Journal of Health Services Research & Policy最新文献

{"title":"Audit of submissions: July 2024-June 2025.","authors":"","doi":"10.1177/13558196251399273","DOIUrl":"https://doi.org/10.1177/13558196251399273","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":"31 1","pages":"4"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145668746","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":"Critically ill patients are not just luggage: The experiences of health workers on the transportation of critically ill patients in hospitals in Tanzania.","authors":"John Maiba, Elibariki Mkumbo, Karima Khalid, Tamara Mulenga Willows, Onesmus Onyango, Carl Otto Schell, Jacob McKnight, Jacquie Oliwa, Tim Baker","doi":"10.1177/13558196251378299","DOIUrl":"10.1177/13558196251378299","url":null,"abstract":"<p><p>BackgroundCritical illness is a life-threatening condition impacting millions of patients globally each year. Critically ill patients often need to be transported within the hospital during their care and the safety and efficiency of transportation are key for good health outcomes. There is a lack of knowledge about the processes and safety of intra-hospital patient transport in low-resourced health care settings.ObjectiveThis study aimed to understand health workers' experiences of the process and the safety of intra-hospital transportation of critically ill patients in Tanzania.MethodsQualitative in-depth interviews were conducted with 15 health workers involved in the care and transportation of critically ill patients in five Tanzanian hospitals. Purposive sampling identified participants. Data were analysed using thematic analysis, guided by the Donabedian quality of care framework.ResultsThree themes of health workers' experiences of patient transportation were identified, the first two related to structures and the third to processes: (i) the design and organisation of hospitals did not facilitate the initiation and conduct of quick, short and safe transport for critically ill patients; (ii) hospitals lacked resources for safe, effective transportation of critically ill patients; (iii) there were weaknesses in the preparation for, conduct of, and handover of information concerning the transportation of critically ill patients. Health workers in Tanzania faced substantial challenges in ensuring safe transportation due to hospital infrastructure limitations, resource shortages, and inadequate processes.ConclusionWe conclude that the transport of critically ill patients is overlooked in hospital services in Tanzania, despite the importance of safe intra-hospital transportation in preventing deaths. Feasible solutions to these challenges are necessary for reducing high mortality and morbidity among critically ill patients.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"46-55"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145176070","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":"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":"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":"56-67"},"PeriodicalIF":2.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12647394/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What determines health insurance ownership in Nepal? Findings from the Nepal multiple indicator cluster survey 2019.","authors":"Prabhat Lamichhane, Rajeev Banjara, Bishnu Prasad Dulal","doi":"10.1177/13558196251372438","DOIUrl":"10.1177/13558196251372438","url":null,"abstract":"<p><p>ObjectiveIn Nepal, various health insurance schemes including community-based and national health insurance programmes have been implemented to reduce financial burdens on the population and improve access to health care, towards the goal of Universal Health Coverage. Despite these efforts, there are limited studies on health insurance ownership in Nepal. This study aimed to determine factors influencing insurance ownership at individual and household level in Nepal.Study designThis study utilized cross-sectional data from the Nepal Multiple Indicator Cluster Survey 2019, a nationally representative survey. This paper reports on analysis of data from 14,769 women and 5491 men aged 15-49 years and 4113 households, using logistic regression and the Cragg hurdle model.ResultsThe study found that less than 6% of respondents had health insurance: 5.8% of women (95% CI 4.82 - 6.88) and 5.1% of men (95%CI: 4.5 - 5.8), with higher rates among older women with higher education, belonging to the Newar ethnic group, and living in urban areas. Age and education were significant predictors of individual insurance ownership. Higher socio-economic status of the household and higher education of the individual were associated with greater likelihood of insurance ownership, while belonging to disadvantaged ethnicities and living in the Sudurpaschim and Madhesh provinces were associated with lower likelihood of insurance ownership.ConclusionHealth insurance ownership is low in Nepal, particularly among disadvantaged ethnicities and low socio-economic status households. Efforts to increase health insurance coverage need to focus on addressing the inequities related to socio-economic status, ethnicity, and regions. Further research is necessary to identify reasons for lower coverage among the specific population groups.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"25-33"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000744","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":"Audit of submissions: July 2024-June 2025.","authors":"","doi":"10.1177/13558196251399273","DOIUrl":"https://doi.org/10.1177/13558196251399273","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"13558196251399273"},"PeriodicalIF":2.7,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495952","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":"Exercise prescription in the management of chronic disease falling through an evidence-practice gap: Perspectives of doctors and nurses in specialist settings.","authors":"Shelley E Keating, Shelley A Wilkinson, Graeme A Macdonald, Ingrid J Hickman, Hannah L Mayr","doi":"10.1177/13558196251362133","DOIUrl":"10.1177/13558196251362133","url":null,"abstract":"<p><p>ObjectivesExercise is a frontline therapy for the management of chronic cardiometabolic disease, however traditional tertiary health care service models do not include exercise physiology. We aimed to explore professional roles, practices, and services regarding exercise care in chronic cardiometabolic disease from the perspectives of specialist doctors and nurses.MethodsUsing a qualitative description design, semi-structured individual interviews were conducted with 32 doctors and 26 nurses involved in the care of relevant patients with liver, kidney, or cardiac disease, or diabetes, across hospital and community settings in a Queensland metropolitan health service. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.ResultsFour overarching themes were identified. Despite universal acceptance of the multifactorial benefits of exercise, there was a lack of confidence in patients' capabilities to exercise and safety concerns due to complex comorbidities. Interviewees considered themselves 'promotors not prescribers' of exercise. There was no structured exercise history taken outside of cardiac rehabilitation units with significant variability in advice provided. Access to exercise specialist services was limited and disease-specific, with inconsistent and fragmented referral pathways. General Practitioners were considered responsible for facilitating exercise specialist involvement in ongoing care, with onus placed on patients to initiate.ConclusionsThere is an evidence-practice gap between the established benefits of exercise for chronic disease management and access to exercise professionals and services, resources, and knowledge. This deprioritises exercise as a frontline therapy with patient care implications. This study identified a need to transform the way that exercise care is accessed and delivered in tertiary settings.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"270-281"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731739","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":"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":"227-235"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411679/pdf/","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":"OA","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":"247-257"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411676/pdf/","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":"OA","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":"10.1177/13558196251344864","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"215-217"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","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":"Trump and the future of health services research and policy in Europe: A view from the US.","authors":"Scott L Greer","doi":"10.1177/13558196251358621","DOIUrl":"10.1177/13558196251358621","url":null,"abstract":"","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"209-211"},"PeriodicalIF":2.7,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584126","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}