Journal of Health Services Research & Policy最新文献

{"title":"Cost-effectiveness of specialized trauma care: A systematic review.","authors":"Soualio Gnanou, Jason Robert Guertin, Pier-Alexandre Tardif, Blanchard Conombo, Mélanie Bérubé, Natalie Yanchar, Simon Berthelot, Janyce Gnanvi, Lynne Moore","doi":"10.1177/13558196251348409","DOIUrl":"https://doi.org/10.1177/13558196251348409","url":null,"abstract":"<p><p>ObjectivesSeveral meta-analyses have shown the effectiveness of specialized trauma care, but evidence on cost and cost-effectiveness remains unestablished. We aimed to systematically review evidence on the cost or cost-effectiveness of hospitals specialized in advanced trauma care compared to non or less-specialized hospitals.MethodsWe conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched PubMed, EMBASE, Cochrane Library, Web-of-Science, EconLit, and grey literature up until June 2024. Two reviewers independently assessed eligibility and extracted relevant data. Reporting quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 checklist. Per Cochrane recommendations, findings were synthesized qualitatively.ResultsWe identified 4 cost-effectiveness, 3 cost-consequence, and 3 cost-analysis studies, mostly US-based retrospective cohorts. Reporting quality was rated high for 4 studies. All cost-effectiveness studies found specialized trauma centres to be more costly but more effective than non-specialized centres, with incremental cost-effectiveness ratios ranging from 655 to 46,175 Int.$2022 (2022 international dollars) per quality-adjusted life-year (QALY) gained, 43,208 to 999,912 Int.$2022 per life-saved, and 48,567 Int.$2022 per life-year gained. Among cost-consequence studies, two found specialized trauma centres to be costlier and less effective, while one found the opposite. All cost analyses indicated higher costs at specialized trauma centres.ConclusionsFull economic evaluations identified in this review suggest that specialized trauma care may be cost-effective according to a threshold of $50,000 per QALY. However, our ability to draw conclusions is hampered by the low number of studies, high heterogeneity in study populations and settings, and lack of consideration of trauma systems and of costs beyond the acute phase. Results highlight a critical gap in evidence to guide policymakers in the development of cost-efficient trauma systems.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251348409"},"PeriodicalIF":1.9,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144216044","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":"Exploring risk factors for COVID-19 mortality and infection in care homes in the west of England: A mixed-methods study.","authors":"Rebecca Wilson, Selin Siviş, Paul Scott, Jeremy Dixon, Karen Green, Judith Westcott, Alice Marriott, Jonathan Banks, Maria Theresa Redaniel","doi":"10.1177/13558196251344174","DOIUrl":"10.1177/13558196251344174","url":null,"abstract":"<p><p>ObjectivesIdentify and explore risk factors associated with COVID-19 infection and mortality rates in care homes in the West of England and gain an understanding of challenges faced during the pandemic, how they were addressed and how care homes can be better equipped for future pandemics.MethodsA mixed-methods study combined observational analysis of numbers of infections and deaths with potential risk factors supported by semi-structured interviews. Thirty-three care homes within a single local authority (LA) in the West of England were included in the quantitative analysis and, in the qualitative study, five care homes were included, including those located outside the participating LA. The quantitative analysis assessed two outcomes: number of weekly COVID-19 cases and deaths between 31/08/2020 and 21/02/2021. Associations with potential care risk factors were analysed using Poisson regression. 14 interviews were conducted with care home staff in various roles between November 2022 and September 2023. Data were analysed thematically.ResultsCare home size was associated with higher COVID-19 infection (large compared with small care homes: incidence rate ratio (IRR) = 12.60, 95% confidence interval (CI) 2.54 to 62.51) and mortality rates (large compared with small care homes: IRR = 16.48, 95% CI 0.81 to 335.88). Qualitative data revealed that care home managers recognized these risks and were focussed on the challenges of implementing infection control within the limitations of their buildings. The primary challenge identified was staff shortages, requiring care home staff to assume expanded responsibilities. There was no evidence of association between hospital discharges and COVID-19 cases (IRR = 0.45, 95% CI 0.11 to 1.83) or deaths (IRR = 0.61, 0.11 to 3.22). The qualitative data highlighted care home staff had feelings of separation and felt under-valued in relation to the wider health care sector. There was also concern that COVID-19 prevention measures prioritised infection control over the psycho-social welfare of residents.ConclusionResearch on the risk factors for infection spread and associated mortality should be prioritised to better protect care homes in future pandemics. This requires making routine data in social care more readily available for research purposes. Proactive planning for future pandemics, by care homes and local authorities, should recognise the individual nature of buildings and the needs of residents.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251344174"},"PeriodicalIF":1.9,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208709","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":"Counseling and other factors associated with contraceptive use among active duty US military servicewomen.","authors":"Kyle E Manetz, Anwar E Ahmed, Catherine T Witkop, Jaqueline E Hamrick, James D Mancuso","doi":"10.1177/13558196251344866","DOIUrl":"https://doi.org/10.1177/13558196251344866","url":null,"abstract":"<p><p>ObjectivesContraceptive prescriptions among U.S. service women rose to 68.7% between 2008 and 2013, which was higher than that seen nationally among women between 2017 and 2019 (65.3%). The objective of this study was to provide estimates of contraceptive use and its determinants among active duty service women, with a particular focus on the associations with contraceptive counseling.MethodsThis was a cross-sectional study using the 2018 Department of Defense Health Related Behaviors Survey of active duty service members. Data from 5353 active duty service women were analyzed. Weighted logistic regression models were used to identify factors associated with contraceptive use. We used a previous survey from 2015 to examine trends in contraceptive use.ResultsThe overall prevalence of contraceptive use was 60.6%, and only 40% had discussed contraception with a health care provider in the past year. Contraception counseling was associated with decreased contraceptive nonuse (adjusted odds ratio = 0.63). Being older, Black or Hispanic race or ethnicity, in the Army, enlisted, identifying as lesbian, gay, or bisexual, and having one or more same sex partners were associated with higher odds of contraceptive nonuse.ConclusionsDespite universal eligibility for free health care, contraceptive counseling and use among US military service women remain suboptimal, and significant disparities in contraceptive use exist by rank, race, ethnicity, and sexual orientation. Improving implementation and enforcement of existing military directives to provide routine contraceptive counseling and services during health care visits, such as through informatics tools, could lower unintended pregnancies, reduce inequities, and increase readiness.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251344866"},"PeriodicalIF":1.9,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119871","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":"On the contribution of health care service provision to reducing health inequalities.","authors":"Gerry McCartney","doi":"10.1177/13558196251344864","DOIUrl":"https://doi.org/10.1177/13558196251344864","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251344864"},"PeriodicalIF":1.9,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110969","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":"We can evaluate rapidly, but should we? Researchers' and research funders' perspectives on the uses, challenges and limitations of rapid health care evaluation.","authors":"Jo Ellins, Kelly Daniel, Manbinder Sidhu","doi":"10.1177/13558196251340549","DOIUrl":"https://doi.org/10.1177/13558196251340549","url":null,"abstract":"<p><p>ObjectivesThere is increasing demand for rapid evaluation in health care to inform timely policy and practice decision-making. This qualitative study explored the perceived benefits, limitations and challenges of rapid evaluation, focusing on how considerations of timescale and research quality are balanced in study design and delivery in England.MethodsWe conducted fifteen semi-structured interviews with researchers and research funders involved in rapid evaluation, based in England. Data were thematically analysed using the Framework Method.ResultsResults are reported around five major themes: (i) rapid evaluations are purpose driven; (ii) 'good enough' evidence; (iii) trade-offs and limitations; (iv) mitigating the speed and rigour trade-off; and (v) deciding if and when to evaluate rapidly. Study participants agreed that rapid evaluation reflected a drive to better align evaluative processes and outcomes to the needs of service planners and policymakers. It was seen to generate quick data for short-term requirements, and information to justify the need for, and inform the design of, longer-term assessments. However, working rapidly could restrict or prohibit some research activities, and there were particular concerns about recruitment being limited to sites and participants that were easier to access in short timescales. Rapid evaluation was considered less suitable for 'high stakes' topics or decisions, where evidence robustness and generalisability was paramount. Several study participants had built an infrastructure to facilitate rapid working which, at least in part, reduced the need to make methodological compromises.ConclusionsRapid evaluation can support real-time learning for innovation and improvement and inform time-critical decisions, but timeliness is only one factor in the production of useful and usable evidence. It is a tool for specific circumstances and purposes, to be used alongside, rather than instead of, long-term and longitudinal designs.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251340549"},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144029401","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":"Tackling health inequalities: What exactly do we mean? Evidence from health policy in England.","authors":"Kath Checkland, Donna Bramwell, Jonathan Hammond, Simon Bailey, Lynsey Warwick-Giles","doi":"10.1177/13558196251334571","DOIUrl":"https://doi.org/10.1177/13558196251334571","url":null,"abstract":"<p><p>ObjectivesTo develop a model to support health systems in clarifying how they might target action to reduce health inequalities, and to use it to understand current policy on health inequalities in England.MethodsWe used the wider literature on the definitions of health inequalities to draw together a schematic model which attempts to link together the different conceptualisations of health inequalities present in the literature with potential sites of action that could be taken by local health systems. We then undertook a document analysis of the policy documents and programmes underlying the recent reorganisation of the NHS in England.ResultsThe need to tackle health inequalities is cited as one of the main rationales underlying the changes. However, there is a lack of clarity within the documents around: the type of inequality being addressed; the identification of the group(s) suffering from inequalities; and the ways in which the assumed ameliorative mechanisms will work in practice. The documents place considerable emphasis on the assumption that closer partnership working will address inequalities, although the mechanisms by which this will be achieved are not specified and previous research demonstrates how difficult this can be.ConclusionsThe aspiration to tackle health inequalities through newly constituted Integrated Care Systems and Boards is welcome. However, it is well known that the contribution that health care services can make to addressing inequalities is relatively limited. Greater clarity is required of policy and local strategy if efforts are to be appropriately targeted.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251334571"},"PeriodicalIF":1.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024805","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":"Voluntary self-disclosed Indigenous identity of patients in four Canadian health care settings: A multiple-site qualitative case study.","authors":"Mandi Gray, Samara Wessel, Richard T Oster, Grant Bruno, Chyloe Healy, Rebecca Rich, Shayla Scott Claringbold, Kienan Williams, Rita Henderson","doi":"10.1177/13558196241300856","DOIUrl":"10.1177/13558196241300856","url":null,"abstract":"<p><strong>Objectives: </strong>The lack of Indigenous health care data in Canada makes it challenging to plan health care services and inform Indigenous leadership on the health care needs of their respective Nations and communities. Several Canadian health care organizations have implemented a voluntary Indigenous identifier of patients within their electronic medical records. This study examines facilitators and barriers to implementing such a voluntary self-reported Indigenous identifier, from the perspective of key stakeholders who work at four Canadian health providers where an Indigenous identifier has been implemented.</p><p><strong>Methods: </strong>The four Canadian sites comprise three hospitals and one health authority. At each site, key stakeholders participated in semi-structured qualitative interviews. Interviews were transcribed and coded. Relevant documents that were publicly available or provided by each site were reviewed.</p><p><strong>Results: </strong>There were four primary findings. First, for the introduction of an Indigenous identifier to be successful there must be pre-existing strong and trusting relationships between Indigenous communities and health care organizations. Second, health care organizations must provide training for those who ask clientele to self-identify as Indigenous, to overcome issues such as any patient backlash. Third, for the relationship between Indigenous people and health organizations to flourish, data governance must be Indigenous-led. Finally, the collection of Indigenous identifier data can enhance Indigenous health care services and health care service planning and delivery.</p><p><strong>Conclusions: </strong>Due to the ongoing distrust of government and health care services among Indigenous peoples and communities, special considerations are required prior to the implementation of an Indigenous identifier. Of primary importance is how health care organizations can contribute to Indigenous data governance and minimize potential harms associated with the collection of such data. The findings of this study can be used to guide other health care sites and Indigenous leaders aspiring for more robust health data by implementing voluntary Indigenous identity data collection.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"117-126"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750726","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":"Collaborative and integrated working between general practice and community pharmacies: A realist review of what works, for whom, and in which contexts.","authors":"Emily Owen-Boukra, Ziyue Cai, Claire Duddy, Nina Fudge, Julia Hamer-Hunt, Fran Husson, Kamal R Mahtani, Margaret Ogden, Deborah Swinglehurst, Malcolm Turner, Cate Whittlesea, Geoff Wong, Sophie Park","doi":"10.1177/13558196241290923","DOIUrl":"10.1177/13558196241290923","url":null,"abstract":"<p><strong>Objectives: </strong>Collaborative and integrated (C + I) working between general practice and community pharmacies has the potential to increase accessibility to services, improve service efficiency and quality of care, and reduce health care expenditures. Many existing studies report challenges and complexities inherent in establishing effective C + I ways of working. The aim of our review is to understand how, when and why working arrangements between General Practitioners (GP) and Community Pharmacists (CP) can provide the conditions necessary for effective communication, decision-making, and C + I working.</p><p><strong>Methods: </strong>We conducted a realist review to explore the key contextual factors and mechanisms through which GP-CP C + I working may be achieved. MEDLINE, Embase, CINAHL, PsycINFO, HMIC, Web of Science, IBSS, ASSIA, Sociological Abstracts, Sociology Database and the King's Fund Library Database were searched for articles and grey literature published between January 2000 and April 2022.</p><p><strong>Results: </strong>A total of 136 documents were included in the final synthesis. Our findings highlight the importance of mutually beneficial remuneration models to support effective integration of services; supportive organisational cultures and values; flexible and agile IT systems/technologies; adequate physical infrastructure and space design to support multidisciplinary teamworking; the importance of establishing patient's trust in collaborative processes between GP-CP; and the need to acknowledge, support and utilise effective triadic relationships.</p><p><strong>Conclusions: </strong>Our research generates new insights regarding how, why and in which contexts C + I working can be achieved between GPs and CPs. The findings of our review can be used to inform future policy, research and clinical practice guidelines for designing and delivering C + I care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"136-148"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11877979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501990","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":"Moral distress: A structural problem with individual solutions.","authors":"Monica L Molinaro","doi":"10.1177/13558196251315330","DOIUrl":"10.1177/13558196251315330","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"77-78"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032956","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":"Organizing to address overtreatment in cancer care near the end of life: Evidence from Denmark.","authors":"Amalie M Hauge, Nis Lydiksen, Mickael Bech","doi":"10.1177/13558196241300916","DOIUrl":"10.1177/13558196241300916","url":null,"abstract":"<p><strong>Objectives: </strong>The purpose of this study is to investigate how organizational factors influence the ethical and economic problems of overtreatment of cancer patients.</p><p><strong>Methods: </strong>The study applies a sequential mixed-method approach. First, our logistic regression model assesses how patient characteristics and hospital department variables influence the use of late cancer treatment (LCT), primarily chemotherapy, in stage IV non-small cell lung cancer cases using Danish registry data. Department-specific variations in LCT use across hospitals are identified, while controlling for population differences. Then, using qualitative data, we explore organizational factors that may influence hospitals' decisions regarding LCT for lung cancer patients.</p><p><strong>Results: </strong>Between 13% and 33.3% of the studied lung cancer population receive LCT within their last 30 days of life. Variation in LCT can in part be explained by organizational factors specific to the hospital departments and their organization of their treatment decision-making process.</p><p><strong>Conclusions: </strong>This article is among the first to show how organizational solutions can contribute to curbing overtreatment. Hospital managers can seek to reduce overtreatment by (a) adjusting the format and frequency of patient consultations, (b) improving the cross-disciplinary collaboration structures, and (c) utilizing team conferences for discussions of treatment cessation.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"89-98"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824177","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}