Journal of Health Services Research & Policy最新文献

{"title":"Indigenous identity identification in administrative health care data globally: A scoping review.","authors":"Mandi Gray, Kienan Williams, Richard T Oster, Grant Bruno, Annelies Cooper, Chyloe Healy, Rebecca Rich, Shayla Scott Claringbold, Gary Teare, Samara Wessel, Rita I Henderson","doi":"10.1177/13558196231219955","DOIUrl":"10.1177/13558196231219955","url":null,"abstract":"<p><strong>Objective: </strong>Both Indigenous and non-Indigenous governments and organizations have increasingly called for improved Indigenous health data in order to improve health equity among Indigenous peoples. This scoping review identifies best practices, potential consequences and barriers for advancing Indigenous health data and Indigenous data sovereignty globally.</p><p><strong>Methods: </strong>A scoping review was conducted to capture the breadth and nature of the academic and grey literature. We searched academic databases for academic records published between 2000 and 2021. We used Google to conduct a review of the grey literature. We applied Harfield's Aboriginal and Torres Strait Islander Quality Appraisal Tool (QAT) to all original research articles included in the review to assess the quality of health information from an Indigenous perspective.</p><p><strong>Results: </strong>In total, 77 academic articles and 49 grey literature records were included. Much of the academic literature was published in the last 12 years, demonstrating a more recent interest in Indigenous health data. Overall, we identified two ways for Indigenous health data to be retrieved. The first approach is health care organizations asking clients to voluntarily self-identify as Indigenous. The other approach is through data linkage. Both approaches to improving Indigenous health data require awareness of the intergenerational consequences of settler colonialism along with a general mistrust in health care systems among Indigenous peoples. This context also presents special considerations for health care systems that wish to engage with Indigenous communities around the intention, purpose, and uses of the identification of Indigenous status in administrative databases and in health care settings. Partnerships with local Indigenous nations should be developed prior to the systematic collection of Indigenous identifiers in health administrative data. The QAT revealed that many research articles do not include adequate information to describe how Indigenous communities and stakeholders have been involved in this research.</p><p><strong>Conclusion: </strong>There is consensus within the academic literature that improving Indigenous health should be of high priority for health care systems globally. To address data disparities, governments and health organizations are encouraged to work in collaboration with local Indigenous nations and stakeholders at every step from conceptualization, data collection, analysis, to ownership. This finding highlights the need for future research to provide transparent explanation of how meaningful Indigenous collaboration is achieved in their research.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"210-221"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138805408","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":"Engaging health care professionals in quality improvement: A qualitative study exploring the synergies between projects of professionalisation and institutionalisation in quality improvement collaborative implementation in Denmark.","authors":"Kathrine Carstensen, Joanne Goldman, Anne Mette Kjeldsen, Stina Lou, Camilla Palmhøj Nielsen","doi":"10.1177/13558196241231169","DOIUrl":"10.1177/13558196241231169","url":null,"abstract":"<p><strong>Objective: </strong>To examine the projects of professionalisation and institutionalisation forming health care professions' engagement in quality improvement collaborative (QIC) implementation in Denmark, and to analyse the synergies and tensions between the two projects given the opportunities afforded by the QICs.</p><p><strong>Methods: </strong>This was a cross-sectional interview study with professionals involved in the implementation of two national QICs in Denmark involving 23 individual interviews and focus group discussions with 75 people representing different professional groups. We conducted a reflexive thematic analysis of the data, drawing on institutional contributions to organisational studies of professions.</p><p><strong>Results: </strong>Study participants engaged widely in QIC implementation. This engagement was formed by a constructive interplay between the professions' projects of professionalisation and institutionalisation, with only few tensions identified. The project of professionalisation relates to a self-oriented agenda of contributing professional expertise and promoting professional recognition and development, while the project of institutionalisation focuses on improving health care processes and outcomes and advancing quality improvement. Both projects were largely similar across professional groups. The interplay between the two projects was enabled by the bottom-up approach to implementation, participation of QI specialists, and a clear focus on developing and delivering high-quality patient care.</p><p><strong>Conclusions: </strong>Future strategies for QIC implementation should position QICs as a framework that promotes the integration of professions' projects of professionalisation and institutionalisation to successfully engage professionals in the implementation process, and thereby optimise the effectiveness of QICs in health care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"163-172"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139672008","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":"Minding the gaps: Recognising ancillary staff contributions in care homes during the COVID-19 pandemic.","authors":"Fiona Marshall","doi":"10.1177/13558196241249347","DOIUrl":"10.1177/13558196241249347","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"141-142"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858167","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 happens when private general practitioners receive incentivisation offers from pharmaceutical sales representatives? A qualitative study in Pakistan.","authors":"Muhammad Naveed Noor, Afifah Rahman-Shepherd, Sabeen Sharif Khan, Rumina Hasan, Amna Rehana Siddiqui, Iqbal Azam, Faiza Bhutto, Afshan Khurshid Isani, Sameen Siddiqi, Robyna Irshad Khan, Sadia Shakoor, Mishal Khan","doi":"10.1177/13558196241230853","DOIUrl":"10.1177/13558196241230853","url":null,"abstract":"<p><strong>Objectives: </strong>Pharmaceutical incentivisation of physicians for profit maximisation is a well-documented health system challenge. This study examined general practitioners' (GPs) reactions to pharmaceutical incentivisation offers in one region in Pakistan.</p><p><strong>Methods: </strong>We used the Standardised Pharmaceutical Sales Representative (SPSR) method and qualitative interviews with GPs. SPSRs were field researchers representing mock pharmaceutical companies who recorded their observations of 267 GPs' responses to pharmaceutical incentivisation offers. We triangulated SPSR data using qualitative interviews with a subset of the same GPs to gather information about how they interpreted different interaction outcomes.</p><p><strong>Results: </strong>We found four major outcomes for GPs being offered incentives by pharmaceutical companies for prescribing medications. GPs might agree to make incentivisation deals, reject incentivisation offers, disallow PSRs to access them, or remain indeterminate with no clear indication of acceptance or rejection of incentivisation offers. GPs rejecting SPSRs' incentivisation offers indicated having active commitments to other pharmaceutical companies, not being able to work with unheard-of companies, and asking SPSRs to return later.</p><p><strong>Conclusions: </strong>The GP-pharmaceutical sales representative interaction that centres on profit-maximisation is complex as offers to engage in prescribing for mutual financial benefit are not taken up immediately. The SPSR method helps understand the extent of distortion of practices impacted by incentivisation. Such an understanding can support the development of strategies to control unethical behaviours.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"173-181"},"PeriodicalIF":1.9,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650902","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":"'I'm a bit of an invisible worker' - Health care and social sector students' experiences of casual and temporary agency work.","authors":"Marja Hult, Jessie Gevaert, Leena Rekola, Raili Honkanen-Korhonen, Kati Ylikahri","doi":"10.1177/13558196231224362","DOIUrl":"10.1177/13558196231224362","url":null,"abstract":"<p><strong>Objectives: </strong>In the wake of national and global personnel shortages, it is becoming increasingly common for students to undertake casual and temporary agency work in the health care and social sectors. This phenomenon can have both advantages and disadvantages for these workers. The objective of this study was to describe health care and social sector students' experiences of such work.</p><p><strong>Methods: </strong>Students currently undertaking casual work in the health care and social sector in Finland were recruited (<i>n</i> = 28). Qualitative semi-structured interviews of these students were conducted in March to May 2021. The data were analysed using inductive content analysis.</p><p><strong>Results: </strong>Respondents reported some positive aspects of casual work. In particular, they liked the freedom to choose the workplace and working times that suited them. However, respondents' experiences were mostly negative. They perceived the induction into work as being insufficient, felt they had too few opportunities to give and receive feedback and believed they were not accepted into the working community.</p><p><strong>Conclusions: </strong>Students who have bad experiences while undertaking causal work in the health care and social sectors may develop an aversion towards working in those sectors after graduating. In order to ensure the sectors are attractive to graduates, casual student workers' induction and experience of the workplace must be improved.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"182-190"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139485704","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":"Single-handed versus multiple-handed general practices: A cross-sectional study of quality outcomes in England.","authors":"Ian Holdroyd, William Chadwick, Adam Harvey-Sullivan, Theodore Bartholomew, Efthalia Massou, Victoria Tzortziou Brown, John Ford","doi":"10.1177/13558196231218830","DOIUrl":"10.1177/13558196231218830","url":null,"abstract":"<p><strong>Objectives: </strong>As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK.</p><p><strong>Methods: </strong>Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices.</p><p><strong>Results: </strong>Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes.</p><p><strong>Conclusions: </strong>We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"201-209"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138805414","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":"Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers.","authors":"Patrick Burch, William Whittaker, Peter Bower, Katherine Checkland","doi":"10.1177/13558196231216657","DOIUrl":"10.1177/13558196231216657","url":null,"abstract":"<p><strong>Objectives: </strong>In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met.</p><p><strong>Methods: </strong>This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection.</p><p><strong>Results: </strong>Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care.</p><p><strong>Conclusions: </strong>Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"191-200"},"PeriodicalIF":2.4,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136397747","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":"Innovative domestic financing mechanisms for health in Africa: An evidence review.","authors":"Nouria Brikci","doi":"10.1177/13558196231181081","DOIUrl":"10.1177/13558196231181081","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This article synthesizes the evidence on what have been called innovative domestic financing mechanisms for health (i.e. any domestic revenue-raising mechanism allowing governments to diversify away from traditional approaches such as general taxation, value-added tax, user fees or any type of health insurance) aimed at increasing fiscal space for health in African countries. The article seeks to answer the following questions: What types of domestic innovative financial mechanisms have been used to finance health care across Africa? How much additional revenue have these innovative financing mechanisms raised? Has the revenue raised through these mechanisms been, or was it meant to be, earmarked for health? What is known about the policy process associated with their design and implementation?&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review of the published and grey literature was conducted. The review focused on identifying articles providing quantitative information about the additional financial resources generated through innovative domestic financing mechanisms for health care in Africa, and/or qualitative information about the policy process associated with the design or effective implementation of these financing mechanisms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The search led to an initial list of 4035 articles. Ultimately, 15 studies were selected for narrative analysis. A wide range of study methods were identified, from literature reviews to qualitative and quantitative analysis and case studies. The financing mechanisms implemented or planned for were varied, the most common being taxes on mobile phones, alcohol and money transfers. Few articles documented the revenue that could be raised through these mechanisms. For those that did, the revenue projected to be raised was relatively low, ranging from 0.01% of GDP for alcohol tax alone to 0.49% of GDP if multiple levies were applied. In any case, virtually none of the mechanisms have apparently been implemented. The articles revealed that, prior to implementation, the political acceptability, the readiness of institutions to adapt to the proposed reform and the potential distortionary impact these reforms may have on the targeted industry all require careful consideration. From a design perspective, the fundamental question of earmarking proved complex both politically and administratively, with very few mechanisms actually earmarked, thus questioning whether they could effectively fill part of the health-financing gap. Finally, ensuring that these mechanisms supported the underlying equity objectives of universal health coverage was recognized as important.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Additional research is needed to understand better the potential of innovative domestic revenue generating mechanisms to fill the financing gap for health in Africa and diversify away from more traditional financing approaches. Whilst their revenue potential in abso","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"132-140"},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9647229","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":"Job preferences of Chinese primary health care workers: A discrete choice experiment.","authors":"Yingxi Lin, Jinfeng Xie, Dan Wu, Yingyu Wang, Yiyuan Cai, Qing Zhao, Lanping Zhang, Jiaqi Li, Wenjun He, Dong Roman Xu","doi":"10.1177/13558196231219386","DOIUrl":"10.1177/13558196231219386","url":null,"abstract":"<p><strong>Objective: </strong>Primary health workers (PHWs) are a critical pillar of health systems but primary health care centers often struggle to attract and retain talented staff. To better understand why this is, we investigated the job preference of PHWs in a Chinese urban setting.</p><p><strong>Methods: </strong>In a discrete choice experiment, PHWs from 15 primary health care centers in Guangzhou, China, made trade-offs between several hypothetical job scenario combinations of salary, type of health institution, <i>bianzhi</i> (permanent post), work years required for promotion, career development and training opportunities, educational opportunities for children, and community respect. Based on the estimate of the mixed logit model, willingness to pay and policy simulations were applied to estimate the utility of each attribute.</p><p><strong>Results: </strong>Data were collected from 446 PHWs. The PHWs were willing to forgo Chinese Renminbi 2806.1 (US$ 438.5) per month to obtain better education opportunities for their children, making it the most important non-monetary factor. Their preferences were also influenced relatively more by salary, <i>bianzhi,</i> and community respect, than with the other attributes we tested for, work years required for promotion, career development and training opportunities, and type of health institution.</p><p><strong>Conclusion: </strong>Salary is a robust predictive factor, while three non-monetary factors (opportunities for children's education, <i>bianzhi,</i> and community respect) are essential in retaining health workers in primary care.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"84-91"},"PeriodicalIF":1.9,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138805411","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 best way to evaluate social prescribing? A qualitative feasibility assessment for a national impact evaluation study in England.","authors":"Abimbola Ayorinde, Amy Grove, Iman Ghosh, Jenny Harlock, Edward Meehan, Natalie Tyldesley-Marshall, Adam Briggs, Aileen Clarke, Lena Al-Khudairy","doi":"10.1177/13558196231212854","DOIUrl":"10.1177/13558196231212854","url":null,"abstract":"<p><strong>Objectives: </strong>Despite significant investment in social prescribing in England over the last decade, we still do not know if it works, or how models of social prescribing fit within wider health and care policy and practice. This study explores current service delivery structures and assesses the feasibility of a national evaluation of the link worker model.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted between May and September 2020, with 25 key informants from across social prescribing services in England. Participants included link workers, voluntary, community and social enterprise staff, and those involved in policy and decision-making for social prescribing services. Interview and workshop transcripts were analysed thematically, adopting a framework approach.</p><p><strong>Results: </strong>We found differences in how services are provided, including by individual link workers, and between organisations and regions. Standards, referral pathways, reporting, and monitoring structures differ or are lacking in voluntary services as compared to clinical services. People can self-refer to a link worker or be referred by a third party, but the lack of standardised processes generated confusion in both public and professional perceptions of the link worker model. We identified challenges in determining the appropriate outcomes and outcome measures needed to assess the impact of the link worker model.</p><p><strong>Conclusions: </strong>The current varied service delivery structures in England poses major challenges for a national impact evaluation. Any future rigorous evaluation needs to be underpinned with national standardised outcomes and process measures which promote uniform data collection.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"111-121"},"PeriodicalIF":2.4,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10910745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138805417","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}