Frontiers in health services最新文献

{"title":"From symbolism to substance: evaluating state disclosure laws and the case for federal oversight.","authors":"Sherri Cheng, Wenjing Duan, Wenqi Zhou","doi":"10.3389/frhs.2025.1666949","DOIUrl":"10.3389/frhs.2025.1666949","url":null,"abstract":"<p><p>Pharmaceutical payments to physicians have long raised concerns about conflicts of interest and rising healthcare costs. While the Physician Payments Sunshine Act (PPSA) established federal transparency standards in 2013, several states had already enacted their own disclosure laws. This study evaluates the hypothesis that individual state policies varied in effectiveness at shaping corporate payment strategies. Specifically, we examined four state policies, Massachusetts (MA), Maine (ME), Minnesota (MN), and West Virginia (WV), using a difference-in-differences design, comparing the outcomes with matched control states before and after PPSA implementation. We analyzed meals and travel payments from four major pharmaceutical companies using ProPublica's Dollars for Docs (2012-2013) and Centers for Medicare & Medicaid Services' Open Payments (2014-2015) data. Results indicate that MA's comprehensive policy, featuring strict reporting requirements, public accessibility, and enforcement, yielded a significant 44% decline in travel payments. In contrast, ME, MN, and WV's policies showed negligible impacts. These findings suggest that disclosure laws exert real influence only when they are comprehensive, transparent, and backed by enforcement. This underscores the critical role of policy structure in addressing conflicts of interest and points to ways the PPSA framework could be strengthened. Based on our findings, we suggest that other nations could strengthen their systems by adopting centralized and standardized reporting systems, similar to the PPSA.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1666949"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260092","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 cross-learning in clinical teams using daily on-site reflective meetings.","authors":"Nawal Khattabi, Ros Axel, Reem AlAbdulmalik, Amal Al-Ali, Erik Hollnagel","doi":"10.3389/frhs.2025.1630722","DOIUrl":"10.3389/frhs.2025.1630722","url":null,"abstract":"<p><strong>Introduction: </strong>Learning is fundamental for improving patient safety and quality. Historically, people have focused on learning from unsuccessful performances, such as accidents, incidents, or near-misses. Contemporary approaches to patient safety emphasize the importance of learning from successful everyday work. This approach to learning is less common in the healthcare system and does not carry the same sense of urgency as learning from work that does not go well. Broadening an organization's learning strategies to include learning from everyday work requires adopting new methods and mindsets.</p><p><strong>Methods: </strong>This study describes the experience of implementing the Resilient Performance Enhancement Toolkit (RPET) in a multisite primary care organization. RPET was introduced through structured daily reflective meetings aimed at fostering cross learning, team adaptation and real-time reflection. Qualitative feedback and thematic observations were collected to explore its impact.</p><p><strong>Results: </strong>The use of RPET varied across 27 Health Centers (HC), with seven early adopters (29 teams) maintaining consistent practices despite pandemic disruptions. By 2023, meeting frequency stabilized, ranging from daily to monthly. Teams reported improvements in patient safety, communication, and team learning, while identifying challenges such as time constraints and interdepartmental coordination. Key benefits included enhanced teamwork, increased risk identification and improved staff morale.</p><p><strong>Conclusion: </strong>Embedding reflective practices into daily routines through RPET can strengthen organizational learning and resilience. This approach offers a practical method for shifting healthcare systems toward proactive, Safety-II aligned strategies that support continuous improvement in dynamic clinical environments.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1630722"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260139","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":"Nurses' attitudes towards factors determining the safety of patients treated in pediatric departments.","authors":"Iwona Malinowska-Lipień, Izabela Sowińska, Sylwia Kocur, Agnieszka Kruszecka-Krówka, Maria Kózka, Agnieszka Gniadek, Łukasz Lompart, Urszula Kalemba, Marta Kasper, Tomasz Brzostek","doi":"10.3389/frhs.2025.1648265","DOIUrl":"10.3389/frhs.2025.1648265","url":null,"abstract":"<p><strong>Introduction: </strong>Patient safety in healthcare is strongly influenced by safety culture, shaped by organizational beliefs, values, and effective management.</p><p><strong>Material and methods: </strong>The study involved 434 nurses from the largest pediatric hospital in southern Poland, one of ten single-profile pediatric hospitals in the country. Data were collected using the Polish version of the Safety Attitudes Questionnaire (SAQ-SF) and a sociodemographic survey.</p><p><strong>Results: </strong>The highest percentage of positive responses (score ≥75) was observed in job satisfaction (56.91%) and stress recognition (53.23%). The lowest results were found in perceptions of management personnel (31.80%) and safety climate (36.41%). Stress levels negatively correlated with the number of nurses per department and shift. Lower assessments of management were associated with higher patient loads and fewer staff. Better working conditions were positively correlated with higher staffing levels.</p><p><strong>Conclusions: </strong>Nurses in pediatric departments reported high job satisfaction and awareness of stress but low ratings of management and safety climate. Higher nurse staffing levels were associated with lower reported stress, indicating a relationship between staffing levels, work environment, and perceptions of patient safety.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1648265"},"PeriodicalIF":2.7,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12504464/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260116","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":"Correction: A multi-stakeholder multicriteria decision analysis for implantable medical devices assessment in China.","authors":"Yizhou Xu, Junjie Wan, Bin Wan, Haixia Ding","doi":"10.3389/frhs.2025.1695328","DOIUrl":"https://doi.org/10.3389/frhs.2025.1695328","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/frhs.2025.1650709.].</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1695328"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234393","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":"Validation of the Jefferson health-related social needs screener.","authors":"Sara Beachy, Kristin L Rising, Richard W Hass, Terry Hyslop, Isabella Muti, Mackenzie Kemp, Rhea E Powell, Cara Martino, Baligh R Yehia, Joseph G Cacchione, Patricia Henwood","doi":"10.3389/frhs.2025.1658661","DOIUrl":"10.3389/frhs.2025.1658661","url":null,"abstract":"<p><strong>Introduction: </strong>Screening for health-related social needs (HRSN) is a growing national health priority. While multiple HRSN screening tools currently exist, none to our knowledge have been evaluated using robust statistical analyses. The goal of this work is to provide results from a validation study of the Jefferson HRSN screener conducted across inpatient and outpatient settings.</p><p><strong>Methods: </strong>This retrospective cross-sectional psychometric study included HRSN assessments conducted across inpatient and outpatient settings with adult patients from March 2023 to May 2024. The study was conducted across a 17-hospital academic health system serving a diverse community in a 9-county area crossing two states<b>.</b> Participants answered the HRSN screener, which includes eight questions across seven HRSN domains (financial, food, housing, utilities, transportation, violence/safety, and social connection) and two follow up questions, as part of standard healthcare encounter procedures. The measure was assessed with item response theory and a two-parameter logistic model. A follow-up analysis using Latent Class Analysis (LCA) was used to assess whether HRSN items and demographic variables could be used to identify people with higher levels of social vulnerability index (SVI). Higher SVI indicates higher levels of needs based on community and neighborhood related factors.</p><p><strong>Results: </strong>The final sample included data from 302,929 adults. Patients were relatively evenly distributed across ages (< 45 years, 32%; 45-64 years, 32%; 65-84 years, 30%; 85+, 4%). Most patients were Non-Hispanic (87%), White (66%), and female (59%). A third of patients were in the medium-high (18%) and high (15%) SVI areas. Positive responses across questions ranged from 0.90%-5.90%. Slopes ranged between 1.67-3.77, and difficulty parameters ranged between 2.20-3.31, indicating that the items can detect a high level of need. LCA results suggested that the eight HRSN items combined with basic demographic variables could help identify people with higher HRSN.</p><p><strong>Discussion: </strong>The Jefferson HRSN screener provides a valid approach for HRSN screening across healthcare settings. The eight screening questions, combined with additional questions to evaluate the patient's desire for help and urgency, can be used to identify patients needing additional resources to address fundamental social needs potentially contributing to health disparities.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1658661"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234421","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":"An analysis of National Cancer Institute-funded scale-up research.","authors":"Cynthia Vinson, Aubrey Villalobos, Margarita Correa-Mendez, Gila Neta","doi":"10.3389/frhs.2025.1624733","DOIUrl":"10.3389/frhs.2025.1624733","url":null,"abstract":"<p><strong>Background: </strong>The National Cancer Institute seeks to support cancer research to advance scientific knowledge that will \"help all people live longer, healthier lives.\" To do this, we need to understand how to effectively and efficiently scale-up evidence-based cancer control innovations (EBIs). We analyzed National Cancer Institute (NCI)-funded implementation science (IS) grants to understand gaps and opportunities for scale-up research.</p><p><strong>Methods: </strong>The National Institutes of Health (NIH) Query, View, and Report (QVR) system was used to identify NCI-funded IS grants focused on scale-up since 2016. Key search terms were identified, and two coders reviewed specific aims to identify IS and scale-up grants. Eligible grants were coded for study characteristics, including administrative, cancer-related, and scale-up related features using Microsoft Excel and iSearch.</p><p><strong>Results: </strong>Of the 61 grants initially identified, 17 were included. Approximately one-third of the grants were conducted abroad (<i>n</i> = 6). Most examined factors related to scale-up (e.g., barriers/facilitators, context) (<i>n</i> = 11). Nine studies assessed the costs and benefits of the scaled-up delivery of an EBI, and seven studies evaluated an implementation strategy for EBI scale-up. Most focused on prevention (<i>n</i> = 11), with seven focusing on screening. Cervical cancer (<i>n</i> = 6) was the most frequently studied cancer type. Most of the research took place in healthcare settings (<i>n</i> = 11).</p><p><strong>Conclusions: </strong>The NCI has funded a limited number of IS grants focused on scale-up. This analysis helps identify the current scope of the NCI portfolio and enables exploration of gaps and opportunities for future research on scale-up across the cancer continuum.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1624733"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234315","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":"Implementation of cross-sectoral rehabilitation in the Nordic countries: a scoping review.","authors":"Helle Bøgard, Signe Green Knakkergaard, Charlotte Simonÿ, Lars Hermann Tang, Jeanette Reffstrup Christensen, Anne Dalhoff Pedersen, Alexander Luijk, Stine Gundtoft Roikjær","doi":"10.3389/frhs.2025.1662230","DOIUrl":"10.3389/frhs.2025.1662230","url":null,"abstract":"<p><strong>Introduction: </strong>Rehabilitation needs are rising in the Nordic countries due to an aging population and declining health profiles<b>.</b> Nordic healthcare systems share common features, including universal access, organization, and substantial tax-based financing. Due to the organization of the healthcare system, patients often experience transitions between sectors as part of the rehabilitation program. This fragmented setup undermines the continuity and quality of rehabilitation, making implementation more difficult. To inform future implementation processes, this scoping review examines the factors that influence cross-sectoral rehabilitation in settings with comparable healthcare systems.</p><p><strong>Methods: </strong>This Scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. The search strategy aimed to identify published, peer-reviewed primary studies on interventions implemented in adult rehabilitation within Nordic countries. Data were charted following Levac et al.'s framework and analyzed using Elo & Kyngäs' content analysis to identify factors influencing implementation. Key study characteristics and implementation approaches were synthesized narratively and in tables.</p><p><strong>Results: </strong>Thirty-six papers were identified. Most studies described the implementation of rehabilitation transitioning from the secondary to the primary sector. A top-down implementation approach was predominantly reported and appears more facilitating than a bottom-up approach. Implementation of rehabilitation across sectors is influenced by an interplay of factors: (1) Organization & Resources: alignment of context with intervention, involvement from front-line personnel, time & resources, the workplace itself, and managers, and (2) Collaboration & Communication, including knowledge and competence, attitudes, communication, patients, and families.</p><p><strong>Conclusion: </strong>While this scoping review conveys that collaboration, communication, resources, and organization have a central role affecting the implementation of cross-sectoral rehabilitation, it further identifies knowledge gaps, such as the lack of the patients' perspective, the use of a framework or other systematic approach to ensure the success of the implementation.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1662230"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12491184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234367","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":"Care management services at safety-net clinics in the United States.","authors":"Joseph H Joo, Anna M Morenz, Michael D Dang, Jennifer R Cardin, Joshua M Liao","doi":"10.3389/frhs.2025.1646788","DOIUrl":"10.3389/frhs.2025.1646788","url":null,"abstract":"<p><p>Federally qualified health centers and rural health centers are key parts of the United States ambulatory safety-net care system. Medicare has sought to encourage care coordination at these safety-net clinics by reimbursing clinicians directly for delivering care management services. In this paper, we described long-term trends in utilization of care management services for Medicare patients at federally qualified health centers and rural health centers vs. non-federally qualified health centers and non-rural health centers. General care management service utilization increased by 207% with 2,251 services submitted in 2023. Denial rates for general care management services increased over time, with 42% of submitted services being denied in 2018, compared to 64% of submitted services being denied in 2023. Compared to general care management services, transitional care management services were delivered far less frequently at federally qualified health centers and rural health centers, with a total of 237 services submitted across the entire six-year study period, and zero services submitted in several study years. Among these services, 188 (79%) were reimbursed with a corresponding cost of $31,551. Despite their greater salience and need for care coordination at safety-net clinics in the United States, there was little utilization of care management services delivered to Medicare patients and reimbursed through the physician fee schedule. The low uptake may reflect a preference for care management services administered outside of Medicare.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1646788"},"PeriodicalIF":2.7,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12502002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253909","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":"Measuring person-centered integrated care for people living with mild to moderate chronic kidney disease and multimorbidity: a cross-sectional survey.","authors":"Taylor Hecker, Sabrina Jassemi, Liza van Vliet, Nancy Verdin, Nazret Russon, Meghan J Elliott, Brenda R Hemmelgarn, Maria J Santana, Kimberly Manalili, Kerry McBrien, Aminu K Bello, Amity Quinn, Pim Valentijn, Maoliosa Donald","doi":"10.3389/frhs.2025.1655472","DOIUrl":"10.3389/frhs.2025.1655472","url":null,"abstract":"<p><strong>Introduction: </strong>Person-centered integrated care (PC-IC) has been shown to improve health outcomes for individuals with chronic conditions. However, there is limited evidence measuring PC-IC delivery to people with mild to moderate chronic kidney disease and co-morbidities. We aimed to assess PC-IC delivery for this population in Alberta, Canada.</p><p><strong>Methods: </strong>We conducted a survey (May-December 2023) using the Rainbow Model of Integrated Care Measurement Tool via weblink or telephone to quantify PC-IC using a 5-point Likert agreement scale. Patients with chronic kidney disease (non-dialysis, non-transplant) and co-morbidities, caregivers, and health care providers in Alberta were invited to participate. Participants were recruited through various methods, including in-clinic posters and web-based posts. We assessed responses using descriptive and non-parametric analyses (e.g., Mann-Whitney <i>U</i>-test).</p><p><strong>Results: </strong>Ninety-seven eligible individuals completed the survey; 24 patients, 12 caregivers, and 61 health care providers. Caregivers rated PC-IC significantly lower than patients (overall score: 3.36/5 and 3.91/5, respectively, <i>p</i> < 0.05) and health care providers rated PC-IC moderately (3.56/5). The lowest scored domain was care coordination amongst patients and caregivers (3.43/5 and 3/5, respectively, <i>p</i> < 0.05) and regional health care laws/regulations amongst health care providers (2.94/5).</p><p><strong>Conclusion: </strong>Survey respondents recognized that the overall delivery of PC-IC is not optimal and identified key areas to address including improving care coordination (e.g., communication between providers) and tackling regional health care laws/regulations (e.g., funding models). Our study highlights the need for further exploration regarding why PC-IC is perceived as suboptimal, particularly among subgroups, and how it can be improved.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1655472"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234329","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":"Standard vs. enhanced implementation strategies to increase adoption of a multidrug-resistant organism alert tool: a cluster randomized trial.","authors":"Cara Ray, Cassie Goedken, Ashley M Hughes, Geneva M Wilson, Natalie R Hicks, Margaret A Fitzpatrick, Makoto M Jones, Christopher Pfeiffer, James Stacey Klutts, Martin E Evans, Katie Joy Suda, Charlesnika T Evans","doi":"10.3389/frhs.2025.1566454","DOIUrl":"10.3389/frhs.2025.1566454","url":null,"abstract":"<p><strong>Background: </strong>The Veterans Health Administration (VHA) launched VA Bug Alert (VABA) to identify admitted patients who are infected or colonized with multidrug-resistant organisms (MDROs) in real time and promote timely infection prevention measures. However, initial VABA adoption was suboptimal. The objective of this project was to compare the effectiveness of standard vs. enhanced implementation strategies for improving VABA adoption.</p><p><strong>Methods: </strong>121 VA healthcare facilities were evaluated for adoption of VABA (at least 1 user registered at a facility) April 2021-September 2022. All facilities initially received standard implementation, which included: VABA revisions based on end-user feedback, education, and internal facilitation via monthly meetings with the MDRO Prevention Division of the VHA National Infectious Diseases Service. Surveys evaluated VABA perspectives among MDRO Prevention Coordinators (MPCs) and/or Infection Preventionists (IPs) before and after initial standard implementation. Facilities not registered for VABA following initial standard implementation (<i>n</i> = 31) were cluster-randomized to continue to receive standard implementation or enhanced implementation (audit and feedback reports and external facilitation via guided interviews to assess VABA use barriers). Percentages of facilities adopting VABA at baseline, after standard implementation (Follow-up 1), and after the enhanced vs. standard implementation trial period (Follow-up 2) were assessed and compared across time points using McNemar's test. VABA adoption was compared by trial condition using Fisher's exact test.</p><p><strong>Results: </strong>Before education, 25% of 167 MPC/IP survey respondents across 116 facilities reported no knowledge/use of VABA. After education, 82% of 92 survey respondents across 80 facilities reported intending to use VABA. At baseline, VABA registrations were 40%. Registrations significantly increased aft Follow-up 1(75%, <i>p</i> < 0.01) and at Follow-up 2 (89%, <i>p</i> < 0.01). Adoption did not significantly differ by assigned implementation condition but was higher among facilities that completed all components of enhanced implementation than those who did not (87.5% vs. 43.5%, <i>p</i> = 0.045). Guided interviews revealed key facilitators of VABA registration, which included perceived fit, implementation activities, and organizational context (e.g., staffing resources).</p><p><strong>Conclusions: </strong>Implementation efforts dramatically increased VABA registrations. Incorporating interview feedback to increase VABA's fit with users' needs may increase its use and help reduce MDRO spread in VA.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1566454"},"PeriodicalIF":2.7,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12488722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234407","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}