Research in health services & regions最新文献

{"title":"Organisation and management of multi-professional care for cancer patients at end-of-life: state-of-the-art from a survey to community and hospital-based professionals.","authors":"Sara Zuccarino, Angela Gioia, Filippo Quattrone, Sabina Nuti, Michele Emdin, Francesca Ferrè","doi":"10.1007/s43999-024-00051-z","DOIUrl":"10.1007/s43999-024-00051-z","url":null,"abstract":"<p><p>Providing timely and satisficing End-of-Life care (EOLC) is a priority for healthcare systems since aging population and chronic diseases are boosting the global demand for care at end-of-life (EOL). In OECD countries the access to EOLC is insufficient. In Italy, the average rate of cancer patients assisted by the palliative care (PC) network at EOL was 28% in 2021, with high variability in the country. Among the Italian regions offering the best coverages, Tuscany has a rate of about 40%, but intraregional variation is marked as well. The study aims to explore the delivery of EOLC to adult cancer patients in public facilities in the Tuscany region through survey data collection among professionals. Two online surveys were delivered to Directors of community-based PC Functional-Units (FUs) and Directors of hospital-based medical-oncology units. All FU Directors responded to the survey (n = 14), and a response rate of 96% was achieved from hospital-unit Directors (n = 27). The results highlight the availability of numerous dedicated services, but reveal heterogeneity among and within organisations, including variations in the professionals involved, pathways, and tools adopted. Care continuity is supported by institutionalized collaboration between hospital and community settings, but hindered by fragmented care processes and heterogeneous transition pathways. Late referral to PC is perceived as a major constraint to EOLC. Developing structured pathways for patient transition to end-stage PC is crucial, and practices/processes should be uniformly implemented to ensure equity. Multi-professional care should be facilitated through tailored supporting tools. Both hospital-unit and FU Directors suggest developing shared pathways between organisations/professionals (82% and 80% respectively) and digital information sharing (61% and 80% respectively). Hospital and community-based professionals have similar perceptions about the concerns and challenges to EOLC provision in the region, but community-based professionals are more sensitive to the importance of improving communication on PC to the public and early discussing EOLC with caregivers. This finding suggests the need of enhancing hospital personnel's awareness about these issues. Professional training and the capacity to assess patients' needs and preferences should be improved. The identified needs can inform future research and interventions to improve the quality and outcomes of EOLC for cancer patients.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11461375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142396906","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":"Utilization of health-related data in the regional context for health service planning in the Federal State of Brandenburg, Germany-a qualitative study.","authors":"Charlotte M Kugler, Daniela Koller, Felix Muehlensiepen, Alexander Pachanov, Anna Kuehne, Dawid Pieper","doi":"10.1007/s43999-024-00050-0","DOIUrl":"https://doi.org/10.1007/s43999-024-00050-0","url":null,"abstract":"<p><strong>Background: </strong>Utilizing regional health data goes hand in hand with challenges: can they be used for health planning, are they applicable to the relevant topics? The study explores current data utilization and needs of stakeholders working in regional health services planning.</p><p><strong>Methods: </strong>We conducted 16 semi-structured expert-interviews with stakeholders of regional health planning in Brandenburg, a federal state in the north-east of Germany, by telephone or online-meeting tools between 05/2022 and 03/2023. The data were analysed according to qualitative content analysis.</p><p><strong>Results: </strong>Utilization of data sources depends on individual knowledge and personnel resources instead of being guided by standardized procedures. Interviewees primarily use internal data; some use many different platforms, studies and reports. Regional health-related data are used for reliable health planning, to prepare resolutions, draft contracts, but also for events and requests from policy makers or the press. Challenges exist in terms of availability, awareness, and acceptance of the data, perceived applicability, the ability to use it and the utilization itself. Many regional health planners indicated they would appreciate a regional integrated cross-organizational data source if the benefits for health planning outweighed the efforts.</p><p><strong>Discussion: </strong>Actors in health planning primarily utilized their own data for planning; additional data sources are not available or the level of aggregation is too high, not known by them or are often not used due to a lack of time. A standardized regional monitoring would require the definition of indicators as well as the strengthening of cross-sectoral planning.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11422541/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142336202","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":"Medical financial hardship in the Southern United States: the struggle continues across generations pre- and post- the Affordable Care Act.","authors":"Biplab Kumar Datta, Steven S Coughlin, Justin Xavier Moore, Jie Chen","doi":"10.1007/s43999-024-00049-7","DOIUrl":"10.1007/s43999-024-00049-7","url":null,"abstract":"<p><strong>Introduction: </strong>Medical financial hardship in the United States is a growing public health concern. This study aims to assess the south vs. non-south disparities in medical financial hardship among US adults of different generations - Boomers (born between 1946 and 1964), Generation X (born between 1965 and 1980), and the Millennials (born between 1981 and 1996) across periods pre- and post- Affordable Care Act (ACA).</p><p><strong>Methods: </strong>This observational study utilizes data from multiple waves of the National Health Interview Survey (NHIS) split into three periods: pre-ACA (2011-2013), ii) post ACA (2015-2018), and iii) COVID-19 pandemic (2021-2022). Multivariable logistic regressions were fitted, separately for each generation in each period, to compare the extent of medical financial hardship among those from South to rest of the US, and Karlson-Holm-Breen (KHB) decomposition was applied to analyze whether there was a mediating impact of health insurance coverage.</p><p><strong>Results: </strong>Adults living in the South were more likely to experience medical financial hardship in all three periods. Residing in the South was associated with 1.7 to 2.6% points (pp) higher probability of medical financial hardship among boomers, 1.8 to 4.0 pp among generation Xers, and 1.7 to 2.8 pp among millennials. The relationship was robust after accounting for chronic comorbidities, sociodemographic and socioeconomic attributes and was partially mediated through differences in health insurance coverage.</p><p><strong>Conclusions: </strong>The problem of medical financial hardship has been deeply rooted in the South across generations, which was partly attributable to the regional differences in health insurance coverage.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2024-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11371974/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142128148","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 home care nursing: mapping potential explanations through a scoping review of the literature.","authors":"A E M Brabers, M A M Meijer, P P Groenewegen, N Bleijenberg, S Zwakhalen, J D de Jong","doi":"10.1007/s43999-024-00048-8","DOIUrl":"10.1007/s43999-024-00048-8","url":null,"abstract":"<p><p>Needs assessment is the starting point of good home care as it determines which care is necessary, based on the needs of patients, their personal situation, and social context. There are indications that practice variation in needs assessment exists among home care nurses. However, little is known about potential explanations for this variation. Therefore, we explored potential explanations for practice variation in other areas and examined whether these explanations can be applied to explain variation in needs assessment in home care nursing. We conducted a scoping review of the literature on practice variation in (1) needs assessment in home care nursing, (2) home care nursing in general, and (3) medical care in general, with searches in PubMed and CINAHL. We assessed over 6,000 references. Ultimately, 386 studies were included. Explanations for practice variation were grouped into micro, meso and macro level. This scoping review provided insight into a wide variety of variables that might play a role in explaining practice variation in (needs assessment in) home care nursing, such as availability of guidelines, organisational culture, team norms, resources, and preferences of patients. However, the small literature on needs assessment by home care nurses devoted more attention to patients and their social context, compared to the literature on practice variation in general. We discuss how and to what extent these variables could relate to practice variation in (needs assessment in) home care nursing. Future research should empirically examine the role of these variables in explaining the observed practice variation.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11336153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038664","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":"Setting priorities in outpatient cardiovascular care to guarantee equitable access: the case of Tuscany region.","authors":"Vera Benedetto, Erica De Vita, Sabina Nuti","doi":"10.1007/s43999-024-00047-9","DOIUrl":"10.1007/s43999-024-00047-9","url":null,"abstract":"<p><p>Universal healthcare systems orient their actions towards promoting, restoring, and improving public health with a particular focus on the need to guarantee equitable access to care. Unwarranted variation in healthcare delivery poses significant challenges to health systems globally, impacting quality of care, financial sustainability, and equity of access. It is therefore important to assist healthcare management in measuring unwarranted variation in order to prioritise intervention strategies to ensure continuity of care and equity. Through an investigation of geographical variation in visit rates and waiting times, the study identifies vulnerable health districts which need priority interventions for patients with cardiovascular disease in the Tuscany region (Italy). Furthermore, a benchmarking-based method for identifying a quantitative estimate of the supply gap to be reduced is proposed. Results illustrate variation in visit rates and waiting times across local health districts in 2021, with some districts experiencing substantially lower rates and longer waiting times compared to the regional median. To address this gap, two targeted interventions aimed at increasing visit volumes and reduced waiting times through advanced training activities, technology integration, and multidisciplinary collaborations are presented. This study contributes to the topic of unwarranted variation by highlighting the necessity of tailored interventions to address diverse healthcare challenges across heterogeneous geographical areas. As healthcare systems globally navigate evolving complexities, the findings and tools presented here offer valuable guidance for policymakers and managers, aiming towards more equitable, efficient, and responsive healthcare services.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11802940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038693","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":"End-of-life cohorts from the Dartmouth Institute: risk adjustment across health care markets, the relative efficiency of chronic illness utilization, and patient experiences near the end of life.","authors":"Kristen K Bronner, David C Goodman","doi":"10.1007/s43999-024-00039-9","DOIUrl":"10.1007/s43999-024-00039-9","url":null,"abstract":"<p><p>Since their inception, small area studies intended to measure health system performance have been challenged by concerns that regional variation in health care may be primarily explained by differences in patient health risk. Controlling for regional population differences depends on appropriate risk adjustment, but the adequacy of the methods used in early analyses was contested. A novel response to these concerns was the development of end-of-life cohorts by Dartmouth Atlas investigators. These were used initially to control for differences in population health status in studies investigating relative efficiency across regions. Later, they became useful for studying hospital-level variation in chronic illness care, and for measuring utilization and patient experiences at the very end of life. Altogether, end-of-life cohorts have been invaluable for clarifying the contribution of health system and provider factors to health care variation and outcomes.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11281768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038663","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":"Residential variations in hypertension prevalence and trends among adults in Bangladesh.","authors":"Shahanaj Parvin, Salma Akter, Md Ismail Hossain, Md Sabuj Ali, Most Sifat Muntaha Soni","doi":"10.1007/s43999-024-00040-2","DOIUrl":"10.1007/s43999-024-00040-2","url":null,"abstract":"<p><strong>Introduction: </strong>Hypertension is a widespread and life-threatening condition globally, with its prevalence increasing rapidly, particularly among adults. This study aims to examine the trend in adult hypertension prevalence and associated risk factors in both urban and rural areas of Bangladesh from 2011 to 2018.</p><p><strong>Methods: </strong>Nationally representative cross-sectional data from the Bangladesh Demographic and Health Survey was used at two time points, 2011 and 2018. In our study, we used a two-step approach for variable selection, combining traditional statistical methods ( <math> <msup><mrow><mi>χ</mi></mrow> <mn>2</mn></msup> </math> test) with a machine learning algorithm (Boruta algorithm).. This study also employed two different multivariate binary logistic regression models to identify the risk factors that are most closely connected to the presence of hypertension (respectively for urban and rural locations).</p><p><strong>Results: </strong>According to the study, hypertension has been on the rise in Bangladesh. In 2011, over a third of adults (38.7%) in urban Bangladesh had hypertension, a number that rose by 22.6% in 2017-18. Though rural areas had a lower hypertension prevalence in 2011 (36%), it surged to 64% in 2017-18, surpassing the rate in urban areas. The results of the multivariate analysis showed that age, gender, education, wealth status, area, and survey year had a significant influence on the determinants of hypertension status in connection to place of residence. According to the odds ratio, the prevalence was significantly higher among older respondents, female respondents, wealthy families and higher-educated respondents.</p><p><strong>Conclusion: </strong>A large proportion of Bangladesh's adult population suffers from hypertension. A health education program is required to develop appropriate strategies, including appropriate weight control, appropriate physical activity, and healthier eating habits. Health authorities should take initiatives to spread awareness among people, particularly at an older age.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"3 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11281750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038692","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":"Understanding regional variation in euthanasia using geomedical frameworks: a critical ethical reflection.","authors":"A Stef Groenewoud, Gert P Westert, Theo A Boer","doi":"10.1007/s43999-023-00034-6","DOIUrl":"10.1007/s43999-023-00034-6","url":null,"abstract":"<p><p>Considerable geographical variation in the uptake of euthanasia has been reported: some municipalities in the Netherlands have a 25 times higher euthanasia rate than other municipalities. Current 'geomedical' frameworks for interpreting practice variation in health care utilization seem inadequately tailored to understand regional variation in morally controversial procedures such as euthanasia. The aim of this conceptual article is threefold: i) to add relevant medical ethical principles to current frameworks; ii) to provide a four-step ethical-geomedical model for the interpretation of geographical differences in the utilization of health care in general and for ethically controversial treatments in specific; iii) to gain better understanding of the existing geographical variation in the incidence of euthanasia by using this framework in our analysis.</p>","PeriodicalId":520076,"journal":{"name":"Research in health services & regions","volume":"2 1","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11281760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038662","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}