Health Care Analysis最新文献

{"title":"Complicated Appendicitis in a Universal Healthcare System: Do Ethnic Disparities Persist?","authors":"Noam Weiner, Nitzan Goldberg, Eyal Meir, Ossama Abu-Hatoum, Uri Kaplan","doi":"10.1007/s10728-025-00558-7","DOIUrl":"10.1007/s10728-025-00558-7","url":null,"abstract":"<p><p>While ethnic disparities in appendicitis outcomes have been previously documented, limited data exist regarding their influence on the incidence of complicated appendicitis within population covered by universal health insurance. This study aimed to assess whether ethnicity (Israeli Jewes vs. Israeli Arabs) is independntly accosioated with the risk of complicated appendicitis in the context of Israel’s universal healthcare system. All adult patients who underwent appendectomy at our institution between January 2010 and December 2021. The primary outcome was appendicitis severity, categorized as complicated or uncomplicated based on pathology reports. Secondary outcomes included length of hospital stay and rehospitalization within six months. Univariable and multivariable logistic regression analyses were performed to identify factors associated with complicated appendicitis. A total of 2,943 patients were included. In the multivariable logistic regression analysis, prolonged in-hospital delay before surgery exceeding 12 h increased the risk of complicated appendicitis (OR = 1.41; 95% CI: 1.14–1.75; p = 0.002). Age over 60 years doubled the risk of complicated appendicitis compared to younger patients (OR = 2.42; 95% CI: 1.81–3.24; p < 0.001). Although Jewish patients were older and had higher rates of complicated appendicitis, ethnicity was not independently associated with complicated appendicitis after adjustment for age, comorbidities, and surgical delay. Ethnicity was not an independent risk factor for complicated appendicitis in a population with universal health coverage. Older age and prolonged in-hospital delay were the primary predictors of complicated disease.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"135-148"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146087584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shared Decision-Making with the \"Professionally-Driven Zone of Patient or Surrogate Discretion\" Model and its Application in Acute Care.","authors":"Joshua T Landry","doi":"10.1007/s10728-025-00524-3","DOIUrl":"10.1007/s10728-025-00524-3","url":null,"abstract":"<p><p>Shared decision-making (\"SDM\") has increased in acceptance and become a gold standard in medical decision-making over the last two decades. Despite this, there continues to be disagreement about several facets of SDM that many existing models or versions do not sufficiently address, including: that there is a lack of agreement about which version or model of SDM to utilize in practice; that there are practical limitations on when SDM ought to be utilized; that SDM may be required to use different \"harm thresholds\" when making decisions for patients who have lost decision-making capacity or competence, or for those who have never had such capacity in the first place; and that many existing models of SDM succumb to what is known as the \"framing problem,\" among other concerns. Elsewhere, this author presented a model of SDM titled, the Professionally-Driven Zone of Patient or Surrogate Discretion (or, Professionally-Driven ZPSD) as a more comprehensive and defensible way forward. This article sets out to expand on the expected benefits of the model, and apply it to several case studies in the acute-care setting in order to demonstrate its functionality as a model of SDM.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"105-117"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Driving Quality Forward: A Study on the Utilization of QI Tools by Hospital Quality Managers.","authors":"Senol Demirci, Demet Gokmen Kavak, Yasin Aras, Figen Cizmeci Senel","doi":"10.1007/s10728-025-00538-x","DOIUrl":"10.1007/s10728-025-00538-x","url":null,"abstract":"<p><p>There are numerous ways to improve the quality of healthcare services, and Quality Improvement (QI) tools play a central role in this. These tools are essential for identifying problems, reducing errors and costs, modifying practices, generating innovative ideas, acquiring and analysing data, visualising issues, and supporting decision-making. Using them effectively promotes healthcare quality, patient safety, and optimal resource utilisation. Despite the importance of QI tools, the lack of systematic and comprehensive data on the frequency and purpose of their use in healthcare facilities constitutes the main problem area of this study. This descriptive and cross-sectional study examines the frequency and purpose of QI tool usage among quality managers in hospitals across Türkiye. The study population comprised quality managers from 248 hospitals who fully completed the survey. It focused on the use of 18 widely recognised QI tools, including Brainstorming, Fishbone Diagram, Five Whys, Flowchart, Control Chart, PDCA Cycle, FMEA, Histogram, Scatter Diagram, Process Mapping, and others. The results indicated that the least known tools were the Swiss Cheese Model, Spaghetti Diagram, Six Thinking Hats, House of Quality, Mapping the Last Ten Patients, Tree Diagram, and Pareto Chart. Conversely, Brainstorming, Fishbone Diagram, Five Whys, and Flowcharts were the most frequently used. QI tools were primarily used for generating ideas, visualisation, identifying problems, and analysing them. Significant differences in tool usage were observed based on experience in healthcare and quality roles. The findings underscore the complementary nature of QI tools and the need for enhanced training and awareness.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":"87-103"},"PeriodicalIF":1.4,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144973695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Synergistic Impact of Healthcare and Education Investments on Sustainable Economic Development: A Study Using Mixed-Method Analysis.","authors":"Dan Zhang, Li Xue, Jingyi Sun, Pengju Xia, Jiangning Wu","doi":"10.1007/s10728-026-00573-2","DOIUrl":"https://doi.org/10.1007/s10728-026-00573-2","url":null,"abstract":"<p><p>Investments in public health and education are usually examined independently, but in developing countries, both are relevant to Sustainable Economic Development (SED). Within an integrated policy framework, this study aims to examine the complementary relationship between investments in health and education and their relationship with SED. A mixed-method approach was employed, consisting of 465 questionnaire responses from participants, including government officials, and 96 semi-structured interviews. Using Partial Least Squares Structural Equation Modeling (PLS-SEM), quantitative data were analyzed, and to contextualize the statistical results, qualitative findings were involved. Results indicate that healthcare infrastructure, coupled with investment in health and education, communicable disease reduction, mental health services, and coordinated public investment, is positively and statistically related to SED. Explained variance is (R² = 0.100), showing that there is a moderate but meaningful contribution in the broader institution context. Findings contribute to existing literature by incorporating cross-sectoral modeling with qualitative institutional-level findings. It provides a more holistic understanding of the relation between coordinated human capital investments and developmental outcomes. These insights recommend integrating policies between the health and education sectors to support inclusive and sustainable development in low- and middle-income countries.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148035824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic Moral Injury in Health Systems: When Institutions Cause Harm Without Intent.","authors":"Yahya Al-Farsi","doi":"10.1007/s10728-026-00571-4","DOIUrl":"https://doi.org/10.1007/s10728-026-00571-4","url":null,"abstract":"<p><p>Moral injury is commonly used to describe the ethical and emotional distress experienced by clinicians who are repeatedly required to act in ways that conflict with their moral commitments within constrained systems. While this concept has helped shift attention away from individual burnout, it has remained largely focused on personal experience. This analysis suggests that moral injury can also arise at the level of health systems themselves. Health systems may produce harm not through neglect, wrongdoing, or failure, but through decisions that are technically correct, rule-compliant, and made in good faith. When such decisions are repeatedly embedded within institutional processes, they can suppress attentiveness to vulnerability, displace moral responsibility, and obscure forms of harm that fall outside formal recognition. Under these conditions, ethical distress becomes patterned and routine rather than exceptional. Drawing on virtue ethics and prior work on mercy in medicine, this paper conceptualizes systemic moral injury as a specific configuration of ethical strain arising from misalignment between the operational logic of health systems and the moral purposes of care. Rather than offering prescriptive solutions, this account develops systemic moral injury as a clarifying concept. It helps explain why ethical discomfort persists among clinicians and patients even in systems that perform well by conventional standards. Recognizing moral injury at the institutional level is essential for ethical clarity, responsible leadership, and the long-term moral sustainability of healthcare systems operating under constraint.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148035875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Rule of Rescue to Distributive Justice: Are Physician-Staffed Ambulances Ethically Justifiable?","authors":"Rotem Waitzman, Noam Jaffe","doi":"10.1007/s10728-026-00570-5","DOIUrl":"https://doi.org/10.1007/s10728-026-00570-5","url":null,"abstract":"<p><p>The integration of physicians into ambulance services has become an increasingly debated policy option in emergency medical systems worldwide. While some observational studies suggest that physician-staffed prehospital units may improve outcomes in selected high-acuity cases, systematic reviews reveal heterogeneous and context-dependent results, and economic analyses highlight substantial financial and opportunity costs [1-4]. This article argues that the central question is not merely clinical effectiveness, but distributive justice: under what conditions is it ethically justifiable to allocate scarce physician expertise to prehospital care rather than to hospital-based services? Drawing on Rawls' theory of justice as fairness [5] and Daniels' account of just health and accountability for reasonableness [6], the article develops a normative framework for evaluating physician deployment in emergency medical services. It clarifies the meaning of equity in prehospital care, distinguishing between equality and vertical equity, and emphasizes the importance of geographic justice and procedural legitimacy. The analysis contends that inequalities in staffing models are justified only if they demonstrably improve the position of the least advantaged populations and are grounded in transparent, revisable allocation processes. The Israeli emergency medical system is examined as a test case of fragmented and largely urban-centered physician deployment. The case illustrates how innovative initiatives may emerge without a coherent distributive framework, thereby exposing the ethical fragility of rescue-driven expansion in the absence of systematic equity criteria. The article concludes that physician-staffed ambulances are ethically defensible only under stringent conditions: measurable benefit to disadvantaged populations, proportionality of benefit to cost and opportunity loss, compliance with procedural standards, and sustained evaluation of system-wide impact. Without these conditions, physician deployment risks shifting emergency medical policy from distributive justice toward rescue-based intuition.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metaphors of Health System Resilience as Tools for Preparedness Imagination.","authors":"Kristiina Janhonen, Aino Rantamäki","doi":"10.1007/s10728-026-00569-y","DOIUrl":"10.1007/s10728-026-00569-y","url":null,"abstract":"<p><p>This article explores how metaphor-based frameworks can enrich understanding of health system resilience and stimulate preparedness imagination, a reflexive practice aimed at generating innovative approaches for facing unknown threats. Observing that uncertainty is narrowly defined in resilience discussions, this study uses an abductive research approach to navigate surprises and creatively adapt knowledge. We propose four metaphors-sailing turbulent seas, zen-like fencing, evolving species, and jazz orchestras-as lenses to view resilience, each bringing unique insights into managing unforeseen crises. In a two-stage process, we began with associative writing, drawing on diverse experiences to question how resilience might manifest in contexts outside healthcare. This was followed by theoretical interpretations, inspired by Dewey's pragmatist learning theory, complexity thinking, and resilience literature. To conclude, we argue that metaphors challenge conventional thinking, detaching from established concepts and definitions to reveal fresh perspectives. The article offers theoretical and practical suggestions for advancing health system resilience, with relevance for training professionals in crisis preparedness and leadership. By treating metaphor development as a form of abductive theorizing, the study positions creative reframing not as an artistic supplement but as a systematic mode of conceptual inquiry essential for advancing resilience scholarship. This conceptual contribution expands the theoretical foundations on which future empirical research, operational models, and preparedness assessments can be built, thereby strengthening the scientific understanding of how health systems can navigate profound uncertainty.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147983808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Paradigm Shift in Addressing Threats to Science.","authors":"Gian Piero Turchi, Eleonora Pinto, Luisa Orrù","doi":"10.1007/s10728-026-00568-z","DOIUrl":"10.1007/s10728-026-00568-z","url":null,"abstract":"<p><p>Current threats to science endangering global health are widely discernible, and the related discussion is ongoing. However, other speculations are progressively taking up the space of clinical debate. These narratives, belonging to ideological stances, take up spaces in daily life and hail different explanations and causes. The modalities through which such different instances and explanations are conveyed result in establishing a different reality of truth, regardless of the scientific debate. As a matter of fact, such modalities lead to an open-conflict structure that frames a discursive layout starting from an exclusive position when interacting. In response to this, we should act in terms of scientific sense, without considering the increasing influence of these narratives as a fact to struggle against, but rather evaluating the possibilities of generating and modifying the configurations of such discursive reality toward a common and shared goal, with pragmatic repercussions.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147785395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators of Clinical Guideline Implementation in Tertiary Care: A Systematic Literature Review.","authors":"Mina Azizzadeh, Sakineh Hajebrahimi, Ali Janati, Javad Babaie","doi":"10.1007/s10728-026-00566-1","DOIUrl":"https://doi.org/10.1007/s10728-026-00566-1","url":null,"abstract":"<p><p>Clinical guidelines (CGs) can improve the quality of care in tertiary hospitals-but only if they are actually used. Past reviews listed facilitators, but did not explain why some work and others fail. This review fills that gap by asking: Under what conditions do facilitators succeed? We systematically reviewed 6948 records (PubMed, Scopus, Web of Science, Magiran, SID) through Nov 2025, selecting 45 high-quality studies. Using the MMAT tool and analytical thematic synthesis, we looked beyond what works to how and when it works. We found that three groups-policymakers, developers, and implementers-must work together in a cycle. Crucially, their actions only succeed under specific conditions: leadership helps only when it is visible, supported by resources, and accountable-not when it is top-down only, CGs are used more when they fit into daily workflow (e.g., emergency kits)-not just when they are simple or short, policies succeed only when paired with practical support (e.g., payment for guideline-based care, feedback systems). We also found that different health systems need different strategies: centralized systems need strong policy integration; high-autonomy settings need peer-led change; resource-limited settings need simple, adaptable tools. Successful implementation is not about more facilitators-but about better-aligned ones. We recommend a shift from top-down orders to collaborative, context-aware planning, where frontline staff, managers, and policymakers co-design solutions.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Challenges of Hypertension Mass Screening Programs: A Scoping Literature Review.","authors":"Javad Babaie, Nazila Azizi, Leila Doshmangir, Amir Yaghubzadeh Khoei","doi":"10.1007/s10728-026-00565-2","DOIUrl":"10.1007/s10728-026-00565-2","url":null,"abstract":"<p><p>One of the recently implemented strategies for hypertension screening is mass screening. It involves the examination of asymptomatic individuals who are at risk for a disease, typically conducted on a large scale across entire population groups. The successful implementation of these programs can facilitate cost-effective management of hypertension within health systems. This study aims to identify the challenges faced by hypertension mass screening programs worldwide. In this scoping review, data were collected by searching relevant keywords on Hypertension, screening and mass screening in the PubMed, Scopus, and Web of Knowledge databases, as well as through manual searches in journals, gray literature, and reference checks, up to the end of October of 2025. EndNote X8 was utilized to manage and screen the studies. The study was not limited to specific population groups, although screening for hypertension. Screening, selection, and analysis of articles were conducted by at least three researchers. Based on the results of 15 studies included from a total of 18,697 identified studies, the challenges to implementing hypertension mass screening programs were classified into 15 subcategories and three categories: Patients related challenges, Health systems related challenges and contextual challenges. While some health systems conduct national mass screening for hypertension, it is important to recognize that this process incurs significant implementation challenges. Therefore, before undertaking programs, it is essential to estimate and allocate the necessary budget. Address potential financial challenges and constraints proactively. Clearly and precisely define the protocol to be followed during the screening process. Train all personnel involved in the screening on this protocol. Develop a digital, user-friendly tool utilizing existing resources to record screening data.</p>","PeriodicalId":46740,"journal":{"name":"Health Care Analysis","volume":" ","pages":""},"PeriodicalIF":1.4,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147700293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"哲学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}