Health Services Research and Managerial Epidemiology最新文献

{"title":"Application of Frailty Quantile Regression Model to Investigate of Factors Survival Time in Breast Cancer: A Multi-Center Study.","authors":"Akram Yazdani,&nbsp;Hojjat Zeraati,&nbsp;Shahpar Haghighat,&nbsp;Ahmad Kaviani,&nbsp;Mehdi Yaseri","doi":"10.1177/23333928231161951","DOIUrl":"https://doi.org/10.1177/23333928231161951","url":null,"abstract":"<p><strong>Background: </strong>The prognostic factors of survival can be accurately identified using data from different health centers, but the structure of multi-center data is heterogeneous due to the treatment of patients in different centers or similar reasons. In survival analysis, the shared frailty model is a common way to analyze multi-center data that assumes all covariates have homogenous effects. We used a censored quantile regression model for clustered survival data to study the impact of prognostic factors on survival time.</p><p><strong>Methods: </strong>This multi-center historical cohort study included 1785 participants with breast cancer from four different medical centers. A censored quantile regression model with a gamma distribution for the frailty term was used, and <i>p</i>-value less than 0.05 considered significant.</p><p><strong>Results: </strong>The 10^th and 50^th percentiles (95% confidence interval) of survival time were 26.22 (23-28.77) and 235.07 (130-236.55) months, respectively. The effect of metastasis on the 10^th and 50^th percentiles of survival time was 20.67 and 69.73 months, respectively (all <i>p</i>-value < 0.05). In the examination of the tumor grade, the effect of grades 2 and 3 tumors compare with the grade 1 tumor on the 50^th percentile of survival time were 22.84 and 35.89 months, respectively (all <i>p</i>-value < 0.05). The frailty variance was significant, which confirmed that, there was significant variability between the centers.</p><p><strong>Conclusions: </strong>This study confirmed the usefulness of a censored quantile regression model for cluster data in studying the impact of prognostic factors on survival time and the control effect of heterogeneity due to the treatment of patients in different centers.</p>","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"10 ","pages":"23333928231161951"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/df/10.1177_23333928231161951.PMC10034283.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192476","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":"The Practice of Infant Sleep Position among Mothers in Jimma Town Public Health Institutions, Jimma, Oromia, South West Ethiopia, 2022.","authors":"Aynalem Yetwale,&nbsp;Bilen Tigstu,&nbsp;Tsegaw Biyazin,&nbsp;Belete Fenta,&nbsp;Yalemtsehay Dagnaw,&nbsp;Yaregal Dessalew","doi":"10.1177/23333928221143356","DOIUrl":"https://doi.org/10.1177/23333928221143356","url":null,"abstract":"<p><strong>Background: </strong>One of the important interventions in the infantile period is the selection of appropriate infant sleeping position. Unsafe infant sleep position is associated with sudden unexpected death in infancy. Yet, little is known about the practice of infant sleep position in Ethiopia. This study aimed to assess the practice of infant sleep position among mothers attending mother and child health service in Jimma town public health institutions, South West Ethiopia, 2022.</p><p><strong>Methods: </strong>An institutional based cross-sectional study design was conducted on 409 women attending Maternal and child health service in Jimma town public health facilities. The data were collected using a pre-tested and semi- structured questionnaire. Binary Logistic regression was used to analyze the association between the practice infant sleeping positions and explanatory variables. The strength of association was evaluated using an odds ratio at a 95% confidence interval and a <i>P</i>-value ≤ .05 was considered to declare significant associations.</p><p><strong>Results: </strong>Four hundred nine women participated in the study, with a response rate of 97%. The practice of recommended infant sleeping position (supine position) in this study was 33.5% [95% CI (28.9% - 38.6%)]. Being married Adjusted odds ratio (AOR) 2.6; 95% CI (1.04-6.48)), residence (AOR 1.88; 95% CI (1.1-3.31)) multi gravidity (AOR 1.6; 95% CI (1.02-2.59)) and having good knowledge of sleeping position (AOR 1.55; 95% CI (1.01-2.38)) were significantly associated with the practice of infant sleep position.</p><p><strong>Conclusion: </strong>The practice of medically recommended infant sleep position in this study was low. Being married, residence, multi gravidity and having good knowledge of sleeping position were significantly associated with the practice of infant sleep position. Therefore, considering these associated factors during health care provision and disseminating information on safe sleep practices for mothers is needed. Also, different stakeholders, including the federal ministry of health, health professionals, and health institutions at different levels, need to give attention to such problems in addition to the service to reduce infant mortality.</p>","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"10 ","pages":"23333928221143356"},"PeriodicalIF":1.6,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/4a/10.1177_23333928221143356.PMC10068967.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9311925","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":"We Live in Interesting Times: How Health Services Research and Managerial Epidemiology Helps Point the Way Forward","authors":"Gregory M. Garrison","doi":"10.1177/23333928221083061","DOIUrl":"https://doi.org/10.1177/23333928221083061","url":null,"abstract":"While big data promises to revolutionize and personalize healthcare, the push of technology has caused medical care to become more fragmented and specialized. Additionally, the COVID-19 pandemic has accelerated change with new sweeping public health guidance and a rapid adoption of tele-healthcare or virtual visits. In this rapidly changing environment, it is more important than ever to scientifically consider the impact of these changes on quality of care, access to care, value of care, and overall health. Last year, Ghosh et.al found a worrisome widening disparity in hospital length-of-stay between black and white patients following implementation of the Hospital Readmission Reduction Project. Studnicki et.al noted that chemical abortions were associated with more emergency department visit morbidity than surgical abortions. And Boretti raised important questions about an alarming rise in COVID-19 cases coinciding with vaccine introduction in Israel. While seemingly unconnected, these studies, all published in this journal, indicate the need to objectively evaluate interventions for potential unintended effects. Healthcare is a complex adaptive system, and as such, outcomes are not necessarily linear and cannot be determined by examining only the components. This journal, Health Services Research & Managerial Epidemiology, is uniquely positioned to study the complex effects of these changes. By applying case-control and cohort studies, the tools of analytic epidemiology, to healthcare service and management issues, we can objectively determine effects and prove or disprove hypotheses. This is a continuation of the vision Dr James Rohrer expressed while founding this journal. As your new editor-in-chief, I am grateful for the foundation that Dr Rohrer developed. A study by Khera et.al, reported in this issue, is a wonderful example of the science this journal can advance. Using a retrospective cohort, his team identified patient characteristics which could be used to determine eligibility for virtual pre-anesthetic medical exams. In 2022, I look forward to publishing more works like this which use the techniques of epidemiology to examine all aspects of healthcare delivery. Ironically, the first known reference of the quote was attributed to Sir Austin Chamberlain, a British statesman and halfbrother to the Prime Minister, during the leadup to World War II. Despite inaccurate and hyperbolic political comparisons to World War II, we are lucky COVID-19 does not match the devastation of a world war which killed 3% of the world’s population or more than 70 million people. While we mourn for those lost to COVID-19, we also recognize it has altered our lives dramatically and changed healthcare delivery suddenly. We are indeed living thru interesting times; it would be a shame not to study them objectively and scientifically.","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"1 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84460939","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":"A Proposed Multi-Criteria Optimization Approach to Enhance Clinical Outcomes Evaluation for Diabetes Care: A Commentary","authors":"T. Wan, Sarah D. Matthews, H. Luh, Yong Zeng, Zhibo Wang, Lin Yang","doi":"10.1177/23333928221089125","DOIUrl":"https://doi.org/10.1177/23333928221089125","url":null,"abstract":"There are several challenges in diabetes care management including optimizing the currently used therapies, educating patients on selfmanagement, and improving patient lifestyle and systematic healthcare barriers. The purpose of performing a systems approach to implementation science aided by artificial intelligence techniques in diabetes care is two-fold: 1) to explicate the systems approach to formulate predictive analytics that will simultaneously consider multiple input and output variables to generate an ideal decision-making solution for an optimal outcome; and 2) to incorporate contextual and ecological variations in practicing diabetes care coupled with specific health educational interventions as exogenous variables in prediction. A similar taxonomy of modeling approaches proposed by Brennon et al (2006) is formulated to examining the determinants of diabetes care outcomes in program evaluation. The discipline-free methods used in implementation science research, applied to efficiency and quality-of-care analysis are presented. Finally, we illustrate a logically formulated predictive analytics with efficiency and quality criteria included for evaluation of behavioralchange intervention programs, with the time effect included, in diabetes care and research.","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"5 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82022316","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":"Risk Factors for COVID-19 Hospitalization in School-Age Children","authors":"L. O'Neill, N. Chumbler","doi":"10.1177/23333928221104677","DOIUrl":"https://doi.org/10.1177/23333928221104677","url":null,"abstract":"Introduction With the recent emergence of the Omicron variant, there has been a rapid and alarming increase in the number of COVID-19 cases among pediatric populations. Yet few US pediatric cohort studies have characterized the clinical features of children with severe COVID-19. The objective of this study was to identify those chronic comorbidities that increase the risk of hospitalization for pediatric populations with severe COVID-19. Methods A retrospective cohort study that utilized the Texas Inpatient Public Use Data file was conducted. The study included 1187 patients (ages 5 to 19) from 164 acute-care Texas hospitals with the primary or secondary ICD-10CM diagnosis code U07.1 (COVID-19, virus identified). The baseline comparison group included 38 838 pediatric patients who were hospitalized in 2020. Multivariable binary logistic regression, controlling for patient characteristics, sociodemographic factors, and health insurance, was used to estimate the adjusted risk of hospitalization for COVID-19. Results Obesity and type 1 diabetes increased the risk of hospitalization with COVID-19 among both children (5-12 years) and adolescents (13-19 years). Adolescents with morbid obesity were 10 times more likely to have severe COVID-19 (p < 0.001). Regardless of age, single-parent households (%) for the patient's zip code was associated with an increased risk of hospitalization with COVID-19 (AOR = 1.02, CI: 1.01-1.03, p < 0.01). Other risk factors included chronic kidney disease (p < 0.05), male gender (p < 0.001), Medicaid (p < 0.001), and charity care (p < 0.001). Conclusion Pediatric providers and public health officials should consider the need to tailor clinical management and mitigation efforts for pediatric populations with identifiable risk factors for severe COVID-19. These findings can be used to improve risk communication with families of children with underlying medical conditions and to prioritize prevention measures, including vaccinations.","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"32 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74270692","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":"COVID-19 Vaccine Acceptance and Associated Factors among Unvaccinated Workers at a Tertiary Hospital in Southern Thailand","authors":"Guanjie Li, Yanxu Zhong, Hein Htet, Yunyan Luo, Xizhuo Xie, W. Wichaidit","doi":"10.1177/23333928221083057","DOIUrl":"https://doi.org/10.1177/23333928221083057","url":null,"abstract":"Background Hospital workers are at high risk of COVID-19 infection which is now vaccine-preventable. However, vaccine refusals also occur among hospital workers, but the associated factors have not been described. Objectives To describe: (1) the level of COVID-19 vaccine acceptance, and; (2) the extent that history of pre-pandemic vaccine hesitancy and health beliefs regarding COVID-19 were associated with COVID-19 vaccine acceptance among workers at a tertiary hospital in southern Thailand. Methods We conducted a cross-sectional study using a paper-based self-administered questionnaire at a tertiary hospital in south Thailand in April 2021 and used multivariable logistic regression to identify psychological-behavioral factors associated with vaccine acceptance. Results Of 359 workers invited to participate, 226 participants returned the questionnaires, 67% of whom reported willingness to accept the vaccine. Vaccine acceptance was associated with perceived severity of disease (Adjusted OR = 2.07, 95% CI = 1.04, 4.10), perceived harm from non-vaccination (Adjusted OR = 2.51, 95% CI = 1.27, 4.96), and lower expectation of vaccine efficacy (Adjusted OR = 3.80, 95% CI = 1.87, 7.71). Conclusion Most workers in this study were willing to accept the COVID-19 vaccine, and such acceptance was associated with components of the health belief model. However, the cross-sectional study design did not allow causal inference, and study data were all self-reported with no probing of the responses. These limitations should be considered as caveats in the interpretation of the study findings.","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"89 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74646088","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":"Knowledge and Attitude towards COVID-19 Vaccination and Associated Factors among College Students in Northwest Ethiopia,2021","authors":"Mastewal Belayneh Aklil, Wubedle Zelalem Temesgan","doi":"10.1177/23333928221098903","DOIUrl":"https://doi.org/10.1177/23333928221098903","url":null,"abstract":"Background It is imperative to ensure optimal vaccine uptake at the population level to combat the deadly COVID-19 pandemic disease. However, refusal of the COVID-19 vaccine, poor knowledge, and a negative attitude towards vaccination are the challenges of the world. College students are among the high-risk subgroups of the population to COVID-19 infection and the main source of information and trust in vaccines to the society. Also, their judgement on vaccine affect the public attitude towards vaccination. Therefore, this study aimed to assess knowledge and attitude towards COVID-19 vaccination and associated factors among college students in Gondar city, northwest Ethiopia. Methods An institution-based cross-sectional study was conducted among 626 study participants in Gondar city. A multistage sampling technique was used to recruit the study participants. A pretested self-administered questionnaire was used to collect the data. Bivariable and multivariable logistic regression analyses were performed to assess factors associated with knowledge and attitude towards COVID-19 vaccination. The level of significance was claimed based on a p-value < 0.05. Results In this study, 46.8% (95% CI: 43.3, 50.6) of study participants had good knowledge and 50% (95% CI: 45.9, 53.7) had a positive attitude towards COVID-19 vaccination. Having comorbidity disease and being male were significantly associated with good knowledge. In addition, being married, being a health science student, being exposed to mass media, having a good knowledge of COVID-19 vaccination, and having paternal primary education were significantly associated with a positive attitude towards COVID-19 vaccination. Conclusion In general, knowledge and attitude towards COVID-19 vaccination among college students are low. Comorbidity disease and sex were predictors of COVID-19 vaccination knowledge, whereas, marital status, category of college students, mass media, paternal education and knowledge about COVID-19 vaccination were predictors of COVID-19 vaccination attitude. Alleviating participants’ concerns and improving their confidence through health education is crucial.","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"14 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77787313","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":"Mechanisms, Pattern and Outcome of Pediatrics Trauma At Agaro General Hospital, Southwest Ethiopia, 2021","authors":"Y. Dagnaw, Belete Fenta, A. Yetwale, Tsegaw Biyazin, Alemayehu Sayih, Nigatu Dessalegn, Emebet Adugnaw, F. Ali, Yitbarek Tesfa","doi":"10.1177/23333928221101975","DOIUrl":"https://doi.org/10.1177/23333928221101975","url":null,"abstract":"Introduction Over 80% of trauma related deaths in children occur in low income and middle-income countries including Ethiopia. Trauma affects several aspects of child life and is still a major concern. Despite the Ethiopian federal ministry of health (FMoH) conducting away different trials, there was an increased burden and high projection of pediatric trauma. In Ethiopia, There is insufficient evidence about the mechanisms, patterns and outcomes of pediatric trauma including this study area, Therefore this study aimed to assess the mechanisms, patterns, and outcomes of pediatric trauma in Agaro General Hospital, Southwest Ethiopia, 2021. Methods and Materials This cross-sectional study was study conducted on randomly selected 405pediatric patients who visited the Agaro General Hospital between 1/1/2018 and 30/8/2021. Data were extracted from each medical chart using a structured checklist. Data were entered into Epi-data 4.4.2.1for cleaning and analyzed using SPSS version 24. Tables, charts, and text are used to report the results. Results A total of 405 patients were included in the study. This study revealed that majority 271 (66.9%) of injured children were males. Most 188 (46.4%) of the traumas were occurred on the street. Fall down injury were the most common 151(37.3%) cause of trauma, followed by road traffic accidents 98 (24.2%). Trauma caused by falls accounted for 43.7% and 34.4% % of all traumas in the 5–12 year and the <5 year age groups respectively. Most 126 (31.1%) of the subjects were exposed to head and face trauma. Majority 256 (63.2%) of children were discharged with improvement, while12 (3.0%) of them have died. Conclusions Pediatric trauma remains a major public health concern. Most of trauma occurred among boys and falldown injury was the most frequent trauma, and the majority of the subjects were exposed to head and face trauma. Therefore, children should receive safety precautions, more supervision, and identification of specific risk factors for these injuries, and should be prohibited from risky practices by concerned bodies including families and traffic officers.","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"53 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91150389","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":"Pregnant and Powerless: Exploring Barriers to Contraceptive use among Women in Mogadishu, Somalia","authors":"A. Gele, Mary Shrestha, Naima Said Sheikh, S. Qureshi","doi":"10.1177/23333928221117057","DOIUrl":"https://doi.org/10.1177/23333928221117057","url":null,"abstract":"Background With a maternal mortality ratio of 692 per 100 000 live births and modern contraception prevalence of 1%, understanding factors hindering Somali women from using modern contraception is key to developing and implementing locally adopted public health responses. The purpose of this qualitative study was to explore factors impeding Somali women in Mogadishu from using modern contraception Methods We conducted a qualitative study using semi-structured, in-depth interviews with 21 married women aged >18 years, living in different neighborhoods in Mogadishu between July—December 2018. We recruited the participants using a convenience sampling method. Results The findings show that health communication messages and contraceptive information provided by health providers (medical barriers) constitute a significant obstacle to women’s access to modern contraception services. Other barriers included prevalent religious fallacies among women and fear of permanent infertility upon modern contraception. Conclusion Training health providers in the principles of modern contraception, in addition to the medical ethics that govern their responsibility to provide correct and relevant information to their patients, is vital for increasing modern contraception use among Somali women. The findings of this study may be used for designing public health interventions that promote acceptance and the use of modern contraception among both women and men in Somalia.","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"22 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83301950","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":"Small Area Variation of Adherence to Clinical Recommendations: An Example from Switzerland.","authors":"Oliver Gruebner,&nbsp;Wenjia Wei,&nbsp;Agne Ulyte,&nbsp;Viktor von Wyl,&nbsp;Holger Dressel,&nbsp;Beat Brüngger,&nbsp;Caroline Bähler,&nbsp;Eva Blozik,&nbsp;Matthias Schwenkglenks","doi":"10.1177/23333928221097741","DOIUrl":"https://doi.org/10.1177/23333928221097741","url":null,"abstract":"<p><strong>Background: </strong>Unwarranted variation in healthcare utilization can only partly be explained by variation in the health care needs of the population, yet it is frequently found globally. This is the first cross-sectional study that systematically assessed geographic variation in the adherence to clinical recommendations in Switzerland. Specifically, we explored 1) the geographic variation of adherence to clinical recommendations across 24 health services at the sub-cantonal level, 2) assessed and mapped statistically significant spatial clusters, and 3) explored possible influencing factors for the observed geographic variation.</p><p><strong>Methods: </strong>Exploratory spatial analysis using the Moran's I statistic on multivariable multilevel model residuals to systematically identify small area variation of adherence to clinical recommendations across 24 health services.</p><p><strong>Results: </strong>Although there was no overall spatial pattern in adherence to clinical recommendations across all health care services, we identified health services that exhibited statistically significant spatial dependence in adherence. For these, we provided evidence about the locations of local clusters.</p><p><strong>Interpretation: </strong>We identified regions in Switzerland in which specific recommended or discouraged health care services are utilized less or more than elsewhere. Future studies are needed to investigate the place-based social determinants of health responsible for the sub-cantonal variation in adherence to clinical recommendations in Switzerland and elsewhere over time.</p>","PeriodicalId":12951,"journal":{"name":"Health Services Research and Managerial Epidemiology","volume":"9 ","pages":"23333928221097741"},"PeriodicalIF":1.6,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9102215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10242742","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}