Frontiers in health services最新文献

{"title":"Barriers and unmet needs related to healthcare for American Indian and Alaska Native communities: improving access to specialty care and clinical trials.","authors":"Donald Warne, Twyla Baker, Michael Burson, Allison Kelliher, Melissa Buffalo, Jonathan Baines, Jeremy Whalen, Michelle Archambault, Kimberly Jinnett, Shalini V Mohan, Rebekah J Fineday","doi":"10.3389/frhs.2025.1469501","DOIUrl":"https://doi.org/10.3389/frhs.2025.1469501","url":null,"abstract":"<p><p>Substantial healthcare barriers, especially to specialty and cancer care, exist for American Indian and Alaska Native (AI/AN) individuals and communities at all levels. The unique history of AI/AN Tribal Nations and resulting policies, treaties, and relationships with the US government and federal agencies have created specific barriers to healthcare and clinical trial access for AI/AN peoples. Commonly, AI/AN peoples harbor a long-standing mistrust of the healthcare system based on lived and historical experiences. The intersection of various barriers to care for AI/AN communities results in health inequities, lack of representation in clinical research, and other disparities faced by historically marginalized and underrepresented peoples. AI/AN patients face unique barriers in their healthcare journey due to a disproportionate burden of life-threatening and chronic diseases, including many cancers. Identifying barriers specific to AI/AN peoples and improving access to high-quality care, with a focus on building on the strengths and capacities in each AI/AN community are vital to improving health equity. In this review, we describe patient, provider, and institutional barriers to healthcare, particularly specialty care and clinical research, for AI/AN peoples, with a focus on the Northern Plains AI communities. Examples and best practices to improve AI/AN patient access to health services, including screening and specialty care, as well as to clinical research, are provided. We emphasize the importance of longitudinal community-based partnerships and strength- and trust-based approaches as essential components of promoting equitable access to high-quality specialty care and recruitment and participation of AI/AN individuals and communities in clinical research.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1469501"},"PeriodicalIF":1.6,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12003380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008584","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":"Effect of family doctor contract services on non-communicable disease management among the elderly: a systematic review and meta-analysis.","authors":"Rong Wu, Fei Fei, Tingting Lu, Jing Zhu, Dan Hu","doi":"10.3389/frhs.2025.1462806","DOIUrl":"https://doi.org/10.3389/frhs.2025.1462806","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this meta-analysis was to examine the effect of family doctor contract service on managing non-communicable diseases (NCDs) among elderly patients.</p><p><strong>Methods: </strong>Chinese and English articles published up to 15 July 2022 were systematically searched. Relevant randomized controlled studies (RCTs) were extracted from seven databases: PubMed, Coherence, Embase, Web of Science, CNKI, Wanfang Data, and WeiPu. All these studies have evaluated the effect of family doctor contract services on chronic disease management among the elderly. A meta-analysis was conducted using either random or fixed effects. Mean difference and risk ratio were used to analyze quantitative and qualitative data, respectively.</p><p><strong>Results: </strong>We identified that 25 independent studies, involving 4,046 elderly patients with chronic diseases across China, were eligible for meta-analysis. The results from these RCTs indicated that family doctors could disseminate knowledge about NCDs to elderly patients, improve their disease management abilities (including drug compliance, healthy diet, regular exercise, non-smoking, and non-drinking), lower blood pressure and blood glucose levels, reduce BMI, and increase quality of life and patient satisfaction (<i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>Family doctor contract services could improve health management for elderly patients with NCDs and should be promoted in China.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1462806"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11985813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060175","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":"Co-creating strategies to promote uptake of HIV self-testing among young adults in Mecklenburg county, North Carolina: a protocol for a pilot implementation study.","authors":"Ucheoma Nwaozuru, Lindsay Miller, Laura H Gunn, Sebastian Marin-Cespedes, Margaret Hanff, Patrick Robinson, Michael Dulin, Meghana Muralidhar, Prashant Jha, Goodness C Mirikwe, Donaldson F Conserve, Chelsea Gulden, Bernard A Davis, Kristie Foley, Joseph Tucker, Meagan Zarwell","doi":"10.3389/frhs.2025.1536236","DOIUrl":"https://doi.org/10.3389/frhs.2025.1536236","url":null,"abstract":"<p><strong>Background: </strong>HIV testing is the gateway to entering HIV care and prevention services. However, HIV testing rates remain low among young adults (18-29 years old) in Mecklenburg County, North Carolina (NC), an ending the HIV epidemic (EHE) priority jurisdiction. We aim to utilize community-engaged and participatory approaches to co-create implementation strategies to promote the reach and uptake of HIV self-testing (HIVST) among young adults in the region. This study protocol outlines the phases of the project and the proposed outcomes.</p><p><strong>Methods: </strong>The Community-engaged Approaches to Expand HIV Self-Testing among Young Adults in Mecklenburg County, North Carolina (CATEST) project will be conducted in three phases, guided by the Consolidated Framework for Implementation Research (CFIR), Community-based Participatory Research (CBPR), and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) frameworks. The formative phase of the study, guided by CFIR, will focus on understanding the barriers, facilitators, and opportunities for implementing HIVST among young adults in Mecklenburg County, North Carolina. The second phase, guided by CBPR, will utilize participatory approaches such as crowdsourcing open calls and charrettes to co-create implementation strategies for HIVST. Then, the final pilot implementation phase, guided by CFIR and RE-AIM, will use mixed methods to evaluate the success of the co-created HIVST implementation strategies using a pre-post design. Participants in the study will complete a baseline survey and a follow-up survey immediately following intervention completion. In addition, a purposive sample of participants and representatives at the participating community organization will complete qualitative exit interviews within 1 month of intervention completion.</p><p><strong>Discussion: </strong>This study protocol outlines the co-creation of implementation strategies, tests their feasibility, and explores preliminary effectiveness in promoting HIVST uptake among young adults in Mecklenburg County, NC. The study will yield insights on the feasibility of leveraging the capabilities of community and youth innovation to promote young adults-centered implementation strategies to advance the reach and adoption of HIVST among young adults.</p><p><strong>Registration: </strong>Registered on Open Science Forum-DOI 10.17605/OSF.IO/2BZWV.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1536236"},"PeriodicalIF":1.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11985853/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031965","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 Learn Together programme (part A): co-designing an approach to support patient and family involvement and engagement in patient safety incident investigations.","authors":"Jane K O'Hara, Lauren Ramsey, Rebecca Partridge, Chris Redford, Siobhan McHugh, Gemma Louch, Penny Phillips, Laura Sheard, Ruth Simms-Ellis, Justin Waring, Joe Langley","doi":"10.3389/frhs.2025.1529035","DOIUrl":"https://doi.org/10.3389/frhs.2025.1529035","url":null,"abstract":"<p><strong>Background: </strong>Whilst patients and families can and do support patient safety in several ways, empirical evidence for the specific impact of involvement in patient safety incident investigations and their outcomes, has been limited, with little information about how to undertake involvement meaningfully.</p><p><strong>Aim: </strong>We aimed to (i) develop a set of common principles to guide involvement of patients and families in patient safety incident investigations; (ii) develop a working programme theory for how these might be enacted; (iii) co-design guidance to support the meaningful involvement of patients and families in patient safety incident investigations.</p><p><strong>Methods: </strong>We synthesised three existing data sets (a literature review, a documentary analysis of incident investigation policies and 42 interviews with patients, families, lawyers, incident investigators, and healthcare staff) relating to patient and family involvement in incident investigations. Ten common principles and a working programme theory were drafted. Within a convened co-design community, we then developed guidance for patients, families, staff, and investigators in local NHS Trust and national investigations, via a series of workshops.</p><p><strong>Findings: </strong>We developed ten 'common principles\" and a working programme theory for an approach that might support meaningful patient and family involvement in incidents investigations. Based on these principles and the programme theory, we co-designed guidance to be used within NHS Trust and national investigations of harm that follow patient safety incidents. The guidance includes information, resources and tools to enable better understanding and practice, from the perspective of patients, families, investigators and staff, on how to be meaningfully involved.</p><p><strong>Conclusions: </strong>Our ten common principles and co-designed guidance emphasise two key things. First, that organizational learning is not the only desired outcome for incident investigations, with patients, families and staff reporting the need for restoration and repair. Second, that investigations can be part of reparation, but when it fails to address the needs of stakeholders arising from investigations, it can compound the harm of the original incident. As a result, we juxtapose existing theories, and illuminate new insights, proposing a theory of \"restorative learning\". We see design as an ongoing phenomenon-the guidance is our current iteration, and we learnt several valuable lessons about doing co-design.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1529035"},"PeriodicalIF":1.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043348","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":"Balancing specialist roles with generalist responsibilities in primary care: have we gone too far?","authors":"Waseem Jerjes","doi":"10.3389/frhs.2025.1438711","DOIUrl":"10.3389/frhs.2025.1438711","url":null,"abstract":"","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1438711"},"PeriodicalIF":1.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782052","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 evolution of health services research in Austria: a bibliometric exploration of trends, themes, and collaborations.","authors":"Kyung-Eun Anna Choi, Sebastian Fitzek","doi":"10.3389/frhs.2025.1501035","DOIUrl":"10.3389/frhs.2025.1501035","url":null,"abstract":"<p><strong>Background: </strong>Health services research (HSR) in Austria has expanded rapidly over the past two decades, reflecting the evolving need for a healthcare system that effectively addresses the broader challenges of an increasingly strained healthcare environment. Mapping the progression and focus areas of this research is essential for guiding policy-making and future studies.</p><p><strong>Objectives: </strong>This bibliometric study aims to chart the evolution of Austrian HSR between 2000 and 2024. By examining publication trends, thematic priorities, collaboration networks, and research impacts, the analysis provides evidence-based insights that inform healthcare strategies and highlight research gaps.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, which targeted peer-reviewed articles published from 2000-July 31, 2024. In total, 81 articles met the inclusion criteria. Bibliometric methods, including coauthorship mapping, keyword co-occurrence analysis, and citation tracking, were used to identify core research themes, key authors, and institutional collaborations.</p><p><strong>Results: </strong>Annual publication outputs increased notably from 2019 to 2020, corresponding to the heightened focus on healthcare during the COVID-19 pandemic. The major themes included mental health, patient care, public health, and disease management, with a growing interest in telemedicine and digital solutions. The Medical University of Vienna led publication activity, and strong international ties were evident, particularly with institutions in the UK and Germany. Citation analyses revealed varied research impacts, with some highly cited studies influencing policy debates and clinical practices.</p><p><strong>Conclusions: </strong>Austrian HSR has a dynamic trajectory, reflecting evolving national priorities and global healthcare challenges. Continued efforts are needed to address gaps involving underserved populations, integrate digital health technologies, and enhance economic evaluations of primary care reforms. Furthermore, better standardization in the reporting of funding sources and conflicts of interest is recommended to strengthen methodological rigor and public trust. By fostering collaboration, transparency, and comprehensive evaluations, HSR can more effectively shape equitable healthcare policies in Austria.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1501035"},"PeriodicalIF":1.6,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782071","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":"Reward frustration and withdrawal from work in health care-a cross-sectional study among health professionals.","authors":"Oliver Hämmig","doi":"10.3389/frhs.2025.1498073","DOIUrl":"10.3389/frhs.2025.1498073","url":null,"abstract":"<p><strong>Introduction: </strong>The health-related consequences of work stress are as broadly studied in the health care sector as they are elsewhere. However, behaviors such as underperforming at work, being less engaged at work, being habitually absent from work without good reason, intending to take unpaid leave, changing jobs or leaving the profession as consequences or correlates of stress and reward frustration at work are largely underresearched, particularly in Switzerland and in health care and across different health professions.</p><p><strong>Methods: </strong>Cross-sectional survey data collected from the workforces of six public hospitals and rehabilitation clinics in German-speaking Switzerland were used for this observational study. A total of 1,441 health care workers from various professions participated in the survey. The study focused on effort-reward imbalance (ERI) as a work stress measure and on six different withdrawal behaviors. Relative frequencies stratified by health professions for all study variables (exposure, confounders, and outcomes) and multiple-adjusted odds ratios as measures of association were calculated.</p><p><strong>Results: </strong>The findings revealed frequent work stress or rather widespread ERI among health professionals (49%). The results further revealed strong to very strong dose-response relationships between work stress levels and the chance or risk of withdrawal from work. Compared with the least stressed individuals, the most stressed individuals were at significantly increased risk for reduced job performance (aOR = 5.2), low work engagement (aOR = 4.4), increased work absenteeism (aOR = 2.2), and intentions to take unpaid leave (aOR = 3.1), to change the job (aOR = 35.0) or to leave the profession (aOR = 12.3).</p><p><strong>Conclusion: </strong>Highly prevalent reward frustration in Swiss health care needs to be reduced to overcome inner resignation and resistance and to prevent health professionals from withdrawing from work, and health care from high follow-up costs above and beyond mere absences from work or high turnover.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1498073"},"PeriodicalIF":1.6,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11937120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143722908","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":"Intention to use telemonitoring for chronic illness management and its associated factors among nurses and physicians at public hospitals in Bahir Dar, northwest Ethiopia: using a modified UTAUT2 model.","authors":"Temesgen Ayenew Alameraw, Mulusew Andualem Asemahagn, Kassahun Dessie Gashu, Agmasie Damtew Walle, Jenberu Mekurianew Kelkay, Abebaw Belew Mitiku, Geleta Nenko Dube, Habtamu Alganeh Guadie","doi":"10.3389/frhs.2025.1460077","DOIUrl":"10.3389/frhs.2025.1460077","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic illnesses need to take care of themselves and seek ongoing medical attention. By using technology, telemonitoring can minimize hospitalization and care costs, while increasing professional productivity, providing constant medical attention and enhancing patient self-care management. Despite all these advantages, nothing is known regarding the intentions of Ethiopian professionals and nurses to adopt telemonitoring technologies. Therefore, the purpose of this study is to evaluate the telemonitoring intention of Ethiopian professionals and nurses, as well as the factors related to it.</p><p><strong>Methods: </strong>A total of 781 randomly chosen nurses and physicians who worked at public hospitals in Bahir Dar City, northwest Ethiopia, participated in a cross-sectional survey. To give everyone an opportunity, the sample size was distributed equitably among the hospitals and the profession according to staffing numbers. The sample was obtained using a simple random sampling technique. Data were gathered by skilled data collectors utilizing a self-administered questionnaire. For additional cleaning and descriptive statistical analysis, the data were imported into EpiData version 4.6 and exported to Statistical Package for Social Science version 25. Analysis of Moment Structure version 23 structural equation modeling was used to ascertain the degree of the association between the variables.</p><p><strong>Result: </strong>The response rate was 732/781 (93.7%), with 55.7% (408/732) of the participants being men and two-thirds (67.6%, 495/732) being nurses. About 55.9% [95% confidence interval (CI): 52.3-59.6] of respondents intended to use telemonitoring. The desire to employ telemonitoring is positively impacted by performance expectancy (<i>β</i> = 0.375, 95% CI: 0.258-0.494), effort expectancy (<i>β</i> = 0.158, 95% CI: 0.058-0.252), facilitating condition (<i>β</i> = 0.255, 95% CI: 0.144-0.368), and habit (<i>β</i> = 0.147, 95% CI: 0.059-0.233). Age and gender positively affected the link between effort expectancy and intention to employ telemonitoring. It was discovered that being young and male has a beneficial relationship impact. Age positively moderated the association between the intention to use telemonitoring and the facilitating conditions, and adults were strongly linked with the relationship.</p><p><strong>Conclusion: </strong>In Bahir Dar City public hospitals, over half of the doctors and nurses have the intention to use telemonitoring. Predictive indicators of intention to utilize telemonitoring that were statistically significant were performance expectancy, effort expectancy, facilitating condition, and habit.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1460077"},"PeriodicalIF":1.6,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11923627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671868","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":"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}