Risk Management and Healthcare Policy最新文献

{"title":"Development of a Risk Prediction Model for Post-Stroke Functional Recovery Based on Clinical and Nursing Factors.","authors":"Ruilin Sun, Zhaojun Liu","doi":"10.2147/RMHP.S609869","DOIUrl":"10.2147/RMHP.S609869","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to develop and validate a risk prediction model for unfavorable functional recovery at 6 months after stroke, incorporating clinical and modifiable nursing-related predictors to support early risk stratification and individualized nursing interventions.</p><p><strong>Methods: </strong>A retrospective cohort study included 1340 stroke patients from a tertiary hospital. Demographic, clinical, imaging, nursing, and psychosocial data were collected. The dataset was split into training and testing sets at a 7:3 ratio using outcome-stratified sampling. Univariate analysis and multivariable logistic regression were used as a predictor screening procedure. A nomogram-based risk prediction model was developed and evaluated for discrimination, calibration, and clinical utility. Patients were further stratified into low-, intermediate-, and high-risk groups based on predicted probability tertiles from the training set.</p><p><strong>Results: </strong>Older age, prior stroke history, comorbidity burden, longer onset-to-admission time, greater neurological deficit severity, lower Glasgow Coma Scale score, and brainstem lesions were independent predictors of unfavorable recovery. Early out-of-bed mobilization within 48 hours, higher self-management behavior score, absence of depressive symptoms, and better social support were linked to reduced risk. The model showed good discrimination and calibration in both sets. Risk stratification showed a stepwise increase in unfavorable recovery rates across the three risk groups. Decision curve analysis indicated net clinical benefit within a reasonable threshold probability range.</p><p><strong>Conclusion: </strong>The developed model combines clinical and modifiable nursing-related predictors and demonstrates good predictive performance. It may serve as a practical tool for early risk stratification and targeted nursing interventions in stroke patients.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"609869"},"PeriodicalIF":2.6,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145464","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":"Health Insurance Schemes and Chronic Disease Management Behaviours in China: Evidence from Women with Non-Communicable Diseases.","authors":"Wenwen Liu, Liangyu Kang, Wenxin Yan, Chenyu Yan, Tianran Wang, Ning Zhang, Victor Yu Cui, Siyu Liu, Liyuan Tao, Min Liu, Jue Liu, Wannian Liang","doi":"10.2147/RMHP.S600628","DOIUrl":"10.2147/RMHP.S600628","url":null,"abstract":"<p><strong>Background: </strong>Women in China bear a disproportionate burden of non-communicable diseases (NCDs), but limited evidence is available on whether different health insurance schemes are associated with chronic disease management behaviours.</p><p><strong>Objective: </strong>To examine the association between insurance type and chronic disease management behaviors among insured Chinese women with NCDs.</p><p><strong>Methods: </strong>We used data from a national cross-sectional online survey of approximately 7,000 women conducted in 31 provinces in China from 1 June to 20 August 2025 by the Institute for Health China Studies, Tsinghua University. Linear probability models with robust standard errors were used to estimate the associations between insurance type and three chronic disease management behaviours: medication adherence, lifestyle intervention, and health surveillance. Dietary regularity and health-product purchases were examined as spillover outcomes.</p><p><strong>Results: </strong>Among survey respondents, 1,101 insured women aged 17-70 years reported at least one physician-diagnosed NCD. Compared with Urban Employee Basic Medical Insurance (UEBMI) enrollees, women covered by the government-funded medical subsidy program (GovMed) had a higher probability of medication adherence (β = 0.116, 95% CI: -0.003 to 0.236), whereas Urban-Rural Resident Basic Medical Insurance (URRMI) enrollees did not differ significantly (β = -0.026, 95% CI: -0.101 to 0.049). After adjustment, differences across schemes in lifestyle intervention and health surveillance were small and not statistically significant. Menopausal heterogeneity was concentrated in medication adherence: among post-menopausal women, GovMed enrollees had a 36.4-percentage-point higher probability of medication adherence than UEBMI enrollees (β = 0.364, 95% CI: 0.219 to 0.509). Supplementary commercial insurance was positively associated with health surveillance, but not with medication adherence or lifestyle intervention. Insurance-related differences in dietary regularity were weak and not statistically robust.</p><p><strong>Conclusion: </strong>Insurance-related differences in chronic disease management among Chinese women with NCDs are most evident for medication adherence, particularly among post-menopausal women. Broader self-management behaviours appear less responsive to scheme differences.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"600628"},"PeriodicalIF":2.6,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13222584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148145472","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":"Machine Learning-Based Early Prediction of Lower Extremity Deep Vein Thrombosis in the ICU: A Multicenter Study.","authors":"Yang Li, Ling Xu, Yunfeng Chen","doi":"10.2147/RMHP.S603569","DOIUrl":"10.2147/RMHP.S603569","url":null,"abstract":"<p><strong>Purpose: </strong>Deep vein thrombosis (DVT) is a prevalent and life-threatening complication in the Intensive Care Unit (ICU). Traditional risk tools often lack specificity for ICU acquired DVT. This study aimed to develop and externally validate an interpretable machine learning (ML) model for accurate DVT risk prediction in critically ill patients.</p><p><strong>Methods: </strong>This multicenter retrospective study included 2000 patients from two centers, partitioned into training, internal testing, and external validation sets. LASSO regression and the Boruta algorithm identified robust predictors. Eight ML algorithms were trained and evaluated using the Area Under the Curve (AUC), calibration plots, and Decision Curve Analysis (DCA). The SHapley Additive exPlanations (SHAP) framework was utilized for model interpretability.</p><p><strong>Results: </strong>The Random Forest (RF) model outperformed other ML algorithms and traditional tools (e.g. Caprini score). It achieved AUCs of 0.869 (95% CI: 0.822-0.916) in training, 0.850 (95% CI: 0.801-0.900) in internal testing, and 0.831 (95% CI: 0.771-0.888) in external validation. SHAP analysis identified six dominant predictors: immobilization duration, D-dimer, femoral vein catheterization, APACHE II score, malignancy, and age. The RF model successfully captured non-linear interactions, particularly exponential risk increases from prolonged immobilization and elevated D-dimer. DCA demonstrated a higher net clinical benefit than default strategies.</p><p><strong>Conclusion: </strong>Integrating six readily available clinical variables, the RF model offers a robust and interpretable tool for DVT risk stratification, outperforming traditional scores. To facilitate real-world clinical application, an accessible web-based calculator is being developed to guide early, personalized thromboprophylaxis in the ICU.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"603569"},"PeriodicalIF":2.6,"publicationDate":"2026-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13221438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139775","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":"Social Determinants of Health, Nursing Care Quality, and Patient Outcomes in Neurological Disorders: A Systematic Review.","authors":"Siyi Yuan, Jing Hou, Xiaofang Yang","doi":"10.2147/RMHP.S597958","DOIUrl":"10.2147/RMHP.S597958","url":null,"abstract":"<p><strong>Background: </strong>Social determinants of health (SDOH) significantly influence healthcare delivery and outcomes, yet their specific impacts on neurological nursing care quality remain insufficiently synthesized.</p><p><strong>Objective: </strong>This systematic review aimed to synthesize evidence on the associations between SDOH and nursing care quality and patient outcomes across major neurological disorders.</p><p><strong>Methods: </strong>Following PRISMA 2020 guidelines, we systematically searched PubMed, Web of Science, and Embase for observational studies published between January 2015 and October 2025. A narrative synthesis approach was employed due to substantial heterogeneity across studies.</p><p><strong>Results: </strong>Sixty-five observational studies (2015-2025) encompassing 5,412,847 patients with stroke, dementia, Parkinson's disease, multiple sclerosis, epilepsy, and traumatic brain injury were included. Low socioeconomic status (SES) was associated with 39% increased stroke mortality and 36-66% higher rates of poor functional outcomes. Racial and ethnic minorities experienced 15-25% reduced access to acute stroke treatments and 27% higher readmission rates. Uninsured patients faced three-fold increased mortality and substantially reduced rehabilitation access, while rural patients received thrombolysis 50-55% less frequently. Optimal nurse staffing ratios (<3 patients per nurse) were associated with substantially reduced racial disparities in stroke readmissions, representing a critical modifiable nursing intervention. Educational attainment, income, occupation, and community deprivation demonstrated dose-response relationships with outcomes.</p><p><strong>Conclusion: </strong>Systematic SDOH screening integration, culturally tailored interventions, enhanced discharge planning, and policy advocacy addressing structural inequalities are essential to advance health equity in neurological nursing care. Nurse staffing optimization emerges as the most actionable strategy to reduce outcome disparities across vulnerable populations. Limitations include the observational nature of included studies, substantial heterogeneity in SDOH measurement, and geographic concentration in the United States.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"597958"},"PeriodicalIF":2.6,"publicationDate":"2026-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139797","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":"Assessing the Alignment of Long-Term Care Insurance Benefits and Service Provision: Evidence from Shandong, China and Implications for Implementation Risk.","authors":"Zhiyan Han, Xinping Wang, Huifen Ma, Haiyan Qu","doi":"10.2147/RMHP.S591495","DOIUrl":"10.2147/RMHP.S591495","url":null,"abstract":"<p><strong>Purpose: </strong>This study assesses the alignment between Long-Term Care Insurance (LTCI) benefit levels and service supply across 16 prefecture-level cities in Shandong Province, China. This study aims to identify whether mismatches exist between LTCI benefits and long-term care service supply across cities in Shandong Province.</p><p><strong>Methods: </strong>Drawing on field investigations and administrative-institutional data (2023-2024), we developed a composite indicator system covering three dimensions of LTCI benefits, namely benefit breadth, benefit depth, and benefit sustainability, as well as two dimensions of service supply, including institutional capacity and human resources. Entropy weighted TOPSIS was used to derive subsystem scores for benefit level (F1) and service supply (F2). The coupling coordination degree model (CCDM) was then applied to evaluate the quality of alignment, and an obstacle degree model was used to identify key barriers.</p><p><strong>Results: </strong>Substantial intercity disparities were observed in both LTCI benefit levels (F1: 0.237-0.798) and service supply (F2: 0.049-0.695). Only one city achieved a well-coordinated status (D = 0.863), while most remained at primary or lower coordination stages. Distinct structural patterns emerged, including benefit-led, service-led, and dual-low development types. Obstacle analysis identified human resource capacity (accounting for 36.9% of obstacles in leading cities) and insufficient payment standards as the dominant barriers to coordination.</p><p><strong>Conclusion: </strong>The LTCI system in Shandong is characterized by significant intercity heterogeneity and structural mismatches between policy design and service delivery. Our analysis identifies human resource capacity and payment standards as the dominant obstacles that hinder the effective translation of insurance funding into accessible care. Policy efforts should prioritize integrated coordination through dynamic payment adjustments and human resource stabilization to ensure the long-term sustainability and equity of the system.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"591495"},"PeriodicalIF":2.6,"publicationDate":"2026-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148139711","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":"Why Do Stunting Interventions Remain Unequal in Urban Areas? A Multivariate Analysis of Subdistrict Risk Profiles in Cirebon City, Indonesia.","authors":"Leivina Saliaputri, Irlandia Ginanjar, Budhi Handoko","doi":"10.2147/RMHP.S594491","DOIUrl":"10.2147/RMHP.S594491","url":null,"abstract":"<p><strong>Purpose: </strong>Childhood stunting remains a persistent human development barrier in Indonesia. While national prevalence has declined to 19.8% as of 2024, aggregate data frequently mask profound micro-level disparities that threaten the 14% national target. A critical research gap exists in meso-level diagnostics; traditional monitoring evaluates indicators in silos, failing to capture the systemic convergence of interventions. We selected four principal indicators, namely Health Insurance (PBI-JKN), Food Assistance (BPNT), Iron Supplementation, and Unmet Contraceptive Need, as they represent the essential intersection of social protection and reproductive health required for effective prevention. This study addresses the problem of localized systemic risk, where standardized city-wide policies fail to reach \"red zones\" within urban villages. Our objective was to quantify subdistrict-level inequality and identify specific performance typologies across 22 subdistricts in Cirebon City.</p><p><strong>Patients and methods: </strong>We conducted a retrospective, cross-sectional analysis of 2023 administrative data. ANOVA-Simultaneous Component Analysis (ASCA) with 1000 permutations was used to decompose variance, followed by SVD-based biplot visualization to map the multivariate performance landscape.</p><p><strong>Results: </strong>The subdistrict effect was statistically significant ([Formula: see text]), with the first two components capturing 92.99% of total variance. Biplot analysis distinguished between \"access-lagging\" facing structural deficits in social protection and \"compliance-lagging\" clusters hampered by behavioral and service-outreach gaps.</p><p><strong>Conclusion: </strong>Urban stunting risk is not monolithic; geography remains a decisive determinant of intervention coverage. This study contributes to the precision public health paradigm by providing a diagnostic framework that enables local governments to move beyond one-size-fits-all models. By identifying neighborhood-specific vulnerabilities, including administrative exclusion and behavioral barriers, policymakers can implement targeted, risk-informed governance to ensure more equitable health outcomes.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"594491"},"PeriodicalIF":2.6,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13212161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058416","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":"Chronic Disease Prevalence and Modifiable Risk Factors Among Undergraduate Students at Ha'il University: A Population-Level Cross-Sectional Study.","authors":"Collins Otieno Asweto, Sehar-Un-Nisa Hassan, Mohamed Ali Alzain, Bandar Alsaif, Mohammed Elshiekh Saeed, Ahmed Kassar, Kamal Elbssir Mohammed Ali, Mouna Ghorbel, Rafat Zrieq, Monzer Hamed, Wei Wang","doi":"10.2147/RMHP.S604127","DOIUrl":"10.2147/RMHP.S604127","url":null,"abstract":"<p><strong>Background: </strong>Rising rates of chronic conditions among Saudi youth underscore the need for early prevention. Using a public‑health lens focused on demographic, academic, and lifestyle influences, this study investigates the risk and protective factors for chronic disease among students at the University of Ha'il to guide youth‑centered health policies and long‑term wellbeing initiatives.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among 10,775 undergraduate students studying in bachelor's degree programs at Ha'il University, Saudi Arabia. Descriptive analyses were used to assess demographic characteristics, academic status, health status, and health-related lifestyles. Multiple logistic regression models were applied to determine which demographic, academic, and health-related lifestyle factors significantly predicted chronic disease among university students.</p><p><strong>Results: </strong>The overall prevalence of chronic diseases was 16.2% (n = 1748). Among chronic diseases, diabetes was the most prevalent 6.8% (n = 731), followed by migraines 5.4% (n = 583), heart disease 2.0% (n = 217), hypercholesterolemia 1.9% (n=201), and others 0.1% (n = 16). The results showed that younger, female, and married students had greater odds of developing chronic disease. Among the study-related variables, academic level, Grade Percentage Average (GPA), missed lectures, and intention to withdraw were significantly associated with chronic diseases. Among psychological variables, high stress levels significantly increased the odds of having chronic disease [AOR = 9.87 (95% CI: 8.01-11.34), p < 0.001]. Students with unhealthy lifestyles were more likely to have chronic diseases than those with a healthy lifestyle [AOR = 2.60 (95% CI: 2.33-2.90), p < 0.001].</p><p><strong>Conclusion: </strong>The 16.2% prevalence of chronic health conditions among university students is a notable public health concern within this typically healthy population. Demographic and academic vulnerabilities were further intensified by modifiable lifestyle behaviors which showed strong associations with chronic disease prevalence thus findings imply prioritizing student health through culturally grounded interventions.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"604127"},"PeriodicalIF":2.6,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037747","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":"Somalia's Drought-Disease Spiral: Climate Shocks as an Emerging Public Health Security Threat.","authors":"Abdiweli Mohamed Abdi, Osman Mohamed Mohamud, Mohamed Ismael Iman, Nor Haji Osman, Abdirahman Mohamed Jimale, Abdikarim Abdi Adam, Mahad Ali Mohamud, Mohamed Ahmed Ali","doi":"10.2147/RMHP.S608198","DOIUrl":"10.2147/RMHP.S608198","url":null,"abstract":"<p><p>This narrative commentary examines Somalia's drought-disease spiral using selected published literature, humanitarian reports, surveillance updates, and climate-health evidence. It focuses on how recurrent droughts, floods, food insecurity, displacement, malnutrition, and fragile health-system capacity interact to increase the risk of climate-sensitive infectious diseases. Somalia is among the countries most vulnerable to climate variability, and repeated environmental shocks have intensified humanitarian needs while placing additional pressure on an already fragile health system. Recent climate-related crises have contributed to severe food insecurity, large-scale internal displacement, limited access to safe water and sanitation, and recurrent outbreaks of infectious diseases, including cholera, acute watery diarrhea, measles, and diphtheria. Malnutrition, particularly among children and displaced populations, further increases vulnerability to infection and worsens health outcomes. This commentary argues that climate-related health threats in Somalia should be understood not only as humanitarian emergencies but also as public health security and risk-management challenges. The drought-disease spiral reflects the convergence of environmental hazards, weak WASH conditions, overcrowded internally displaced persons settlements, undernutrition, and limited surveillance and response capacity. Breaking this cycle requires a shift from repeated emergency response toward anticipatory prevention and resilience-building. Priority actions include strengthening climate-informed disease surveillance, integrating climate and health early warning systems, expanding WASH services in internally displaced persons settlements and other vulnerable communities, investing in climate-resilient health facilities, improving nutrition-sensitive outbreak preparedness, and strengthening multisectoral coordination across health, WASH, nutrition, climate, livestock, and humanitarian sectors. These actions are essential to reduce preventable disease, protect vulnerable populations, and strengthen health-system resilience in Somalia.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"608198"},"PeriodicalIF":2.6,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13200193/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037739","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":"Public-Access Defibrillation in Megacities: Structural Barriers and Systemic Opportunities in Shanghai, China.","authors":"Yu Gao, Xin Zhou, Li Luo","doi":"10.2147/RMHP.S590419","DOIUrl":"10.2147/RMHP.S590419","url":null,"abstract":"<p><strong>Background: </strong>Despite nationwide efforts to expand public-access defibrillation (PAD) in China, the use of automated external defibrillators (AEDs) remains extremely low. Although spatial disparities in AED deployment have been widely reported, less is known about the structural, procedural, and behavioral factors that hinder effective use in real-world emergencies. This study explored multilevel barriers and opportunities within Shanghai's PAD system.</p><p><strong>Methods: </strong>Guided by the Social Ecological Model, we conducted in-depth semi-structured interviews with 42 participants involved in AED financing, deployment, management, maintenance, training, digital platform development, and emergency response. Interviews were conducted between December 2024 and June 2025, with data transcription, checking, and preliminary analysis continuing until July 2025. Data were analyzed using inductive and deductive thematic analysis. Themes were organized across system, organizational, community, and individual levels.</p><p><strong>Results: </strong>Shanghai's PAD system is shaped by interacting barriers across multiple levels. At the individual level, limited emergency knowledge, fear of causing harm, and uncertainty about legal protection reduced bystanders' willingness to act. At the organizational and system levels, fragmented governance, inconsistent maintenance standards, restricted venue access, non-standard signage, and disconnected digital platforms limited AED visibility, accessibility, and timely activation. At the same time, several opportunities emerged. High-willingness population groups could be targeted through scenario-based, recurrent training. Data-informed AED siting and hybrid fixed-plus-mobile deployment models using taxis or delivery riders may help reduce spatial inequities. Participants also highlighted the need for a centralized, government-led AED information platform linked to emergency dispatch and device management.</p><p><strong>Conclusion: </strong>AED installation alone is insufficient to deliver effective PAD. In Shanghai, PAD performance is constrained less by device availability itself than by fragmented governance, weak system integration, and persistent behavioral barriers. Strengthening legal protection, improving cross-sector coordination, integrating AED information with dispatch systems, and promoting activation-oriented public training may help translate AED availability into lifesaving action.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"590419"},"PeriodicalIF":2.6,"publicationDate":"2026-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13199715/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037749","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":"Financial Management Innovation in Hospital Groups: An Empirical Study of Ophthalmology Specialty Care Under Consolidation.","authors":"Bihui Ye, Xiaoqiong Pan, Zhengxing Wu","doi":"10.2147/RMHP.S599522","DOIUrl":"10.2147/RMHP.S599522","url":null,"abstract":"<p><strong>Objective: </strong>This study examines financial management innovation in a provincial public ophthalmology hospital group in China, focusing on associations among consolidation, shared services, digital transformation, financial performance, and operational efficiency.</p><p><strong>Methods: </strong>We used a mixed-methods single-case design. The quantitative analysis used a campus-month panel from January 2020 to December 2024 (2 campuses x 60 months; N=120 campus-month observations), with descriptive statistics, correlation analysis, and campus fixed-effects pre-post association models with clustered standard errors. Semi-structured interviews with 28 managers and key staff were audio-recorded, transcribed, and thematically coded.</p><p><strong>Results: </strong>Consolidation and digital transformation were associated with higher operating margins and improved process performance, but estimates should be interpreted as observational associations. In adjusted models, the post-consolidation period was associated with 2.8-3.4 percentage points higher operating margins. Centralized procurement was associated with 18% lower average supply cost in participating categories, and RPA-supported claims processing was associated with a 35% shorter processing cycle and 94% accuracy. The absence of a financial shared service center remained associated with inefficiencies, including an average accounts payable cycle of 45 days.</p><p><strong>Conclusion: </strong>In this single-case observational study, hospital group consolidation was associated with higher operating margins, especially when paired with selective digital transformation. The findings are hypothesis-generating and suggest that integration benefits may depend on shared service implementation and interoperable digital platforms.</p>","PeriodicalId":56009,"journal":{"name":"Risk Management and Healthcare Policy","volume":"19 ","pages":"599522"},"PeriodicalIF":2.6,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13197673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148018887","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}