Health Research Policy and Systems最新文献

{"title":"Evaluation of the effect of DRG payment policy based on interrupted time series modeling: evidence from a tertiary hospital in Anhui Province.","authors":"Guangju Mo, Erchang Zhu, Xinlei Fang, Jingbo Ma, Sijing Kong, Xuan Guo, Zheng Lu","doi":"10.1186/s12961-024-01255-y","DOIUrl":"10.1186/s12961-024-01255-y","url":null,"abstract":"<p><strong>Background: </strong>The payment methodology for diagnosis-related groups (DRG) has implications for both society and medical institutions. Our study aims to analyse the impact of the reform of the payment policy according to the DRG on the operation of a tertiary hospital in Anhui Province.</p><p><strong>Methods: </strong>Monthly data were collected from April 2020 to September 2023 during the reform period for a tertiary hospital on nine types of operational indicators, including average length of stay (ALOS), number of discharges, number of outpatient visits, percentage of discharged patients undergoing level III or IV surgery, bed turnover rate, inpatient essential drug utilization rate, low-risk group mortality, outpatient subaverage cost and inpatient subaverage cost. The data were divided into two phases according to the time of DRG implementation: pre-reform (April 2020-December 2021) and post-reform (January 2022-September 2023), and the segmented regression model with interrupted time series data was used to analyse the changes in the trend of each type of indicator before and after the reform. Statistical analysis was performed using R software (4.3.1).</p><p><strong>Results: </strong>After the implementation of the DRG, the number of discharges increased by 112 800 patients (95% confidence interval [CI] 31.125-194.484, P = 0.008), the bed turnover rate rose by 1.403% (95% CI 1.028-1.778, P = 0.022) and the percentage of discharged patients undergoing level III or IV surgery decreased by 0.098% (95% CI -0.181 to -0.015, P = 0.022). The low-risk group mortality decreased by 0.016% (95% CI -0.027 to -0.005, P = 0.007), and the inpatient subaverage cost decreased by 81.514 CNY (95% CI -121.782 to -41.245, P < 0.001). However, there were no significant differences in the trends of average length of stay, outpatient visits, inpatient essential drug utilization rate and outpatient subaverage cost after the DRG implementation.</p><p><strong>Conclusions: </strong>The findings show that the DRG reform has positively impacted hospital functioning, including quality, safety, efficiency and costs. Although the average length of stay remained unchanged, there was an increase in discharged patients and outpatient visits, indicating hospitals adapted to the new payment model. The reduction in low-risk group mortality suggests improvements in patient safety and care quality. However, challenges remain, as evidenced by decreased surgical complexity and initial drops in bed turnover rates. While the DRG reform holds promise for enhancing healthcare efficiency and controlling costs, potential negative effects such as patient selection bias and coding changes need to be monitored. Future research should focus on the long-term effects of the DRG policy across different healthcare institutions.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"167"},"PeriodicalIF":3.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building a research agenda on preventing and addressing sexual assault and intimate partner violence against trans people: a two-stage priority-setting exercise.","authors":"Janice Du Mont, Rachel Cheung, Joseph Friedman Burley, Sarah Daisy Kosa, C Emma Kelly, Brittany A E Jakubiec, Sydney Brouillard-Coyle, Sheila Macdonald","doi":"10.1186/s12961-024-01245-0","DOIUrl":"10.1186/s12961-024-01245-0","url":null,"abstract":"<p><strong>Background: </strong>Transgender (trans) people experience high rates of sexual assault (SA) and intimate partner violence (IPV) and seldom receive the care and supports they need post-victimization. However, there is little to no research that aids in the development or improvement of related interventions. We undertook a study to build a novel Canadian research agenda on SA/IPV against trans people to guide future work and address these profound gaps in knowledge.</p><p><strong>Methods: </strong>Guided by the Child Health and Nutrition Research Initiative (CHNRI) method for research priority-setting, we developed and circulated two consecutive surveys to a multi-stakeholder group of government decision makers; mental health, health and social service providers, researchers and trans communities, among others, who proposed research questions related to preventing and addressing SA/IPV against trans persons. The initial survey launched March 2021 garnered responses from 213 stakeholders. These items were cleaned and collated into 20 final questions that fell within seven thematic areas. The refined research questions were evaluated in August 2021 on predefined criteria for answerability, feasibility, impact and equity by 79 of 95 survey 1 respondents who agreed to participate in the second survey (response rate = 83.2%). The questions were ranked using a research priority score calculated by dividing the sum of all the answers for each question across the four criteria by the number of answers received.</p><p><strong>Results: </strong>All questions were highly rated on each individual criterion and each had an overall research priority score of above 80%, with the most highly ranked question falling within the theme, \"improving quality and implementation of education and training: How can training (e.g., for university/college students, educators, nurses, physicians, social workers, police, lawyers, security guards) be improved to better support trans survivors of sexual assault and intimate partner violence?\".</p><p><strong>Conclusions: </strong>These questions form Canada's first research agenda on SA/IPV against trans people. Together, they reflect the insights of stakeholder groups who have been historically excluded from research priority-setting processes and will guide future and much-needed work on the topic. Actionable information on preventing and addressing SA/IPV against trans persons will help reduce negative outcomes associated with being victimized.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"163"},"PeriodicalIF":3.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653913/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Embedding a culture of research in Canadian community hospitals: a qualitative study.","authors":"Kian Rego, Paige Gehrke, Madelyn P Law, Kathryn Halverson, Dominique Piquette, Elaina Orlando, Susan M Jack, Deborah Cook, Rosa Myrna Marticorena, Alexandra Binnie, Jennifer L Y Tsang","doi":"10.1186/s12961-024-01243-2","DOIUrl":"10.1186/s12961-024-01243-2","url":null,"abstract":"<p><strong>Background: </strong>In Canada, academic hospitals are the principal drivers of research and medical education, while community hospitals provide patient care to a majority of the population. Benefits of increasing community hospital research include improved patient outcomes and access to research, enhanced staff satisfaction and retention and increased research efficiency and generalizability. While the resources required to build Canadian community hospital research capacity have been identified, strategies for strengthening organizational research culture in these settings are not well defined. This study aimed to understand how research culture is experienced and shaped in Canadian community hospitals to provide strategies for strengthening research culture in these settings.</p><p><strong>Methods: </strong>This qualitative descriptive study, as part of a larger study, explored the underlying dimensions of research culture. Participants were purposefully sampled and included healthcare providers, research staff or hospital administrators from community hospitals across Canada, with non-existent, emerging or established research programs. Data were collected via virtual semi-structured interviews and a demographic questionnaire. Interview transcripts were analyzed using reflexive thematic analysis and Schein's Model of Organizational Culture as a sensitizing framework. Demographic data were analyzed using descriptive statistics.</p><p><strong>Results: </strong>A total of 38 participants from 20 Canadian community hospitals described their experiences of research culture illustrating three key themes. As community hospital research programs matured, participants described a shift in research culture whereby research became more embedded in \"the way things are done\" within the community hospital. Recommended strategies to achieve an embedded culture of research involve: communications; relationship building; mentorship, training and education opportunities; selecting locally relevant studies; and systems-level support. A top-down approach to embedding research culture was contrasted with a bottom-up approach.</p><p><strong>Conclusions: </strong>This study described the underlying dimensions of community hospital research culture and targeted strategies for strengthening research culture at different levels of research program maturity. Community hospitals without pre-existing research infrastructure were able to foster a culture of research from the bottom-up by emphasizing the value of embedding research in clinical practice. Although challenging, fostering a culture of research from the bottom-up may be necessary to propel research forward and initiate the process to build research capacity within a community hospital.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"164"},"PeriodicalIF":3.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing multi-sectoral collaborations for the prevention and control of NCDs in Thailand with a new approach.","authors":"Bundit Sornpaisarn, Somsak Chunharas, Sarnti Sornpaisarn, Pairoj Saonuam, Rifat Farzan Nipun, Chaniphun Butryee, Bhubate Samutachak, Maneekwan Chandarasorn, Nattapon Supadulya, Suttikarn Chunsuttiwat, Sumonmarn Singha, Wiwat Rojanapithayakorn, Kumnuan Ungchusak, Jürgen Rehm","doi":"10.1186/s12961-024-01262-z","DOIUrl":"10.1186/s12961-024-01262-z","url":null,"abstract":"<p><strong>Background: </strong>To achieve the Sustainable Development Goals (SDGs) by 2030, Thailand must engage in effective multi-sectoral collaboration (MSC). However, implementing MSC in Thailand presents significant challenges. Although Thailand had a 2011-2020 MSC strategic plan for the control of non-communicable diseases (NCDs) with the prime minister taking the lead, joined by many non-health ministers, not a single meeting was called over those 10 years. This paper describes the development of a new tool created to enhance MSC between health and non-health sectors in controlling NCDs in Thailand. Stakeholder-engaged research will be used to implement and evaluate this tool. This paper also describes the research planned to test the new approach.</p><p><strong>Methods: </strong>The authors used two main methods: (1) a narrative review on MSC enhancement and (2) a series of four consultation meetings with key stakeholders - in the health, non-health and academic sectors - to develop a research study to implement and evaluate the new approach.</p><p><strong>Results: </strong>To address previous MSC implementation problems, the proposed novel MSC enhancement approach emphasizes three principles: (1) pursuit of committed-stakeholder involvement at the middle-management level, instead of relying on the top-management level, an approach which has never been successful; (2) production of knowledge to support specific, achievable target policies; and (3) use of a comprehensive set of knowledge-translation activities and knowledge brokers to solve the problem of ineffective routine official communications between members of the MSC. Using participatory consultations during the research proposal development, middle-level officials from three non-health ministries (the Ministries of Agriculture, Finance and Education) agreed to join the MSC to work together to solve specific problems regarding the control of NCDs. A target-advocated policy for each ministry was formulated and agreed upon by both non-health-sector and health-sector stakeholders.</p><p><strong>Conclusions: </strong>This new approach (middle-management oriented), if implemented, may encourage more commitment from the Ministries' representatives, policy-relevant knowledge generation and effective communications between ministries involved in an MSC. Ideally, it would complement the conventional approach (top-management oriented) in enhancing the MSC for controlling NCDs, and thereby bring hope for achieving the NCD-related SDGs for Thailand and possibly other countries as well.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"169"},"PeriodicalIF":3.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key element missed in nutrition policy: why does undernutrition not decline among pregnant women in Ethiopia?","authors":"Shiferaw Gelchu, Dessalegn Wirtu, Merga Dheresa, Dawit Galgalo, Haro Miesa","doi":"10.1186/s12961-024-01257-w","DOIUrl":"10.1186/s12961-024-01257-w","url":null,"abstract":"<p><p>Pregnancy is the most delicate stage in human life that requires high quality and several types of food to meet maternal and foetal nutritional demands. During pregnancy, food taboo is practised habitually by Ethiopian women, suggesting that they are affected by macro and micronutrient deficiencies. In Ethiopia, there is a greater magnitude of food taboo practices during pregnancy. This implies the need for attention to eliminating harmful cultural practices of food restriction during pregnancy from concerned bodies. Therefore, appropriate nutritional policies and strategies focusing on food taboos during pregnancy are crucial to counter maternal and foetal health problems related to nutritional inadequacy.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"168"},"PeriodicalIF":3.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11657871/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study on the management system for investigator-initiated studies in healthcare institutions in Beijing, China.","authors":"Xiayan Chen, Jiaxue Meng, Hongling Chu, Yangfeng Wu, Huijuan Li","doi":"10.1186/s12961-024-01264-x","DOIUrl":"10.1186/s12961-024-01264-x","url":null,"abstract":"<p><strong>Background: </strong>The Measures for Management of Investigator-Initiated Studies (IISs) Conducted by Healthcare Institutions (trial version) (referred to as Management Measures) has been piloted successively in 12 provincial regions across China since 1 October 2021 and took effect nationwide on 1 October 2024. This study aimed to examine the perspectives, attitudes and challenges of administrators and investigators within healthcare institutions in Beijing regarding IIS management to provide further strategic guidance in China.</p><p><strong>Methods: </strong>This descriptive qualitative study included 13 focus group discussions among 74 participants from 25 healthcare institutions stratified selected in Beijing, including 13 executive-level administrators, 41 functional administrators and 20 investigator representatives. The focus groups were conducted from November to December 2021. The discussion topics focussed on current status of IIS management in healthcare institutions and the participants' attitudes and challenges in implementation of the Management Measures, mainly on the specific management system establishment, independent scientific review, management by study type and whole-process supervision.</p><p><strong>Results: </strong>Opinions varied among institution presidents/directors regarding the establishment of clinical research management committees and offices, with significant challenges identified in insufficient human resources and difficulties in integrating with existing management models. While scientific review was seen as essential, there was disagreement on how to implement it. Interviewees raised concerns about redundancy for grant-supported projects, unclear distinctions between scientific and ethical reviews, efficiency delays, reviewer qualifications and intellectual property risks. Although management by study type might help control risks, the qualification restrictions on the leading sites and investigators were viewed as excessively stringent. No institution has achieved whole-process supervision of all IISs, primarily due to insufficient human resources, ineffective supervision and management systems, and insufficiently trained professionals.</p><p><strong>Conclusions: </strong>This study reveals that the current management of IISs is generally weak in Beijing and should be strengthened by implementing Management Measures. However, major challenges existed for the implementation, mainly including: a lack of clear and feasible management models to follow, insufficient human resources for both scientific review and whole-process supervision, and worries about restricting research initiatives. It takes time to overcome these challenges, which may be achieved through building management capacity at national, regional and institutional levels, learning successful management models that were piloted in various regions and further policy research to develop specific guidance.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"165"},"PeriodicalIF":3.6,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142853634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of an integrated knowledge translation approach in five African countries: a mixed-methods comparative case study.","authors":"Kerstin Sell, Eva Rehfuess, Jimmy Osuret, Esther Bayiga-Zziwa, Bezinash Geremew, Lisa Pfadenhauer","doi":"10.1186/s12961-024-01256-x","DOIUrl":"10.1186/s12961-024-01256-x","url":null,"abstract":"<p><strong>Background: </strong>Integrated knowledge translation (IKT) aims to enhance evidence-informed decision-making in public health and healthcare by establishing continuous relationships between researchers and knowledge users, in particular decision-makers. The Collaboration for Evidence-Based Healthcare and Public Health in Africa (CEBHA+) undertook research on noncommunicable diseases in Ethiopia, Malawi, Rwanda, South Africa and Uganda. Alongside the research activities, we implemented an IKT approach, which entailed training and the development and implementation of site-specific IKT strategies. We evaluated these strategies according to a predefined programme theory.</p><p><strong>Methods: </strong>Drawing on our published protocol ( https://rdcu.be/dyfBP ), we interviewed and surveyed CEBHA+ researchers and their decision-making counterparts during two project stages (3/2020-2/2021; 9/2022-5/2023) and collected IKT-related documents. Transcripts and documents were analysed using qualitative content analysis and surveys were analysed descriptively, with subsequent integration, cross-case analysis and revision of the programme theory.</p><p><strong>Results: </strong>A total of 36 researchers and 19 decision-makers participated in surveys, focus groups and/or interviews, and we collected 92 documents. Relationship building, capacity building and collaborative research were the most proximal intervention outcomes: CEBHA+ researchers and their counterparts built mutual appreciation and partnerships, accessed contacts and networks, and expanded skills in conducting and using research and in IKT. The level of trust between partners varied. Intermediate outcomes were changes in attitudes and knowledge; beyond the conceptualization in our initial programme theory, researchers substantially increased their understanding of the decision-making context and developed a vision for \"research impact\". While it was challenging to evaluate distal outcomes, the IKT approach was linked to the production of research perceived as addressing local priorities and being highly applicable and contextualized, and some consideration of evidence among decision-makers. Unintended effects included high opportunity costs associated with undertaking IKT. An unanticipated outcome was the heightened interest of the research funder in policy engagement. Our updated programme theory constitutes a low-level theory for IKT.</p><p><strong>Conclusions: </strong>Whilst this study faced many challenges common to the evaluation of knowledge translation interventions, it presents rich, theory-informed insights into IKT outcomes. These are based on documented IKT activities and participants' views, particularly in-depth insights of researchers' experiences with implementing the CEBHA+ IKT approach.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"162"},"PeriodicalIF":3.6,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Analysis of how a complex systems perspective is applied in studies on socioeconomic inequalities in health and health behaviour-a call for reporting guidelines.","authors":"Andrea L Mudd, Michèlle Bal, Sanne E Verra, Maartje P Poelman, Carlijn B M Kamphuis","doi":"10.1186/s12961-024-01248-x","DOIUrl":"10.1186/s12961-024-01248-x","url":null,"abstract":"<p><strong>Background: </strong>A complex systems perspective is gaining popularity in research on socioeconomic inequalities in health and health behaviour, though there may be a gap between its popularity and the way it is implemented. Building on our recent systematic scoping review, we aim to analyse the application of and reporting on complex systems methods in the literature on socioeconomic inequalities in health and health behaviour.</p><p><strong>Methods: </strong>Selected methods and results from the review are presented as a basis for in-depth critical reflection. A traffic light-based instrument was used to assess the extent to which eight key concepts of a complex systems perspective (e.g. feedback loops) were applied. Study characteristics related to the applied value of the models were also extracted, including the model evidence base, the depiction of the model structure, and which characteristics of model relationships (e.g. polarity) were reported on.</p><p><strong>Results: </strong>Studies that applied more key concepts of a complex systems perspective were also more likely to report the direction and polarity of relationships. The system paradigm, its deepest held beliefs, is seldom identified but may be key to recognize when designing interventions. A clear, complete depiction of the full model structure is also needed to convey the functioning of a complex system. We recommend that authors include these characteristics and level of detail in their reporting.</p><p><strong>Conclusions: </strong>Above all, we call for the development of reporting guidelines to increase the transparency and applied value of complex systems models on socioeconomic inequalities in health, health behaviour and beyond.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"160"},"PeriodicalIF":3.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of the public health service in the implementation of heat health action plans for climate change adaptation in Germany: A qualitative study.","authors":"Karin Geffert, Stephan Voss, Eva Rehfuess, Bernd Rechel","doi":"10.1186/s12961-024-01231-6","DOIUrl":"10.1186/s12961-024-01231-6","url":null,"abstract":"<p><strong>Background: </strong>In response to climate change-induced increases in heat periods, the WHO recommends the implementation of heat health action plans (HHAPs). In Germany, HHAPs are implemented neither comprehensively nor nationwide. Several recommendations have identified the public health service (PHS) at municipal and federal state levels as a key actor regarding to heat and health. Therefore, this study aimed at assessing the role of the PHS in implementing HHAPs at municipal and federal state levels in Germany.</p><p><strong>Methods: </strong>We conducted a policy document analysis to assess the legal basis for the work of the PHS in the 16 federal states in Germany. Furthermore, we conducted semi-structured interviews with 16 experts from within and outside the PHS to explore their perceptions of the PHS in the implementation of HHAPs. The interviews were analysed using reflective thematic analysis.</p><p><strong>Results: </strong>The policy document analysis revealed that heat is not mentioned in any of the federal states' regulatory frameworks for the PHS, while tasks related to environment and health are addressed, but tend to remain vague. The interviews confirmed that there is currently no clearly defined role for the PHS in implementing HHAPs in Germany and that the actual role primarily depends on the local setting. Main barriers and facilitators could be assigned to three levels (individual, organizational and political), and two overarching contextual factors (awareness of the need for adaptation and existence of other public health emergencies) influenced the implementation of HHAPs across all levels. At the individual level, motivation, knowledge and competencies, and previous experience were possible barriers or enablers. At the organizational level, administrative structures, financial and human resources, leadership and networks were barriers or facilitators, while at the political level they included legislation and political decisions.</p><p><strong>Conclusions: </strong>The PHS could and should be a relevant actor for implementing measures addressing health and climate change locally, in particular because of its focus on vulnerable populations. However, our findings suggest that the legal basis in the federal states of Germany is insufficient. Tailored approaches are needed to overcome barriers such as rigid, non-agile administrative structures and competing priorities, while taking advantage of facilitators such as awareness of relevant actors.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"161"},"PeriodicalIF":3.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11619655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence is not enough: health technology reassessment to de-implement low-value care.","authors":"Sara Ingvarsson, Henna Hasson, Ulrica von Thiele Schwarz, Per Nilsen, Marta Roczniewska, Hanna Augustsson","doi":"10.1186/s12961-024-01249-w","DOIUrl":"10.1186/s12961-024-01249-w","url":null,"abstract":"<p><strong>Background: </strong>The use of low-value care (LVC) is a persistent challenge in health care. Health technology reassessment (HTR) assesses the effects of technologies currently used in the health care system to guide optimal use of these technologies. Consequently, HTR holds promises for identifying and reducing, i.e., de-implementing, the use of LVC. There is limited research on how HTR is executed to support the de-implementation of LVC and whether and how HTR outcomes are translated into practical application. The aim of this study is to investigate how HTR is conducted to facilitate de-implementation of LVC and to investigate how the results of HTR are received and acted on in health care settings.</p><p><strong>Methods: </strong>This study is a qualitative interview study with representatives from health technology assessment agencies (n = 16) that support the regional health care organizations in Sweden and with representatives from the health care organizations (n = 7). Interviews were analysed with qualitative content analysis.</p><p><strong>Results: </strong>We identified three overarching categories for how HTR facilitates de-implementation of LVC and how the results are received and acted on in health care settings: (1) involving key stakeholders to facilitate de-implementation of LVC in identifying potential LVC practices, having criteria for accepting HTR targets, ascertaining high-quality reports and disseminating the reports; (2) actions taken by health care organization to de-implement LVC by priority setting and decision-making, networking between health care organizations and monitoring changes in the use of LVC practices; and (3) sustaining use of LVC by not questioning continued use, continued funding of LVC and by creating opinion against de-implementation.</p><p><strong>Conclusions: </strong>Evidence is not enough to achieve de-implementation of LVC. This has made health technology assessment agencies and health care organizations widen the scope of HTR to encompass strategies to facilitate de-implementation, including involving key stakeholders in the HTR process and taking actions to support de-implementation. Despite these efforts, there can still be resistance to de-implementation of LVC in passive forms, involving continued use of the practice and more active resistance such as continued funding and opinion-making opposing de-implementation. Knowledge from implementation and de-implementation research can offer guidance in how to support the execution phase of HTR.</p>","PeriodicalId":12870,"journal":{"name":"Health Research Policy and Systems","volume":"22 1","pages":"159"},"PeriodicalIF":3.6,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}