Frontiers in health services最新文献

{"title":"Communication and resolution programs expose hard-to-hear truths.","authors":"Gerald B Hickson, Richard C Boothman, Alice M Krumm, Ronald Wyatt","doi":"10.3389/frhs.2024.1523363","DOIUrl":"10.3389/frhs.2024.1523363","url":null,"abstract":"<p><p>Communication and Resolution Programs' (CRP) favorable impact on professional liability claims continues to draw attention, but because they are deliberately aligned to advance the health system's mission rather than amelioration of litigation exposure, CRPs stand a better chance of delivering durable healthcare improvements than traditional responses to patient harm. CRP adherents employ focused investigations overseen by their own patient safety leader in order to engage patients with a principled response following unintended clinical outcomes. Focused on safety and unencumbered by litigation delays, CRP investigations are more apt than traditional responses to lay bare patient safety risks including professionalism challenges. Leaders, however, must be prepared to embrace and address hard-to-hear truths about dysfunctional systems or disruptive humans that threaten outcomes of care or clinical staff wellbeing.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"4 ","pages":"1523363"},"PeriodicalIF":1.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leading the way in pediatric sexual health screenings: evaluating pediatric emergency department workflows for the integration of STI screening tools.","authors":"Laura Schubel, Deanna-Nicole Busog, Azade Tabaie, Monika Lemke, Danielle Foltz, Gia Badolato, Natasha Ajay Kaushal, Monika K Goyal, Kristen Miller","doi":"10.3389/frhs.2025.1493318","DOIUrl":"10.3389/frhs.2025.1493318","url":null,"abstract":"<p><strong>Introduction: </strong>Emergency department (ED) encounters offer strategic opportunities for sexually transmitted infection (STI) screening, prevention, and treatment for adolescents at risk for STIs who may not otherwise have access to routine screening. This study determined optimal ED implementation of the Teen Health Screen (THS), a validated, tablet-based, patient-reported, sexual risk assessment, and evaluated its implementation feasibility under variable workflows and high-stress tasks.</p><p><strong>Methods: </strong>Workflow analysis included semi-structured interviews with patients, caregivers, and clinical staff members and clinical observations to understand patient and clinical workflow. The study was conducted in two urban pediatric EDs over six weeks. Participants included patients, parents/caregivers, registration staff, nurses, social workers, child life specialists, providers, and health IT experts.</p><p><strong>Results: </strong>The primary study outcome was development of a general model of ED workflow and patient-clinician engagement, focusing on patient flow, clinical tasks, people, and technologies involved. Workflow analyses identified key opportunities for THS deployment during the nurse assessment process, which aligns with other existing screening activities and offers privacy. This approach addresses potential barriers to integration such as privacy concerns, language and literacy barriers, the sensitivity of discussing sexual history, comfort with technology, tablet accessibility and security, and internet availability.</p><p><strong>Discussion: </strong>Workflow analysis provided valuable insights to the perceptions, thoughts, and practicality of implementing the THS in the ED. Interviews revealed general acceptance of the new process but highlighted logistical challenges, particularly with staffing and patient surge. Implementing the THS in ED settings appears feasible, with important opportunities identified for integration to improve patient safety, including staffing and workflow optimization.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1493318"},"PeriodicalIF":1.6,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652322","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restorative initiatives: emerging insights from design, implementation and collaboration in five countries.","authors":"Jo Wailling, Graham Cameron, Iwona Stolarek, Stephanie Turner, Beelah Bleakley, Nick O'Connor, Catriona Harwood, Michael Power, Kathryn Turner, Allison Kooijman, Nelly D Oelke, David Gustafson, Rob Robson, Murray Anderson Wallace, Gerard Drennan, Jo Hughes, Jane K O'Hara, Fin Swanepoel, Christopher H LeMaster","doi":"10.3389/frhs.2025.1472738","DOIUrl":"https://doi.org/10.3389/frhs.2025.1472738","url":null,"abstract":"<p><strong>Introduction: </strong>Restorative systems are human centred and distinguished by an emphasis on relational principles and practices. Emerging evidence indicates that a restorative approach holds promise to mitigate and respond to harm in the complex health environment. Advocates are collaborating with clinicians and institutions to develop restorative responses to adverse events.</p><p><strong>Method: </strong>This paper shares the insights of an international network who have been collaborating to nurture the development of restorative policy and practice in five countries since 2019 (Aotearoa New Zealand, Australia [New South Wales & Queensland]; Canada [British Columbia], England and the United States [California]). Our work is at varying stages of maturity and incorporates co-designing, implementing, and evaluating restorative responses to adverse events.</p><p><strong>Results & discussion: </strong>The viewpoint provides an overview of the core principles, emerging evidence, and shares our collective reflections about the constraining and enabling factors to development. We recognise that we cannot speak to the breadth of work underway worldwide. Our hope is that by drawing on our experiences, we can offer some thoughts about what a restorative lens offers the future of patient and family involvement in patient safety, whilst providing the opportunity for transparent critique of work to date.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1472738"},"PeriodicalIF":1.6,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11906477/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143652308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of patients' exit knowledge and associated factors for drugs dispensed at outpatient pharmacies in Ethiopia.","authors":"Temesgen Geta Hardido, Christian Kebede, Tamirat Beyene","doi":"10.3389/frhs.2025.1436591","DOIUrl":"10.3389/frhs.2025.1436591","url":null,"abstract":"<p><strong>Background: </strong>Patients' knowledge of dispensed drugs is essential to prevent preventable patient mortality and facilitating their recovery from illnesses. Several studies have been conducted in Ethiopia, but the overall level of patients' exit knowledge about the dispensed drugs and associated factors has not been estimated. The objective of this review is to assess overall level patients' exit knowledge of dispensed drugs and associated factors in Ethiopia.</p><p><strong>Methods and materials: </strong>Only articles published in English were included in this review. PubMed, EMBASE and CINAHL, Web of Science, Google Scholar, Scopus, Ethiopian University Repository Online, and the Cochrane Library are the main databases. The review included cross-sectional studies written in English that met the inclusion criteria. Using a random effects model, the overall level patients' exit knowledge of dispensed drugs was estimated. Additionally, funnel plots and Eggers' test were used to assess publication bias. STATA version 14 was used to perform all statistical analyzes.</p><p><strong>Results: </strong>This review included 10 studies involving 3,431 patients in Ethiopia. In Ethiopia, the overall patients' knowledge towards dispensed drugs was 50.73% [95% CI (31.81; 69.66); I2 = 99.4%, <i>P</i> < 0.001]. The patients' exit knowledge of dispensed drugs was statistically associated with the education level of the patients and the availability of adequate drug information.</p><p><strong>Conclusions: </strong>One in two patients has good knowledge of dispended drugs in Ethiopia. Therefore, patients need special attention when dispensing drugs and leaving a health facility. Furthermore, the Ethiopian government, pharmacists, and other stakeholders must take immediate action to improve patients' knowledge about dispensed drugs in Ethiopia and identified factors.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024544256, identifier: CRD42024544256.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1436591"},"PeriodicalIF":1.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enabling good transition processes from child to adult medical care: a study protocol.","authors":"Camilla Ida Ravnbøl, Laura Altweck, Silke Schmidt, Lene Bistrup, Stefan Borgwardt, Sidse Marie Arnfred, Pia Jeppesen, Philipp von Bismarck, Julie Bork Nellegaard, Alexander Prehn-Kristensen, Ada Colic","doi":"10.3389/frhs.2025.1520013","DOIUrl":"10.3389/frhs.2025.1520013","url":null,"abstract":"<p><p>Hundreds of patients each year transfer from child to adult medical care when they become adults. The transfer in health care comes with a risk of interrupted treatment or a failure to follow treatment properly, which can have serious consequences for the physical and mental health and well-being of the young person, and for their future ability to engage in education, work or social life. The Child to Adult Transition project (CAT) is a cross-country and inter-disciplinary innovation and research project that aims to address this pertinent topic. CAT focuses on young people in rheumatology and mental health care in Denmark and Germany and develops transition programmes to support young persons and their parents in the transfer from child to adult medical care, while exploring how young people experience and reflect on this transition and their experiences of the CAT programs. The CAT study has a longitudinal, mixed-methods study design, surveying young patients (age 15-25 years), their parents/guardians, and health-care professionals via interviews (individual or group), field observations, and/or online surveys. At baseline, interviews will be conducted with 24-68 adolescents and young adults, 24-68 parents/guardians, and 24-68 health-care professionals in both countries and across disciplines. 13-14 observations will be made in three settings and, at baseline, 400 adolescents and young adults will receive the survey. Interviews and surveys will be repeated after six and 12 months. The study will focus on topics such as everyday life as a young patient, transition experiences, somatic, and mental health, and quality of life. The CAT project period runs from January 2023 to December 2025. Recruitment to the CAT study is ongoing and all ethical approval have been obtained from the different departmental sites and ethical committees. The project combines different medical disciplines (child, adolescent and adult rheumatology and mental health), academic disciplines (medicine, anthropology and psychology) as well as countries (Germany, Denmark). It also combines person-groups (young persons, parents, professionals) and methods (interviews, observations, surveys). This approach provides new perspectives on the medical, psychological and anthropological aspects of the complex nature of the medical transfer. The findings will feed into the guidelines on transitional care, can also be used in other medical disciplines, and can be prepared as popular publications and other media enabling a broader audience to be reached. The study protocol is registered on the Open Science Framework: https://osf.io/vdy9p.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1520013"},"PeriodicalIF":1.6,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11903410/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Requirements for effective investigation and learning after suicide: the views of persons with lived experience and professionals.","authors":"Elin Fröding, Charles Vincent, Boel Andersson-Gäre, Åsa Westrin, Axel Ros","doi":"10.3389/frhs.2025.1519124","DOIUrl":"10.3389/frhs.2025.1519124","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to provide a deeper understanding of what persons with lived experience and professionals with experience of patient safety, suicide research, and investigations consider to be most important in investigations of healthcare before suicide to learn and improve the care of suicidal patients.</p><p><strong>Method: </strong>This is a qualitative study based on 15 semistructured interviews with persons with lived experience of suicidality and professionals. Thematic analysis was used.</p><p><strong>Results: </strong>The persons with lived experience and the professionals agreed that a holistic approach to the investigations is crucial. They should embrace a longer period of time, involve family and significant others, integrate the perspective and expectations of the patient, and analyze factors of significance for suicidality, suicide prevention, and safety. There is a need to improve the investigations through the involvement of all stakeholders and actors, securing competence in the investigation team and prioritizing cases to investigate.</p><p><strong>Conclusions: </strong>Substantial changes in the approach and performance of investigations of suicide in healthcare are needed to make these investigations valuable for increasing the safety of the care of suicidal patients. A holistic perspective during the analysis is crucial for understanding the suicidal process, the interacting factors, and the care process preceding suicide. Competencies in suicidality, suicide prevention, and patient safety must be included in the analysis team to ensure high quality and relevance. To improve the value of these investigations, we suggest establishing a template based on current knowledge to ensure attention to variables of significance for a safe care of suicidal patients.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1519124"},"PeriodicalIF":1.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11893547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is improvement science, and what makes it different? An outline of the field and its frontiers.","authors":"Julie E Reed, Grazia Antonacci, Natalie Armstrong, G Ross Baker, Sonya Crowe, Karin Pukk Harenstam, Dougal Hargreaves, Yogini H Jani, Lloyd Provost, Martin Rejler, Carl Savage, Johan Thor, Sharon Williams, Thomas Woodcock","doi":"10.3389/frhs.2024.1454658","DOIUrl":"10.3389/frhs.2024.1454658","url":null,"abstract":"<p><p>Improvement science has emerged as an interdisciplinary field of enquiry to provide methodological and scientific rigour to the practice and study of improvements in healthcare, and with contributions from a wide range of stakeholders and perspectives. However, compared to more well-established health-related sciences, the science of improvement remains in relative infancy. Whilst the improvement community has grown considerably, there is no existing articulation of the scope of what matters to the health and social care improvement community, and how this aligns to the enquiries of the field of improvement science. This paper aims to outline key areas of interest to the improvement community, and to propose distinguishing features of improvement science that help differentiate it from other areas of enquiry. Two over-arching research questions are identified, along with ten associated areas of enquiry which are grouped into three clusters: (1) improvement in practice, (2) aligning improvement efforts and (3) advancing the contribution of the improvement community. Four features that collectively define and distinguish the field of improvement science are proposed. The outline of the improvement landscape provides a common language for the diverse improvement community, supporting people to transcend disciplinary interests and constraints, and to consider how, collectively, we can improve health and care. Others are invited to refine and advance mapping of the improvement landscape by identifying gaps and increasing contributions from diverse perspectives.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"4 ","pages":"1454658"},"PeriodicalIF":1.6,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11884242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the health of the rural population in India through bundling WASH practices.","authors":"Trung Thanh Nguyen, Dil Bahadur Rahut, Raja Timilsina, Manh Hung Do, Tetsushi Sonobe, Navneet Manchanda","doi":"10.3389/frhs.2025.1500504","DOIUrl":"10.3389/frhs.2025.1500504","url":null,"abstract":"<p><p>Achieving access to clean and safe water, sanitation, and hygiene (WASH) for all is one of the Sustainable Development Goals. However, most efforts to improve access to clean and safe WASH focus on a single practice, resulting in a low adoption rate and limited impact. This study analyses data from 63,732 rural households from the 76th Round of the Indian National Sample Survey in 2018 to (i) identify the factors associated with the adoption of WASH practices using logit estimations, (ii) explore adoption disparities via the Blinder-Oaxaca decomposition method, and (iii) assess the health impacts of having one vs. a combination of several, i.e., bundles of practices, using the heteroskedasticity-based instrumental variable approach. The findings reveal that (i) the wealth status of rural households and education levels of household heads are significant factors associated with the adoption, (ii) female-headed households and those belonging to scheduled castes and tribes are disadvantaged in adoption, and (iii) bundling several practices is more effective in mitigating health problems compared to single-practice adoption. Therefore, prioritizing bundled practices for impoverished households, those with lower educational attainment, female-headed households, and scheduled castes and tribes is crucial for enhancing health outcomes and alleviating the disease burden in rural India.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1500504"},"PeriodicalIF":1.6,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported outcome measures to deliver patient and family-centered care in pediatrics: the ball is now in our court.","authors":"Sumedh Bele, Maria J Santana","doi":"10.3389/frhs.2025.1529731","DOIUrl":"10.3389/frhs.2025.1529731","url":null,"abstract":"<p><p>Patient-reported Outcome Measures (PROMs) are self-reported questionnaires that are used to deliver patient and family-centered care, but their use in routine pediatric clinical care remains limited. The American Institute of Medicine (IOM) recommends patient-centered care to achieve high quality health care delivery and PROMs can be used in routine pediatric clinical care to support six critical dimensions of patient-centered care endorsed by the IOM. The growing evidence including our systematic review of pediatric PROMs, shows that incorporating PROMs into routine pediatric clinical practice significantly enhances the quality of care and has a positive impact on Health-related Quality of Life (HRQL) among children and youth. Thus, we are sharing our perspectives on the current evidence, emphasizing the need for using PROMs in routine pediatric clinical care and proposing strategies for pediatric implementation.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1529731"},"PeriodicalIF":1.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11876031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143559739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The power and pain of words: how language matters in responding to patients after harm.","authors":"E M Benjamin, A Peterson, L Schweitzer, S Calcasola, F Korn, P Lodato, J Bradley, C Hemmelgarn","doi":"10.3389/frhs.2025.1513670","DOIUrl":"10.3389/frhs.2025.1513670","url":null,"abstract":"<p><p>A change is slowly occurring in the ways healthcare responds to patients after they experience harm. The imperative to be transparent with patients and families has been accepted as a key element of high quality, safe and patient-centered healthcare. The language used to describe the experience of the people impacted by harm events is also evolving, recognizing that certain words can help or hinder the experience of patients affected by harm. The language describing these efforts is shifting from legal and institutional terminology to more inclusive terms recognizing broader groups impacted by harm. We describe the evolution of language regarding harm response and make recommendations for the future of the field. While our observations on language are specific to the terminology used in the United States, the concept of moving to more patient-centered language is universal. Other countries should make similar reviews to use more patient-centered language when discussing patient harm.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1513670"},"PeriodicalIF":1.6,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11865032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}