Research in health services & regions最新文献

{"title":"Educational differences in cancer incidence, stage at time of diagnosis, and survival in Norway.","authors":"Kenz Al-Shather, Yngvar Nilssen, Inger Kristin Larsen, Erlend Hem, Berit Horn Bringedal","doi":"10.1007/s43999-025-00075-z","DOIUrl":"10.1007/s43999-025-00075-z","url":null,"abstract":"<p><strong>Aim: </strong>The study investigates differences in cancer incidence, stage, and survival between municipalities with varying levels of education in Norway. It replicates the design of a similar study conducted in Oslo to assess whether similar patterns are present nationwide.</p><p><strong>Method: </strong>We used aggregated data from the Cancer Registry of Norway (2014-2023) to calculate age-standardized incidence rates, stage at diagnosis, and five-year relative survival for colon, rectal, lung, melanoma, breast, and prostate cancer across municipalities. Municipalities were grouped by educational level (low, medium, high), and outcomes were compared.</p><p><strong>Results: </strong>The study included 191,213 cases. Age-standardized incidence rates (per 100,000 person-years) differed significantly by education for all cancer types except breast cancer (p = 0.70). Melanoma and breast cancer incidence was highest in high-education areas (melanoma: 45.2 vs. 36.9; breast: 135.6 vs. 120.3), while lung cancer was highest in low-education areas (64.4 vs. 56.3). Colon, rectal, and prostate showed smaller but significant differences (colon: 54.7 vs. 54.5, p < 0.001; rectal: 24.5 vs. 25.9, p < 0.001; prostate: 189.8 vs. 191.5, p < 0.001). Low-education areas had the highest proportion of distant metastases for most cancers, with significant variation for lung (p = 0.003) and prostate (p < 0.001). Mid- or high-education areas more often had localized disease, except melanoma. Low-education areas had lower five-year relative survival, significant only for breast cancer (p = 0.037).</p><p><strong>Conclusion: </strong>Cancer incidence, stage, and survival varied between municipalities grouped by inhabitants' educational level. Findings align with those of the Oslo study, highlighting consistent education-related disparities in cancer outcomes nationwide.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping and managing geographic variation in elective surgeries through user-friendly data presentation: insights from Tuscany region.","authors":"Alessia Caputo, Milena Vainieri, Sabina Nuti","doi":"10.1007/s43999-025-00074-0","DOIUrl":"10.1007/s43999-025-00074-0","url":null,"abstract":"<p><p>Geographic variation in elective surgical procedures poses challenges to healthcare equity, efficiency, and resource allocation. This study investigates variation in 14 elective surgical procedures performed in Tuscany, Italy, in 2022, focusing on both regional and Local Health Authority levels. Using hospital discharge data, we calculated treatment rates and the Systematic Component of Variation (SCV) to quantify unwarranted variation, applying McPherson et al. (1996)'s thresholds for interpretation. Results revealed substantial differences across procedures, with low SCVs for hip replacement and inguinal hernia repair, and very high SCVs for vein stripping and coronary artery bypass grafting. To support interpretation and governance, we developed a graphical tool that visually represents SCV levels using an intuitive, color-coded format. The tool was designed to reduce the uncertainty healthcare professionals often face when interpreting variation without clear clinical benchmarks, helping them distinguish between acceptable and potentially unwarranted differences. It was presented during the 2023 Tuscan Performance Evaluation System event and pilot-tested in 2025 with 23 healthcare professionals. The tool improved participants' ability to identify the most appropriate level of governance for action and increased confidence in understanding variation patterns. This study offers a replicable model for analyzing variation and demonstrates the value of user-friendly data visualizations in supporting informed, equity-oriented healthcare decisions. Further validation is recommended to assess long-term impact.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12440846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of COVID-19 and other determinants on the reduction of non-urgent emergency department access in North-East Italy: does supply affect demand?","authors":"Michele Gobbato, Federico Vola, Ivana Burba, Luca Lattuada, Laura Regattin","doi":"10.1007/s43999-025-00073-1","DOIUrl":"10.1007/s43999-025-00073-1","url":null,"abstract":"<p><p>This study examines the impact of the COVID-19 pandemic on non-urgent emergency department (ED) utilizzation in Friuli Venezia Giulia, Italy, comparing the pre-COVID (2019) and COVID (2021) periods. A retrospective observational analysis at the municipal level assessed admission rates of non-urgent patients, identified by \"white code\" triage. Variables analyzed included driving time to the nearest ED, altitude, and the effect of closing first intervention points. Results showed a significant 31% reduction in non-urgent ED visits from 2019 to 2021, with a mean reduction of 37.8% in municipalities affected by ED closures. A multivariate linear model showed that increased driving time and higher pre-pandemic admission rates were both associated with greater reductions in access, while altitude showed a positive correlation with access rates. The findings suggest that service supply limitations, such as ED closures, significantly reduce non-urgent ED utilization, especially in lowland and hilly areas, but less so in mountainous regions.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12401819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Patients potentially in need for palliative care in Germany-A regional small-area estimation based on death registry data.","authors":"Daniela Gesell, Farina Hodiamont, Claudia Bausewein, Eva Grill, Daniela Koller","doi":"10.1007/s43999-025-00072-2","DOIUrl":"10.1007/s43999-025-00072-2","url":null,"abstract":"","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12367587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The PopGrouper as a tool for morbidity adjustment in regional comparisons of health care: an analytical framework.","authors":"Anika Kreutzberg, Chrissa Tsatsaronis, Thomas G Grobe, Wilm Quentin, Reinhard Busse","doi":"10.1007/s43999-025-00068-y","DOIUrl":"10.1007/s43999-025-00068-y","url":null,"abstract":"<p><strong>Background: </strong>Analyzing regional variations can help improve equity, efficiency, and quality in health care provision. The PopGrouper is a population-based classification system which classifies persons with similar health care needs into distinct groups. It exhibits a high degree of morbidity differentiation. We present an analytical framework to use the PopGrouper in examining regional variations across different outcomes and populations using routine patient-level data.</p><p><strong>Methods: </strong>We develop a two-step empirical strategy to examine the relative regional performance on a set of efficiency and quality outcomes (e.g., hospital bed days, cost of care, mortality). First, we propose PopGroup-standardized observed-to-expected ratios to compare regional performance. Second, we develop a multilevel regression model to separately estimate regional variation related to patient need measured by the PopGroup and variation related to regional characteristics.</p><p><strong>Results: </strong>We provide an analytical framework that demonstrates the PopGrouper's application as a tool for morbidity adjustment in the assessment of relative regional performance in efficiency and quality outcomes and the regional characteristics that explain this performance. We provide suggestions for empirical notation, interpretation of results, and graphical analyses of findings. The developed framework will be applied in subsequent empirical papers.</p><p><strong>Conclusion: </strong>This paper sets the analytical foundations to be applied in regional comparative analyses using the PopGrouper allowing for conclusions about unexplained variations in quality and efficiency of health care.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12325817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144791696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors associated with institutional delivery in south Asian countries: evidence from five recent demographic and health surveys.","authors":"Sifat Muntaha Soni, Md Ismail Hossain, Salma Akter, Shahjadi Ireen, Shuvongkar Sarkar, Shahanaj Parvin, Mansura Begum, Rebeka Sultana","doi":"10.1007/s43999-025-00071-3","DOIUrl":"10.1007/s43999-025-00071-3","url":null,"abstract":"<p><strong>Background: </strong>Maternal and infant mortality is a major public health concern especially in South Asian nations. A significant proportion of mothers and infant died as a result of complications during birth. The delivery of healthcare facilities plays key role to lowering these mortality rates. The present study aimed to explore the prevalence of institutional delivery and its determinants in five South Asian countries.</p><p><strong>Methods: </strong>Data were extracted from five South Asian countries latest demographic and health survey data, including Afghanistan (2015), Bangladesh (2017-18), Nepal (2016), Myanmar (2015-16), and Pakistan (2017-18), all of which were pooled for the present study. A total of 38,975 women were included in this study after data handling. A multivariate binary logistic regression model was performed to identify the factors influencing institutional delivery.</p><p><strong>Results: </strong>More than half of all deliveries among the women were reported as occurring in a medical facility. The proportion of institutional deliveries was highest in Pakistan (68.80%), and lowest in Myanmar (40.60%). This study found that women who give birth at after 20 years' age had 1.25 times higher chance of getting healthy facility during delivery (OR 1.25, [1.19, 1.32]). The odds of institutional delivery were 2.18 times higher for highly educated women (OR 2.18, [1.89, 2.52]) and 2.88 times higher for rich women (OR 2.88, [2.70, 3.07]). The likelihood of getting his wife delivered in a hospital increased with the husband's education level. Women who accessed by any media showed 33% higher chance of getting healthy facility during child birth. Women who did not obtain ANC from a skilled provider had a reduced likelihood of selecting healthcare facility delivery by 71% (OR 0.29, [0.28, 0.31]) compared to women who did. Women who didn't take any health care decision by-self had 16% lower chance of getting institutional delivery facility than others. Most importantly, rural area in south Asian countries presented lower odds of receiving healthy facility during delivery (OR 0.63, [0.59, 0.68]).</p><p><strong>Conclusions: </strong>In conclusion, improving maternal health among South Asian countries requires addressing both individual and community-level factors. Women with higher education, better socioeconomic status, media exposure, and access to prenatal care are more likely to utilize medical services. Strengthening evidence-based health policies and ensuring strong leadership can enhance women's quality of life through better access to health care.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12316627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144762989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A closer look at regional differences in euthanasia practices in the Netherlands.","authors":"Wieke M R Ligtenberg, Theo A Boer, A Stef Groenewoud","doi":"10.1007/s43999-025-00069-x","DOIUrl":"10.1007/s43999-025-00069-x","url":null,"abstract":"<p><strong>Background: </strong>In research on practice variation, the body of knowledge on regional differences in the incidence of euthanasia is limited, and important questions have remained unanswered until now.</p><p><strong>Objective: </strong>This paper aims to gain insight in the differences between euthanasia practices in high-incidence regions and low-incidence regions, by looking at (potential differences in) a) patient characteristics; b) timelines and the process of euthanasia; c) the setting in which euthanasia takes place; and d) morally relevant themes.</p><p><strong>Methods: </strong>This explorative study uses a unique and fully anonymized dataset based on notes made by one of the authors (TAB) during a period of nine years in which he was an ethicist in a Dutch Euthanasia Review Committee. We analyzed these data using descriptive statistics and testing for statistical significance of differences in euthanasia practices in high-incidence regions and low-incidence regions.</p><p><strong>Results: </strong>Some significant differences were found between high and low-incidence regions. Compared to low-incidence regions, high-incidence regions were characterized by patients being older at time of death, a shorter time span between patients' first euthanasia request and their eventual death, patients more often having a GP as a consulting doctor, and euthanasia more frequently being the main dying means (as opposed to assisted suicide). The low incidence regions had somewhat younger patients, more patients with dementia, a longer life expectancy, more psychiatrists as consulting doctors, and more assisted suicides compared to the higher incidence regions.</p><p><strong>Conclusion: </strong>This study adds new insights to the existing literature on (regional differences in) end-of-life care, with a specific focus on euthanasia. Until now, euthanasia practices have mainly been studied at national levels. National data show significant differences between regions. The black box of local practices has not been opened before. Our results have implications for practice, as they may inform discussions on appropriate care at the end of life in general, and euthanasia in particular.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12287479/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients potentially in need for palliative care in Germany-A regional small-area estimation based on death registry data.","authors":"Daniela Gesell, Farina Hodiamont, Claudia Bausewein, Eva Grill, Daniela Koller","doi":"10.1007/s43999-025-00070-4","DOIUrl":"10.1007/s43999-025-00070-4","url":null,"abstract":"<p><strong>Background: </strong>Demographic change and the increasing prevalence of chronic illnesses lead to a higher demand for palliative care. Currently, little is known about potential need for palliative care at a small-area level in Germany. However, this is crucial for the planning of services. We aimed to calculate the proportion of the population potentially in need of palliative care on a small-area level and to illustrate the nationwide variations.</p><p><strong>Methods: </strong>Retrospective cross-sectional study based on causes of death statistics in Germany. Causes of death of all adult deceased in Germany in 2022 were included. The potential need for palliative care was identified based on Murtagh et al. (2014) using ICD-10-codes. Geographic variation was analyzed on district level.</p><p><strong>Results: </strong>1,062,452 persons were documented in the causes of death statistics, of which 752,643 died with a potential palliative care need (70.8%). Overall mean age was 79.5 years (SD 12.7), 50.1% were female (n = 532,248). Most deaths were due to neoplasms (23,675; 22.6%) and cardiovascular diseases (230,338, 21.7%). The numbers of deceased with potential need per 100,000 inhabitants varied between districts from 578 to 1,438, with highest values in districts in Saxony, Thuringia, Saxony-Anhalt, and lowest in Bavaria and Baden-Wuerttemberg.</p><p><strong>Discussion: </strong>Our definition of potential palliative care need included both deaths due to oncological diseases, who commonly receive palliative care, and non-oncological conditions. The findings highlight the regional differences in potential palliative care need on small-area level and the importance of comprehensive healthcare planning adapted to the specific needs of individuals.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12254454/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower ambulatory care availability and greater hospital capacity are associated with higher hospital case volumes.","authors":"Doreen Müller, Manas K Akmatov, Dominik Graf von Stillfried","doi":"10.1007/s43999-025-00066-0","DOIUrl":"10.1007/s43999-025-00066-0","url":null,"abstract":"<p><strong>Introduction: </strong>The German hospital reform introduces population-based planning to allocate hospital budgets, considering each hospital's role in meeting regional care needs. However, current hospital case numbers may reflect supply-side factors, such as physician density and socioeconomic disparities, rather than actual morbidity. Ambulatory care utilization inversely correlates with hospital usage, emphasizing the need to integrate ambulatory sector data into hospital planning. This study examines factors influencing hospital and office-based case numbers at the district level.</p><p><strong>Methods: </strong>Linking 2021 data from the Federal and State Statistical Offices, INKAR data and health insurance claims data in Germany at the district level, a multiple linear regression model assessed the association between case counts in hospitals or office-based practices per 10,000 residents and distance to the nearest general practitioner (GP), as well as hospital bed and GP density. The Global Moran's I as well as a geographically weighted regression (GWR) analysis were conducted to assess regional differences.</p><p><strong>Results: </strong>Multiple linear regression revealed that greater GP distance, fewer GPs and more hospital beds were linked to more hospital cases, while office-based cases rose with shorter GP distance. Global Moran's I confirmed spatial clustering, and GWR revealed heterogeneous effects of primary-care access on hospital admissions, whereas bed capacity uniformly increased hospital cases and shorter GP distances consistently predicted more office visits across Germany.</p><p><strong>Discussion: </strong>Our findings align with research showing supply-induced demand of hospital cases and emphasize the need for coordinated hospital and ambulatory care planning to improve access, reduce unnecessary hospital admissions, and optimize patient outcomes.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12151972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical variations and potential low-value neuroimaging examinations in Norway from 2013 to 2022.","authors":"Ingrid Øfsti Brandsæter, Jan Porthun, Eivind Richter Andersen, Bjørn Morten Hofmann, Elin Kjelle","doi":"10.1007/s43999-025-00065-1","DOIUrl":"10.1007/s43999-025-00065-1","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the variations in the use of neuroimaging over time and across geographical regions and to investigate the use of two potential low-value neuroimaging examinations for all imaging in an entire country (Norway), including both inpatient and outpatient services from 2013 to 2022.</p><p><strong>Method and methods: </strong>Data on neuroimaging for outpatients was collected from the Norwegian Health Economics Administration, and inpatient data were collected from individual Hospital Trusts (HT) in Norway. The data were analysed using descriptive statistics.</p><p><strong>Results: </strong>On average, 413,303 (786 per 10,000 inhabitants) neuroimaging examinations were performed annually in Norway. Overall, the use increased by 16% during the study period. Substantial geographical variations were found both in general and for the two potential low-value neuroimaging examinations; Brain Magnetic Resonance Imaging (MRI) and Head Computed Tomography (CT). For general neuroimaging, the HT with the highest use performed twice as many examinations as the HT with the lowest use per inhabitant. For the potential low-value neuroimaging examinations, the HTs with the highest use performed two and three times as many examinations as the HTs with the lowest use per inhabitant.</p><p><strong>Conclusion: </strong>There was temporal and geographical variation in the general use of neuroimaging and the use of the two potential low-value examinations, Brain MRI and Head CT. In Norway, the estimated annual cost of low-value neuroimaging examinations is about EUR 4.0 million. Reducing the use of low-value imaging would free up resources for examinations of high value.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12095830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}