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

{"title":"Engaging frontline employees using innovation contests: Lessons from Massachusetts General Hospital","authors":"Olivia S. Jung PhD ,&nbsp;Julia Jackson MBA ,&nbsp;Maulik Majmudar MD ,&nbsp;Paula McCree MS ,&nbsp;Eric M. Isselbacher MD, MSc","doi":"10.1016/j.hjdsi.2022.100615","DOIUrl":"10.1016/j.hjdsi.2022.100615","url":null,"abstract":"<div><p>In this article, we describe how innovation contests—a vehicle to crowdsource ideas and problem-solving efforts—propelled frontline employees to exert discretionary efforts in organizational problem-solving at Massachusetts General Hospital. As designers and administrators of four innovation contests in three disease centers, we share firsthand knowledge of how the contests enabled clinicians and administrative staff, whose primary job is delivering high-quality patient care, to become involved in ideation, selection, and implementation of their own ideas. We describe the processes that we designed and implemented, ideas that these processes generated, and findings from interviewing employees about their experiences afterwards. Our findings suggest that the benefits of implementing innovation contests were multifaceted. To employees, the contests provided a platform to voice suggestions and participate in any aspect of the innovation process that they found interesting. To managers, the contests revealed real, empirical issues affecting operation and patient care based on frontline employees’ knowledge. To the organization as a whole, the contests promoted collaborative problem-solving among likeminded, innovative employees.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100615"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47539637","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":"Information exchange among providers and patient-centeredness in transitional care: A five-year retrospective analysis","authors":"Jing Li ,&nbsp;Glen Mays ,&nbsp;Jessica Miller Clouser ,&nbsp;Gaixin Du ,&nbsp;Arnold Stromberg ,&nbsp;Brian W. Jack ,&nbsp;Huong Q. Nguyen ,&nbsp;Mark V. Williams","doi":"10.1016/j.hjdsi.2022.100626","DOIUrl":"10.1016/j.hjdsi.2022.100626","url":null,"abstract":"<div><h3>Background</h3><p>Responding to the shift toward value-based care, hospitals engaged in widespread experimentation of implementing transitional care (TC) strategies to improve patient experience and reduce unnecessary readmissions. However, which groups of these strategies are most strongly associated with better outcomes remains unknown.</p></div><div><h3>Methods</h3><p>Using a retrospective longitudinal design, we collected hospitals' TC strategy implementation data for 370 U S. hospitals and obtained claims data for 2.4 million Medicare fee-for-service beneficiaries hospitalized at them from 2009 to 2014. We applied estimated mixed-effects regression models controlling for patient, hospital, and community covariates to assess relationships between TC strategy groups and trends in hospitals’ 30-day hospital readmissions, with observation stay and mortality rates as secondary outcomes.</p></div><div><h3>Results</h3><p>Hospitals' adoption of TC groups was associated with higher readmission rates at baseline and larger readmission rate reductions compared to not adopting any of 5 TC groups. The TC group including timely information exchange across care settings, engaging patients and caregivers in education, and/or identifying and addressing patients’ transition needs was associated with the largest reductions. Hospitals not implementing any of the 5 TC groups had higher mortality rates and lower observation stay rates throughout the study period.</p></div><div><h3>Conclusions</h3><p>Our findings suggest that timely information sharing among providers across the care continuum and engaging patients in discharge planning and education may correspond with reduced readmissions.</p></div><div><h3>Implications</h3><p>Our research suggests that hospitals responded to shifts in policy by implementing a diversity of TC strategy combinations; it also provides guidance regarding which combinations of TC strategies corresponded with larger readmission reductions.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100626"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40314237","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":"Does racism impact healthcare quality? Perspectives of Black and Hispanic/Latino Patients","authors":"Mary G. Findling ,&nbsp;Laurie Zephyrin ,&nbsp;Sara N. Bleich ,&nbsp;Motunrayo Tosin-Oni ,&nbsp;John M. Benson ,&nbsp;Robert J. Blendon","doi":"10.1016/j.hjdsi.2022.100630","DOIUrl":"10.1016/j.hjdsi.2022.100630","url":null,"abstract":"<div><p>This analysis of a 2020 nationally representative sample of 1003 U.S. Black and Hispanic/Latino households shows that experiencing racism in healthcare is associated with significantly worse quality of healthcare and lower trust in doctors reported by patients. These findings emphasize that improving healthcare for Black and Hispanic/Latino patients will require major efforts to eliminate racism on the part of health professionals and healthcare institutions.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100630"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47785232","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":"Leveraging Accountable Care Organization infrastructure for rapid pandemic response in independent primary care practices","authors":"Carly Amon ,&nbsp;Jennifer King ,&nbsp;Jordan Colclasure ,&nbsp;Kim Hodge ,&nbsp;C. Annette DuBard","doi":"10.1016/j.hjdsi.2022.100623","DOIUrl":"10.1016/j.hjdsi.2022.100623","url":null,"abstract":"<div><h3>Background</h3><p>Population risk segmentation and technology-enabled preventive care workflows are core competencies for Accountable Care Organizations (ACOs) that may also have relevance for public health emergencies.</p></div><div><h3>Methods</h3><p>During the early weeks of the COVID-19 pandemic, we aimed to leverage existing ACO capabilities to support 467 primary care practices across 27 states with pandemic response. We used Medicare claims and electronic health records to identify patients with increased COVID-19 vulnerability, for proactive outreach and guidance for “Staying Well at Home.”</p></div><div><h3>Results</h3><p>302,125 patients met intervention criteria; 45% were reached within the first 6 weeks. Engagement in the initiative was uneven among ACO-participating practices. ACO staff identified prior practice engagement in core ACO workflows as a major facilitator of success and staffing shortages as a major barrier. Small practice size, non-metropolitan location, penetration of value-based payment models in the practice, and pre-pandemic Annual Wellness Visit completion rates were independently associated with successful outreach to COVID-vulnerable patients.</p></div><div><h3>Conclusions</h3><p>Rapid adaptation of ACO infrastructure assisted independent practices across the country to reach vulnerable patients with proactive guidance for staying well at home. The initiative was most successful in smaller, non-metropolitan practices and those with greater engagement in core ACO initiatives pre-pandemic.</p></div><div><h3>Implications</h3><p>Our experience suggests that primary care participation in accountable care models can contribute to preparedness for future public health crises.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 2","pages":"Article 100623"},"PeriodicalIF":2.5,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213076422000124/pdfft?md5=32966152c75c67d261cf28f667792f0f&pid=1-s2.0-S2213076422000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127519585","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":"Advancing primary care with Artificial Intelligence and Machine Learning","authors":"Zhou Yang ,&nbsp;Christina Silcox ,&nbsp;Mark Sendak ,&nbsp;Sherri Rose ,&nbsp;David Rehkopf ,&nbsp;Robert Phillips ,&nbsp;Lars Peterson ,&nbsp;Miguel Marino ,&nbsp;John Maier ,&nbsp;Steven Lin ,&nbsp;Winston Liaw ,&nbsp;Ioannis A. Kakadiaris ,&nbsp;John Heintzman ,&nbsp;Isabella Chu ,&nbsp;Andrew Bazemore","doi":"10.1016/j.hjdsi.2021.100594","DOIUrl":"10.1016/j.hjdsi.2021.100594","url":null,"abstract":"<div><p><span><span>Primary care is the largest </span>healthcare delivery platform in the US. Facing the </span>Artificial Intelligence<span> and Machine Learning technology (AI/ML) revolution, the primary care community would benefit from a roadmap revealing priority areas and opportunities for developing and integrating AI/ML-driven clinical tools. This article presents a framework that identifies five domains for AI/ML integration in primary care to support care delivery transformation and achieve the Quintuple Aims of the healthcare system. We concluded that primary care plays a critical role in developing, introducing, implementing, and monitoring AI/ML tools in healthcare and must not be overlooked as AI/ML transforms healthcare.</span></p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100594"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39639445","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":"Use of telemedicine for initial outpatient subspecialist consultative visit: A national survey of general pediatricians and pediatric subspecialists","authors":"Kristin N. Ray ,&nbsp;James C. Bohnhoff ,&nbsp;Kelsey Schweiberger ,&nbsp;Gina M. Sequeira ,&nbsp;Janel Hanmer ,&nbsp;Jeremy M. Kahn","doi":"10.1016/j.hjdsi.2021.100600","DOIUrl":"10.1016/j.hjdsi.2021.100600","url":null,"abstract":"<div><h3>Background</h3><p>Evidence-based strategies are needed to support appropriate use of telemedicine<span> for initial outpatient subspecialty consultative visits. To inform such strategies we performed a survey of general pediatricians and pediatric subspecialists about use of telemedicine for patients newly referred for pediatric subspecialty care.</span></p></div><div><h3>Methods</h3><p>We developed and fielded an e-mail and postal survey of a national sample of 840 general pediatricians and 840 pediatric subspecialists in May and June 2020.</p></div><div><h3>Results</h3><p>Of 266 completed surveys (17% response rate), 204 (76%) thought telemedicine should be offered for some and 29 (11%) thought telemedicine should be offered for all initial subspecialist visits. Most respondents who indicated telemedicine should be offered for some initial consultations believed this decision should be made by subspecialty attendings (176/204, 86%). Respondents prioritized several data elements to inform this decision, including clinical information and family-based contextual information (e.g., barriers to in-person care, interest in telemedicine, potential communication barriers). Factors perceived to reduce appropriateness of telemedicine for subspecialty consultation included need for interpreter services and prior history of frequent no-shows. Responses from generalists and subspecialists rarely differed significantly.</p></div><div><h3>Conclusions</h3><p>Survey results suggest potential opportunities to support the appropriate use of telemedicine for initial outpatient pediatric subspecialty visits through structured transfer of specific clinical and contextual information at the time of referral and through strategies to mitigate perceived communication or engagement barriers.</p></div><div><h3>Implication</h3><p>Pediatric physician beliefs about telemedicine for initial outpatient subspecialty consultative visits may inform future interventions to support appropriate telemedicine use.</p></div><div><h3>Level of evidence</h3><p>Survey of a national sample of clinicians.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100600"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10807534","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":"Association of community-level social vulnerability with US acute care hospital intensive care unit capacity during COVID-19","authors":"Thomas C. Tsai ,&nbsp;Benjamin H. Jacobson ,&nbsp;E. John Orav ,&nbsp;Ashish K. Jha","doi":"10.1016/j.hjdsi.2021.100611","DOIUrl":"10.1016/j.hjdsi.2021.100611","url":null,"abstract":"<div><p>The COVID-19 pandemic has placed unprecedented stress on US acute care hospitals, leading to overburdened ICUs. It remains unknown if increased COVID-19 ICU occupancy is crowding out non-COVID-related care and whether hospitals in vulnerable communities may be more susceptible to ICUs reaching capacity. Using facility-level hospitalization data, we conducted a retrospective observational cohort study of 1753 US acute care hospitals reporting to the US Department of Health and Human Services Protect database from September 4, 2020 to February 25, 2021. 63% of hospitals reached critical ICU capacity for at least two weeks during the study period, and the surge of COVID-19 cases appeared to be crowding out non-COVID-19-related intensive care needs. Hospitals in the South (OR = 3.31, 95% CI OR 2.31–4.78) and West (OR = 2.28, 95% CI OR 1.51–3.46) were more likely to reach critical capacity than those in the Northeast, and hospitals in areas with the highest social vulnerability were more than twice as likely to reach capacity as those in the least vulnerable areas (OR = 2.15, 95% CI OR 1.41–3.29). The association between social vulnerability and critical ICU capacity highlights underlying structural inequities in health care access and provides an opportunity for policymakers to take action to prevent strained ICU capacity from compounding COVID-19 inequities.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100611"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39642803","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":"An innovation tournament to improve medical residency","authors":"David A. Asch,&nbsp;Lisa M. Bellini,&nbsp;Sanjay V. Desai,&nbsp;Deirdre Darragh,&nbsp;Elizabeth L. Asch,&nbsp;Judy A. Shea","doi":"10.1016/j.hjdsi.2022.100614","DOIUrl":"10.1016/j.hjdsi.2022.100614","url":null,"abstract":"<div><p>Two large national studies of resident duty hours incidentally revealed surgical and medical resident dissatisfaction with residency training. Aiming for an inclusive and democratic approach to improve graduate medical education, we conducted a national innovation tournament--reaching out to the program directors of all 474 US internal medicine residency programs to invite them and their residents and associate program directors to participate. Participants could submit multiple ideas as individuals or teams in four domains: [1] resident well-being and personal and professional development; [2] resident education and clinical preparedness; [3] resident sleep and alertness; and [4] patient safety. Residents and program directors were reinvited to rate ideas, whether they had submitted ideas themselves or not. We used a schedule of lottery-based prizes to stimulate the submission and rating of ideas and encourage engagement. 164 residents and program directors from 51 different programs submitted 328 ideas. 153 residents and program directors from 48 different programs submitted 15,345 ratings of ideas. Winning ideas aimed to reduce residents’ work burden or improve their mental health, sleep, eating, or relaxation or reflected technical fixes to the operations of residency, such as changing vacation schedules and the timing of pay. The results of this tournament provided actionable suggestions to improve residency training now being tested in our own residency programs. Innovation tournaments drive engagement and generate value by their opportunities for inclusion and by shifting problem solving to the end user.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100614"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7d/5f/nihms-1778219.PMC8881444.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39746971","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":"Expansion of telemedicine during COVID-19 at a VA specialty clinic","authors":"Michelle D. Balut ,&nbsp;Tamar Wyte-Lake ,&nbsp;William Neil Steers ,&nbsp;Karen Chu ,&nbsp;Aram Dobalian ,&nbsp;Boback Ziaeian ,&nbsp;Leonie Heyworth ,&nbsp;Claudia Der-Martirosian","doi":"10.1016/j.hjdsi.2021.100599","DOIUrl":"10.1016/j.hjdsi.2021.100599","url":null,"abstract":"<div><h3>Background</h3><p>COVID-19 rapidly accelerated the implementation of telemedicine in U.S. Department of Veterans Affairs (VA) specialty care clinics. This mixed-methods study was conducted at a VA medical center to understand the use of telemedicine, and the barriers and facilitators to its implementation, in cardiology outpatient clinics.</p></div><div><h3>Methods</h3><p>Quantitative analyses modeled monthly trends of telemedicine use over 24-months (March 2019–March 2021) with segmented logistic regression and adjusted for socio-demographic predictors of patient-level telemedicine use. Qualitative interviews were conducted (July–October 2020) with eight cardiology clinicians.</p></div><div><h3>Results</h3><p>At the onset of COVID-19, likelihood of telemedicine use was ∼12 times higher than it was pre-COVID-19 (p &lt; 0.001). White (OR = 1.38, 95% CI:1.23–1.54), married (OR = 1.25, 95% CI:1.11–1.40), Veterans with other health insurance (OR = 1.19, 95% CI:1.06–1.35), were more likely to use telemedicine. Veterans with higher health risk factors were less likely (OR = 0.95, 95% CI:0.93–0.97). Facilitators to rapid expansion of telemedicine included prior telemedicine experience; provider trainings; and staff champions. In contrast, lack of technical support and scheduling grids for virtual visits and patient ability/preference served as barriers.</p></div><div><h3>Conclusions</h3><p>Findings suggest that once mutable barriers were addressed, the medical center was able to expand its telemedicine efforts during COVID-19. Beyond the pandemic, a hybrid of virtual and face-to-face care might be feasible and likely beneficial for healthcare providers and patients in specialty care.</p></div><div><h3>Implications</h3><p>The ability to rapidly transition from in-person to virtual visits can potentially assist with the continuity of care and management of chronic disease during infectious outbreaks and other major disasters that obstruct traditional care models.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100599"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8616735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39886327","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":"Change in self-reported health: A signal for early intervention in a medicare population","authors":"Dana Drzayich Antol ,&nbsp;Angela Hagan ,&nbsp;Hannah Nguyen ,&nbsp;Yong Li ,&nbsp;Gilbert S. Haugh ,&nbsp;Michael Radmacher ,&nbsp;Kurt J. Greenlund ,&nbsp;Craig W. Thomas ,&nbsp;Andrew Renda ,&nbsp;Karen Hacker ,&nbsp;William H. Shrank","doi":"10.1016/j.hjdsi.2021.100610","DOIUrl":"10.1016/j.hjdsi.2021.100610","url":null,"abstract":"<div><h3>Background</h3><p><span>Health plans and risk-bearing provider organizations seek information sources to inform proactive interventions for patients at risk of adverse health events. Interventions should take into account the strong relationship between social context and health. This retrospective cohort study of a Medicare Advantage population examined whether a change in self-reported health-related </span>quality of life (HRQOL) signals a subsequent change in healthcare needs.</p></div><div><h3>Methods</h3><p>A retrospective longitudinal analysis of administrative claims data was conducted for participants in a Medicare Advantage plan with prescription drug coverage (MAPD) who responded to 2 administrations of the Centers for Disease Control and Prevention 4-item Healthy Days survey within 6–18 months during 2015–2018. Changes in HRQOL, as measured by the Healthy Days instrument, were compared with changes in utilization and costs, which were considered to be a reflection of change in healthcare needs.</p></div><div><h3>Results</h3><p>A total of 48,841 individuals met inclusion criteria. Declining HRQOL was followed by increases in utilization and costs. An adjusted analysis showed that every additional unhealthy day reported one year after baseline was accompanied by an $8 increase in monthly healthcare costs in the subsequent six months for the average patient.</p></div><div><h3>Conclusions</h3><p>Declining HRQOL signaled subsequent increases in healthcare needs and utilization.</p></div><div><h3>Implications</h3><p>Findings suggest that HRQOL assessments in general, and the Healthy Days instrument in particular, could serve as a leading indicator of the need for interventions designed to mitigate poor health outcomes and rising healthcare costs.</p></div><div><h3>Level of evidence</h3><p>III.</p></div>","PeriodicalId":29963,"journal":{"name":"Healthcare-The Journal of Delivery Science and Innovation","volume":"10 1","pages":"Article 100610"},"PeriodicalIF":2.5,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39745302","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}