Risk Management and Healthcare Policy最新文献

{"title":"Declining Influenza Vaccination Uptake, Attitudes, and Knowledge Among Healthcare Workers in Chengdu, China, in the Post-COVID-19 Era.","authors":"Lin Xu, Shaohua Chen, Chunmei Li, Xiaogang Zhou, Li Tang","doi":"10.2147/RMHP.S490301","DOIUrl":"10.2147/RMHP.S490301","url":null,"abstract":"<p><strong>Purpose: </strong>Despite the benefits of influenza vaccination, particularly for healthcare workers (HCWs) at higher risk, vaccination coverage among HCWs in China remains low. This study aims to provide updated insights into the knowledge, attitudes, practices, and barriers related to influenza vaccination among HCWs in China post-COVID-19 era, to inform strategies for improving vaccination rates and healthcare safety.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted between December 2023 and January 2024 at two tertiary hospitals in Chengdu, China. Logistic regression analyses were used to identify factors associated with HCWs' influenza vaccination uptake for the 2023-2024 season.</p><p><strong>Results: </strong>Of the 602 HCWs who completed the questionnaire (response rate: 86.0%), influenza vaccination uptake for the 2023-2024 season was low at 14.1%, down from 31.2% in 2021-2022 and 18.4% in 2022-2023. Main reasons for vaccine hesitancy included mistrust of vaccines (56.0%), inconvenient access (52.0%), and concerns over time, cost, and information (57.6%). Although most HCWs acknowledged the protective benefits of vaccination, only one-third supported mandatory vaccination, with concerns about personal autonomy among opponents. Multivariable logistic regression analysis showed that HCWs were more likely to be vaccinated if they believed it was essential for their job [adjusted odds ratio (aOR): 2.21; 95% confidence interval (CI): 1.13, 4.30), recognized their higher risk (aOR: 2.37; 95% CI: 1.09, 5.15), and were aware of high-risk groups for influenza vaccination (aOR: 2.49; 95% CI: 1.41, 4.40) as well as the age group with a higher infection rate (aOR: 1.89; 95% CI: 1.01, 3.51). However, those favoring increased campaign visibility had lower vaccination rates (aOR: 0.38; 95% CI: 0.17, 0.82).</p><p><strong>Conclusion: </strong>The persistently low influenza vaccination rates among HCWs in China post-COVID-19 highlight significant gaps in healthcare risk management. Targeted interventions, including enhanced education and better vaccine access, are needed, along with further discussion on mandatory vaccination as a potential solution.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"3049-3063"},"PeriodicalIF":2.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830948","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":"Including Health System Capacities into the Assessment Framework of a Temperature-Resilience Health System.","authors":"Jingyi Zhao, Xiaowei Hao, Xiaofeng Sun, Yajie Du, Meng Zhang, Qing Wang","doi":"10.2147/RMHP.S494486","DOIUrl":"10.2147/RMHP.S494486","url":null,"abstract":"<p><strong>Introduction: </strong>This study includes health system capacities into the assessment framework of a temperature-resilience health system while accounting for system interactions.</p><p><strong>Methods: </strong>In accordance with the guidelines provided by the World Health Organization, the conceptual framework of a climate-resilient health system has been adopted. The International Health Regulations are utilized to assess the health system capacities in 171 countries from year 2011 to 2019. Exploratory factor analysis and reliability tests have been conducted to confirm the validity and reliability of the framework. Moreover, a data-driven decision-making trial and evaluation laboratory method is employed to quantify the interactions among the structured aspects.</p><p><strong>Results: </strong>The assessment framework consists of five aspects, namely high temperature-sensitive risks, low temperature-sensitive risks, low-temperature exposure, vulnerability factors and health system capacities. Globally, the mean (standard deviation) for addressing the first four aspects are 0.77 (0.14), 0.87 (0.13), 0.88 (0.21), 0.72 (0.17), respectively, and health system capacities reach 0.67 (0.17). This study identifies health system capacities as the main driving forces. Interactions between it and other aspects call for multisectoral and coordinated actions. On a global scope, low-temperature exposure and its health risks, with the strongest dependence, should be prioritized to enhance temperature resilience, especially in high-income countries. In order to mitigate these risks, it might be necessary to disrupt the cascade effects resulting from low-temperature exposure by leveraging the capacities of coordination and multisectoral communication. Notably, low-income countries are more affected by high-temperature exposure, thus requiring flexible ways to strengthen temperature resilience.</p><p><strong>Discussion: </strong>Our study underscores the significance of health system capacities in strengthening a temperature-resilient health system. Undoubtedly, the development of the temperature-resilient health system ought to follow a coordinated and flexible approach, giving priority to dealing with low-temperature exposure.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"3085-3098"},"PeriodicalIF":2.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831022","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 a New Case-Based Payment System on Quality of Care: A Difference-in-Differences Analysis in China.","authors":"Xinyu Zhang, Mengcen Qian, Jiaqi Yan, Ruixin Wang, Dawei Lyu, Xiaohua Ying, Shenglan Tang","doi":"10.2147/RMHP.S488825","DOIUrl":"10.2147/RMHP.S488825","url":null,"abstract":"<p><strong>Purpose: </strong>China has developed and widely piloted a new case-based payment, ie, the \"Diagnosis-Intervention Packet\" (DIP) payment, which has a granular classification system. We evaluated the impact of DIP payment on the quality of care in a large pilot city in China and explored potential mechanisms of quality change.</p><p><strong>Methods: </strong>The city started to implement DIP payment with a hospital-level cap on July 1, 2019. Using a 5% random sample of discharge records from July 2017 to June 2021, we employed a difference-in-differences approach to compare two mortality measures (in-hospital mortality, mortality of surgical patients), two readmission measures (all-cause readmission within 30 days, readmission with the same principal diagnosis within 30 days) and a patient safety measure (operation associated complications or adverse event) in 13 pilot hospitals and 27 non-pilot hospitals before and after DIP payment reform.</p><p><strong>Results: </strong>Of 122,637 discharge records included, 43,023 (35.1%) were from pilot hospitals. After DIP payment, the readmission rate within 30 days and readmission rate with the same principal diagnosis in pilot hospitals decreased significantly by 3.2 percentage points (<i>P</i> <0.001) and 1.8 percentage points (<i>P</i> <0.001), respectively. The in-hospital mortality rate, the mortality rate of surgical patients, and the rate of operation-associated complications or adverse events did not have significant changes. The decrease in quality measures was primarily driven by tertiary hospitals, was more obvious over time after the policy adoption, and was more pronounced in groups with higher intensity of care.</p><p><strong>Conclusion: </strong>This study indicated that DIP payment with a cap in the study city was associated with improved quality of care among patients in pilot hospitals. The provider's behavior of increasing the intensity of care, especially for more severe patients, may partially contribute to the results.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"3113-3124"},"PeriodicalIF":2.7,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831043","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":"How Public Service Accessibility Affects Health of Migrants: Evidence from China.","authors":"Jingqian Li, Yu Wang","doi":"10.2147/RMHP.S475634","DOIUrl":"10.2147/RMHP.S475634","url":null,"abstract":"<p><strong>Background: </strong>The effects of public service accessibility on migrant health can provide insights for local governments to optimize public service resource allocation. This study aimed to investigate the relationship between public service accessibility and the health of heterogeneous migrant populations in China, as well as the underlying mechanisms of this relationship.</p><p><strong>Materials and methods: </strong>Data from the 2017 China Migrants Dynamic Survey were utilized, employing ordinary least squares, instrumental variable estimation, and mediating and moderating effect analyses.</p><p><strong>Results: </strong>Findings of the regression analysis suggest a positive association between public service accessibility and better health outcomes for migrants, particularly for less educated migrants. Mediating effect analysis revealed that both public service equalization and efficiency significantly mediate the relationship between public service accessibility and migrant health. Enhanced equalization of public services was strongly linked to improved health outcomes among less educated migrants. In contrast, improved public service efficiency significantly benefit highly educated migrants. Moderating effect analysis showed that administrative hierarchy and public service expenditure preference negatively influence the effects of public service accessibility on migrant health. This diminishing effect is more pronounced among less educated migrants in cities with higher administrative hierarchies and among highly educated migrants in cities with a higher proportion of public service expenditure.</p><p><strong>Conclusion: </strong>This study highlights the relationship between public service accessibility and improved migrant health. Its findings suggest that optimized allocation of public service resources could enhance health equity in China's migrant population.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"3065-3084"},"PeriodicalIF":2.7,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11646460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831017","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":"Understanding Healthcare Personnel's Perceptions About Reducing Low-Value Care: A Scoping Review.","authors":"Jiamin Li, Dan Yang","doi":"10.2147/RMHP.S494013","DOIUrl":"10.2147/RMHP.S494013","url":null,"abstract":"<p><strong>Objective: </strong>To systematically and comprehensively search the studies describing healthcare personnel's perceptions about reducing low-value care.</p><p><strong>Design: </strong>Scoping review.</p><p><strong>Methods: </strong>Evidence sources included PubMed, ProQuest and CINAHL databases from inception to 13th September 2023, along with grey literature, expert suggestions and reference lists from the included articles. Studies were included if they contained information about healthcare personnel's perceptions and involvement in reducing low-value care. The extracted data included general study characteristics, the type of low-value care of interest, clinical settings, and main findings related to healthcare personnel's perceptions. Three frameworks were used to guide the data synthesis. First, the main findings from the included studies were mapped onto the Process of De-adoption Framework to capture the aspects of low-value care that healthcare personnel focused on, including the identification of low-value care, barriers and facilitators to reducing low-value care, and intervention strategies. The identified barriers and facilitators were then mapped onto the relevant domains of the <i>Theoretical Domains Framework</i>. Finally, the intervention strategies, as informed by healthcare personnel's perceptions, were mapped to the <i>Cochrane Effective Practice and Organization of Care taxonomy framework</i>.</p><p><strong>Results: </strong>The 37 included studies were those published since 2011. Of these, 15 studies were conducted in the United States. Most included studies (n = 19) described low-value care not specific to a care measure. Twelve of the included studies described healthcare personnel's perceptions regarding the identification of low-value care, 34 studies described healthcare personnel's perceptions regarding influence factors to reducing low-value care and 18 studies described healthcare personnel's perceptions regarding intervention strategies to reduce low-value care. \"Knowledge\" (n = 16) and 'environmental context and resources' (n = 16) were the most common influence factors of reducing low-value care. \"Education\" was the most commonly discussed intervention strategy for reducing low-value care (n = 14).</p><p><strong>Conclusion: </strong>Healthcare personnel's perceptions focused on identifying low-value care, barriers and facilitators of reducing low-value care and intervention strategies to reduce low-value care. Education was potentially the main effect of the intervention strategies in addressing lack of knowledge, which is the main barrier to reducing low-value care. Future research should develop and implement intervention strategies to reduce low-value care based on healthcare personnel's perceptions.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"3029-3047"},"PeriodicalIF":2.7,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11629665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808745","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":"Improving the Process of Managing Psychosocial Risks in Organizations.","authors":"Pavlo Saik, Vitaliy Tsopa, Serhii Cheberyachko, Oleg Deryugin, Svitlana Sokurenko, Iryna Suima, Vasyl Lozynskyi","doi":"10.2147/RMHP.S488263","DOIUrl":"10.2147/RMHP.S488263","url":null,"abstract":"<p><strong>Introduction: </strong>Psychosocial risks (PSRs) are identified as one of the main modern occupational safety issues, primarily related to occupational stress, and need to be reduced to safe levels in accordance with international requirements. The research purpose is to improve the process of managing the PSRs in the occupational safety and health management systems of employees, taking into account the impact of psychosocial dangers in accordance with the requirements of ISO 45001:2018 and ISO 45003:2021 standards.</p><p><strong>Methods: </strong>To develop the process of managing the PSRs, a system analysis method is applied, which allows determining the structural relationships between the variable elements of dangerous psychosocial factors described in the ISO 45003:2021 standard.</p><p><strong>Results: </strong>The bow-tie model has been improved to determine the relationship between psychosocial dangers and the dangerous event occurrence - experiencing stress by an employee, taking into account the influence of various dangerous psychosocial factors, which provides for an additional risk level assessment for restoring the health of an employee who has experienced stress. The process of psychosocial risk management consisting of ten steps is proposed, which involves identifying the relationship between psychosocial dangers and consequences for human health, taking into account the impact of various dangerous psychosocial factors based on questionnaires, followed by analysis and processing of the duration and intensity of experiencing stress. To reduce the impact of subjective assessments of the duration and intensity of experiencing stress on the psychosocial risk level, it is proposed to take into account the value of individual perception of experiencing stress (stress resistance) and the employees' health condition.</p><p><strong>Discussion: </strong>The scientific novelty is to determine the psychosocial risk level as the sum of the risk values from the impact of each dangerous psychosocial factor, which are characteristic of aspects of work organization, social conditions at work, working environment, equipment, dangerous tasks and the level of employee health. The practical value is the development of scales for assessing the impact of dangerous psychosocial factors and a form for documenting the process of managing psychosocial risks with the indication of precautionary measures to control them.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"2997-3016"},"PeriodicalIF":2.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803573","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 Organizational Justice on Turnover Intention Among Primary Healthcare Workers: The Mediating Role of Work Motivation.","authors":"Shichao Zhao, Zhaofei Ma, Hongyu Li, Zhanning Wang, Ying Wang, Huifen Ma","doi":"10.2147/RMHP.S486535","DOIUrl":"10.2147/RMHP.S486535","url":null,"abstract":"<p><strong>Background: </strong>Adequate staffing of primary healthcare workers (PHCWs) is essential for strengthening healthcare systems, yet high turnover intention among these workers presents a significant challenge. While existing strategies primarily target economic incentives and career progression, this study proposes that enhancing organizational justice could offer a novel and impactful approach to retention. Drawing on equity theory and self-determination theory, the study examines how organizational justice influences turnover intention and the mediating roles of both the intensity and type of work motivation.</p><p><strong>Methods: </strong>This is a cross-sectional study design. A multi-stage cluster sampling method was utilized to administer a questionnaire survey to 1,200 PHCWs from 36 primary health institutions in Shandong Province, China.</p><p><strong>Results: </strong>Multivariate linear regression analysis revealed that organizational justice significantly reduces turnover intention among PHCWs (β = -0.435, p < 0.001). Among its three dimensions, distributive justice (β = -0.203, p < 0.001) and procedural justice (β = -0.177, p < 0.01) had significant impacts on turnover intention, whereas interactional justice did not. The study also confirmed the mediating role of work motivation, with work motivation type accounting for 18.2% of the total effect, exerting a greater influence than work motivation intensity, which accounted for 13.8% of the total effect.</p><p><strong>Conclusion: </strong>This study finds that organizational justice, especially distributive and procedural justice, reduces turnover intention among PHCWs in China. Work motivation mediates this effect, with motivation type having a stronger influence than motivation intensity. Enhancing organizational justice through transparent systems for compensation, promotion, and inclusive decision-making can foster the internalization of work motivation, providing a sustainable approach to improving retention and supporting the stability of the primary healthcare workforce.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"3017-3028"},"PeriodicalIF":2.7,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803575","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":"Analysis and Validation of a Diagnostic Nomogram for Predicting the Risk of Acute Respiratory Failure for Non-HIV Related Pneumocystis Jirovecii Pneumonia Patients.","authors":"Wenjie Bian, Yue Xin, Jing Bao, Pihua Gong, Ran Li, Keqiang Wang, Wen Xi, Yanwen Chen, Wentao Ni, Zhancheng Gao","doi":"10.2147/RMHP.S476812","DOIUrl":"10.2147/RMHP.S476812","url":null,"abstract":"<p><strong>Objective: </strong>Pneumocystis Pneumonia (PCP), primarily affecting individuals with weakened immune systems, is a severe respiratory infection caused by pneumocystis jirovecii and can lead to acute respiratory failure (ARF). In this article, we explore the risk factors of ARF and propose a prognostic model of ARF for PCP patients.</p><p><strong>Methods: </strong>In this multi-center, retrospective study in 6 secondary or tertiary academic hospitals in China, 120 PCP patients were screened from the Dryad database for the development of a predictive model. A total of 49 patients from Peking University People's Hospital were collected for external validation. Crucial clinical features of these patients are selected applying univariate and multivariate logistic regression analysis. We established an intuitive nomogram. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA) and clinical impact curve (CIC) were plotted to evaluate the model's performance.</p><p><strong>Results: </strong>A cohort of 120 patients formed the training cohort for the development of the model, with 49 patients constituting the test cohort. Univariate and multivariate logistic regression analysis identified five risk factors associated with ARF, which are age, fever, dyspnea, high neutrophil count and use of antibiotics. A nomogram was then proposed based on these factors. The area under the ROC curve (AUROC) in the development group has reached 0.8576, while the validation group has an AUROC of 0.7372, indicating commendable ability for predicting ARF. In addition, results for Hosmer-Lemeshow test indicate the effectiveness of our model. Furthermore, DCA and CIC curves demonstrate excellent clinical benefit.</p><p><strong>Conclusion: </strong>We present a nomogram for predicting ARF in non-HIV related PCP patients. The prognostic model may provide references in clinical medicine, promote timely treatment and improve therapeutic outcomes of PCP patients.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"2971-2980"},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11626392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803572","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 Medical Risk Perception on Patient Satisfaction: The Moderating Role of Shared Decision-Making.","authors":"Kairu Zhou, Li Chen, Min Li","doi":"10.2147/RMHP.S482908","DOIUrl":"10.2147/RMHP.S482908","url":null,"abstract":"<p><strong>Purpose: </strong>The perception of medical risks is ubiquitous, influencing patients' healthcare experiences, yet the \"black box\" of this influencing process is seldom explored. This study explores the relationship between medical risk perception, trust, and patient satisfaction while taking shared decision-making as a moderator.</p><p><strong>Methods: </strong>A stratified random sample of 450 inpatients from a tertiary public hospital in Guangzhou was selected for investigation, from June 2023 to September 2023. A moderated mediation model was tested using the PROCESS program, wherein medical risk perception was linked to patient satisfaction through trust, with shared decision-making acting as the moderating variable.</p><p><strong>Results: </strong>Medical risk perception had a significant negative predictive effect on patient satisfaction (<i>β</i> = -0.383, <i>p</i> < 0.001), and after introducing the mediating variable, the negative predictive effect of medical risk perception on patient satisfaction remained significant (<i>β</i> = -0.237, <i>p</i> < 0.001). Trust partially mediated the relationship between medical risk perception and patient satisfaction, with the mediating effect accounting for 37.86% of the total effect. The interaction term between medical risk perception and shared decision-making (<i>β</i> = 0.211, <i>p</i> < 0.001) significantly predicted trust.</p><p><strong>Conclusion: </strong>This study confirmed the mediating and moderating effects of trust and shared decision-making on the relationship between medical risk perception and patient satisfaction. The theoretical model constructed based on the theory of information asymmetry provides strategies and methods for healthcare managers to improve the quality of healthcare services and alleviate tensions in doctor-patient relationship.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"2981-2995"},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796463","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":"Nomograms for Predicting Overall and Cancer-Specific Survival Among Second Primary Endometrial Cancer in Primary Colorectal Carcinoma Patients.","authors":"Linli Liu","doi":"10.2147/RMHP.S481880","DOIUrl":"10.2147/RMHP.S481880","url":null,"abstract":"<p><strong>Background: </strong>Endometrial cancer (EC) is one of the most frequent gynecologic cancers, approximately 20% of patients are regarded as high-risk with poor prognosis. However, more details of patients with second primary endometrial cancer (SPEC) after colorectal cancer (CRC) remain poorly understood. We therefore proposed to construct two nomograms to predict 3- and 5-year overall survival (OS) and cancer-specific survival (CSS) rates to facilitate clinical application.</p><p><strong>Methods: </strong>A total of 1631 participants were identified in the SEER database from 1973 to 2020. We constructed and validated the nomograms for predicting OS and CSS. The receiver operating characteristic curves, calibration plot, decision curve analysis, C-index, net reclassification improvement, and integrated discrimination improvement were applied to evaluate the predictive performance. Finally, the Prognostic index was calculated and used for risk stratification of Kaplan-Meier survival analysis based on different treatment options.</p><p><strong>Results: </strong>Nomograms of OS and CSS were formulated based on the independent prognostic factors utilizing the training set. The 3- and 5- years of OS nomogram demonstrated good discrimination (AUC = 0.840 and 0.829, respectively), well-calibrated power, and excellent clinical effectiveness. Our nomograms of predicting OS and CSS had a concordance index of 0.801 and 0.866 compared with 0.676 and 0.746 for the AJCC staging system, and more importantly, demonstrated a better forecast accuracy. Chemoradiotherapy displayed a significant survival benefit in the high-risk groups, but proceeding to surgery plus chemotherapy showed a favorable survival for the low groups based on all patients.</p><p><strong>Conclusion: </strong>We developed and internally validated multivariable models that predict OS and CSS risk of SPEC in patients with a CRC to help clinicians make applicable clinical decisions for patients.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"17 ","pages":"2959-2970"},"PeriodicalIF":2.7,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803574","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}