Health Services Insights最新文献

{"title":"Palliative Care for Newborns in India: Patterns of Care in a Neonatal Palliative Care Program at a Tertiary Government Children's Hospital.","authors":"Mohammad Ishak Tayoob, Spandana Rayala, Megan Doherty, Hima Bindu Singh, Madireddy Alimelu, Swapna Lingaldinna, Gayatri Palat","doi":"10.1177/11786329231222858","DOIUrl":"10.1177/11786329231222858","url":null,"abstract":"<p><p>Neonatal palliative care is a specialized area within children's palliative care, which focusses on the needs of infants with life-limiting or life-threatening conditions. Nearly one quarter of global neonatal deaths occur in India, where neonatal palliative care evidence is limited. This study describes the development and implementation of a neonatal palliative care program within a neonatal intensive care unit (NICU) at a government hospital, describing the implementing an 8-month pilot palliative care program for neonates, including the patterns of care, and barriers and enablers of success. The hospital-based palliative care team included trained pediatric palliative care physicians, a nurse, and a counselor. There was a steady increase in monthly referrals. There were 110 referrals in total, including 89 (81%) deaths and 18 (16%) babies were alive at the time of final follow-up, 10 months after the pilot program was completed. The program addressed physical symptoms, including providing morphine, as well as psychosocial and spiritual concerns of families. A model of hospital-based palliative care for neonates can be implemented within NICUs in tertiary government hospitals in India. Neonatal palliative care programs should include partnerships with charitable organizations to support implementation costs and provide palliative care training, mentorship, and capacity-building support.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329231222858"},"PeriodicalIF":2.4,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10807304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139546041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disclosure Concerns and the Correlation Among Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV Receiving Antiretroviral Therapy in Taiwan.","authors":"Tzy-Yu Yao, Bo-Huang Liou, Wu-Chien Chien, Fei-Ling Wu","doi":"10.1177/11786329231224620","DOIUrl":"10.1177/11786329231224620","url":null,"abstract":"<p><p>Gay, bisexual, and other men who have sex with men (GBMSM) are associated with the widespread human immunodeficiency virus (HIV) transmission in Taiwan. Additionally, little is known about disclosure patterns and rates, as well as factors influencing disclosure, among GBMSM living with HIV in the country. HIV prevention for GBMSM is effective when HIV status is disclosed. For instance, GBMSM disclosing their HIV status can result in early pre-exposure prophylaxis with a serodiscordant partner. In this cross-sectional study of 200 GBMSM living with HIV conducted from June to November 2020, we assessed internalized homophobia (IHP Scale) and social support (Multidimensional Scale of Perceived Social Support), as well as self-reported disclosure and non-disclosure. Among the participants, 75.5% revealed their HIV status within 3 months of diagnosis. Younger age, occupation type, and number of sexual partners were some factors associated with disclosure. Those receiving more social support and who experienced less IHP were more likely to reveal their HIV status. On the contrary, older GBMSM and GBMSM living with HIV who worked in educational enterprises still experienced severe IHP. Policymakers and healthcare practitioners should be aware of the problems faced by GBMSM living with HIV and offer practical assistance to improve their mental health.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329231224620"},"PeriodicalIF":2.4,"publicationDate":"2024-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10804901/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139542226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Catheterization and Outcomes for Elderly Patients Hospitalized With Heart Failure.","authors":"Palak Patel, Ivan Richard, Giuseppe Filice, Ivan Nikiforov, Priyaranjan Kata, Anish Kumar Kanukuntla, Arthur Okere, Christopher S Hollenbeak, Pramil Cheriyath","doi":"10.1177/11786329231224616","DOIUrl":"10.1177/11786329231224616","url":null,"abstract":"<p><strong>Background: </strong>Heart failure affects over 6 million people in the United States (US) with limited evidence to support the use of cardiac catheterization. The benefit of its use remains mostly as expert opinion. This study intends to assess the benefits and risks of cardiac catheterization in elderly patients admitted for heart failure.</p><p><strong>Methods: </strong>This was a retrospective study using data from the National Inpatient Sample, including admissions 65 years and older hospitalized for heart failure, between 2008 and 2016. The outcomes analyzed were in-hospital mortality, total hospital costs, and length of stay.</p><p><strong>Results: </strong>After controlling for covariates, cardiac catheterization was found to have a protective association with mortality (OR 0.87, 95% CI 0.833-0.912, <i>P</i> < .0001), an increased hospital length of stay by 2.88 days (95% CI: 2.84-2.92 days, <i>P</i> < .0001) and approximately $16 255 increase in cost.</p><p><strong>Conclusions: </strong>Cardiac catheterization was associated with decreased in-hospital mortality, longer length of stay and higher total costs in admissions with heart failure aged 65 years or older.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329231224616"},"PeriodicalIF":2.8,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798072/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Day Admission Surgery Program in a Prospective Payment System: What Are the Financial Incentives?","authors":"Fabian Grass, Matthias Roth-Kleiner, Nicolas Demartines, Fabio Agri","doi":"10.1177/11786329231222970","DOIUrl":"10.1177/11786329231222970","url":null,"abstract":"<p><strong>Background: </strong>Day admission surgery (DAS) is meant to provide a better in-hospital experience for patients and to save costs by reducing the length of stay. However, in a prospective payment system, it may also reduce the reimbursement amount, leading to unintended incentives for hospitals.</p><p><strong>Methods: </strong>Over a 4-month period in 2021 and based on predefined clinical and logistic criteria, patients from different surgical sub-specialties were identified to follow the institutional DAS program. Revenue-analysis was performed, considering the Swiss diagnosis-related group (SwissDRG) prospective payment policy. Revenue with DAS program was compared to revenue if patients were admitted the day prior surgery (No DAS) using nonparametric pooled bootstrap <i>t</i>-test. All other costs considered identical, an estimation of the average cost spared due to the avoidance of pre-operative hospitalization in the DAS setting was carried out using a micro-costing approach.</p><p><strong>Results: </strong>Overall, 105 inpatients underwent DAS over the study period, totaling a revenue of CHF 1 209 840. Among them, 25 patients (24%) were low outliers due to the day spared from the DAS program and triggering a mean (SD) financial discount of Swiss Francs (CHF) 4192 (2835), yielding a total amount of CHF 105 435. DAS revealed a mean revenue of CHF 7320 (656), compared to CHF 11 510 (1108) if patients were admitted the day before surgery (No DAS, <i>P</i> = .007).</p><p><strong>Conclusion: </strong>In a PPS, anticipation of financial penalties when implementing a DAS for all-comers is key to prevent an imbalance of the hospital equation if no financial criteria are used to select eligible patients. Promptly revising workflow to maintain constant fixed costs for a greater number of patients may be a valuable hedging strategy.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329231222970"},"PeriodicalIF":2.8,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10798120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139512093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Shot for All!: Addressing the Barriers to Pneumonia Vaccination Program in the Philippines.","authors":"Dalmacito A Cordero","doi":"10.1177/11786329231224622","DOIUrl":"10.1177/11786329231224622","url":null,"abstract":"","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329231224622"},"PeriodicalIF":2.8,"publicationDate":"2024-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada","authors":"J. P. Kuwornu, Fernando Maldonado, Gary Groot, E. Penz, Elizabeth J Cooper, Amy Reid, Darcy D Marciniuk","doi":"10.1177/11786329231224621","DOIUrl":"https://doi.org/10.1177/11786329231224621","url":null,"abstract":"An integrated disease management program otherwise called a clinical pathway was recently implemented in Saskatchewan, Canada for patients living with chronic obstructive pulmonary disease (COPD). This study compared the real-world costs and consequences of the COPD clinical pathway program with 2 control treatment programs. The study comprised adult COPD patients in Regina (clinical pathway group, N = 759) matched on propensity scores to 2 independent control groups of similar adults in (1) Regina (historical controls, N = 759) and (2) Saskatoon (contemporaneous controls, N = 759). The study measures included patient-level healthcare costs and acute COPD exacerbation outcomes, both tracked in population-based administrative health data over a one-year follow-up period. Analyses included Cox proportional hazards models and differences in means between groups. The bias-corrected and accelerated bootstrap method was used to calculate 95% confidence intervals (CI). The COPD pathway patients had lower risks of moderate (hazard ratio [HR] =0.57, 95% CI [0.40-0.83]) and severe (HR = 0.43, 95% CI [0.28-0.66]) exacerbations compared to the historical control group, but similar risks compared with the contemporaneous control group. The COPD pathway patients experienced fewer episodes of exacerbations compared with the historical control group (mean difference = −0.30, 95% CI [−0.40, −0.20]) and the contemporaneous control group (mean difference = −0.12, 95% CI [−0.20, −0.03]). Average annual healthcare costs in Canadian dollars were marginally higher among patients in the COPD clinical pathway (mean = $10 549, standard deviation [SD] =$18 149) than those in the contemporaneous control group ($8841, SD = $17 120), but comparable to the historical control group ($10 677, SD = $21 201). The COPD pathway provides better outcomes at about the same costs when compared to the historical controls, but only slightly better outcomes and at a marginally higher cost when compared to the contemporaneous controls.","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"63 9","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139454993","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":"Identifying a Cohort of People Who Are Transgender and Gender-Diverse Within Saskatchewan’s Administrative Health Databases","authors":"Gwen Rose, Seanna Goalen, Megan Clark, Stéphanie Madill","doi":"10.1177/11786329231222122","DOIUrl":"https://doi.org/10.1177/11786329231222122","url":null,"abstract":"This was a retrospective cohort study. Algorithms were developed to identify a cohort of people who were trans and gender diverse (PTGD) among provincial-level administrative health databases (physician, hospital, emergency department, and pharmacy) from April 1, 2012 to September 30, 2020. Then, healthcare usage was compared between the identified cohort and the general population. There were 6466 unique individuals identified in the cohort, out of a total population of 1.2 million Saskatchewan residents (~0.5%). They had a mean age of 42.5 (SD 17.7) years. 1946 (30.1%) had a female sex marker and 4560 (69.9%) had a male sex marker, which may not indicate their lived gender. The cohort had increased healthcare usage 2 years prior to their index date, compared to the general population, which continued to rise to 1 year past their index date across physician, emergency department visits, and hospitalizations. The results for drugs were mixed. The percentage of PTGD identified in Saskatchewan was comparable to other studies. Healthcare utilization among the cohort was higher than the general population. Further research could use external data sources to validate and improve the cohort identification methods. The large majority of individuals with a male sex marker deserves further investigation.","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"26 20","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139456075","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":"Comparative Effectiveness of Home- versus Center-Based Cardiac Rehabilitation Following Heart Transplantation.","authors":"Alireza Hosseinpour, Maryam Koushkie Jahromi","doi":"10.1177/11786329231222377","DOIUrl":"10.1177/11786329231222377","url":null,"abstract":"","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"16 ","pages":"11786329231222377"},"PeriodicalIF":2.8,"publicationDate":"2023-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10752116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Doctors' Perceptions of the Media Coverage during the Covid-19 Pandemic: A Case Study in Stockholm.","authors":"Clara Brune, Janne Agerholm, Ann Liljas","doi":"10.1177/11786329231222168","DOIUrl":"10.1177/11786329231222168","url":null,"abstract":"<p><p>The strain on healthcare systems including emergency departments increased substantially during the Covid-19 pandemic,negatively affecting healthcare workers and their well-being. The emotional distress experienced by healthcare staff during the pandemic was worsened by confusion and conspiracy theories that circulated in the news and online media. Reports on the pandemic and general consumption of media intensified as the public's demand for information increased. There is limited research on how doctors perceived media coverage, and how they were affected in their work. This study aimed to explore how medical doctors in emergency departments perceived the media coverage during the Covid-19 pandemic. Twelve doctors at two different emergency departments in Stockholm, Sweden, participated. Interview questions on media were asked as part of a more extensive questionnaire. Informants' responses were analysed qualitatively. The results indicate that doctors to some extent used media as a source of information, due to limited access to knowledge about the virus. Results further suggest that media coverage triggered fear of infection, caused worry and job strain. The doctors percieved that the media coverage on Covid-19 affected patient-seeking behaviour as well as the doctor-patient relationship. The findings can be relevant in preparation for future pandemics and considered in development of policy for media and emergency departments.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"16 ","pages":"11786329231222168"},"PeriodicalIF":2.8,"publicationDate":"2023-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10752069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139048575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Covid-19 and Pre-Morbid Lifestyle-Related Risk Factors-A Review.","authors":"Ifeoma N Monye, Moyosore Taiwo Makinde, Tijani Idris Ahmad Oseni, Abiodun Bamidele Adelowo, Samba Nyirenda","doi":"10.1177/11786329231215049","DOIUrl":"10.1177/11786329231215049","url":null,"abstract":"<p><p>Since its outbreak in December 2019 in China, COVID-19 has spread like wild fire to affect many communities of the world. The high infectivity and case fatality rates of the disease among the general population and the severely ill patients respectively drew the attention of the global community. Our review showed that socio-demographic and lifestyle-related risk factors and underlying comorbid diseases were directly and indirectly associated with increased susceptibility and severity of COVID-19. These factors included older age (⩾60 years), male gender, and ethnic minority groups (especially blacks), smoking, low serum level of vitamin D, unhealthy diet, physical inactivity (with poor exposure to sunlight), overweight/obesity, high blood pressure/hypertension, high blood cholesterol, cardiovascular diseases (like stroke and coronary heart disease), diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, chronic liver disease, and some cancers (like leukemia, lymphoma, or myeloma). The literature further revealed that the clinical progression of the majority of these associated risk factors can be modified through effective and comprehensive risk reduction through healthy living and lifestyle modification. COVID-19 preventive and treatment guidelines that give adequate attention to risk reduction and healthy lifestyle among people-either in the pre-, peri-, or post-COVID-19 stage, should be developed by public health policymakers and clinicians. This will play a significant role in the global effort to combat the pandemic, and reduce its negative impact on the life expectancy and socio-economic development of the world particularly in low- and middle-income countries (LMICs).</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"16 ","pages":"11786329231215049"},"PeriodicalIF":2.4,"publicationDate":"2023-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10691316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138477457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}