Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

{"title":"Endorsement of the Lisbon Outcome Statement and Launch of a National Programme for Age-Friendly Cities and Communities in Portugal.","authors":"Miguel Arriaga, Yon Yongjie, Thiago Herick de Sa, Ana Justo, Gisele Câmara, Andreia Costa","doi":"10.1177/00469580241298829","DOIUrl":"10.1177/00469580241298829","url":null,"abstract":"<p><p>Portugal is one of the European Union countries with the highest rates of people aged 65 or more. The old-age dependency index is the third highest in Europe. Longevity is a remarkable human achievement but without a comprehensive approach to fostering healthy ageing over the life-course, the burden on health and care systems and social services will increase. This issue is compounded as life expectancy rises, but many of these additional years are not lived in good health. Promoting healthy ageing is an essential political and moral strategy for the well-being both of individuals and societies. Concerning this, Portugal endorsed the Lisbon Outcome Statement drawn up based on the 2023 Regional Summit on Policy Innovation for Healthy Ageing and made its commitment for the creation of age-friendly environments. The National Programme for Age-Friendly Cities and Communities in Portugal is one of the first concrete steps to fulfill that endorsement.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580241298829"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795600/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association of 340B Program Drug Margins with Covered Entity Characteristics.","authors":"Robert J Nordyke, James Motyka, Julie A Patterson","doi":"10.1177/00469580251324051","DOIUrl":"10.1177/00469580251324051","url":null,"abstract":"<p><p>The 340B Drug Pricing Program aims to help facilities serving low-income and uninsured patients to stretch scarce resources by allowing covered entities to purchase outpatient drugs at federally mandated discounted rates while often receiving reimbursement for them at higher rates by commercial payers and Medicare. Despite increasing focus on the expansion and impact of the program, profit margins under 340B have not been fully explored. We aimed to examine drug-, facility-, and geographic-level factors that influence drug margins among 340B covered entities. We conducted a cross-sectional analysis of predictors of facility-level 340B margins for 5 drug classes in a multivariable regression model using 2021 data linked across multiple proprietary and public datasets. Regression results show that drug, facility characteristics, and geographic healthcare market-level characteristics influence drug margins under the 340B program. Adjusted 340B margins were higher in hospital outpatient departments than free-standing offices (ie, hospital-affiliated physician offices and independent, 340B eligible clinics) and among covered entities in more concentrated (ie, less competitive) markets. Covered entity market power, quantified by a facility-level measure of non-340B drug margins indicating pricing power, and area wealth were both associated with higher 340B drug margins. Margins on 340B drugs were higher among facilities in stronger bargaining positions and those serving wealthier areas. These findings add to the growing body of literature on expansions of the 340B program into more affluent communities, informing calls for reforms to ensure the 340B program serves low-income and uninsured patients.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251324051"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Intelligent Delivery Systems and Automated Rail Logistics on the Efficiency and Safety of Clinical Item Transportation: A Observational Studies.","authors":"Yi Li, Ping He, Xue-Lian Peng, Min Peng","doi":"10.1177/00469580251314760","DOIUrl":"10.1177/00469580251314760","url":null,"abstract":"<p><p>This paper aims to establish an intelligent delivery system integrated with track logistics and explores its impact on the clinical transportation of goods. The study analyzed hospital delivery items before and after the implementation of an intelligent delivery system combined with automated track logistics in 2023. Delivery conditions prior to the system's activation served as the control group, while those post-implementation formed the observation group. This research assesses the effects on transportation efficiency, resource allocation, transport safety, and satisfaction among medical staff. The average delivery time of goods significantly decreased following the adoption of the intelligent delivery system combined with automated track logistics (<i>P</i> < .01). The total number of adverse delivery-related events was reduced from 25 to 4 (<i>P</i> < .01). Departmental medical staff reported substantial increases in scores for delivery efficiency, error incidence, and overall satisfaction with the delivery process (<i>P</i> < .01). The integration of the intelligent delivery system with automated track logistics significantly enhances the efficiency of clinical goods transportation, optimizes resource allocation, ensures the safe transport of items, and improves the patient experience and clinical staff satisfaction with delivery operations. Regular system maintenance and adjustments, supported by professional technical personnel, are essential to fully leverage the system's advantages.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251314760"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773519/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"4 Steps to 4Ms: A Navigation Guide for a Hospital-Based Composite Measure of 4Ms Care and the Implications for Outcomes Assessment.","authors":"Benjamin Rosner, Robert Thombley, Stephanie Rogers, Julia Adler Milstein","doi":"10.1177/00469580251323135","DOIUrl":"10.1177/00469580251323135","url":null,"abstract":"<p><p>The 4Ms Framework is the foundation of the Age-Friendly Health System (AFHS) movement. While the framework is based on standalone evidence for each M, there is limited evidence about the impact on outcomes when practiced as a set. A composite measure capturing adherence to the many care processes that comprise the 4Ms is a necessary but complex component of closing the evidence gap. We offer a navigation guide that addresses key considerations for developing a hospital-based composite measure of 4Ms care. The Institute for Healthcare Improvement operationalizes the 4Ms Framework as a minimum set of Assessment and Act On care processes. In developing a composite measure of inpatient 4Ms adherence, we offer a 4 step framework with associated discussion of considerations related to composite measure type (eg, continuous, dichotomous), and synchrony within and across the Ms containing these care processes. Using real-world electronic health record data capturing care process adherence in the 4Ms implementation at a large academic hospital, we illustrate the considerations, and report the implications for sample size and composite measure scoring. We also present our selected composite measure-a dichotomous measure delineating 4Ms care when all encounter-level processes (those needing to be done only once during the hospital encounter) are followed and all day- and shift-level processes are followed for at least 50% of hospital days. While there is no single, standard approach to create a 4Ms composite at this early stage of the AFHS movement, as organizations develop their measure(s), our guide and the considerations we suggest should serve to inform this process and support progress toward meaningful measurement.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251323135"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Opportunities in Implementing a Multicomponent Dementia Caregiver Program in a Complex Healthcare System.","authors":"Connor M Warren, Laura Ellen Ashcraft, Amanda Peeples, Kirstin Manges Piazza, Octavia Goodman, Laura N Gitlin, Judith A Long, Robert E Burke, Rachel M Werner, Rebecca T Brown","doi":"10.1177/00469580251322364","DOIUrl":"10.1177/00469580251322364","url":null,"abstract":"<p><p>The Tailored Activity Program (TAP), an intervention for people living with dementia (PLWD) and their caregivers, has been shown to reduce behavioral symptoms for PLWD and caregiver burden. While TAP is proven as an evidence-based practice (EBP), it has yet to be implemented at scale. The Department of Veterans Affairs (VA) has prioritized the Age-Friendly Health System (AFHS) initiative, providing an opportunity to test implementation of TAP in a complex healthcare system. We conducted semi-structured pre-implementation interviews with leaders and clinicians at 6 VA Medical Centers (VAMCs) to engage key implementation partners and understand their unique implementation contexts. We utilized team-based rapid qualitative analysis to identify themes related to implementation determinants. We interviewed 65 unique informants in 58 interviews (5 VAMC leaders, 36 department leaders, and 17 frontline clinical staff). Informants identified 4 key factors critical to consider prior to implementing TAP: (1) alignment with organizational priorities; (2) perceived value and fit with existing clinical workflows; (3) competition with existing organizational and clinical priorities; and (4) considerations about the effect of caregiver burden on participation. We identified key factors to consider for successful implementation of a multicomponent intervention for PLWD and their caregivers within a complex healthcare system. As the AFHS initiative expands, there is a growing need for EBPs focused on the care of PLWD and their caregivers. These factors can guide clinicians, leaders, and implementation scientists in planning for implementation and sustainment of EBPs to bolster AFHS initiatives.Trial RegistrationRegistered 05 May 2021, at ISRCTN #60,657,985.Reporting GuidelinesThe COnsolidated criteria for REporting Qualitative research (COREQ) checklist was used to ensure proper standards for reporting qualitative studies (see attached).</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251322364"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"End-of-Life Health Costs Were Predicted Primarily by Prior Health Costs, and Secondarily by Temporal, Health and Demographic Factors.","authors":"Jiska Cohen-Mansfield, Michal Skornick-Bouchbinder, Moshe Hoshen","doi":"10.1177/00469580251326315","DOIUrl":"https://doi.org/10.1177/00469580251326315","url":null,"abstract":"<p><p>We examined regression models predicting health services standardized costs (HSSC) during the years preceding death using varied temporal parameters related to the dependent and independent variables. The regression models sought to elucidate how costs before the final year of life, temporal factors, and demographics are associated with costs in the final year. Anonymized data were derived from the records of Israel's largest health maintenance organization for 71,855 people aged 65+ in 2006, who died between 2008 and 2011. In the regression models, the Independent Variables of <i>age</i>, <i>sex</i>, and <i>comorbidity</i> (as measured by the Charlson Comorbidity Index) were significant predictors of the dependent variable of <i>HSSC during the final year of life</i>. However, the strongest predictor (independent variable) of the dependent variable, <i>HSSC in the final year of life</i> was the independent variable, <i>HSSC in the years preceding the final year of life</i>. Prediction was more accurate when the predicting period was closer to the predicted period. Accuracy declined as the predicted period approached death. The results provide insights into methodological considerations in the process of prediction of end-of-life expenditures, which may assist in setting methodological standards that may facilitate arriving at consistent findings in this field. While end-of-life is associated with aberrant increases in costs, that is, increases that deviate from prior predictions, significant predictions can still be made.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251326315"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Implementing Palliative Care Services for Cancer Patients in Low- and Middle-Income Countries: A Systematic Review.","authors":"Neema Florence Vincent Mosha, Patrick Ngulube","doi":"10.1177/00469580251325429","DOIUrl":"10.1177/00469580251325429","url":null,"abstract":"<p><p>Palliative care (PC) services are essential for cancer patients, particularly in low- and middle-income countries (LMICs), where cancer-related deaths are disproportionately high. Despite their significance, access to effective PC remains limited in many LMIC settings. This systematic review aims to identify strategies for implementing PC services for cancer patients in these regions, focusing on the challenges faced. A comprehensive search was conducted for peer-reviewed articles published between January 2004 and July 2024, utilizing the databases Web of Science, Scopus, PubMed, and Google Scholar. The Critical Appraisal Skills Program (CASP) assessment tool was employed to evaluate the quality of the studies following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for transparency. Out of approximately 966 818 articles retrieved, only 17 studies met the defined inclusion criteria. The findings highlighted effective strategies for delivering PC services in LMICs, including patient navigator-led programs, telemedicine, and home health care services. The review highlighted several interventions for PC services, including massage, Cancer and Living Meaningfully (CALM), and light therapies. However, it also identified significant challenges, such as the educational levels of caregivers, patient acceptance of PC services, logistical issues, medication side effects, and a preference for traditional healing practices. This systematic review highlights the critical need for effective PC services for cancer patients in LMICs, where cancer-related mortality rates remain alarmingly high. By synthesizing data from various studies, this analysis offers a comprehensive framework for developing successful palliative care initiatives in these regions. It emphasizes the importance of training caregivers of cancer patients to enhance their confidence in delivering palliative care services and counseling patients about the benefits of these services. Utilizing this information can help practitioners and policymakers improve palliative care services, ultimately enhancing the quality of life for cancer patients in LMICs.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251325429"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11967213/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community Health Worker Requirements to Accelerate Progress Towards Universal Health Coverage in Africa: An Overview of Contemporary Estimates and Implications of Full-Time Versus Part-Time Working Arrangements.","authors":"James Avoka Asamani, Sunny C Okoroafor, Kasonde Mwinga","doi":"10.1177/00469580251323381","DOIUrl":"10.1177/00469580251323381","url":null,"abstract":"<p><p>Primary health care is the most effective approach to achieving universal health coverage (UHC) and ensuring health security. In this approach, community health workers play a crucial role by delivering a comprehensive array of preventive, promotive, and curative services. Their contributions are vital in addressing health inequities, ensuring that all individuals have access to essential health services. By empowering these workers, we can foster a more equitable health system that meets the diverse needs of communities. African leaders are pursuing a 2 million community health worker agenda, but there are lingering questions about how to set targets of the density of community health workers needed in countries to achieve the sustainable development goals. By examining the implications of empirical estimates and incorporating nuances of working hours of community health workers, we find a wide range of density from 11.2 to 59.5 community health workers per 10 000 population depending on country context and the community health worker's working arrangements. If community health workers are not full-time workers and work between 30% and 65% of their time, the current shortage of community health workers is between 580 000 and 954 500. However, if all the existing community health workers were to be employed full-time, the needs-based shortage of community health workers would shrink significantly to just 210 000. These should be considered ordered guesses and not planning targets for countries. Countries are encouraged to use the available health workforce planning tools to estimate its context-appropriate requirements for community health workers as part of the broader health workforce planning.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251323381"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851756/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Digital Leadership Enhances Employee Empowerment, Techno-work Engagement, and Sustainability: SEM Analysis in Public Healthcare.","authors":"Ali Nawaz Khan, Yumei Wang, Naseer Abbas Khan, Ali Ahmad","doi":"10.1177/00469580251317653","DOIUrl":"10.1177/00469580251317653","url":null,"abstract":"<p><p>The rapid digital transformation in the public healthcare sector demands effective digital leadership to improve organizational performance. This study investigates the impact of digital leadership on employee empowerment and its subsequent effects on techno-work engagement and sustainability performance within public healthcare institutions in Pakistan. A survey-cum questionnaire method was employed for 334 respondents of employees of public healthcare institutions in the Punjab Province of Pakistan. It used structured questionnaires to measure digital leadership, sense of empowerment, techno-work engagement, and sustainability performance. Structural Equation Modeling (SEM) was performed on data to examine the proposed relationships among the variables. The findings of SEM showed that digital leadership positively influences employees' sense of empowerment. Empowerment significantly predicted techno-work engagement and sustainability performance. Techno-work engagement also positively affected sustainability performance. Mediation analysis revealed that the sense of empowerment mediates the relationship between digital leadership and both techno-work engagement and sustainability performance. The findings demonstrate that digital leadership enhances employee empowerment, which in turn boosts techno-work engagement and sustainability performance in the public healthcare sector. Organizations should promote digital leadership practices to empower employees and achieve sustainable outcomes.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251317653"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Physical Function and Edentulism in Older Adults: Findings from the Indonesian Family Life Survey 2014.","authors":"Rieski Prihastuti, Daisuke Hinode, Makoto Fukui, Omar M M Rodis, Yoshizo Matsuka","doi":"10.1177/00469580251317643","DOIUrl":"10.1177/00469580251317643","url":null,"abstract":"<p><p>This study aimed to determine the association between physical function and edentulism among older adults. The fifth wave of Indonesian Family Life Survey (IFLS-5) data was used. Physical function was evaluated through physical performance, physical capability, and appendicular skeletal muscle mass (ASM). Edentulous was found in 10.96% of 2554 older adults. Low physical performance (OR 2.02, 95% CI 1.32-3.09; <i>P</i> = .001) was shown to be associated with edentulism in the 60 to 69 age group. In the 70 to 79 age group, both low physical performance (OR 1.62, 95% CI 1.04-2.53; <i>P</i> = .033) and 1 dependency in ADL/IADL (OR 1.75, 95% CI 1.02-2.98; <i>P</i> = .04) were significantly associated with edentulism. Two or more dependencies in ADL/IADL (OR 4.02, 95% CI 1.15-13.99; <i>P</i> = .029) demonstrated significant association with edentulism in older adults ≥80 years. These findings highlighted the importance of maintaining natural teeth and improving oral health during the aging process.</p>","PeriodicalId":54976,"journal":{"name":"Inquiry-The Journal of Health Care Organization Provision and Financing","volume":"62 ","pages":"469580251317643"},"PeriodicalIF":1.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11851746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143493978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}