Health Services Insights最新文献

{"title":"Prevalence of Preoperative Anxiety and Associated Factors Among Surgical Patients: Systematic Review and Meta-Analysis in Ethiopia.","authors":"Magarsa Lami, Abraham Negash, Jerman Dereje, Ahmed Hiko, Sinetibeb Mesfin, Arsema Gebreyesus, Nano Belama, Nesredin Ahmed Omer, Bikila Balis, Usmael Jibro","doi":"10.1177/11786329251316748","DOIUrl":"10.1177/11786329251316748","url":null,"abstract":"<p><strong>Background: </strong>Preoperative anxiety is commonly characterized as a feeling of tension, apprehension, nervousness, distressing fear, and emotional discomfort preceding surgery. Different studies across the countries indicated an inconsistent prevalence of preoperative anxiety and its associated factors. Therefore, this study aimed to determine the pooled prevalence of preoperative anxiety and associated factors among surgical patients in Ethiopia.</p><p><strong>Methods: </strong>In this study, all observational study designs conducted in Ethiopia were included while studies that did not report our main outcome of interest or did not meet the quality criteria by Joanna Briggs Institute (JBI) critical appraisal techniques were excluded. Electronic databases (PubMed, SCOPUS, Web of Science Core Collection, CAB Abstract, EMBASE, and CINHAL (EBSCO)), Google Scholar, and lists of references were used to search works of literature in Ethiopia. STATA version 17 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Computing values assessed heterogeneity among the studies for <i>I</i> ² and <i>P</i>-values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias respectively.</p><p><strong>Results: </strong>A total of 10 studies were included with a total of 3054 participants. The pooled prevalence of preoperative anxiety among surgical patients in Ethiopia was 60% (95% CI: 55-66, <i>P</i> < .001, <i>I</i> ² = 90.00%). The overall prevalence among non-obstetric patients was 59% (95% CI: 53-66) while among obstetric 66% (95% CI: 62-69). Fear of complication (AOR = 2.32, 95% CI: 1.23, 3.41, <i>P</i> = .62, <i>I</i> ² = 0.00%), postoperative pain (AOR = 1.92, 95% CI: 1.29, 2.56, <i>P</i> = .37, <i>I</i> ² = 0.00%), and fear of death (AOR = 2.27, 95% CI: 1.53, 3.00, <i>P</i> = .70, <i>I</i> ² = 0.00%) were significantly associated with preoperative anxiety.</p><p><strong>Conclusion: </strong>This study revealed a high pooled prevalence of preoperative anxiety among surgical patients in Ethiopia. The findings showed that fear of complication, postoperative pain, and fear of death were significantly associated with preoperative anxiety. This implies that a multidisciplinary approach involving various healthcare professionals is essential to optimize patient care and outcomes by addressing postoperative pain through pain management, counselling on fear of death, and complications to reduce the level of preoperative anxiety.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251316748"},"PeriodicalIF":2.4,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143189027","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":"Effects of Women's Participation in Household Decision Making on Skilled Birth Attendants Supervised Delivery in Bangladesh.","authors":"Md Badsha Alam, Shimlin Jahan Khanam, Md Awal Kabir, Atika Rahman Chowdhury, Tahir Ahmed Hassen, Susmita Das, Md Nuruzzaman Khan","doi":"10.1177/11786329251316674","DOIUrl":"10.1177/11786329251316674","url":null,"abstract":"<p><strong>Background: </strong>While the importance of women's participation in household decision making in enhancing access to healthcare services is widely acknowledged, limited evidence exists on the link between women's participation in household decision making and skilled birth attendants (SBA) supervised delivery. This study aims to fill this gap by examining the effects of women's participation in household decision making on SBA supervised delivery in Bangladesh.</p><p><strong>Methods: </strong>Data of 3607 mothers who had given birth within 2 years of the survey date were extracted from the 2022 Bangladesh Demographic and Health Survey (BDHS) and analyzed. The outcome variable considered was SBA supervised delivery, and the primary explanatory variable was a composite index of women's participation in household decision making generated from their responses regarding decision-making on own healthcare, large household purchases, and visits to their family or relatives. Multi-level mixed-effects logistic regression was used to explore the effects of women's participation in household decision making on SBA supervised delivery, adjusted for potential confounders.</p><p><strong>Results: </strong>The reported prevalence of SBA supervised delivery was 70%. Women lacking participation power and moderately empowerment in household decision-making were 15% (aOR= 0.85, 95% CI: 0.66-1.08) and 20% less likely to had SBA supervised delivery (aOR = 0.80, 95% CI: 0.64-0.99) compared to those with high participation power, respectively. This association remained consistent across all 3 empowerment domains, with lower likelihoods of SBA supervised delivery among women lacking empowerment.</p><p><strong>Conclusion: </strong>The findings of this research affirm the positive effects of women's participation in household decision making on SBA supervised delivery in Bangladesh. Recommendations include increasing women's empowerment in household decision making and raising awareness and education about the importance of SBA supervised delivery.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251316674"},"PeriodicalIF":2.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143065187","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":"Mortality and Length of Stay Implications of Deterioration-Associated Transfer to the Intensive Care Unit over Different Time Frames.","authors":"Kathy W Belk, Joseph Beals, Samantha J McInnis","doi":"10.1177/11786329241312877","DOIUrl":"10.1177/11786329241312877","url":null,"abstract":"<p><strong>Background: </strong>Quality improvement initiatives in the acute care setting often target reduction of mortality and length of stay (LOS). Unplanned care escalations are associated with increased mortality risk and prolonged LOS, but may be precipitated by different factors, including appropriate triage, bed availability, and post-admission deterioration.</p><p><strong>Objectives: </strong>This work evaluates different transfer timeframes to quantify the impact of deterioration-associated unplanned transfers to intensive care (ICU) on mortality and LOS, informing evidence-based interventions to improve patient care.</p><p><strong>Design: </strong>This retrospective analysis examined 519 181 adult inpatients discharged from 15 hospitals in the United States. A propensity matched cohort analysis compared mortality and overall hospital LOS for patients admitted to routine and intermediate care units who did and did not have an unplanned ICU transfer within 12, 12-48, or ⩾48 hours from admission.</p><p><strong>Methods: </strong>Population cohorts were matched on age, sex, admitting unit type, admission type, and admission acuity. Multivariable regression analysis was used to estimate the impact of unplanned transfer on mortality and LOS. Sensitivity sub-analyses compared direct ICU admissions to unplanned ICU transfers using the same transfer timeframes and endpoints.</p><p><strong>Results: </strong>Patients with unplanned transfers in each of three timeframes had statistically higher mortality rates and longer LOS than matched cohorts without unplanned transfer. Differences between cohorts was greatest in patients transferring ⩾48 hours post-admission for both mortality (25.1% vs 1.9%, <i>P</i> < .0001) and LOS (<i>x¯</i> = 14.7 vs 5.3, <i>P</i> < .0001). Multivariate analysis showed unplanned ICU transfer significantly increased odds of mortality and prolonged LOS, with later transfers having the most profound influence (19-fold increase in mortality and 2-fold increase in LOS). Sensitivity analyses found a statistically significant increase in mortality and LOS associated with unplanned ICU transfer across all three timeframes.</p><p><strong>Conclusion: </strong>The association of later transfers with elevated mortality and LOS underscores the importance of timely intervention on patient deterioration.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329241312877"},"PeriodicalIF":2.4,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11748078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004355","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":"Toward Resilient Maternal, Neonatal and Child Health Care: A Qualitative Study Involving Afghan Refugee Women in Pakistan.","authors":"Yasir Shafiq, Ameer Muhammad, Kantesh Kumar, Zabin Wajid Ali, Saba Noor, Zamir Hussain Suhag, Rehman Tahir, Abdullah Jan, Luca Ragazzoni, Francesco Barone-Adesi, Martina Valente","doi":"10.1177/11786329241310733","DOIUrl":"https://doi.org/10.1177/11786329241310733","url":null,"abstract":"<p><strong>Background: </strong>Afghan refugees in Pakistan, particularly in Quetta, Balochistan, encounter formidable barriers in accessing maternal, newborn, and child health (MNCH) services. These challenges have been intensified by the COVID-19 pandemic and entrenched systemic health inequities.</p><p><strong>Methods: </strong>This qualitative study, conducted from February to April 2023, aimed to assess the obstacles within health systems and community environments that hinder MNCH service access among Afghan refugees. The study involved 20 key informants through in-depth interviews and focus group discussions, including Afghan refugee women, community elders, health workers, and representatives from non-governmental organizations and government agencies. The research focused on experiences during the initial four waves of the COVID-19 pandemic (2020-2021), utilizing a conceptual framework integrating Health Emergency Disaster Risk Management (Health-EDRM) with primary health care.</p><p><strong>Findings: </strong>The study identified significant systemic barriers to accessing MNCH services, such as insufficient funding, inadequate health infrastructure, and discriminatory practices within the healthcare workforce. Additionally, community-level obstacles were prominent, including cultural and language differences, geographical isolation, and economic constraints. The integration of Health-EDRM into local health systems was minimal, with many stakeholders either needing to be made aware of or unengaged with the framework.</p><p><strong>Conclusion: </strong>The findings highlight a critical need for comprehensive policy reforms, infrastructure enhancement, and community-centered approaches to address Afghan refugees' health needs effectively. Strengthening the integration of health-EDRM into health systems is crucial for enhancing resilience and ensuring continuous care during health emergencies. The study calls for concerted efforts to implement culturally sensitive health interventions that include disaster risk management components to improve MNCH outcomes among Afghan refugees in crisis-affected settings. Addressing systemic and community-level barriers makes creating a more resilient and equitable health system for vulnerable populations possible.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329241310733"},"PeriodicalIF":2.4,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142947663","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":"Healthcare Professionals' Ratings and Views of Person-Centred Care in the Context of Allogeneic Hematopoietic Stem Cell Transplantation.","authors":"Anna O'Sullivan, Jeanette Winterling, Annika Malmborg Kisch, Karin Bergkvist, David Edvardsson, Yvonne Wengström, Carina Lundh Hagelin","doi":"10.1177/11786329241310735","DOIUrl":"https://doi.org/10.1177/11786329241310735","url":null,"abstract":"<p><strong>Introduction: </strong>Allogeneic stem cell transplantation (allo-HCT) involves a long trajectory with high risk of complications. In person-centred care (PCC), patients' needs, resources and the care relationship are central to the care process. Healthcare professionals' (HCPs) ratings of PCC have not previously been investigated in this context.</p><p><strong>Objectives: </strong>The aim of this study was to investigate healthcare professionals' ratings and views of person-centred care in allo-HCT care, and associations with individual characteristics and targeted PCC education.</p><p><strong>Design: </strong>Cross-sectional study, employing quantitative and qualitative methods.</p><p><strong>Methods: </strong>85 HCPs at two Swedish allo-HCT centres participated (80% women; mean age: 44 years, range: 23-72 years). A survey was conducted using the PCC Assessment Tool (P-CAT), containing 13 items, a total scale (min 13-max 65) and two subscales (I: min 8-max 40; II: min 5-max 25). Additionally, HCPs' written responses to four study-specific questions about PCC were collected.</p><p><strong>Results: </strong>The mean for P-CAT total scale was 45.31, (subscale I: 28.41; subscale II: 16.90). Higher ratings of PCC were reported for assessment of patients' needs, discussion about how to provide PCC and patients' care, while time to provide PCC, the care environment and how the organization prevents providing PCC were rated lower. Higher age and targeted PCC education were associated with higher PCC ratings. HCPs described PCC as the patient being seen as a capable individual with their own resources, with PCC increasing patient and family involvement-giving higher satisfaction and tailored care for patients. However, HCPs reported time as a barrier for PCC.</p><p><strong>Conclusion: </strong>HCPs' ratings of PCC in this context are high regarding discussing and assessing patients' needs, but there is room for improvement regarding organizational and environmental aspects. Targeted PCC education increases the level of PCC. HCPs' views of PCC partly reflect the foundations of PCC-patient's narrative, capability and involvement.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329241310735"},"PeriodicalIF":2.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11694289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142931375","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":"JURNI (Journeying with Patients' Understanding and Responding to Needs Interactively): An In-Hospital Navigation Application for Timely Diagnosis and Treatment of Breast Cancer at the University Malaya Medical Centre.","authors":"Sarinder Kaur Dhillon, Foad Kalhor, Wong Seng Kai, Teh Mei Sze, Nisha Mohd Shariff, Manisha Sekaran, Nur Aishah Taib","doi":"10.1177/11786329241309309","DOIUrl":"10.1177/11786329241309309","url":null,"abstract":"<p><p>One of the main challenges in breast cancer management is health system literacy to provide optimal and timely diagnosis and treatments within complex and multidisciplinary health system environments. Digitalised patient navigation programs have been developed and found to be helpful in high- and low-resource settings, but gaps remain in finding cost-effective navigation in the public sector in Malaysia, where resources are scarce and unstable. Hence, we set out to develop a virtual patient navigation application for breast cancer patients to enhance knowledge about cancer diagnosis and treatments and provide a tracking mechanism to ensure quality care. This paper identifies the requirement for in-hospital patients' navigational needs for cancer diagnosis, the cancer diagnosis and treatment process's components and pathways, developing the app and usability study on the usefulness of a cancer navigation mobile application in navigating cancer care at the University of Malaya Medical Centre (UMMC). Key features found when designing the in-hospital application are managing the medical appointments, finding the location of each medical department, and providing information to breast cancer patients, healthcare managers and providers to ensure a coordinated care pathway. In future work, we plan to implement the JURNI in-hospital patient navigation and perform usability studies involving the actual patients, physicians and administrators. We are also working towards enhancing data security, adding other local languages and artificial intelligence capabilities to improve the patient's journey.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329241309309"},"PeriodicalIF":2.4,"publicationDate":"2024-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11662331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142876859","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":"Minimum Acceptable Diet and Associated Factors among 6-23 Months Age Children in Wondo Genet District, Sidama Region, Ethiopia.","authors":"Amelo Bolka Gujo, Assefa Philipos Kare","doi":"10.1177/11786329241308099","DOIUrl":"10.1177/11786329241308099","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate child feeding practices can have significant negative effects on the well-being and survival of children under two years old. This study was aimed at assessing the minimum acceptable diet (MAD) and associated factors among 6 to 23 months age children in Wondo Genet district, Sidama region, Ethiopia.</p><p><strong>Methods: </strong>A community-based cross-sectional study was conducted from 1 to 30 July in 2023 among 422 children aged 6 to 23 months. Multi-stage sampling method was applied to select kebeles and study participants. Trained data collectors gathered data using pretested questionnaire. Data was entered into EPI Info 7 and analyzed using IBM SPSS version 26. MAD as a composite indicator was produced based on the proportion of children aged 6 to 23 months who met the minimum meal frequency (MMF) and minimum dietary diversity (MDD) on the previous day. To assess the factors determining adherence to MAD, multi-variable logistic regression analyses were employed. The outputs were presented using an adjusted odds ratio (AOR) with 95% confidence intervals (CI).</p><p><strong>Results: </strong>In this study, 419 mothers/caretakers participated with a response rate of 99.3%. The proportion of children who met the MAD were 26.5% (95% CI: 22.29%, 30.71%). Increased odds of meeting MAD were associated with being from food-secured households (AOR = 2.39, 95% CI: 1.48 to 3.86), utilization of growth monitoring services (AOR = 2.05, 95% CI: 1.23 to 3.39), mother attended formal education (AOR = 1.88, 95% CI: 1.15 to 3.08), and being in age range of 12-23 months (AOR = 2.14, 95% CI: 1.26 to 3.63).</p><p><strong>Conclusion: </strong>The prevalence of MAD was very low. Factors associated with a MAD included maternal education, child age, growth monitoring service utilization, and food security. To enhance MAD provision, it is crucial to strengthen child feeding practices tailored to the local context.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329241308099"},"PeriodicalIF":2.4,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11653471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142852912","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":"Does Physician-Hospital Vertical Integration Affect Hospital Output?","authors":"Soumya Upadhyay, Neeraj Bhandari","doi":"10.1177/11786329241304619","DOIUrl":"10.1177/11786329241304619","url":null,"abstract":"<p><strong>Background: </strong>Physician-hospital vertical integration is gaining steam but it is unclear how they affect hospital output.</p><p><strong>Objective: </strong>To examine the direct impact of vertical integration on hospital output.</p><p><strong>Design: </strong>A pooled design with 6-year data using linear regressions was used. Then, panel data design with hospital fixed effects was used.</p><p><strong>Methods: </strong>We linked American Hospital Association data (2016-2021) with AHRQ Comparative Health System Performance Initiative's Compendium (2018, 2020, 2021; 34 987 hospital-year observations) to develop new measures of vertical integration and assess its relationship with several measures of hospital output including annualized total admissions, total number of inpatients days, and total number of emergency department (ED) and outpatient visits.</p><p><strong>Results: </strong>We find that a hospital's entry into a vertical integration has little or no impact on a broad set of metrics capturing hospital output.</p><p><strong>Conclusion: </strong>Our findings suggest that vertical integrations as currently structured may not yield meaningful gains in output or productivity and hospitals faced with declining productivity need to carefully consider the expected gains from vertical integration strategies.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329241304619"},"PeriodicalIF":2.4,"publicationDate":"2024-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828340","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":"Impact of Educational Background on the Quality of Standardized Residency Training Program: The Case of China, a Cohort Study.","authors":"Xiaoyu Tu, Xiaoquan Ding, Wanru Huang, Xiangrong Xu, Paulo Moreira, Runju Zhang","doi":"10.1177/11786329241306392","DOIUrl":"10.1177/11786329241306392","url":null,"abstract":"<p><strong>Objectives: </strong>Residency training is important worldwide and recent studies have put more emphasis on its quality evaluation. This study aims to first explore the impact of educational backgrounds on the quality of gynecology and obstetrics (OB-GYN) standardized resident training (SRT) program in China, which may provide crucial evidence for policy considerations to improve SRT quality.</p><p><strong>Methods: </strong>A total of 397 OB-GYN resident graduates were enrolled in this retrospective cohort study. They were divided into three groups according to their educational background, that is Bachelor of Medicine (BM), Master of Medicine (MM), and Doctor of Medicine (DM) groups. The characteristics and the results of SRT graduation examination and annual assessment of these residents were collected and compared using one-way analysis of variance or Pearson's chi-square test. A multivariable logistic regression analysis was performed to identify the association between sociodemographic variables and pass rates of SRT graduation examination. Besides, a subgroup analysis on training time for the DM group was performed. Strobe protocol was followed.</p><p><strong>Results: </strong>The residents were older in DM group than that in BM and MM groups (<i>P</i> < 0.001). There was significant difference of the training length and the proportion taking part in SRT graduation examination among three groups (<i>P</i> < 0.001). Although the written test scores of SRT graduation examination were the lowest in BM group (<i>P</i> = 0.015), there was no significant difference in other results among three groups. No significant variable was found associated with the pass rates of SRT examination. No significant difference was found in the subgroup analysis of DM group.</p><p><strong>Conclusion: </strong>Overall, the SRT quality of OB-GYN residents with different educational backgrounds was good and comparable. However, residents with BM degrees had lowest written scores and need to be strengthened during training. The training time of residents with DM degrees can be shortened according to their own conditions.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329241306392"},"PeriodicalIF":2.4,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827794","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":"Evaluation of In-Hospital and Community-Based Healthcare Utilization and Costs During the Coronavirus 2019 (COVID-19) Pandemic in Alberta, Canada: A Population-Based Descriptive Study.","authors":"Kathy Liu, Elissa Rennert-May, Zuying Zhang, Adam G D'Souza, Alysha Crocker, Tyler Williamson, Reed Beall, Jenine Leal","doi":"10.1177/11786329241306390","DOIUrl":"10.1177/11786329241306390","url":null,"abstract":"<p><strong>Background: </strong>Assessing the financial burden of COVID-19 is important for planning health services and resource allocation to inform future pandemic response.</p><p><strong>Objectives: </strong>This study examines the changing dynamics in healthcare utilization patterns and costs from a public healthcare perspective during the COVID-19 pandemic in Alberta, Canada.</p><p><strong>Design: </strong>Population-based descriptive study.</p><p><strong>Methods: </strong>All adult patients over the age of 18 years who had a laboratory-confirmed COVID-19 diagnosis in Alberta, Canada from March 1, 2020 to December 15, 2021. We described demographic information and community- and hospital-based healthcare utilization and costs. We compared changes in each outcome throughout the first four waves of the pandemic.</p><p><strong>Results: </strong>Among 255,037 patients, hospitalization incurred significantly higher costs (<i>N</i> = 20,603; aRR = 755.51; marginal cost: $21,738.17 CAD; <i>P</i> < .01). Wave 2 recorded the highest cost for Emergency Department (ED) visits (aRR = 1.10; marginal cost: $79.19 CAD; <i>P</i> < .01). Compared to Wave 1, Waves 2-4 all recorded significantly lower costs for out-patient visits. Wave 2's in-patient cost for patients that required ICU admission was significantly lower than Wave 1 (aRR = 0.75; marginal cost: -$24,142.47 CAD; <i>P</i> = .02).</p><p><strong>Conclusion: </strong>COVID-19 exerted a heavy toll on healthcare services, and the dynamics of this continue to evolve. Utilization of ED and in-patient services were particularly high. Severe infections requiring hospitalization and ICU admission are more expensive than non-hospitalized and non-ICU hospital admits. Future studies should clarify specific factors, such as sociodemographic determinants, that contribute to evolving patterns of health services consumption and changing trends in cost to holistically inform responses to future pandemics.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"17 ","pages":"11786329241306390"},"PeriodicalIF":2.4,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11639006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827782","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}