Research in health services & regions最新文献

{"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}

{"title":"Maternal healthcare utilisation, women empowerment, and delivery care: geographical variations in India.","authors":"Prachi Verma, Ningombam Sanjib Meitei, Sanjram Premjit Khanganba","doi":"10.1007/s43999-025-00063-3","DOIUrl":"https://doi.org/10.1007/s43999-025-00063-3","url":null,"abstract":"<p><p>This study utilises the National Family Health Survey- 5 (NHFS-5) data to compare performance in three key indicators called pillars of maternal health, namely-Maternal Healthcare Utilisation (MHU), Women Empowerment (WE), and Delivery Care (DC) across six zones of India: East, West, North, South, Central, and Northeast. It employs the Statistical Performance Index (SPI) by the World Bank to calculate zonal scores for the pillars. Univariate and multivariate statistical analyses reveal significant zonal disparities in all the three pillars (MHU: p < .001, WE: p < .002, and DC: p < .010). Northeast zone has the lowest MHU score (M = 56.52) and the second-lowest DC score (M = 46.60), despite having the second highest WE score (M = 66.37), only behind the South zone which leads in all pillars (MHU; M = 80.38, WE; M = 69.21, and DC; M = 57.60). WE accounts for only a small part of the variability in MHU (R²= .166), indicating that WE alone is insufficient to improve MHU outcomes. This study emphasises the need for further exploration of factors such as difficult terrains and low hospital density, especially in the Northeast zone.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12055738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045963","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":"Advancing health equity in Nova Scotia by exploring gaps in healthcare delivery: a mixed methods protocol.","authors":"Jennifer Lane, Neda Alizadeh, Christine Cassidy, Neil Forbes, Holly McCulloch, Katrina Jarvis, Helen Wong, Courtney Pennell, Lori Wozney, Kris Lane, Brittany Barber, Kelly Lackie, Bukola Oladimeji, S M Kawser Zafor Prince, Drew Burchell, Noah Doucette, Cyril O'Brien, Wyatt LeRoy, Kendra MacEachern, Elizabeth Obeng Nkrumah, Joshua Edward, Arezoo Mojbafan, Megan White, Tatianna Beresford, Janet Curran, JianLi Wang, Marilyn Macdonald","doi":"10.1007/s43999-025-00062-4","DOIUrl":"https://doi.org/10.1007/s43999-025-00062-4","url":null,"abstract":"<p><p>Population health issues are addressed by various regional initiatives in the Canadian province of Nova Scotia (NS). A need for research on the root causes of health inequities suggests there may be a lack of evidence to inform current initiatives within the region. To address this gap, a three-phase sequential mixed methods study called Advancing Health Equity in NS by Exploring Gaps in Healthcare Delivery will operationalize Intersectionality Theory and employ an integrated knowledge translation approach to identify and explore gaps in health service delivery. This will promote a better understanding of how to improve the integration of health equity in health service and delivery systems and thus population health and well-being. The following objectives will be addressed in each phase: 1) create an inventory of NS-relevant knowledge that relates to health equity, 2) examine the integration of health equity in NS health service and delivery systems using a context-specific health equity lens, and 3) mobilize knowledge on how gaps in service delivery can be addressed to improve the integration of health equity and better meet the needs of people living in NS. The study results from this protocol will be used to integrate health equity in NS health service and delivery systems, enhancing the quality of care for populations rendered vulnerable by structural inequalities, and working to prevent negative impacts to health and wellbeing.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12021763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144036005","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":"Sex-specific and regional differences in the prevalence of diagnosed autoimmune diseases in Germany, 2022.","authors":"Manas K Akmatov, Claudia Kohring, Frank Pessler, Jakob Holstiege","doi":"10.1007/s43999-025-00061-5","DOIUrl":"10.1007/s43999-025-00061-5","url":null,"abstract":"<p><strong>Background: </strong>Research on the epidemiology of autoimmune diseases is impeded due to the rarity of most autoimmune diseases. We aimed to assess the prevalence of diagnosed autoimmune diseases in Germany and examine their sex-specific and regional differences.</p><p><strong>Methods: </strong>A cross-sectional study using the nationwide ambulatory claims data of females and males of any age with statutory health insurance from 2022 was designed (N = 73,241,305). Autoimmune diseases were identified by diagnostic codes of the International Classification of Diseases and Related Health Problems, 10th Revision, German Modification (ICD-10-GM). Regional differences were examined at the level of urban and rural districts (N = 401). To control for demographic differences across districts we applied the direct standardization method to calculate sex- and age-standardized prevalences with the German population in 2022 used as a standard population. Furthermore, we calculated prevalence ratios (PR) and 99% confidence intervals (99% CI) to examine sex differences.</p><p><strong>Results: </strong>Of 73,241,305 insurees (median age, 45; interquartile range, 26-63 years), 6,307,120 had at least one (any) autoimmune disease in 2022, corresponding to a crude prevalence of 8.61% (99% CI: 8.60-8.62%). Of all individuals with autoimmune diseases, 67% were females. The prevalence of single autoimmune diseases varied between 0.008% (pemphigus) and 2.3% (autoimmune thyroiditis). Other autoimmune diseases with a high prevalence were psoriasis (1.9%), rheumatoid arthritis (1.4%), and type 1 diabetes (0.75%). The prevalence was higher in females than males for 25 of the 31 autoimmune diseases with the highest PR observed for autoimmune thyroiditis (PR 5.92; 99% CI: 5.88-5.95), primary biliary cirrhosis (5.60; 5.36-5.84) and systemic lupus erythematosus (5.15; 4.97-5.36). Males were more likely to be diagnosed than females with type 1 diabetes (1.37; 1.36-1.39), ankylosing spondylitis (1.40; 1.39-1.43) and Guillain-Barré syndrome (1.31; 1.27-1.37). The only autoimmune disease without sex difference was myasthenia gravis (1.00; 0.97-1.03). At district level the age- and sex-standardized prevalence of at least one (any) autoimmune disease differed by a factor of nearly 2 between 5.91% and 11.62%. In general, the prevalence was higher in East (former GDR) than West (former FRG) Germany.</p><p><strong>Conclusion: </strong>Although most autoimmune diseases were rare, when considered as a whole, autoimmune diseases turned out to be more common than previously assumed, with one out of 12 individuals affected in Germany.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712719","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":"Practice variation in induction of labour: women's role in the decision-making process.","authors":"Anne E M Brabers, Tamar M Van Haaren-Ten Haken, Judit K J Keulen, Pien M Offerhaus, Marianne J Nieuwenhuijze, Judith D de Jong","doi":"10.1007/s43999-025-00059-z","DOIUrl":"10.1007/s43999-025-00059-z","url":null,"abstract":"<p><p>In the Netherlands, percentages of induction of labour (IOL) range from 14.3 to 41.1% in regional maternity care networks (MCNs). In this study, we focus on women's contribution in explaining this variation in range. We examine if different factors at the level of the individual woman (micro) and the level of the woman's social context (meso) are related to decision-making on IOL, and the variation. We used an online questionnaire inviting women counselled for IOL (n = 180, response rate 40%) from six different MCNs, three with a high and three with a low percentage of IOL. Factors included are, for example, attitude towards birth, reason for IOL, and social norms. Descriptive statistics and regression analyses were performed to examine the relation between the included factors and the intended decision on IOL. Our results show that only the factor women's attitude towards birth is related to the intended decision on IOL. The more women believe that birth is a medical process, the higher the odds that the intended decision is to induce labour. This may contribute to variation in IOL between individual women, but appears to contribute less to variation in IOL between MCNs. This is because the percentages of women with an intended decision for IOL do not differ within MCNs with a low or high percentage of IOL. A next step in explaining practice variation, is to examine mechanisms at the level of the individual healthcare provider (micro) and the MCN (meso).</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11836261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143451355","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 instrumental value of advance directives: lesson learned from the COVID-19 pandemic for policymaking.","authors":"Elisabeth Stock, Christian H Nickel, Bernice S Elger, Andrea Martani","doi":"10.1007/s43999-025-00060-6","DOIUrl":"10.1007/s43999-025-00060-6","url":null,"abstract":"<p><p>Open conversations between patients and healthcare professionals (HCP) are required to evaluate which treatments are reasonable for the individual case, especially towards the end of life. Advance Care Planning (ACP), which often results in drafting an Advance Directive (AD), is a useful tool to help with decisions in these circumstances, but the rate of AD completion remains low. During the COVID-19 pandemic, ACP and AD gained popularity due to the alleged advantage that they could facilitate resource allocation, to the benefit of public health. In this article, which presents a theoretical reflection grounded in scientific evidence, we underline an even stronger ethical argument to support the implementation of AD in end-of-life care (eol-C) i.e. the instrumental value at the individual level. We show, with particular reference to lessons learned from the COVID-19 pandemic, that AD are instrumentally valuable in that they: (1) allow to thematise death; (2) ensure that overtreatment is avoided; (3) enable to better respect the wish of people to die at their preferred place; (4) help revive the \"lost skill\" of prognostication. We thus conclude that these arguments speak for promoting the territorially uniform implementation and accessibility of high-quality AD in care.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"4 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11799459/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191690","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":"Individual- and community-level correlates of intermittent preventive treatment of malaria in pregnancy in Ghana: further analysis of the 2019 Malaria Indicator Survey.","authors":"Jacob Owusu Sarfo, Patience Fakornam Doe, Dickson Okoree Mireku","doi":"10.1007/s43999-024-00058-6","DOIUrl":"10.1007/s43999-024-00058-6","url":null,"abstract":"<p><strong>Background: </strong>Ghana adopted the policy on Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) in 2004. Notwithstanding the government's and other stakeholders' efforts in Ghana, optimal uptake (three or more doses of IPTp-SP) has slightly declined since 2016. The study examined the individual and community-level correlates of pregnant women who take optimal or none/partial doses (less than three doses) of IPTp-SP using the Ghana Malaria Indicator Survey (GMIS) 2019.</p><p><strong>Methods: </strong>We conducted a secondary analysis of the GMIS 2019 data. Our analytical sample included 1,151 women aged 15-49 with their most recent birth in the last two years before the survey.</p><p><strong>Results: </strong>The overall uptake among participants was approximately 8.2% for none, 30.15% for 1-2 (partial), and 61.6% for 3 or more (optimal) doses of IPTp-SP. The level of uptake differs depending on the individual rather than community-level characteristics of pregnant women. Individual-level demographic factors- residents in Upper East (OR 3.0, 95% CI; 1.2-7.3) and Upper West (OR 5.3, 95% CI; 1.9-14.7) -and health-related factors-the four or more antenatal (ANC) visits (OR 3.3, 95% CI; 1.8-6.0) were associated with optimal IPTp-SP uptake among pregnant women in Ghana. However, late scheduling of the first ANC visit in the second trimester (OR 0.7, 95% CI; 0.5-1.0)- predicted less IPTp-SP uptake.</p><p><strong>Conclusions: </strong>Few regions (Upper East and West) are doing better than the capital, Greater Accra Region, in terms of optimal uptake. Also, early scheduling of ANC in the first trimester and increased ANC attendance are key for increased uptake. There is a need for policy, interventions, and research on malaria prevention in pregnancy to improve the decline in uptake.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"22"},"PeriodicalIF":0.0,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142879563","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":"What next for the Australian Atlas of Healthcare Variation series? Focusing the system on appropriate and sustainable health care.","authors":"Gillian Giles, Heather Buchan, Carolyn Hullick, Marge Overs, Anne Duggan","doi":"10.1007/s43999-024-00056-8","DOIUrl":"10.1007/s43999-024-00056-8","url":null,"abstract":"<p><p>Mapping, identifying and reducing unwarranted healthcare variation is integral to improving the appropriateness of care - minimising wasteful or unnecessary care and redirecting care to those who could benefit most (J Eval Clin Pract 26: 687-696, 2020). The Australian Atlas of Healthcare Variation series has examined variation in healthcare use since 2015. The findings reported in the Atlas series have led to important system changes. National safety and quality standards, mandatory for all hospitals and day procedure services, now require health service organisations to monitor and investigate variation and address unwarranted variation. Clinical care standards have been developed for clinical conditions in which the Atlas series has identified considerable variation. But the overuse of low-value care and underuse of high-value care persists, as suggested by the marked variation the Atlas series continues to uncover. We must now develop an approach that systematically links reporting of data and investigation of variation with a suite of responses to address unwarranted variation. This paper focuses on efforts to reduce low value-care, so that resources can be redirected to supporting high-value care as well as reducing waste and cutting carbon emissions from health care (Med J Aust 216: 67-68, 2022).</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11655825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142857449","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":"Socioeconomic and geographic variation in adjuvant chemotherapy among elderly patients with stage III colon cancer in Norway - a national register-based cohort study.","authors":"Elin Marthinussen Gustavsen, Stig Norderval, Liv Marit Dørum, Aina Balto, Ragnhild Heimdal, Barthold Vonen, Eva Stensland, Ellinor Haukland, Beate Hauglann","doi":"10.1007/s43999-024-00057-7","DOIUrl":"10.1007/s43999-024-00057-7","url":null,"abstract":"<p><strong>Background: </strong>About half of the patients diagnosed with colon cancer are 70 years or older. Standard treatment for stage III colon cancer is major surgical resection followed by adjuvant chemotherapy (ACT). Norwegian guidelines recommend initiation of ACT within 6 weeks after resection.</p><p><strong>Objective: </strong>This study investigated socioeconomic and geographic variation in the recommended provision of ACT to elderly patients with stage III colon cancer in Norway.</p><p><strong>Methods: </strong>This population-based retrospective cohort study included patients aged 70 years or older diagnosed with stage III colon cancer between 2011 and 2021 who underwent major surgical resection. Individual data were obtained from national registries. Multilevel logistic regression analysis was used to model variation in provision of ACT.</p><p><strong>Results: </strong>Of 4 501 included patients, 603 (13%) and 1 182 (26%) received ACT within 6 and 8 weeks after resection, respectively. The provision of ACT decreased with increasing age and frailty. Odds of ACT within 6 weeks decreased for patients with low socioeconomic status (SES) compared to high SES (odds ratio (OR) 0.67 (95% confidence interval (CI) 0.50-0.91)), and decreased for patients living alone compared to those living with a cohabitant (OR 0.72 (95% CI 0.58-0.91)). Geographic variation was found between hospital referral areas (OR 0.41-2.58).</p><p><strong>Conclusions: </strong>Our study found that ACT provision to elderly stage III colon cancer patients is associated with SES and geography, indicating variation in guidelines adherence. Further research is needed to explore the impact of ACT timing among elderly patients with stage III colon cancer in Norway.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11652436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840670","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":"Socioeconomic factors influencing rural-urban ambulance response time disparities in Connecticut.","authors":"Eashwar Krishna","doi":"10.1007/s43999-024-00055-9","DOIUrl":"10.1007/s43999-024-00055-9","url":null,"abstract":"<p><p>Across the U.S, it is a documented fact that rural areas have longer ambulance response times and tend to have lower median income. The objective of this study was to test if the rural-urban emergency medical service (EMS) response time disparity was related to wealth disparity in the state of Connecticut. All mean EMS response times were sourced from the 2016 Office of Emergency Medical Services Data Report. Rural definitions were sourced from the Connecticut Office of Rural Health. Median income data was drawn from the Connecticut Office of Policy and Management. A Mann-Whitney U test determined if the average rural EMS response time was greater than the non-rural EMS response time. Pearson coefficients quantified the relationship between median income and EMS response time. A t-test ascertained if the average median income differed between the two datasets. The mean EMS response time was 12.98 min (SD = 3.36) rural and 8.26 min (SD = 2.12) non-rural. Rural mean response time and median income were not significantly correlated (r = -.148, p=.247); non-rural mean response time and median income were also not significantly related. No significant disparity was detected (t=0.478, p=.633) between the mean rural household income ($98,258) and mean non-rural household income ($95,706). Significant disparities in EMS response times can exist between rural and non-rural towns separate from median income trends, as is the case in Connecticut. These findings may have limited generalizability because of Connecticut's relatively high median income as compared to other states yet may be relevant to states with similar economic metrics.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11615172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142776293","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}