Risk Management and Healthcare Policy最新文献

{"title":"From Ulcer to Amputation: A Systematic Review of Prognostic Models for Diabetic Foot Ulcer Amputation.","authors":"Xiao-Ran Xie, Ming-Feng Yu, Rong Xu, Yu Liu, Jing Zhang","doi":"10.2147/RMHP.S542262","DOIUrl":"10.2147/RMHP.S542262","url":null,"abstract":"<p><strong>Aim: </strong>To systematically analyze and compare studies on risk prediction models for diabetic foot ulcers progressing to amputation, facilitate clinical decision-making, and provide recommendations for improving modeling strategies in future research.</p><p><strong>Methods: </strong>We searched Medline, Embase, Cochrane Library, and Clinicaltrials.gov from inception to January 29, 2025, to identify studies on risk prediction models for diabetic foot ulcers progressing to amputation. After study screening and data extraction, we evaluated bias and applicability using the Prediction Model Risk of Bias Assessment Tool.</p><p><strong>Results: </strong>We included 18 papers comprising 15 development studies and 3 external validation studies. The development studies reported 17 models, while the validation studies externally validated 12 models. The area under the curve of all models ranged from 0.557 to 0.957. The most commonly used predictors were peripheral arterial disease, glycated hemoglobin, infection, Wagner classification, and ulcer depth. All included studies had low concerns regarding applicability but exhibited high risk of bias, primarily due to insufficient events per variable, missing data, inadequate consideration of data complexity, lack of model performance assessment, and absence of internal validation.</p><p><strong>Conclusion: </strong>Risk prediction model research for diabetic foot ulcer progression to amputation remains in its early stages. Future efforts should prioritize prospectively developing and externally validating models with robust performance and low bias, accompanied by rigorous internal validation and transparent reporting. (Funding: Natural Science Foundation of Hubei Province (2022CFB145) and Research Fund of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (2023D36)).</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3099-3111"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132788","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":"Capacities in Laboratory-Based Epidemiological Surveillance in Cameroon's Littoral Region: A Cross-Sectional Study.","authors":"Ketina Hirma Tchio-Nighie, Augustin Murhabazi Bashombwa, Etienne Guenou, Jerome Ateudjieu","doi":"10.2147/RMHP.S546587","DOIUrl":"10.2147/RMHP.S546587","url":null,"abstract":"<p><strong>Background: </strong>Laboratories are a critical part of epidemiological surveillance implementation through their participation in cases' detection and investigation. The Integrated Disease Surveillance and Response (IDSR) strategy is implemented in Cameroon since 2003 although weaknesses in terms of low detection, timeliness and reporting rates are reported. The present study was conducted to assess the implication of health facilities' laboratories in epidemiological surveillance by evaluating the activities conducted, the availability of resources and communication pathways.</p><p><strong>Methods: </strong>A cross-sectional descriptive study was conducted in laboratories of health facilities in the Littoral region of Cameroon selected from health districts by stratified random sampling from April to May 2024. Data were collected using a face-to-face structured questionnaire administered to head of each laboratory. Collected data included health facilities' characteristics, epidemiological surveillance activities conducted in the laboratories, availability of supplies and equipment, data reporting and availability of energy supply.</p><p><strong>Results: </strong>Out of the 302 laboratories reached, 273 (90.4%) consented to participate in the survey. Most (198 [72.53%]) of the laboratories declared being involved in samples' collection while only 61 (22.34%), 18 (6.59%) and 93 (34.07%) declared to be involved in screening of suspected cases during outbreaks, case confirmations during outbreaks and notification of suspected cases respectively. Regarding the availability of transport supplies/equipment, out of the 273 laboratories, 43 (15.8%), 105 (38.5%) and 123 (45.1%) laboratories had Cary Blair medium, isothermal carrying cases and safety bags respectively. It is noted that 26 (9.5%) laboratories reported not communicating their results with surveillance units. A total of 263 (96.3%) laboratories declared to have the national distribution electricity service as their main source of energy and 78 (29.7%) laboratories had an alternative energy source.</p><p><strong>Conclusion: </strong>The present study revealed gaps in terms of participation of health facilities' laboratories in key epidemiological surveillance such as case confirmation and results' reporting. Weakness in terms of supply chain are also noted. Efforts to strengthen laboratory surveillance capacities must prioritize investments in reliable supply chains and sustainable infrastructure.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3089-3098"},"PeriodicalIF":2.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12453048/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145132822","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":"Optimized Homologous Sequence Alignment for the Identification of CYP21A2 Variants in 21-Hydroxylase Deficiency Using Next-Generation Sequencing Technology.","authors":"Yibo Chen, Qi Yu, Lisha Ge, Lixin Weng, Xiaoli Pan, Xiaoxia Zhou, Nani Zhou, Yanjie Wang, Jia Jia, Haibo Li","doi":"10.2147/RMHP.S514355","DOIUrl":"10.2147/RMHP.S514355","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop a novel homologous sequence analysis technique using high-throughput sequencing data to enhance CYP21A2 mutation detection. The approach leverages next-generation sequencing to overcome existing limitations and improve 21-hydroxylase deficiency diagnostic accuracy.</p><p><strong>Methods: </strong>From April 21, 2022, to February 21, 2023, a total of 100 unrelated participants were enrolled at the Women and Children's Hospital of Ningbo University, selected based on clinical manifestations and genetic testing results. The study used next-generation sequencing combined with a homologous sequence alignment (HSA) algorithm, which calculated the sequencing read ratios from homologous regions to identify pathogenic or likely pathogenic variants in the CYP21A2 gene. All detected variants were further validated using long-range PCR or multiplex ligation-dependent probe amplification. The accuracy of the HSA algorithm was systematically assessed.</p><p><strong>Results: </strong>Among the 100 participants, 84 were identified as carriers of CYP21A2 mutations, while 16 were diagnosed with 21-hydroxylase deficiency. A total of 107 pathogenic mutations were detected using the homologous sequence alignment algorithm, comprising of 99 single nucleotide variants or insertions/deletions, 6 copy number variants, and 8 fusion mutations. Additionally, eight cases of CYP21A2-CYP21A1P gene conversions were identified based on HSA scores and confirmed through long-range PCR or multiplex ligation-dependent probe amplification. The algorithm demonstrated a positive predictive value of 96.26% for identifying mutations in CYP21A2. The most frequently observed mutations included c.955C > T, c.844G > T, c.293-13C > G, c.518T > A, and exon-level deletions.</p><p><strong>Conclusion: </strong>In genetic testing, particularly when addressing misalignment challenges associated with highly homologous genes such as CYP21A2, application of the HSA algorithm enables accurate mutation detection using commonly employed short-read sequencing methods. Through the characterization of homologous sequence features and optimization of the HSA algorithm, accurate mutation detection can be achieved in more homologous gene families (eg, HBA1/HBA2, SMN1/SMN2, GBA/GBAP1).</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3063-3078"},"PeriodicalIF":2.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114877","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":"Development and Validation of a Predictive Model for Postpartum Hemorrhage in Non-Primiparous Women Who Deliver Vaginally.","authors":"Cuiping Zhou, Rongsheng Zhou","doi":"10.2147/RMHP.S537335","DOIUrl":"10.2147/RMHP.S537335","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the risk factors for postpartum hemorrhage in non-primary women giving birth naturally and construct a predictive model.</p><p><strong>Methods: </strong>Retrospective analysis of the clinical data of 436 second-time mothers who underwent natural childbirth in the Department of Obstetrics, Hefei Third People's Hospital. The cases were divided into a bleeding group (n=41) and a non-bleeding group (n=395) based on whether there was bleeding greater than 500 mL within 24 hours after delivery. Independent risk factors were established through univariate and multivariate analyses, a logistic regression model was established, and bootstrap resampling was used to internally verify and assess the calibration of the model.</p><p><strong>Results: </strong>Among the 436 cases of maternal delivery included in the study, 41 (9.40%) were cases of postpartum hemorrhage. The results of the multifactor analysis indicated that in vitro fertilization, body mass index (BMI), episiotomy, placenta previa, newborn weight, and manual removal of the placenta were independent risk factors for postpartum hemorrhage (PPH) in non-primary mothers. Subsequently, a model was constructed, exhibiting an AUC value of 0.839 (95% CI: 0.758-0.919). The Hosmer-Lemeshow test of the calibration curve yielded a chi-squared value of 8.1013 and a P-value of 0.4236, indicating an excellent performance of the DCA curve.</p><p><strong>Conclusion: </strong>In vitro fertilization, body mass index (BMI), episiotomy, placenta previa, newborn weight, and manual removal of the placenta are identified as independent risk factors for postpartum hemorrhage (PPH) in non-primary mothers. The constructed logistic regression model is capable of more accurately identifying high-risk PPH mothers and providing a reference basis for individualized interventions.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3079-3088"},"PeriodicalIF":2.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449884/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114917","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":"Streamlining Patient Fall Prevention and Management Through Human-Centered AI-Based Decision Support Systems.","authors":"Firda Rahmadani, Fatima Y Alshamsi, Balqees Almazrouei, Aisha Hanaya Alsuwaidi, Mohammed Alhammadi, Mecit Can Emre Simsekler","doi":"10.2147/RMHP.S516070","DOIUrl":"10.2147/RMHP.S516070","url":null,"abstract":"<p><p>Patient falls are a major concern in healthcare due to their impact on patient safety, prolonged hospital stays, and increased costs. Traditional fall prevention methods often lack precision and adaptability, emphasizing the need for predictive approaches. This study reviews the current literature and explores the integration of human-centered artificial intelligence (AI)-based decision support systems to improve fall prevention through proactive risk assessment and prediction. This system enables early identification of fall risks, facilitating personalized interventions and real-time monitoring via advanced sensors and wearable devices. These technologies may provide timely alerts to caregivers and support administrators in optimizing resource allocation. Additionally, this study highlights the importance of systems thinking, recognizing patient falls as outcomes of interconnected system failures. By leveraging causal loop analysis and feedback mechanisms, healthcare stakeholders can develop dynamic, system-wide strategies to enhance fall prevention and operational efficiency.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3051-3062"},"PeriodicalIF":2.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12449887/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114857","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":"Development and Internal Validation of a Predictive Model for Deep Venous Thrombosis Following Colpocleisis in Elderly Patients with Pelvic Organ Prolapse.","authors":"Qi Wang, Stefano Manodoro, Xiaoxiang Jiang, Chaoqin Lin","doi":"10.2147/RMHP.S535933","DOIUrl":"10.2147/RMHP.S535933","url":null,"abstract":"<p><strong>Purpose: </strong>Colpocleisis is a surgical option for elderly women with advanced pelvic organ prolapse (POP), often complicated by comorbidities that heighten postoperative deep venous thrombosis (DVT) risk. Effective tools for predicting postoperative DVT in these patients are lacking. This study aimed to develop a predictive model for the risk of DVT following colpocleisis and to validate its performance.</p><p><strong>Patients and methods: </strong>This retrospective study included elderly patients who underwent colpocleisis for advanced POP between August 2019 and December 2024. Demographics, obstetric history, comorbidities, preoperative tests, and surgical details were analyzed. The primary endpoint was postoperative DVT, confirmed by ultrasound examination. Univariate and multivariable logistic regression analyses identified risk factors, which informed the development of a predictive nomogram-a graphical tool that translates statistical risk into a user-friendly format for individual prediction. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis (DCA), which evaluates the net clinical benefit across threshold probabilities.</p><p><strong>Results: </strong>Of 307 patients, 8.8% (27/307) developed postoperative DVT. Multivariable analysis identified insulin-dependent diabetes, elevated preoperative cholesterol, and D-dimer levels as independent risk factors. The nomogram demonstrated strong discriminatory ability, with AUCs of 0.809 (95% confidence interval [CI]: 0.760-0.857) in the training set and 0.802 (95% CI: 0.752-0.852) in the validation set. At the optimal threshold (0.494), sensitivity was 0.725, specificity 0.848, positive predictive value (PPV) 0.805, and negative predictive value (NPV) 0.728. Calibration curves showed alignment between predicted and observed outcomes, while DCA demonstrated significant net benefit.</p><p><strong>Conclusion: </strong>This nomogram is a valuable tool for early DVT risk stratification in elderly colpocleisis patients. External validation in prospective multicenter studies is warranted.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3041-3050"},"PeriodicalIF":2.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12447959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114868","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":"Inpatient Participation in Patient Safety Behaviors: Decision-Making Typologies from a Qualitative Study.","authors":"Chunni Wang, Haoning Shi, Xingyao Du, Ying Peng, Mingzhao Xiao, Qinghua Zhao, Huanhuan Huang","doi":"10.2147/RMHP.S538389","DOIUrl":"10.2147/RMHP.S538389","url":null,"abstract":"<p><strong>Background: </strong>Patient participation in safety behaviors has been recognized as a critical component of reducing medical errors and improving healthcare outcomes in hospitalized settings. However, there is currently a lack of research to understand the decision-making processes that drive these behaviors.</p><p><strong>Purpose: </strong>This study aimed to identify and construct the different types of decision-making personas adopted by inpatients when thinking about participating in patient safety.</p><p><strong>Methods: </strong>A qualitative phenomenological study was conducted at a tertiary hospital in Chongqing from October to December 2024. Inpatients meeting the inclusion and exclusion criteria were selected via purposive sampling, and semi-structured interviews were performed to explore their motivation, willingness, decision-making factors, decision-making balance, and effect evaluation during their participation in patient safety decision-making. Data were analyzed using Colaizzi's seven-step method, facilitating the process from raw data to factual labeling and ultimately to the construction of personas dimensions. Patient characteristics were extracted and personas were constructed by artificial intelligence (AI), with the visualization of these personas achieved through a combination of character images and labels.</p><p><strong>Results: </strong>This study developed four distinct personas that reflect the decision-making types of inpatients' participation in patient safety, with the personas classifications as follows: self-driven decision-makers, passive collaborators, resource-limited decision avoiders, and self-assertive decision-makers.</p><p><strong>Conclusion: </strong>The diversity of patients' decision-making types necessitates targeted interventions, such as shared decision-making tools, simplified communication, community support provision, and trust reconstruction. Future research should also include longitudinal studies and cross-cultural validation.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3029-3039"},"PeriodicalIF":2.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12444088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145114852","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":"Clinical Characteristics and Risk Factors for Progressive Pulmonary Fibrosis in Primary Sjögren's Syndrome: A Case-Control Study.","authors":"Jianping Diao, Lin Qiao, Xinwang Duan, Min Hui, Mengtao Li, Yan Zhao, Xiaofeng Zeng, Dong Xu","doi":"10.2147/RMHP.S533705","DOIUrl":"10.2147/RMHP.S533705","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the clinical characteristics and identify risk factors associated with progressive pulmonary fibrosis (PPF) in individuals diagnosed with primary Sjögren's syndrome (pSS).</p><p><strong>Methods: </strong>A retrospective case-control study was conducted from individuals with pSS-associated interstitial lung disease (pSS-ILD) registered in the Chinese Rheumatism Data Center between June 2010 and October 2023. Participants were categorized into two groups: those with PPF (pSS-PPF) and those without PPF (pSS-non-PPF). Comparative analyses were performed on clinical manifestations, laboratory parameters, pulmonary function, and treatment history between the two groups.</p><p><strong>Results: </strong>Sixty-six individuals with pSS-ILD were included, of whom 29 met the criteria for PPF. Compared to pSS-non-PPF group, the pSS-PPF group demonstrated a higher rate of expectoration (48.3% vs 16.2%, <i>p</i> = 0.005) and crackles on auscultation (41.4% vs 13.5%, <i>p</i> = 0.01), but lower rates of parotid gland enlargement (3.4% vs 32.4%, <i>p</i> = 0.003), and arthritis (6.9% vs 27%, <i>p</i> = 0.035). Additionally, the incidence rate of the subjects suffering xerophthalmia and xerostomia in the PPF group was lower (24.1% vs 2.7%, <i>p</i> = 0.023). Pulmonary function testing showed significantly reduced forced vital capacity percentage predicted (83.6±15.6 vs 91.3±14.6, <i>p</i> = 0.042) and diffusing capacity of the lung for carbon monoxide percentage predicted (DLCO%, 54.2±21.5 vs 68.5±13.6, <i>p</i> = 0.003) in the PPF group. Multivariate logistic regression identified a baseline DLCO% < 60% as an independent risk factor for PPF. Parotid gland enlargement and arthritis were potentially protective. The predictive model demonstrated good performance, with an area under the curve of 0.821 (95% CI: 0.716~0.925, <i>p</i> < 0.001). The sensitivity was 58.6% and the specificity was 91.7%.</p><p><strong>Conclusion: </strong>A baseline DLCO% < 60% is an independent predictor of PPF in individuals with pSS. The developed predictive model shows strong discriminatory ability, while further validation in larger cohorts is warranted.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3017-3028"},"PeriodicalIF":2.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12441109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088343","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":"Impact of Enhanced Outpatient Pooling Level on Healthcare Utilization, Costs and Fund Expenditures in China: An Interrupted Time Series Analysis.","authors":"Yanghaotian Wu, Shuting Zheng, Jingfu Qiu","doi":"10.2147/RMHP.S541047","DOIUrl":"10.2147/RMHP.S541047","url":null,"abstract":"<p><strong>Background: </strong>China introduced the outpatient pooling fund model into Urban Employee Basic Medical Insurance (UEBMI) to increase the compensation level for outpatient costs, but the empirical evidence is extremely limited. As an early adopter of China's healthcare reform, Sanming City increased the reimbursement rate of general outpatient visits for UEBMI enrollee in August 2016. The reimbursement rate for UEBMI enrollees seeking general outpatient care at primary hospitals increased from 40% to 90%, and for secondary and above hospitals from 30% to 70%. This study aimed to assess the changes in medical service utilization, medical costs, and medical insurance fund expenditures among UEBMI enrollees after the improvement of outpatient pooling level for employees.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using monthly monitoring data on public hospitals from August 2015 to August 2017 in Sanming City, China. An interrupted time-series analysis was performed to evaluate the level and trend changes in medical services utilization, medical costs, and UEBMI fund expenditures before and after the improvement of outpatient pooling level.</p><p><strong>Results: </strong>After the intervention, the number of monthly outpatient visits per capita for UEBMI enrollees increased by 0.047 immediately (<i>P</i><0.05), while the change in inpatient demand was insignificant (<i>P></i>0.05). The medical cost per outpatient visit increased by 0.6% per month (<i>P</i><0.001). The out-of-pocket (OOP) cost per outpatient visit decreased by 23.66% immediately (<i>P</i><0.001), with a monthly increase of 1.61% afterward (<i>P</i><0.001). The outpatient fund expenditures increased by 151.68% immediately (<i>P</i><0.001), but decreased by 2.37% per month in the long term (<i>P</i><0.01). The total and inpatient fund expenditures varied insignificantly (<i>P></i>0.05).</p><p><strong>Conclusion: </strong>The improvement of outpatient pooling level for urban employees had positive effects on stimulating the demand for outpatient medical services, reducing OOP costs, and maintaining the sustainability of UEBMI funds, while the long-term effect was weakened, and the substitution effect between inpatient and outpatient healthcare was insignificant. There is an urgent need to improve the outpatient benefits, establish a value-based outpatient payment method and an intelligent medical insurance fund monitoring system.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"2977-2989"},"PeriodicalIF":2.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12433653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071324","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":"Comparative Analysis of Detection Capabilities for Hepatitis B Antibody, Hepatitis C Antibody, and Syphilis Antibody in Different Medical Institutions in Kaifeng, China.","authors":"Hang Li, Zhen Zhang, Qian Li, Hao Huang, Chun-Yan Ma","doi":"10.2147/RMHP.S536815","DOIUrl":"10.2147/RMHP.S536815","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze the participation and results of the interlaboratory quality assessment for serological biomarkers of infectious diseases, including a five-panel test for hepatitis B, hepatitis C antibodies, and syphilis spirochete antibodies in Kaifeng City, China.</p><p><strong>Methods: </strong>The assessment conducted by the Center for Clinical Laboratories in Kaifeng City from 2021 to 2022 was retrospectively analyzed. Laboratories participating in the interlaboratory quality assessment activities received two batches of independent clinical laboratory quality control material. These samples were tested in accordance with the provided test instruction manual. The reported results were statistically compared and assessed against those obtained by the clinical testing center.</p><p><strong>Results: </strong>Data analysis revealed no significant differences in report rates and passing rates among medical institutions of varying levels. However, a significant statistical difference was observed between primary and tertiary hospitals (<i>X</i> ² = 341.1, <i>P</i> < 0.05). Additionally, a similar significant difference was noted in the results obtained using different methodologies (<i>X</i> ² = 0.997, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>The retrospective analysis of interlaboratory quality assessment activities, along with the statistical assessment of test results, assists clinical laboratories in identifying potential systematic and random errors, as well as other factors contributing to control loss. This process facilitates the timely development of effective improvement measures, enhancing test quality and ensuring the provision of accurate and reliable laboratory data for clinical use.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"18 ","pages":"3009-3016"},"PeriodicalIF":2.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076591","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}