medRxiv - Health Systems and Quality Improvement最新文献

{"title":"Patient involvement in the biopsychosocial model of care integrated with primary health services: Experience from three health districts in South Kivu, Democratic Republic of Congo","authors":"Bertin Mutabesha Kasongo, Christian Eboma Ndjangulu Molima, Gérard Jacques Mparanyi, Samuel Lwamushi Makali, Pacifique Lyabayungu Mwene-Batu, Albert Mwembo Tambwe, Hermès Karemere, Ghislain Balaluka Bisimwa, Abdon Mukalay wa Mukalay","doi":"10.1101/2024.09.05.24313096","DOIUrl":"https://doi.org/10.1101/2024.09.05.24313096","url":null,"abstract":"Introduction: Involving people in the provision of care and in decision-making about their health is one of the keys to success and to improving service delivery in the provision of quality health care. Patient involvement in the biopsychosocial model of care is poorly documented in the Democratic Republic of Congo (DRC). The aim of this study is to describe patients' involvement in the choice of their health policy, their responsibility in holistic care and their capacity to support the biopsychosocial model.\u0000Methods: This qualitative research was conducted in three health districts in the province of South Kivu, DRC. Using a tool inspired by the International Alliance of Patients' Organizations' Declaration of Patient-Centered Healthcare, we conducted 27 individual interviews between February and April 2024. These interviews concerned people in complex situations, attending health centers and belonging to patient clubs in six health areas covered by the study. A content analysis of the discourse from the various interviews was carried out.\u0000Results: Patient involvement in the biopsychosocial model of care depended on multiple factors, including relational aspects (partnership between providers and patients, discussion of therapeutic possibilities and guidance for choice), educational aspects (advice and teaching received from caregivers, development of skills), empowerment (responsibility for care), organizational aspects (inclusive and participatory planning, access to different health services) and community aspects (role of entourage and patient clubs).\u0000Conclusions: The various factors influencing patient involvement in the BPS model should be taken into account in the definition of policies and the process of integrating biopsychosocial care. Some of the strategies suggested to support the model, such as raising awareness of the humanization of care, improving the availability of resources and strengthening financial autonomy, will help to improve the quality of care and accessibility to quality health services.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating and Addressing Demographic Disparities in Medical Large Language Models: A Systematic Review","authors":"Mahmud Omar, Vera Sorin, Donald U Apakama, Ali Soroush, Ankit Sakhuja, Robert Freeman, Carol R Horowitz, Lynne D Richardson, Girish Nadkarni, Eyal Klang","doi":"10.1101/2024.09.09.24313295","DOIUrl":"https://doi.org/10.1101/2024.09.09.24313295","url":null,"abstract":"Background: Large language models (LLMs) are increasingly evaluated for use in healthcare. However, concerns about their impact on disparities persist. This study reviews current research on demographic biases in LLMs to identify prevalent bias types, assess measurement methods, and evaluate mitigation strategies.\u0000Methods: We conducted a systematic review, searching publications from January 2018 to July 2024 across five databases. We included peer-reviewed studies evaluating demographic biases in LLMs, focusing on gender, race, ethnicity, age, and other factors. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tools. Results: Our review included 24 studies. Of these, 22 (91.7%) identified biases in LLMs. Gender bias was the most prevalent, reported in 15 of 16 studies (93.7%). Racial or ethnic biases were observed in 10 of 11 studies (90.9%). Only two studies found minimal or no bias in certain contexts. Mitigation strategies mainly included prompt engineering, with varying effectiveness.\u0000However, these findings are tempered by a potential publication bias, as studies with negative results are less frequently published.\u0000Conclusion: Biases are observed in LLMs across various medical domains. While bias detection is improving, effective mitigation strategies are still developing. As LLMs increasingly influence critical decisions, addressing these biases and their resultant disparities is essential for ensuring fair AI systems. Future research should focus on a wider range of demographic factors, intersectional analyses, and non-Western cultural contexts.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online group-based Acceptance and Commitment Therapy for stroke survivors: a study of fidelity of delivery within the Wellbeing After Stroke study","authors":"Hannah Foote, Audrey Bowen, Sarah Cotterill, Emma Patchwood","doi":"10.1101/2024.09.05.24313107","DOIUrl":"https://doi.org/10.1101/2024.09.05.24313107","url":null,"abstract":"<strong>Objectives</strong> To explore whether practitioners can deliver the Acceptance and Commitment Therapy-based Wellbeing After Stroke intervention with fidelity to both the clinical protocol and the Acceptance and Commitment therapy model.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomedical engineers density indicator per hospital beds","authors":"Luis G. Ayala","doi":"10.1101/2024.09.05.24313063","DOIUrl":"https://doi.org/10.1101/2024.09.05.24313063","url":null,"abstract":"A biomedical engineers density indicator per hospital beds (<strong><em>ϱ</em></strong>BEhb) is presented. It calculates the ratio between the number of biomedical engineers providing professional services within the hospital setting, either as internal staff or mixed staff as reported by the World Health Organization, and the available hospital beds in a health system for a specific year.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of COVID-19 Lockdowns on Mental Health: A Comparative Study","authors":"Kfir Orgad","doi":"10.1101/2024.09.02.24312962","DOIUrl":"https://doi.org/10.1101/2024.09.02.24312962","url":null,"abstract":"The COVID-19 pandemic led to unprecedented global lockdowns aimed at controlling the spread of the virus. While effective in reducing transmission, these lockdowns have had significant repercussions on mental health. This study examines the prevalence and incidence of mental health problems during the COVID-19 lockdowns, comparing countries that implemented strict lockdown measures with those that did not. Using statistical analysis, we demonstrate that lockdowns are associated with a statistically significant increase in mental health issues. These findings suggest that public health policies during pandemics must balance the physical and mental health needs of the population.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"56 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety During Night Duty: Survey of 3885 Doctors Across India","authors":"Rajeev Jayadevan, Deepa Augustine, TS Anithadevi, Reshmi Ramachandran, Joseph Benaven","doi":"10.1101/2024.09.03.24312775","DOIUrl":"https://doi.org/10.1101/2024.09.03.24312775","url":null,"abstract":"<strong>Background</strong> Reports of violence against doctors at the workplace are on the rise. In August 2024, a young female doctor was raped and murdered during night duty at her workplace in Kolkata, India. This incident prompted nationwide protests and a service shutdown by doctors’ organizations advocating for improved workplace safety.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"104 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Guidance for the Reporting of Bibliometric Analyses: A Scoping Review","authors":"Jeremy Y. Ng, Henry Liu, Mehvish Masood, Niveen Syed, Dimity Stephen, Ana Patricia Ayala, Michel Sabe, Marco Solmi, Ludo Waltman, Stefanie Haustein, David Moher","doi":"10.1101/2024.08.26.24312538","DOIUrl":"https://doi.org/10.1101/2024.08.26.24312538","url":null,"abstract":"Despite the growth in the number of bibliometric analyses published in the peer-reviewed literature, few articles provide guidance on methods and reporting to ensure reliability, robustness, and reproducibility. Consequently, the quality of reporting in existing bibliometric studies varies greatly. In response, we are developing a preliminary Guidance List for the repOrting of Bibliometric AnaLyses (GLOBAL), a reporting guideline for bibliometric analyses. This paper outlines a scoping review that aims to identify and categorise bibliometric recommendations from the literature to develop an initial list of candidate items for the GLOBAL. Five bibliographic databases, three preprint servers, and grey literature were systematically searched. Twenty-three out of 48,750 records fulfilled the inclusion criteria. Six documents contained bibliometric reporting recommendations based on a complete or partial literature review; all other sources (n = 17) contained opinion-based recommendations. A 32-item recommendation list that will inform the development of the GLOBAL was created. A paucity of evidence-based studies on bibliometric reporting exists in the literature, supporting the need to create a reporting guideline for bibliometric analyses. The next step in the GLOBAL project will focus on conducting a two-round Delphi study to achieve consensus on which of the 32 items should be included in GLOBAL.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rapid Assessment of Mortality Surveillance in Uganda, 2024","authors":"Marie Gorreti Zalwango, Caroline Kyozira, Mariam Nambuya, Martin Bulamu, Allan Muruta","doi":"10.1101/2024.08.28.24312727","DOIUrl":"https://doi.org/10.1101/2024.08.28.24312727","url":null,"abstract":"Background: Mortality surveillance aids in identifying and addressing their causes allowing health systems to adapt and respond effectively. This rapid assessment aimed to create awareness on the state of mortality surveillance in Uganda, highlight existing gaps and provide recommendations required for an improved mortality system hence the eventual improvement of public health in the country.\u0000Methods: An assessment of mortality surveillance in Uganda was conducted from November 2023 to June 2024 through data reviews and plenary discussions engaging various stakeholders in Uganda. Eight (8) workshops/meetings were conducted over a period of eight months to generate information on mortality data sources, processes of data generation and challenges affecting the system. Reports generated from the meetings and workshops were summarized and presented as descriptive narratives. Data from DHIS2 was analyzed using excel and presented using charts and tables.\u0000Results: The rapid assessment of mortality surveillance in Uganda highlighted opportunities for improved mortality surveillance through the existence of various sources of data. It was highlighted that 66.9% of the death occur in communities, however, there is a major data completeness gaps where sub-optimal data from the community is feed into the national health statistics database (DHIS2) to enable stakeholder analysis and utilization. Furthermore, a number of data quality issues were identified in the health facility generated data where 33% of the deaths occur. These include: data completeness where the national referral specialized health institutes do not feed their data into the national data base, late reporting and the lack of coordination and standardization of reporting among the various partners.\u0000Conclusion: The existence of structures to conduct mortality surveillance in Uganda presents an opportunity for improved mortality surveillance despite the highlighted gaps and challenges. Adoption of strategies aimed to enable the successful implementation of an efficient mortality surveillance program like: strengthening governance and operations of death reporting activities, establishing a clear definition of institutional roles and responsibilities, raising awareness and advocacy at all levels, building technical capacities, improving allocation of resources, and leveraging on shared interests by both implementing and development partners could improve mortality surveillance and the health of the population through utilization of the generated data.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142224139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DEVELOPMENT AND CROSS-VALIDATION OF A SHORT QUESTIONNAIRE TO EVALUATE SELF-REPORTED POSITIVE HEALTH; A CROSS SECTIONAL PANEL STUDY OF STRUCTURAL VALIDITY AMONG A GENERAL DUTCH POPULATION","authors":"Lenny M.W. Nahar-van Venrooij, Margot J. Metz, Marja van Vliet, Vera P. van Druten, Babette C. van der Zwaard","doi":"10.1101/2024.08.26.24312579","DOIUrl":"https://doi.org/10.1101/2024.08.26.24312579","url":null,"abstract":"Objectives: In this study it was aimed to further develop and cross-validate a short questionnaire to measure self-reported Positive Health in general (Dutch) populations for evaluative purposes, stemming from the original 42 items of the My Positive Health dialogue tool (MPH). Positive Health refers to ′health from the perspective of patients and citizens′ following the concept of Huber et. al. Design and setting: A cross sectional study was performed among a panel representative for the general adult Dutch population living at home. Participants: Response rate was 76%, 1327 of a total of 2457 respondents were female, and mean age (year) was 53.3 ± 17.8. Methods: First, item reduction was carried out through content discussions following statistical output retrieved from factor structures and loadings, inter-item correlations (IIC) and internal consistency (Cronbach′s alphas). Next, among the other half of the study population, measurement properties for the developed short questionnaire were calculated using goodness of fit indices from confirmatory factor analyses (CFA). Results: The item reduction process (n=1199) resulted in a questionnaire of 22 items (PH22) with a four-factor structure and explained variance of 62.4%. Cronbach′s alphas were 0.84, 0.92, 0.81, and 0.78 for the renamed factors ′Physical fitness′ (5 items), ′Contentment with life′ (9 items), ′Daily life management′ (5 items) and ′Future perspective′ (3 items), respectively. Cross validation (n=1258) showed adequate goodness of fit indices of the PH22, based on both first- and second-order CFA. The scores of the PH22 were normally distributed. No floor or ceiling effects were present. Conclusions: A short 22 item questionnaire to measure self-reported Positive Health in a general (Dutch) population for evaluative purposes such as scientific or policy research at Positive Health or patient-centered interventions was developed and cross-validated, named PH22. This study supports its structural validity. To use this questionnaire in practice its test-retest reliability and responsiveness should be known also. Future research has to reveal this.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A framework for chronic care quality: results of a scoping review and Delphi survey","authors":"Grace Marie V. Ku, Willem Van De Put, Mohamed Ali Ag Ahmed, Deogratias Katsuva, Megumi Rosenberg Kano, Bruno Meessen","doi":"10.1101/2024.08.21.24312364","DOIUrl":"https://doi.org/10.1101/2024.08.21.24312364","url":null,"abstract":"Frameworks conceptualising quality of care abound and vary; some concentrate on specific aspects (e.g., safety, access, effectiveness), others all-encompassing. However, to our knowledge, tailoring to systematically arrive at a comprehensive care for chronic conditions quality (CCCQ) framework has never been done. We conducted scoping review and Delphi survey to produce a CCCQ framework, comprehensively delineating aims, determinants and measurable attributes.\u0000With the assumption that specific groups (people with chronic conditions, care providers, financiers, policy-makers, etc) view quality of care differently, we analysed 48 scientific and 26 grey literature deductively and inductively using the Institute of Medicine quality of care framework as the foundation. We produced a zero-version of the quality of chronic care framework, detailing aims, healthcare system determinants, and measurement mechanisms. This was presented in a Delphi survey to 49 experts with diverse chronic care expertise/experience around the world. Consensus was obtained after the first round, with the panel providing suggestions and justifications to expand the agreed-upon components. Through this exercise, a comprehensive CCCQ framework encompassing the journey through healthcare of people with chronic conditions was developed. The framework specifies seven CCCQ aims and identifies health system determinants which can be acted upon with organising principles and measured through chronic care quality attributes related to structures, processes and outcomes. Tailoring quality of care based on the nature of the diseases/conditions and considering different views can be done to ensure a comprehensive offer of healthcare services, and towards better outcomes that are acceptable to both the health system and PwCCs.","PeriodicalId":501556,"journal":{"name":"medRxiv - Health Systems and Quality Improvement","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142185084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}