conducted while taking notes necessary for charting and billing requirements. The intern and senior resident together navigate the EHR to ensure proper documentation. In addition, attending physicians precept every patient, providing the aspect of layered learning. The roles are then reversed and the senior resident becomes the intern’s scribe. The intern is able to focus on patient care without any distractions that would have been present if the intern was fully in charge of the visit. The resident addresses any missed items with the intern before conclusion of each office visit. EHR training in this manner resulted in 15% more patient encounters while building rapport between the residents. Our assessment included an examination of patient visit counts and an open-ended survey administered to all interns and residents. Adapting training to telehealth during COVID-19 highlights adaptations to in-person training that could be implemented in the virtual environment while maintaining connection between the preceptor and resident. For example, use of a “virtual precepting room”, providing the most up to date best practice information and training residents how to provide the best possible care with the limited information received when only seeing the patient virtually. We conducted qualitative interviews with residents approximately one month into the training to assess residents’ perceptions of its impact and support they received. Results: Analysis of the Resident-as-Teacher suggests that it provided more patient interactions for interns and residents, as well as facilitated rapport building on the team. For adapting training to telehealth, interviews with residents noted a few challenges but support from attendings was appreciated. Conclusions: EHRs have been viewed more as a system required in health care and less of a tool to aid in organization and communication. With appropriate training, EHRs can be an asset to clinical care while working in conjunction with patient-centered care. Providers working together during a resident training period can promote ","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68339372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pairing a medical scribe with a hospitalist physician improved clinician satisfaction, increased productivity and provided a return on investment","authors":"Nathaniel Kesner, Michael Corvini, Cassy Panter","doi":"10.21037/jhmhp-21-26","DOIUrl":"https://doi.org/10.21037/jhmhp-21-26","url":null,"abstract":"","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49374811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lun Li, Christina Mastrangelo, Noah Briller, Mussie Tesfaldet, Olga Starobinets, Shawn Stapleton
{"title":"Prioritizing MR radiology functions for virtual operations: a feasibility study","authors":"Lun Li, Christina Mastrangelo, Noah Briller, Mussie Tesfaldet, Olga Starobinets, Shawn Stapleton","doi":"10.21037/jhmhp-21-92","DOIUrl":"https://doi.org/10.21037/jhmhp-21-92","url":null,"abstract":"","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43289149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
More than a decade ago, the Healthier Hospitals Initiative challenged health systems to improve sustainability and safety in the healthcare sector. Since then, the design and creation of healthy healthcare buildings has become a key component of improving individual and population health, guided by the idea that built environments should facilitate, not impede, progress toward healthful lifestyles and better health outcomes. This movement is grounded in research to inform the evidence-based design process, the science and aesthetics of green and well buildings, metrics on health outcomes for patients and staff, and longterm financial benefits for healthcare organizations. This article is an informed synthesis and analysis of best practices that represent the key features of healthy buildings; discusses research-based building-design interventions, protocols, and policies that promote the creation of healthy buildings; outlines pertinent building-certification programs and standards; identifies the measurable benefits of healthy buildings for patients, staff, financial stakeholders, and communities; and recommends specific actions that hospital and health system leaders can take to make healthy buildings a reality benefiting all stakeholders Examples of institutions that have been successful in this effort are offered as possible models and sources of inspiration for organizations that aim to make their built environments healthier.
{"title":"Advancing human health, safety, and well-being with healthy buildings","authors":"S. Marberry, Robin Guenther, L. Berry","doi":"10.21037/jhmhp-21-63","DOIUrl":"https://doi.org/10.21037/jhmhp-21-63","url":null,"abstract":"More than a decade ago, the Healthier Hospitals Initiative challenged health systems to improve sustainability and safety in the healthcare sector. Since then, the design and creation of healthy healthcare buildings has become a key component of improving individual and population health, guided by the idea that built environments should facilitate, not impede, progress toward healthful lifestyles and better health outcomes. This movement is grounded in research to inform the evidence-based design process, the science and aesthetics of green and well buildings, metrics on health outcomes for patients and staff, and longterm financial benefits for healthcare organizations. This article is an informed synthesis and analysis of best practices that represent the key features of healthy buildings; discusses research-based building-design interventions, protocols, and policies that promote the creation of healthy buildings; outlines pertinent building-certification programs and standards; identifies the measurable benefits of healthy buildings for patients, staff, financial stakeholders, and communities; and recommends specific actions that hospital and health system leaders can take to make healthy buildings a reality benefiting all stakeholders Examples of institutions that have been successful in this effort are offered as possible models and sources of inspiration for organizations that aim to make their built environments healthier.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47920822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amber L. Stephenson, Minakshi Raj, S. Thomas, E. Sullivan, Matthew J. Depuccio, Bram P. I. Fleuren, A. McAlearney
Family and friends who serve as caregivers are becoming increasingly important in supporting adults to complete various tasks such as transportation, shopping, and health care responsibilities like medication management (1). It is estimated that the number of adults older than 65 in the United States will nearly double in the next four decades (2), and over 80% of family caregivers of older adults are responsible for coordinating care between and among providers (3). However, the inclusion of these caregivers in the health care delivery process lacks recognition, coordination and standardization (4). Despite efforts to include caregivers (e.g., through informal or formal proxy access to their care recipient’s patient portal), policies and procedures around caregiver inclusion are complex and inconsistently implemented (5). One policy, the Caregiver Advise, Record, Enable (CARE) Act, was developed by AARP, then introduced to state legislatures, and is intended to provide designated caregivers with discharge instructions and guidance. The CARE Act, now signed into law by 40 states, aims to provide health care providers with practices that integrate caregivers into the process of care delivery, but has failed to be broadly implemented within health care organizations (6). A national survey of health care executives, clinical leaders, and clinicians about caring for caregivers found that 79% of respondents are either not very familiar or not at all familiar with the CARE Act (6). Medicaid waivers are intended to provide caregivers with training and, in some cases, compensation; yet these efforts are uncoordinated across the U.S. (5). Tools have also been developed to offer caregivers shared access to electronic health records. Yet a significant issue remains: how are caregivers ultimately included in the team itself? Understanding caregiver inclusion in healthcare teams is essential to maximize the benefits they have to offer for improving patient outcomes. Most centrally, team-based patient care can be understood as an information sharing/ distribution of expertise problem, in which the optimal care solution might depend on important information that is not shared among members of the care team (7). For instance, a patient may receive information about wound care from their doctor during a visit, but the caregiver responsible for overseeing the wound care may not directly receive those instructions from the provider. This type of communication gap may then result in negative patient outcomes. More dramatically, health care teams failing to adequately include the caregiver’s unique perspective may make suboptimal treatment decisions. In this commentary, we discuss considerations surrounding caregiver inclusion in health care teams and outline the implications of caregiver engagement for Editorial Commentary
{"title":"Reconceptualizing family caregivers as part of the health care team","authors":"Amber L. Stephenson, Minakshi Raj, S. Thomas, E. Sullivan, Matthew J. Depuccio, Bram P. I. Fleuren, A. McAlearney","doi":"10.21037/jhmhp-21-56","DOIUrl":"https://doi.org/10.21037/jhmhp-21-56","url":null,"abstract":"Family and friends who serve as caregivers are becoming increasingly important in supporting adults to complete various tasks such as transportation, shopping, and health care responsibilities like medication management (1). It is estimated that the number of adults older than 65 in the United States will nearly double in the next four decades (2), and over 80% of family caregivers of older adults are responsible for coordinating care between and among providers (3). However, the inclusion of these caregivers in the health care delivery process lacks recognition, coordination and standardization (4). Despite efforts to include caregivers (e.g., through informal or formal proxy access to their care recipient’s patient portal), policies and procedures around caregiver inclusion are complex and inconsistently implemented (5). One policy, the Caregiver Advise, Record, Enable (CARE) Act, was developed by AARP, then introduced to state legislatures, and is intended to provide designated caregivers with discharge instructions and guidance. The CARE Act, now signed into law by 40 states, aims to provide health care providers with practices that integrate caregivers into the process of care delivery, but has failed to be broadly implemented within health care organizations (6). A national survey of health care executives, clinical leaders, and clinicians about caring for caregivers found that 79% of respondents are either not very familiar or not at all familiar with the CARE Act (6). Medicaid waivers are intended to provide caregivers with training and, in some cases, compensation; yet these efforts are uncoordinated across the U.S. (5). Tools have also been developed to offer caregivers shared access to electronic health records. Yet a significant issue remains: how are caregivers ultimately included in the team itself? Understanding caregiver inclusion in healthcare teams is essential to maximize the benefits they have to offer for improving patient outcomes. Most centrally, team-based patient care can be understood as an information sharing/ distribution of expertise problem, in which the optimal care solution might depend on important information that is not shared among members of the care team (7). For instance, a patient may receive information about wound care from their doctor during a visit, but the caregiver responsible for overseeing the wound care may not directly receive those instructions from the provider. This type of communication gap may then result in negative patient outcomes. More dramatically, health care teams failing to adequately include the caregiver’s unique perspective may make suboptimal treatment decisions. In this commentary, we discuss considerations surrounding caregiver inclusion in health care teams and outline the implications of caregiver engagement for Editorial Commentary","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46673637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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