Frontiers in health services最新文献

{"title":"<i>I need it. Without it, I wouldn't have gone, and I do want to go</i>: patient perspectives on the acceptability and appropriateness of two patient-centered interventions to improve adherence to annual lung cancer screening.","authors":"Lorella Palazzo, Casey Luce, Anjali Vasavada, Kayne Mettert, Hongyuan Gao, James D Ralston, Nadejda Bezman, Beverly B Green, Kristine Rogers, Melissa L Anderson, Yu-Ru Su, Matthew Triplette, Lisa Carter-Bawa, Karen J Wernli","doi":"10.3389/frhs.2026.1810956","DOIUrl":"10.3389/frhs.2026.1810956","url":null,"abstract":"<p><strong>Introduction: </strong>Low adherence to annual lung cancer screening (LCS) has tempered mortality benefits in clinical practice. Herein, we assessed the acceptability and appropriateness of two patient-centered interventions addressing adherence barriers to annual LCS.</p><p><strong>Methods: </strong>Participants were Kaiser Permanente Washington members, aged 50-78 years, who participated in a pragmatic randomized trial (\"The Larch Trial\"). The trial tested: (1) health communication including a video to improve patient knowledge of timeliness to return; and (2) outreach reminders to patients to schedule annual screenings after their primary care provider (PCP) ordered a scan without an appointment. Participants, randomly sampled on sex, race/ethnicity, tobacco status, and trial arm, completed semistructured, virtual interviews that lasted for 60 min. The interviews explored intervention acceptability and appropriateness, and barriers and facilitators to both. Transcripts were analyzed using a rapid group analysis process informed by the Consolidated Framework for Implementation Research. Identified themes were second-coded for acceptability and appropriateness in accordance with the Implementation Outcomes Framework.</p><p><strong>Results: </strong>A total of 32 participants were interviewed; 66% were non-Hispanic white, 53% male, and 53% currently use tobacco. The participants found the interventions acceptable and appropriate with variations by LCS history and information needs. Some participants found the video helpful and comforting, especially first-time screeners. Other participants, particularly those engaged in annual LCS, found that the video lacked new information. The participants strongly endorsed the reminder intervention for encouraging LCS and clarifying the timing of repeat screening. Most participants endorsed the annual screening scan ordered without a PCP visit. The participants preferred the multimodal delivery of reminders for reinforcement. Facilitators of acceptability and appropriateness included video design and perceived educational value, and an electronic health record ecosystem supporting communication aligned with routine practice. Barriers included content perceived as not novel, lack of information to address specific needs, and excessive reminders.</p><p><strong>Discussion: </strong>Video-based content in LCS is generally acceptable and appropriate to patients if tailored by LCS history. Patient outreach reminders are acceptable and appropriate when mirroring other healthcare system communications. Participants already engaged in LCS did not feel they needed to see their PCP one year later for repeat screening (within 1 year). Future studies should test interventions in other populations and healthcare systems using different communication strategies.</p><p><strong>Clinical trial registration: </strong>clinicaltrials.gov, identifier #NCT05747443.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1810956"},"PeriodicalIF":2.6,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129384","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":"Economic evaluation of primary health care integration and targeted mass drug administration in counties in western Kenya.","authors":"Josphat Martin Muchangi, Wyckliff Omondi, Meshack Ndirangu, Carol Karutu, Irene Chami, Gilbert Wangalwa, Michael Ofire, Robert Ofwete, Kioko Kithuki, Nelly Saiti, Samuel Kamau, Lenson Kariuki, Paul Kibati, Japheth Athanasio, Geoffrey Njuhi, Yvonne Opanga, Emmanuel Musombi, Faith Mutegi, Dollycate N Wanja, Festus Kipkorir, Hesbon Aoko, Chitiavi Juma","doi":"10.3389/frhs.2026.1858666","DOIUrl":"10.3389/frhs.2026.1858666","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The 2025 World Health Organization (WHO) Global Report on Neglected Tropical Diseases (NTDs) highlights major progress made worldwide in controlling and eliminating these diseases. Sustaining NTD control requires cost-efficient strategies integrated into routine health systems. We evaluated the cost-effectiveness of integrating soil-transmitted helminths (STH) and schistosomiasis (SCH) treatment into routine Primary Health care (PHC) services compared with the campaign-based approach across four counties and selected sub-counties, wards, and primary health facilities in western Kenya. While the overall study assessed feasibility, treatment coverage, and economic outcomes, this manuscript evaluated the cost-effectiveness of integrating STH/SCH treatment into primary healthcare (PHC) versus campaign-based mass drug administration (MDA) in western Kenya.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A quasi-experimental mixed-method study design was adopted for field-based data collection and analysis in 24 wards (12 wards for PHC-integrated, 12 wards for the campaign) across four counties. Cost data was collected from programme records. Cost parameters were informed by the WHO-CHOICE disease model, and relevant economic evaluation literature. A Markov state-transition model simulated a 5,000-person cohort over 5 years, estimating the Disability Adjusted Life Years (DALYs) averted using Global Burden of Diseases (GBD)disability weights (0.006 light, 0.024 moderate, 0.049 heavy infection). ICERs were calculated from a health system perspective. Study teams supporting both intervention arms received training to ensure consistent implementation and clear differentiation between the campaign and PHC-integrated delivery models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The costing analysis showed that the campaign-based approach accounted for the largest share of program expenditures Kes 17.26 million (USD 133,814) against Kes 9.74 million (USD 75,519) for PHC integrated; a 44% reduction, largely due to its higher logistical and operational requirements, although it achieved the highest immediate treatment coverage. In contrast, the PHC-integrated model operated with lower overall costs, primarily associated with consumables and routine service delivery, while relying on existing health system infrastructure and staff including the Community health providers (CHPs). Campaign-based approach achieved higher coverage of 102.3% compared to 77.3% averting 19,230 DALYs compared to 12,840 for PHC integrated (additional 6,390 DALYs). This however translated to USD 0.25 (Kes 32.48) (cost per person treated (387,852 targeted Vs 299,960 treated) against USD 0.3 (Kes 39.54) per person treated (426,207 targeted against 436,059 treated) by the campaign approach. Economic modelling using a simulated cohort of 1,000 individuals annually over a five-year time horizon indicated that PHC integration could generate cost savings over time compared with repeated cam","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1858666"},"PeriodicalIF":2.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119463","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":"Mapping the landscape of implementation science training: gaps and opportunities to strengthen capacity for implementation research and practice.","authors":"Hannah Begna, Helene Chokron Garneau, Sobia Khan, Mark McGovern, Julia Moore","doi":"10.3389/frhs.2026.1787246","DOIUrl":"10.3389/frhs.2026.1787246","url":null,"abstract":"<p><strong>Introduction: </strong>To (1) summarize the current landscape of implementation science (IS) training in North America, (2) describe participant characteristics from The Center for Implementation (TCI), one of the largest IS training programs, and (3) identify opportunities to inform future capacity-building efforts.</p><p><strong>Methods: </strong>We conducted a structured environmental scan of North American IS training programs; online surveys were then distributed to all identified programs to collect information on program characteristics and target audience. We then performed descriptive and qualitative analyses of the survey results and de-identified demographic and participant response data from TCI course participants.</p><p><strong>Results: </strong>Fifty-seven IS training programs were identified across North America. Most programs (59.6%) were located in the United States and were primarily graduate level (54.4%), certificate programs (36.8%), and fellowships or post-doctoral opportunities (29.8% each). Nearly half (47.4%) enrolled ≤10 participants per cohort, and approximately 10% enrolled more than 50 participants. Nearly all programs admitted academic audiences (94.7%), with fewer targeting participants from public health (57.9%) or healthcare providers (43.9%). TCI participants (<i>N</i> = 1,632 for demographic data; <i>N</i> = 436 for qualitative analysis) were a diverse audience representing multiple sectors, most frequently healthcare (26.9%), IS (17.6%), public health (17.0%), and education (15.6%). Organizational affiliations included nonprofit organizations (22.7%), healthcare institutions (18.1%), higher education (17.7%), and government (15.9%). Through qualitative analysis of TCI participant introductions, we identified four major themes reflecting participants' professional contexts and motivations for IS training: (1) system roles, (2) current implementation activities, (3) learning motivations, and (4) application of IS concepts to their work.</p><p><strong>Discussion: </strong>Current IS trainings in North America are primarily focused on a research audience. Expanding IS implementation training and education to a broader audience, in particular implementation support practitioners who are not engaged in research, but who seek to apply IS to solve problems, is warranted.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1787246"},"PeriodicalIF":2.6,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119511","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":"Quality of diabetes health education provided by healthcare professionals to patients with type 1 and type 2 diabetes mellitus across different healthcare settings: a scoping review protocol.","authors":"Nontsikelelo Qebengu, Mabina Mogale","doi":"10.3389/frhs.2026.1917504","DOIUrl":"https://doi.org/10.3389/frhs.2026.1917504","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus is a major global public health challenge associated with substantial morbidity, premature mortality, escalating healthcare costs, and reduced quality of life. High-quality diabetes health education, particularly through Diabetes Self-Management Education and Support (DSMES), is fundamental to effective diabetes self-management. However, considerable variability exists in the quality of education delivered by healthcare professionals, and existing evidence remains fragmented, particularly regarding educational quality, digital health integration, and implementation across diverse healthcare settings.</p><p><strong>Objective: </strong>This scoping review aims to map and synthesise existing evidence on the quality of diabetes health education delivered by HCPs' across diverse healthcare settings.</p><p><strong>Methods and analysis: </strong>This scoping review will follow the methodological framework proposed by Arksey and O'Malley, enhanced by Levac and colleagues, and refined by the Joanna Briggs Institute. Electronic databases will be systematically searched, and studies will be selected in accordance with predefined Population, Concept, and Context eligibility criteria. Two reviewers will independently screen studies, extract data using a standardised charting form guided by Donabedian's Structure-Process-Outcome framework, and report the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR).</p><p><strong>Results: </strong>This scoping review will provide a comprehensive synthesis of the evidence on the quality of diabetes health education delivered by healthcare professionals. The findings are expected to inform healthcare professional education and training, strengthen educational quality, support evidence-informed policy and practice, and guide future research to improve diabetes care across diverse healthcare settings.</p><p><strong>Conclusion: </strong>The scoping review will provide a comprehensive synthesis of evidence on the quality of diabetes health education delivered by HCPs'. The findings are expected to inform policy, strengthen professional training, and support evidence-based improvements in DSMES delivery, particularly in resource-limited and underserved settings.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1917504"},"PeriodicalIF":2.6,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13635125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119589","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":"Authentic content as an effective mechanism for embedding patient voices in health innovation: a hypothesis and conceptual framework.","authors":"Rohin Malhotra","doi":"10.3389/frhs.2026.1833920","DOIUrl":"https://doi.org/10.3389/frhs.2026.1833920","url":null,"abstract":"<p><p>Health innovation systems continue to face persistent inefficiencies, mistrust, and escalating development costs despite rapid scientific progress. Although patient-engagement is increasingly recognised as essential for patient-centred healthcare innovation, there is limited conceptual and empirical research explaining how patient voices can be systematically embedded within processes and it is relatively unexplored in literature how this influences measurable outcomes such as engagement, collaboration, trust and return-on-investment. This paper addresses this gap through a hypothesis and conceptual analysis informed by interdisciplinary literature, industry reports and case-based evidence examining the integration of patient voices across health innovation processes and posits that authentic content functions as an effective and scalable mechanism for embedding patient voices across multiple stages of the health innovation lifecycle. The emergence of artificial intelligence also offers the potential to increase and amplify diffusions from authentic content and facilitate mass personalisation of patient voices across innovation lifecycles but, even without this, authentic content is proposed as a strategic priority and a high-fidelity mechanism for multi-level stakeholder engagement that may be associated with enhanced patient access and stronger financial outcomes. The timing of authentic content deployment is also hypothesised to be an important determinant of its potential impact, with earlier integration proposed to produce a \"leftward shift\" in the cumulative trajectory of stakeholder-engagement and value-creation and an acceleration of development that, if empirically supported, may be associated with longer periods of effective commercial market exclusivity, faster patient access to medicines, and more efficient provision of access through greater scalability. If validated through future empirical research and academic rigour, authentic content may represent a scalable and measurable approach for embedding patient voices as a strategic driver of engagement, innovation efficiency, and patient-centred value creation in health innovation systems.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1833920"},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119488","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-designing PROFESS: a community health worker support framework to strengthen engagement in TB and HIV care in Madagascar.","authors":"Onja Gabrielle Ravololohanitra, Haingotiana Razafimanantsoa, Larissa Hecht, Michel Tiaray Harison, Norosoa Assunta Felananirina Rakotoherimora, Harizaka Emmanuel Andriamasy, Nadine Muller","doi":"10.3389/frhs.2026.1910840","DOIUrl":"https://doi.org/10.3389/frhs.2026.1910840","url":null,"abstract":"<p><p>Community health workers (CHWs) are central to primary health care in low- and middle-income countries, yet their engagement is often uneven across health domains. In Madagascar, approximately 50,720 CHWs serving on a voluntary, unsalaried basis link communities to the formal health system, but only a minority is actively engaged in tuberculosis (TB) or HIV service delivery despite substantial disease burden. This community case study describes a two-stage initiative by a consortium of government disease programmes, an NGO, and an academic partner to strengthen CHW engagement in TB and HIV care in Madagascar. Stage 1 combined a cross-sectional survey of CHWs across four regions with a nested qualitative component identifying system-level constraints. Stage 2 convened national, sub-national, and community-based stakeholders across sectors in a three-day design-thinking workshop, producing PROFESS, a seven-lever framework operationalised as a guide for strengthening CHW support including concrete measures related to Protection (financial), Recognition, Coordination, Formation (training), Equipment, Supervision, and Security of CHWs. PROFESS has been validated by the Malagasy Ministry of Public Health and published as an operational guide. This case highlights two key lessons for fragmented, evidence-scarce settings: workforce-support frameworks anchored in foundational system functions are transferable across disease domains, and co-design produces institutionally adoptable outputs only when paired with operational elaboration. Remaining challenges include the definition of minimum support packages and the sequencing of implementation across levers. A pilot implementation of PROFESS is currently underway, with first results expected in 2027.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1910840"},"PeriodicalIF":2.6,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13631075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119455","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":"Pivoting in the pandemic: how HIV-focused community-health workers addressed COVID-19 disparities.","authors":"Sonjia Kenya, BreAnne Young, Olveen Carrasquillo","doi":"10.3389/frhs.2026.1813009","DOIUrl":"https://doi.org/10.3389/frhs.2026.1813009","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic significantly overburdened the U.S. healthcare system and magnified pre-existing care delivery gaps in communities of color. In Miami-Dade County, Black residents account for 64% of AIDS-related deaths and experienced a COVID-19 mortality rate of 6.1%, compared to 3.9% among White residents. Community Health Worker (CHW) interventions represent a promising strategy to overcome social and economic barriers to care.</p><p><strong>Methods: </strong>Leveraging a decade-long partnership with nine community-based organizations, an established CHW network originally designed for HIV outreach, was adapted to address COVID-19 disparities in high-risk minority communities. From June 2021 through May 2023, this CHW coalition incorporated COVID-19 education and vaccination support into existing outreach protocols to ensure the approach remained aligned with community values.</p><p><strong>Results: </strong>During the 2-year intervention, the CHW network provided COVID-19 education regarding risk factors and vaccine safety to over 400,000 local residents. Furthermore, 8,672 individuals were screened for COVID-19, and 5,341 people were successfully referred for vaccination through these community-led efforts.</p><p><strong>Discussion: </strong>Findings support engaging CHWs to deliver interventions as an adaptable strategy to improve access to care and increase uptake of resources shared about COVID-19 screening and vaccination. By being respected and well-known by their neighbors, those who work in CHW-led interventions are uniquely positioned to promote awareness and dispel myths in highly vulnerable communities. This model demonstrates the value of utilizing trusted community peers trained in healthcare navigation to bridge gaps during public health emergencies.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1813009"},"PeriodicalIF":2.6,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119482","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":"Infant mortality across EU health systems: heterogeneity encoding, fixed effects regression, and machine learning in a small macro panel.","authors":"Ecmel Kisa, Adnan Kisa","doi":"10.3389/frhs.2026.1893109","DOIUrl":"https://doi.org/10.3389/frhs.2026.1893109","url":null,"abstract":"<p><strong>Introduction: </strong>The infant mortality rate is widely used in comparative health research, but less is known about how panel regression and machine-learning models perform in small macro-level health datasets when they are evaluated using comparable information and the same out-of-period test period.</p><p><strong>Methods: </strong>Using a balanced panel of 25 European Union countries observed annually from 2000 to 2022 (575 country-year observations, no missing data) assembled from OECD and World Bank sources, we separated an explanatory analysis from a predictive analysis. The explanatory layer used a two-way fixed effects regression with country-clustered standard errors. The predictive layer trained pooled linear regression, tuned Random Forest, Gradient Boosting, and a Multilayer Perceptron, with and without explicit country information, on 2000-2017 and evaluated them on a held-out 2018-2022 window, alongside two naive benchmarks (persistence and historical country mean) and two prediction-compatible fixed effects specifications. Hyperparameters were tuned by expanding-window temporal cross-validation within the training period, leaving the test window untouched.</p><p><strong>Results: </strong>Under common out-of-period evaluation, a simple persistence benchmark achieved the strongest predictive performance (R² = 0.74), closely followed by tuned Gradient Boosting and Random Forest with country information (R² = 0.71 and 0.69). Explicit country encoding improved the tree-based models, but adding country information was not enough to improve the linear specifications substantially. The prediction-compatible fixed effects and pooled linear models both produced negative out-of-period R² values. Model rankings varied across evaluation windows: in an alternative pre-pandemic split, tuned nonlinear models outperformed persistence. In the explanatory fixed effects model, GDP per capita and the total fertility rate were significant under conventional country-clustered inference, although neither remained significant under a small-cluster wild-bootstrap sensitivity analysis; the substantive covariate block had a partial R² of 0.366 net of country and year effects.</p><p><strong>Conclusion: </strong>In this EU infant-mortality panel, much of the predictive signal came from persistent country-specific outcome history. Country information improved the tree-based models, while model flexibility also remained important. The strong within-panel fit of the fixed-effects model did not translate into strong out-of-period prediction.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1893109"},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119434","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":"Learning from 30 years of systems thinking in healthcare.","authors":"Christian von Plessen, Paul Batalden, Peter Lachman, Julie K Johnson","doi":"10.3389/frhs.2026.1795979","DOIUrl":"https://doi.org/10.3389/frhs.2026.1795979","url":null,"abstract":"<p><p>Systems thinking is a foundational discipline for the quality improvement practitioner. A 1997 publication on building knowledge of healthcare as a system created a bridge between system thinking and quality management, summarized the thinking about systems thinking and quality improvement at that time, and created a 10-step exercise to guide participants in applying systems thinking in their own healthcare settings. During the past 30 years, our understanding of how systems thinking can be applied in healthcare has evolved. We now recognize several limitations to our previous thinking, in particular, the need to distinguish between product logic and service logic. Products are particularly well-suited for quality improvement initiatives that address standardization of linear processes while services are not. Further, we need to consider the role of coproduction for the person seeking care and the relationship and communication with the clinical team. Finally, we must design the system to include care that transcends organizational boundaries. In essence, we need to apply systems thinking to care that is non-linear, involves multiple organizations, and importantly, is coproduced with the patient. We propose a revised and updated systems thinking exercise to help healthcare leaders and patients to apply this discipline in their daily practice.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1795979"},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119429","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 systematic nursing intervention on perioperative ocular symptoms in refractive surgery patients: evaluation using the ocular surface disease index scale.","authors":"Yidi Zhang, Ping Zhang, Ran Zhu, Xiumei Wu, Jincui Wei","doi":"10.3389/frhs.2026.1864071","DOIUrl":"https://doi.org/10.3389/frhs.2026.1864071","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of systematic nursing intervention on perioperative ocular symptoms in patients undergoing femtosecond laser-assisted <i>in situ</i> keratomileusis (FS-LASIK), using the Ocular Surface Disease Index (OSDI) scale.</p><p><strong>Methods: </strong>A prospective case-control study was conducted including 69 patients (137 eyes) who underwent FS-LASIK between September 2023 and June 2024. Patients were randomly divided into an experimental group (37 patients, 74 eyes) receiving systematic nursing interventions and a control group (32 patients, 63 eyes) receiving routine care only. Preoperative and postoperative measures included refractive status, tear film breakup time (BUT), and OSDI scores.</p><p><strong>Results: </strong>Preoperatively, there were no significant differences between groups in refractive status, BUT, or OSDI scores (all <i>P</i> > 0.05). Postoperatively, refractive status remained comparable (<i>P</i> > 0.05), but significant differences were found in OSDI scores (<i>P</i> = 0.002). Pearson correlation analysis revealed that OSDI scores were positively correlated with age in the experimental group (<i>r</i> = 0.43, <i>P</i> = 0.032). In the control group, OSDI scores were negatively correlated with both first BUT (<i>r</i>=-0.72, <i>P</i> = 0.005) and mean BUT (<i>r</i>=-0.52, <i>P</i> = 0.001).</p><p><strong>Conclusion: </strong>Systematic nursing interventions significantly improved compliance with postoperative eye care, alleviated anxiety related to ocular discomfort, promoted faster recovery, and enhanced surgical satisfaction.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"6 ","pages":"1864071"},"PeriodicalIF":2.6,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119508","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}