Journal of Health Services Research & Policy最新文献

{"title":"Beyond mitigation: Adaptation, policy and resilience for health services facing climate change.","authors":"John Richmond, Cheryl Mitchell","doi":"10.1177/13558196261447201","DOIUrl":"https://doi.org/10.1177/13558196261447201","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261447201"},"PeriodicalIF":2.7,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147773447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impediments to diabetes management among older women: A qualitative study from rural Meghalaya, India.","authors":"Alacrity Muksor, Daksha Parmar","doi":"10.1177/13558196261437023","DOIUrl":"https://doi.org/10.1177/13558196261437023","url":null,"abstract":"<p><p>ObjectivesThis study aims to explore the impediments to diabetes management among older women living in rural areas of Meghalaya, a northeastern state in India.MethodsThe study adopted a narrative inquiry approach. In-depth interviews were conducted with 29 older women (aged 60 and above), selected purposively. Findings were analyzed thematically using the open or inductive coding approach in NVivo 12.0.ResultsSeven key themes emerged from the study. These were: (i) negative impacts of physiological changes on diabetes management for the participants, (ii) weak social support which hindered diabetes care, (iii) experiences of ill-treatment by relatives and a sense of helplessness, (iv) caregiving roles as barriers to care, (v) difficulties in accessing treatment due to geographical barriers, (vi) expensive treatment due to comorbidities, and (vii) feelings of guilt due to financial dependency.ConclusionsOur study found a confluence of structural and individual-level barriers that hindered diabetes management among older women in rural Meghalaya. These barriers were linked not only to age and disease but also to gendered social roles, systemic health care gaps, and economic insecurity. This study emphasises the need to reinforce current healthcare policies and programmes targeting older women and to advocate for a comprehensive, multisectoral approach to address these issues effectively.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261437023"},"PeriodicalIF":2.7,"publicationDate":"2026-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147607993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the quality of care at the end of life? Qualitative findings from a nationally-representative post-bereavement survey across England and Wales.","authors":"Joanna Goodrich, Sophie Pask, Chukwuebuka Okwuosa, Therese Johansson, Lynn Laidlaw, Cara Ghiglieri, Rachel Chambers, Anna E Bone, Stephen Barclay, Fliss E M Murtagh, Katherine E Sleeman","doi":"10.1177/13558196251398678","DOIUrl":"10.1177/13558196251398678","url":null,"abstract":"<p><p>ObjectivesTo explore the quality of end-of-life care in England and Wales using the experiences of bereaved family carers, and to develop person-centred quality of care domains for end-of-life care.MethodsQualitative analysis of free-text responses from a nationally-representative cross-sectional post-bereavement survey. Inductive thematic analysis of free-text responses to open-ended questions about care in last 3 months of life, circumstances of death, and experiences of care and bereavement, guided by the Institute of Medicine's quality domains. Participants were adults who registered the death of an adult relative in England and Wales between August and December 2022, identified using mortality data and stratified sampling (by age, gender, cause of death, place of death and geographical area).ResultsOf 1194 respondents, 1083 (90.7%) gave at least one free-text response. Six themes about quality of end-of-life care were identified: (1) accessing care; (2) timely and coordinated care; (3) individualised care; (4) the nature of communication and care; (5) family-centred care and support; and (6) safe and equitable care. Difficulty accessing care, challenges navigating a complex system, and poorly-coordinated care were interpreted as leading to a lack of physical and psychological safety. Timeliness of care was considered paramount but often not achieved. <i>How</i> care was provided was as important as <i>what</i> was provided: empathic relational care (in contrast to transactional, task-based care) led to dying people and their families reporting feeling reassured, supported and safe.ConclusionsWe identify aspects of quality important for care which are currently not always achieved, and provide a refined model of the quality of end-of-life care to guide policy and research.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"85-97"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12988001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145850209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating North Carolina's Medicaid transformation: Caregivers' perspectives through a family-centered lens.","authors":"Brittany J Raffa, Monisa Aijaz, Brenda Amezquita-Castro, Paula H Song, Valerie A Lewis, Christopher M Shea","doi":"10.1177/13558196251395593","DOIUrl":"10.1177/13558196251395593","url":null,"abstract":"<p><p>BackgroundMedicaid provides health insurance for 40% of the United States (US) pediatric population. There is an increasing trend among states to transition from a fee-for-service model for Medicaid reimbursement to relying on risk-based delivery systems using Managed Care Organizations (MCOs). In 2021, most beneficiaries in North Carolina (NC) transitioned to one of five MCOs from Medicaid Direct. While research has examined the effects of these transitions, less is known on the impact of MCOs on the experiences of caregivers of children getting care for themselves and their children. This study aimed to explore the experiences of caregivers following the NC Medicaid Transformation, both in enrolling and accessing care for themselves, when applicable, and for their children.MethodsWe conducted a qualitative descriptive study to examine experiences of caregivers of children during the NC Medicaid Transformation. We identified participants from clinic sites and health services organizations in North Carolina. Nineteen caregivers participated in semi-structured interviews or a focus group. We conducted rapid qualitative analysis of transcripts for timely, action-oriented analysis. Rapid qualitative analysis involved developing a summary template with inductive domains from the interview guide categories.ResultsAmong caregivers, all were mothers, and the majority resided in urban areas. Eleven caregivers were adult Medicaid beneficiaries in addition to their child receiving Medicaid. Caregivers described a variety of experiences and three themes were identified: increased obstacles among families with health conditions requiring additional care and non-English speakers; crucial role of clinical staff in navigating the transformation and accessing care; satisfaction with MCOs despite challenges.ConclusionsIncreasing access to specialty care by strengthening network adequacy standards, investing trained support staff within MCOs on how to best serve families with health conditions requiring additional care and non-English speaking families, and reimbursing clinical staff who are already performing a care management role, could positively impact families receiving care through Medicaid MCOs.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"110-119"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding why health professionals are leaving the UK national health service (NHS) - A systematic review and narrative synthesis.","authors":"Chukwunwuba R Onyejesi, Tiffeny James, Kalpa Kharicha","doi":"10.1177/13558196251384845","DOIUrl":"10.1177/13558196251384845","url":null,"abstract":"<p><p>BackgroundThere is a global health care workforce crisis with staff shortages and difficulties with recruitment and retention, including in the UK's National Health Service (NHS). To address this, it is important to understand why people decide to leave the NHS. Previous reviews have focused on specific NHS professions and have rarely considered factors in other settings which attract staff away from the NHS. This review aimed to include all professions in a systematic review of factors which \"push\" clinical staff to leave, or consider leaving, the NHS and which \"pull\" them to other destinations.MethodsWe searched PubMed, Web of Science, CINAHL, and EMBASE for peer-reviewed articles and Google Scholar for grey literature using search terms related to all NHS professions and intentions to leave the NHS. We included qualitative, quantitative, and mixed methods studies and analysed data using a textual narrative synthesis with an integrated design.ResultsThirty-two papers were eligible for inclusion. We identified four key push factors: (1) high job demands due to, for example, staff shortages and increased workload; (2) failing organisational structures including poor pay and limited opportunities for career development; (3) personal and emotional factors such as work-related health issues and poor work/life balance, and (4) wider factors, including Brexit. The majority of factors identified as being responsible for high turnover were related to job demands and the organisational structure within the NHS. Factors pulling people to other destinations were discussed less frequently than push factors, but included perceptions of better: pay, working conditions, and work/life balance in other countries. Limitations to the studies included in the review were that evidence on all NHS professions was not available, and many of the studies were based on data collected retrospectively with the risk of recall bias.ConclusionPull and push factors affect multiple NHS professions. Further comparative studies comparing the UK with other countries can help inform potential interventions to improve staff retention.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"125-139"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12988014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145251494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the English NHS 10-year health plan offer transformational change and a break with the past or more of the same?","authors":"David J Hunter","doi":"10.1177/13558196251395730","DOIUrl":"10.1177/13558196251395730","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"69-71"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Review of residential and nursing care home policies on safety incident reporting in England.","authors":"Mel Steer, Kate Sykes, Justin Waring, Celia Mason, Pamela Dawson, Craig Newman, Lesley Young-Murphy, Michele Spencer, Jason Scott","doi":"10.1177/13558196251392508","DOIUrl":"10.1177/13558196251392508","url":null,"abstract":"&lt;p&gt;&lt;p&gt;ObjectivesIn care homes, safety incident reporting, and the policy framework that surrounds safety incident reporting, is not well understood. This study aims to review safety incident reporting and safety policies in residential and nursing care homes in England. It aims to better understand safety incident reporting practices and identify lessons for the sector regarding approaches to safety incident reporting to improve safety. The objectives were to investigate what policies exist, identify the methods and any technology used for safety incident reporting and consider the data captured in safety incident reports. It aims to contribute to discussions regarding developing systems-based approaches to safety management in care homes.MethodsA qualitative documentary analysis of safety incident reporting policies in residential and nursing care homes in England was undertaken. Policies were collected from 23 organisations whose staff participated in interviews (n = 75) regarding safety incident reporting between January 2021 until June 2022 and from a structured internet search using specified search terms between April 2022 and May 2022. To be included, a policy needed to refer to safety incident reporting in any capacity and be partially or wholly related to care homes or nursing homes in England. Safety incidents could include staff, residents, contractors, and visitors to the home. Data, extracted using a bespoke framework based on study objectives, were tabulated and analysed deductively and inductively. For the selected policies, the Care Quality Commission website was searched for the latest inspection report and the overall rating was extracted.ResultsForty-one policy documents were retrieved and screened for inclusion. Twenty-five policies (from 23 organisations) were reviewed. Three were from the internet search and 22 were obtained from interview participants. There was considerable variability in the length and comprehensiveness of the policies, with some homes using untailored, 'off-the-shelf' standardised policies produced by a specialist company. Twenty-two (88%) referred to other policy and legislative documents important to safety incident reporting and all but three (12%) policies identified a designated person or role with responsibility for the reports. Only one policy incorporated resident accounts and views into the incident report. Two policies referred exclusively to electronic recording systems with most (n = 19) referring to paper-based reporting systems.ConclusionsThe study identified the extent of, and gaps, in safety incident reporting policies, with reporting practices situated within a broad framework of governance. Incident reporting is as much a matter of governance as practice and there may be a greater opportunity to learn from incident reports than there is currently. Further research about how staff navigate multiple risks, develop adaptive approaches for the contextual conditions, and use safety incident ","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"72-84"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12988002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145573674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternity staff opinions on perinatal death reviews: Parent involvement and changes to standardising the system.","authors":"Emily O'Connor, Aenne Helps, Richard Greene, Keelin O'Donoghue, Sara Leitao","doi":"10.1177/13558196251395529","DOIUrl":"10.1177/13558196251395529","url":null,"abstract":"<p><p>ObjectivesPerinatal death review programmes collect perinatal mortality data and identify modifiable factors in preventable perinatal deaths. Reviews may provide closure and answers to bereaved parents. Many parents remain uninvolved in the review process. This qualitative study aimed to explore the opinions of maternity staff regarding the existing review system, parent involvement in reviews and standardising the review system.MethodsThis study involved interviews with staff from three maternity units in different locations around Ireland. A topic guide was used to guide the discussion. We spoke with staff members from different backgrounds and managerial levels, including doctors, midwives, patient advocates, risk managers and pastoral care. Thematic analysis was conducted to analyze the results.Results32 interviews were conducted between May and December 2022. Three themes and six associated subthemes were generated relating to communication with parents regarding review and their involvement in this process. Participants felt that parents were not involved enough in the review process and that communication with parents about reviews needed improvement. A parent advocate was viewed as important for guidance and support for parents during the review process. Facilitators included an easy-to-use, electronic review form and providing education about the review process. Barriers included local resistance to changing the process and lack of time to complete reviews.ConclusionPerinatal death reviews are not standardised in Ireland. Communication with parents and parent involvement in reviews could be improved. Highlighted facilitators and barriers should be addressed prior to implementing any proposed changes to the review system.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"98-109"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145654377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taskification in general practice: A solution to, or an aggravator of, the workforce crisis?","authors":"Amanda N Rasmussen, Imelda Mcdermott, Sharon Spooner","doi":"10.1177/13558196251400266","DOIUrl":"10.1177/13558196251400266","url":null,"abstract":"<p><p>As a solution to the current international workforce crisis in general practice, many countries are introducing initiatives of task-shifting. These initiatives involve a tendency to 'taskification', which means that complex work is dissected into smaller tasks that are delegated between different healthcare professionals. Drawing on existing academic literature and international policy developments, this essay aims to problematise the idea of taskification as a solution to the workforce crisis in general practice. The concept of taskification is introduced and elaborated by tracing its roots to the theories of Taylorism and New Public Management. Like these organizational paradigms, the concept of taskification reflects a prioritization of efficiency, standardization, and managerial control, which may fragment healthcare delivery and undermine the holistic and discretionary nature that traditionally characterizes general practice. Furthermore, taskification is discussed in relation to challenges in general practice and international policy developments, which illustrate that taskification, while aimed at reducing workloads, often adds new pressures through supervision, \"rescue\" work, and the complexity of care, ultimately risking burnout and reduced efficiency. We conclude that while taskification offers potential solutions to workforce challenges in general practice, it risks unintended consequences such as care fragmentation, increased workload pressures, and compromised patient safety. A nuanced approach with adequate training, supervision, and protection of GP time is suggested to ensure these strategies benefit healthcare systems, practitioners, and patients.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"120-124"},"PeriodicalIF":2.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145549492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How state language access policies and communications mediate access to critical healthcare information.","authors":"Carolyn J Heinrich, Sayil Camacho, Mary-Margaret McGowan, Montrell Sanders","doi":"10.1177/13558196261438972","DOIUrl":"https://doi.org/10.1177/13558196261438972","url":null,"abstract":"<p><p>ObjectivesTo examine the role of state language access policies and state agency communications practices in facilitating access to vaccine information for Limited English Proficient (LEP) populations in the U.S.MethodsState language access policy data were linked to audit study field experiment data documenting the experiences (<i>n</i> = 455) of individuals of differing racial/ethnic identities and language use interacting with state health agencies to access COVID-19 vaccinations in the 50 states and District of Columbia. Regression analyses investigate whether state language access policies are associated with these outcomes: access to translation or interpretation, state health agency use of recommended communication practices, and receipt of information on how to access the vaccine.ResultsGovernment agency requirements for language access were associated with 17% higher availability of translation and interpretation services and greater use of recommended communications practices by state agencies. The use of nudges and absence of racialized or judgmental language in communications increased receipt of vaccine information by 13-26%. Interpretation was lacking in more than 40% of Spanish-language speaker phone encounters with state agencies.ConclusionsLEP populations are among the least likely to be vaccinated and disproportionately experienced negative consequences of the COVID-19 pandemic. Enacting state language access requirements and instituting training programs for health agency employees involved in vaccine distribution could help to increase vaccine access and avert some of the harmful, racialized impacts of future pandemics.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196261438972"},"PeriodicalIF":2.7,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147581423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}