Healthcare-The Journal of Delivery Science and Innovation最新文献

{"title":"Effective healthcare coverage in Canada: The caring and responding in Edmonton project","authors":"Moutasem A. Zakkar ,&nbsp;Sarah Deck ,&nbsp;Se Lim Jang ,&nbsp;Fariba Kolahdooz ,&nbsp;Adrian Wagg ,&nbsp;André Corriveau ,&nbsp;Sangita Sharma","doi":"10.1016/j.hjdsi.2025.100771","DOIUrl":"10.1016/j.hjdsi.2025.100771","url":null,"abstract":"<div><h3>Background</h3><div>Despite the progress towards Universal Health Coverage (UHC) in Canada, individuals experiencing socioeconomic disadvantages continue to face barriers to accessing necessary health services. This study explored the observational insights of social care providers (SCPs), who regularly engage with vulnerable populations and healthcare systems, to better understand these barriers in Edmonton, Canada.</div></div><div><h3>Methods</h3><div>A qualitative descriptive design was employed, guided by COREQ criteria. Purposive sampling recruited SCPs from 22 community organizations serving Indigenous community members and people experiencing homelessness, substance use, and immigration-related challenges. Deductive thematic analysis, structured around the Effective Coverage (EC) framework, was used to analyze interview data. A coding framework was developed a priori, and inductive coding identified interpretive themes within each EC category.</div></div><div><h3>Results</h3><div>Sixty-five SCPs participated. Findings were organized into four EC categories: service availability, accessibility, acceptability, and utilization. Within these, ten themes were identified: insufficient service capacity, restrictive access policies, service denial, unaffordable care, transportation barriers, racism, stigma, patient-related deterrents to seeking care, language barriers, and barriers to navigating the healthcare system. These themes illustrate how institutional policies, resource limitations, and communication challenges intersect with socioeconomic disadvantages to hinder access to and quality of care. SCPs also described how their organizations often intervene to help clients overcome these barriers.</div></div><div><h3>Conclusion</h3><div>SCPs can provide valuable observational insights into healthcare access barriers. While these perspectives do not represent direct patient accounts, they offer critical input for designing policy interventions to improve UHC. Applying the EC framework may enhance equity and support continuous quality improvement.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100771"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465114","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":"Measuring prescriptions dispensed from urgent care through the VA community care benefit","authors":"Alexis K. Barrett ,&nbsp;John P. Cashy ,&nbsp;John Roehm ,&nbsp;Xinhua Zhao ,&nbsp;Maria K. Mor ,&nbsp;Katie J. Suda ,&nbsp;Chester B. Good ,&nbsp;Shari S. Rogal ,&nbsp;Kelvin A. Tran ,&nbsp;Jennifer A. Hale ,&nbsp;Ron Nosek ,&nbsp;Carolyn T. Thorpe ,&nbsp;Francesca Cunningham ,&nbsp;Michael J. Fine ,&nbsp;Walid F. Gellad","doi":"10.1016/j.hjdsi.2025.100765","DOIUrl":"10.1016/j.hjdsi.2025.100765","url":null,"abstract":"<div><h3>Background</h3><div>The Department of Veterans Affairs (VA) now offers eligible Veterans an urgent care benefit covering visits and 14-day prescriptions outside of VA. Prescriptions written and dispensed outside VA lack the clinical decision support of VA-issued prescriptions, raising concerns about safety and polypharmacy. To date, there has been limited analyses of prescribing patterns through the urgent care benefit.</div></div><div><h3>Methods</h3><div>We used a repeated cross-sectional design to examine Veterans who filled non-VA urgent care prescriptions from 07/30/2019 to 03/20/2023. Data were sourced from the Community Care Reimbursement System (CCRS), which tracks all VA-paid medications dispensed by non-VA pharmacies. We identified potentially noncompliant prescriptions as those not meeting VA urgent care benefit restrictions. We also identified prescriptions continued in VA as a “new VA medication” after 30-days from the urgent care fill.</div></div><div><h3>Results</h3><div>Overall, 83,862 Veterans received 271,476 non-VA urgent care prescriptions. Veterans’ average age was 55.9, with 79.3 % male, 73.0 % White, 86.7 % non-Hispanic, and 41.4 % rural dwelling. Urgent care use increased from 341 prescription fills in March 2020 to 9738 in January 2023. Frequently filled prescriptions included antimicrobials (n = 114,492, 42.2 %) and hormones/synthetics/modifiers, like steroids (n = 44,457, 16.4 %). Potentially noncompliant prescriptions accounted for 9.3 %, with 6.7 % not on the urgent/emergent formulary and 2.6 % supplied for over 14 days. Over 70,704 (26.0 %) prescriptions were continued in VA post-urgent care visit, of which 15 % had no prior VA fill (i.e., new VA medication). Veterans with new continued VA prescriptions were more likely to be male (79.4 % vs. 73.9 %) and from urban areas (59.3 % vs. 57.5 %) (All P &lt; .001).</div></div><div><h3>Conclusions</h3><div>Veterans increasingly received non-VA prescriptions through urgent care centers in the community from 2019 to 2023, including drug classes of interest to VA due to potential risks of inappropriate prescribing (e.g., steroids) or drug interactions (e.g., antibiotics). The CCRS database can be integrated with other VA databases as a quality improvement tool to improve care coordination and drug safety.</div></div><div><h3>Implications</h3><div>This evaluation highlights the need for improved clinical decision support for non-VA prescriptions and demonstrates the potential of integrated data systems to monitor and enhance medication safety and coordination within VA.</div></div><div><h3>Level of evidence</h3><div>Cross-sectional analysis of national VA data.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100765"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144471110","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":"Enhanced obstetric training to address maternity care workforce shortages in tribal, rural, and underserved communities: a case from Oklahoma","authors":"Elizabeth Charron ,&nbsp;Guimy Castor ,&nbsp;Carrigan P. Veach ,&nbsp;Renda Chubb ,&nbsp;Blake J. Lesselroth ,&nbsp;Viviane Elisabeth de Souza Santos Sachs ,&nbsp;Morgan Richards ,&nbsp;C. Michele Markey ,&nbsp;Juliana Fernandes Filgueiras Meireles ,&nbsp;Lamont E. Cavanagh ,&nbsp;Erin Jorgensen ,&nbsp;Jameca Price ,&nbsp;Karen P. Gold","doi":"10.1016/j.hjdsi.2025.100768","DOIUrl":"10.1016/j.hjdsi.2025.100768","url":null,"abstract":"<div><div>The United States is facing a shortage of pregnancy care providers, especially in tribal, rural, and underserved (TRU) communities. In Oklahoma, more than half of the state's counties are considered maternity care deserts that lack obstetric (OB) providers or services. Limited access to pregnancy care in Oklahoma's TRU areas contributes to the state's high rates of maternal morbidity and mortality. Family medicine (FM) physicians receive basic OB training during residency and are often the only providers delivering pregnancy care for geographically isolated and socially vulnerable populations in these counties. In 2021, the University of Oklahoma School of Community Medicine launched an enhanced OB training curriculum for FM residents to help address workforce shortages in Oklahoma's TRU communities. This article describes the design and implementation of the enhanced training curriculum, summarizes results from the first 2 years of implementation, and shares lessons learned for the field.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100768"},"PeriodicalIF":2.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018754","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":"Transforming latent tuberculosis infection (LTBI) testing and treatment at a federally qualified health center","authors":"Ranjani K. Paradise ,&nbsp;Carolyn Fisher ,&nbsp;Hanna H. Haptu ,&nbsp;Deborah McManus ,&nbsp;Jennifer Cochran","doi":"10.1016/j.hjdsi.2025.100766","DOIUrl":"10.1016/j.hjdsi.2025.100766","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>The Massachusetts Department of Public Health partnered with Lynn Community Health Center (LCHC) to scale up testing and treatment for latent tuberculosis infection (LTBI) for a non-US born patient population. The project team developed a workflow to manage patients through the LTBI care cascade with screening performed in primary care and diagnostic testing, evaluation, and treatment undertaken by a TB team within the health center. To support the clinical workflow, the team implemented process improvements, addressed access barriers, and made electronic health record (EHR) enhancements.</div></span></li><li><span>•</span><span><div>LCHC successfully increased LTBI testing and treatment for non-US born patients, while sustaining engagement through the care cascade.</div></span></li><li><span>•</span><span><div>Strategic distribution of responsibilities, attention to process refinement, EHR enhancements, and collaboration with public health experts helped make the scale-up possible.</div></span></li><li><span>•</span><span><div>Three core factors kept patients more engaged, minimized gaps in treatment, and alleviated burdens associated with LTBI treatment: 1) flexibility with scheduling visits, 2) focus on building trusting, supportive relationships between care providers and patients, and 3) consistent outreach, reminders, and follow-up with patients on treatment.</div></span></li><li><span>•</span><span><div>Maintaining high testing and treatment volumes requires consistent effort, sustained attention, and staffing continuity.</div></span></li></ul></div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 2","pages":"Article 100766"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144633806","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":"Delivering health equity at scale: Organizational experience with value-based care focused on marginalized populations","authors":"Michael Tang ,&nbsp;Charisse Hunter ,&nbsp;Shoshanah Brown ,&nbsp;Aarthi Rao ,&nbsp;Pooja K. Mehta ,&nbsp;Kameron Matthews","doi":"10.1016/j.hjdsi.2025.100760","DOIUrl":"10.1016/j.hjdsi.2025.100760","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100760"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143894977","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":"Using codesign to engage primary care practices in a participatory change process","authors":"Sarah J. Fadem ,&nbsp;Benjamin F. Crabtree ,&nbsp;Lawrence C. Kleinman","doi":"10.1016/j.hjdsi.2025.100761","DOIUrl":"10.1016/j.hjdsi.2025.100761","url":null,"abstract":"<div><div>Healthcare has experienced significant transformation in recent years with many changes being imposed on practices from outside sources. When tailoring outside interventions to specific settings, it is important to engage practice members in participatory processes. Yet, tailoring remains a difficult and poorly understood element of implementation. Codesign is one method to achieve context-sensitive, bottom-up change by engaging stakeholders in the design process. With a complex adaptive system (CAS) perspective, codesign reframes interventions as tools to empower practices to drive change based on local challenges and experiences rather than change being imposed upon them. Observing adaptations and facilitating innovations of practice members offers insight into dynamics of the CAS, implementation context, and its limitations. Here, the codesign process is illustrated through a pediatric primary care practice adopting integrated health.</div><div>Contextual inquiry was performed using ethnographic observations to identify barriers and facilitators to integrated health. Observation findings informed codesign workshops with clinicians. Workshop transcripts and drawings were analyzed using an immersion/crystallization approach guided by the Practice Change Model (PCM), an established framework based on complexity science concepts. In these workshops, clinicians described tension between their motivations to care for complex patients and limitations imposed by the health system. Participants’ knowledge of their real-world context allowed them to identify resources and opportunities for changes they could make within their current environment. The reconciliation of the ideal and the real is a core benefit of codesign methods. This innovative approach can be applied more generally to support the development, implementation, and evaluation of interventions that reflect real world interactions and complexities.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100761"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143892158","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":"AI-enabled decision support: The convergence of technology and decision science","authors":"Danielle S. Browne ,&nbsp;Ling Chu ,&nbsp;Michael Burton ,&nbsp;Joshua M. Liao","doi":"10.1016/j.hjdsi.2025.100757","DOIUrl":"10.1016/j.hjdsi.2025.100757","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100757"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068195","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":"Changes in primary care encounter rates during the veteran health administration’s electronic health record transition","authors":"Ashok Reddy ,&nbsp;Jonathan Staloff ,&nbsp;Jorge Rojas ,&nbsp;Eric Gunnink ,&nbsp;Scott Hagan ,&nbsp;Alisa Becker ,&nbsp;John Geyer ,&nbsp;Stefanie A. Deeds ,&nbsp;Karin Nelson ,&nbsp;Edwin S. Wong","doi":"10.1016/j.hjdsi.2025.100758","DOIUrl":"10.1016/j.hjdsi.2025.100758","url":null,"abstract":"<div><h3>Background</h3><div>Electronic health record (EHR) transitions can cause major disruptions in the provision of primary care services. Veteran Health Administration (VHA), one of the largest integrated healthcare systems, underwent a major EHR transition at two sites. To date, there is limited data on the experience of primary care service lines at EHR transition sites.</div></div><div><h3>Objective</h3><div>To describe and quantify changes in the provision of primary care services at two sites that have experienced EHR transition.</div></div><div><h3>Design</h3><div>We conducted a retrospective study of primary care encounters 12 months before and after EHR transition. In addition, we applied economic structural change analysis using the expanded length of time (10 years of prior primary care encounters at sites) to understand how the transition of EHR compares to other major changes in primary care encounter volume during this time period.</div></div><div><h3>Data source and main measure</h3><div>Primary care encounters were measured using algorithms pre- and post-EHR transition from the national VHA Corporate Data Warehouse (CDW) and Cerner Millennium (CDW2) Databases.</div></div><div><h3>Key results</h3><div>In Spokane, the average number of monthly primary care encounters decreased from 7155 (SD = 682) in the 12 months prior to October 2020 (transition date) to 4181 (SD = 813) in the 12 months after implementation, a decrease of 41.6 %. The average number of monthly primary care encounters decreased from 8029 (SD = 511) in the 12 months prior to April 2022 (transition date) to 6495 (SD = 1152) in the 12 months after implementation, a decrease of 19.1 %. The structural change analysis identified EHR transition dates at both sites, including a major decrease in volume of primary care encounters.</div></div><div><h3>Conclusions</h3><div>Given the substantial decrease in primary care services, VHA must identify strategies to mitigate both the amount and the duration of reduced primary care encounters during the EHR transition.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100758"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143579592","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":"Clinical decision support amidst a global pandemic: Value of near real-time feedback in advancing appropriate post-discharge opioid prescribing for surgical patients","authors":"Brendin R. Beaulieu-Jones ,&nbsp;Margaret T. Berrigan ,&nbsp;Jayson S. Marwaha ,&nbsp;Chris J. Kennedy ,&nbsp;Kortney A. Robinson ,&nbsp;Larry A. Nathanson ,&nbsp;Charles H. Cook ,&nbsp;Jordan D. Bohnen ,&nbsp;Gabriel A. Brat","doi":"10.1016/j.hjdsi.2025.100764","DOIUrl":"10.1016/j.hjdsi.2025.100764","url":null,"abstract":"<div><h3>Implementation lessons</h3><div>Non-evidence based factors influence post-surgical opioid prescribing practices. Delivering automated near real-time opioid prescribing feedback may encourage providers to prescribe opioid quantities which are more aligned with patient consumption and institutional guidelines.</div><div>COVID-19 presented unprecedented challenges to healthcare delivery. We observed a substantial deviation in guideline-concordant opioids prescribing during the initial outbreak. However, our institution's pre-existing opioid prescribing feedback system and decision aid may have helped limit the duration and magnitude of the observed deviations by informing prescribers of atypically large opioid prescriptions and encouraging use of institutional data.</div><div>Combined with provider education, a non-directive decision aid, in the form of near, real-time email feedback, may be an effective mechanism to advance evidence-based opioid prescribing, as it retains flexibility and provider autonomy while encouraging data-driven decision making.</div></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100764"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144071498","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":"Rethinking handoffs to optimize continuity: Four practical lessons from a novel hospitalist model","authors":"Andrew W. Schram ,&nbsp;Caleb J. Murphy ,&nbsp;David O. Meltzer","doi":"10.1016/j.hjdsi.2025.100763","DOIUrl":"10.1016/j.hjdsi.2025.100763","url":null,"abstract":"","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"13 1","pages":"Article 100763"},"PeriodicalIF":2.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143936625","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}