Frontiers in health services最新文献

{"title":"Patient navigation in German emergency care (NODE). Study protocol of a multi-center mixed-methods trial.","authors":"Daniela Krüger, Maria Altendorf, Felix Holzinger, Cornelia Wäscher, Hanna Winkler, Martin Möckel, Christoph Heintze, Judith Stumm, Konrad Schmidt, Anna Slagman","doi":"10.3389/frhs.2025.1524552","DOIUrl":"10.3389/frhs.2025.1524552","url":null,"abstract":"<p><strong>Background & objective: </strong>The objective of the study is to explore and to evaluate existing patient navigation models between emergency departments (ED) and alternative outpatient emergency care providers. Therefore, three different patient navigation models in emergency care in Berlin, Germany will be evaluated regarding their efficiency, quality of care, patient safety, patient satisfaction, costs and cost-effectiveness: (1) a hospital-owned separate outpatient care model within the ED premises or on the hospital grounds, (2) an urgent care practice of the Regional Association of Statutory Health Insurance (SHI) Physicians at the ED location, and (3) a standard care ED with prospective assessment of patient-care and urgency levels by ED doctors.</p><p><strong>Methods: </strong>In a convergent, parallel, mixed-methods, multi-center study design, patients' and health care providers' perspectives assessed by qualitative methods will be triangulated with the results of a quantitative prospective cohort study at six EDs in Berlin, Germany. This study includes four working modules: (1) a systematic literature review; (2) qualitative semi-structured interviews with patients (<i>n</i>∼15-20), as well as four focus group interviews with health care providers (<i>n</i>∼5); (3) a prospective multi-centre cohort study in adult, self-referred emergency patients at two time points (t0: <i>n</i> = 1,031; t1: <i>n</i> = 344), primary endpoint: proportion of patients treated other than standard emergency care, secondary endpoints: secondary efficiency, patient-reported outcome measures (PROMs), patient safety, quality of care, clinical outcomes, and cost-effectiveness; participant observation of patients' treatment trajectories and organizational processes at three different patient navigation models (<i>n</i>∼10-15), an online provider survey; and (4) data triangulation and recommendations for practice and policy.</p><p><strong>Discussion: </strong>This is the first study to compare different patient navigation and cooperation models to standard ED care in Germany and evaluate their effectiveness. Results will provide deep insights into the efficiency, patient satisfaction, quality of care, patient safety and cost-effectiveness. This will help providers and policymakers organise future emergency care in Germany. The study is expected to contribute to health services and systems research.</p><p><strong>Trial registration: </strong>DRKS00030398.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1524552"},"PeriodicalIF":2.7,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12417391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042564","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 access to healthcare services for sickle cell disease patients in Nigeria: perspectives and views of healthcare professionals.","authors":"Godspower Onavbavba, Obi Peter Adigwe, Solomon Oloche Onoja","doi":"10.3389/frhs.2025.1466299","DOIUrl":"10.3389/frhs.2025.1466299","url":null,"abstract":"<p><strong>Introduction: </strong>In sub-Saharan Africa, the burden of sickle cell disease remains high. With annual sickle cell births of about 150,000, Nigeria is reported to have the highest prevalence of the disease globally. This study aimed to explore the views and perspectives of healthcare professionals regarding access to healthcare services for sickle cell disease.</p><p><strong>Methods: </strong>A quantitative cross-sectional design was employed for this study. Participants comprised healthcare practitioners across Nigeria. A well-structured questionnaire was utilised for data collection. A stratified multistage sampling strategy was used for the study, and respondents were recruited from all the six geographical zones in the country. Data collected were entered into Statistical Package for Social Sciences (SPSS) software version 25. Descriptive and inferential statistical analyses were undertaken. Results were presented in frequencies and percentages.</p><p><strong>Results: </strong>The response rate was 83.5% (1,002/1,200); male and female participants were of similar proportions, as indicated by 51.2% and 48.8%, respectively. A significant proportion of the participants (43.1%) disagreed that development partners have adequately contributed to the funding of sickle cell disease research in Nigeria. The majority of the respondents (81%) indicated that providing special funding for health research can facilitate access to healthcare services for sickle cell patients, whilst a similar proportion (79.2%) disagreed that the government alone bears the responsibility for healthcare initiatives for the disease. A third of the study participants (67.8%) were of the view that current research and development efforts towards sickle cell disease were inadequate.</p><p><strong>Conclusion: </strong>This study describes health professionals' views on access to healthcare for sickle cell, and the findings revealed the criticality of private and development sector funding in reducing the burden of the disease. Furthermore, capacity building at the primary healthcare level would not only ensure access to the basic healthcare needs of patients but could also demystify the condition.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1466299"},"PeriodicalIF":2.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030739","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":"Sustainability of evidence-based primary care programs in Abu Dhabi: impact of COVID-19.","authors":"Latifa Baynouna Alketbi, Nico Nagelkerke, Hanan Abdelbaki","doi":"10.3389/frhs.2025.1591667","DOIUrl":"10.3389/frhs.2025.1591667","url":null,"abstract":"<p><strong>Introduction: </strong>The Abu Dhabi Ambulatory Healthcare Services (AHS) implemented the Chronic Disease Care (CDC) and Patient-Centered Medical Home (PCMH) programs. This study describes the implementation and integration of these two programs into the operations of AHS centers and assesses their long-term sustainability.</p><p><strong>Method: </strong>This retrospective cohort study included all AHS centers. The sustainability of both programs was assessed twice yearly using the NCQA self-assessment audit and the CDC system audit. The care outcomes were measured through routinely collected Key Performance Indicators (KPIs) at multiple data collection points in 2018, 2021, and 2022. The study period included the COVID-19 period, providing an opportunity to examine the effect of pre-pandemic program scores on centers' performance during the pandemic. The KPIs are categorized into clinical, preventive, and utilization outcomes.</p><p><strong>Results: </strong>Linear regression showed that the key performance indicator (KPI) for the best-performing centers had significantly higher PCMH scores, <i>B</i> = 0.447, <i>p</i> = 0.03, with no effect on the centers' financial revenue, <i>B</i> = 0.209, <i>p</i> = 0.29. Similarly, using univariate linear regression, a higher chronic disease care program assessment at the end of 2022 was significantly associated with centers performing better in clinical KPI, <i>B</i> = 0.480, <i>p</i> = 0.013. The Chronic Diseases Program assessment at the end of 2022 was as well positively and significantly associated with higher performance of centers regarding the NCQA PCMH standards, <i>B</i> = 0.647, <i>p</i> < 0.001. Pearson correlation analysis indicated significant correlations between clinical and preventive KPI achievements and the 2022 PCMH and CDC scores.</p><p><strong>Conclusion: </strong>The AHS centers successfully implemented both programs sustainably. The study findings highlight areas for sustainability research that demonstrate the value of sustainable interventions.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1591667"},"PeriodicalIF":2.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030874","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":"Can a doctor be too old to practice medicine?","authors":"Jonathan T W Au Eong","doi":"10.3389/frhs.2025.1521832","DOIUrl":"10.3389/frhs.2025.1521832","url":null,"abstract":"","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1521832"},"PeriodicalIF":2.7,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12415005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030782","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":"Impact of family doctors on gradient utilization of health services among diabetic patients: evidence from a real-world study.","authors":"Yin Fan, Mengyun Sui, Leiyu Shi, Long Xue, Su Xu","doi":"10.3389/frhs.2025.1618955","DOIUrl":"10.3389/frhs.2025.1618955","url":null,"abstract":"<p><strong>Objective: </strong>The family doctor system plays a crucial role in promoting the gradient utilization of health resources. However, empirical evidence regarding the use of health services across different levels of care by diabetic patients under family doctor contracts remains limited. This study aimed to investigate the impact of the family doctor system on the gradient utilization of health services among diabetic patients using real-world data.</p><p><strong>Methods: </strong>We conducted an eight-year cohort study in Shanghai from 2014 to 2021, with a final sample size of 491,674 participants, including 459,600 contracted and 32,074 non-contracted patients. We employed inverse probability weighted regression adjustment (IPWRA) and zero-inflated negative binomial regression models to estimate the net effects. Among contracted patients, 52.08% were female, with an average age of 66.31 years; in comparison, non-contracted patients were younger, and over 60% resided in urban areas. The annual number of outpatient and inpatient visits was 32.47 and 0.42 for contracted patients, and 34.63 and 0.35 for non-contracted patients, respectively.</p><p><strong>Results: </strong>Study results showed that, outpatient visits decreased across all levels of hospital (coef. = -7.37%, IRR = 0.92 <i>P</i> < 0.01), with a more pronounced reduction in secondary and tertiary hospitals compared to community health centers. This translated to a notable decrease of 2.43 days in the total number of outpatient visits. Conversely, hospitalization rates increased, particularly in community health centers (coef. = 26.88%, IRR = 1.30, <i>P</i> < 0.01). Overall, the data suggest that having a family doctor is associated with reduced outpatient visits, especially in higher-level hospitals, while hospitalizations are more concentrated in community health centers.</p><p><strong>Conclusion: </strong>Hospitalization rates can be reduced through targeted measures: strengthening early screening for diabetic complications; implementing a health-focused digital management system with outcomes-linked performance evaluations; enhancing clinical decision support and re mote monitoring systems to enable timely interventions by family doctors; developing clear referral protocols to minimize unnecessary hospital admissions; and conducting regular competency training for primary care providers.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1618955"},"PeriodicalIF":2.7,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12411513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145016736","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":"Adoption and acceptability of a perioperative nutrition program among total joint arthroplasty patients.","authors":"Derek S Yocum, Leila Hammond, Emma Housholder, Néma McGlynn, Sara Y Oikawa, Claudia Kabele, Adam Cien, Jeffrey D Yergler","doi":"10.3389/frhs.2025.1555209","DOIUrl":"10.3389/frhs.2025.1555209","url":null,"abstract":"<p><strong>Introduction: </strong>Perioperative nutrition interventions improve postoperative outcomes after total joint arthroplasty (TJA). Despite this improvement, adoption and acceptability of nutrition interventions among orthopedic patients have never been assessed, even though they are key factors in patient adherence and practitioner buy-in. To address this knowledge gap, the adoption and acceptability of a 4-week perioperative nutrition program were explored.</p><p><strong>Methods: </strong>Patients who underwent TJA at a single orthopedic clinic in South Bend, Indiana, USA, were invited to participate. Eligible patients were informed of the nutrition program > 2 weeks prior to their scheduled surgery. Two weeks postoperatively, patients were administered a digital questionnaire that captured their demographic information, whether they purchased the nutrition program or not, reasons for non-participation, and acceptability of the nutrition program among those who participated based on the theoretical framework of acceptability.</p><p><strong>Results: </strong>A total of 341 patients were approached, of which 208 consented. There were no demographic differences between the participants who purchased the nutrition program (105) and those who did not (103). The majority of the participants who purchased the nutrition program (78.7%, <i>n</i> = 85) were satisfied with it, and 65.7% (<i>n</i> = 71) believed it improved their surgical recovery. The most common reason cited for non-participation was cost.</p><p><strong>Conclusion: </strong>A nutrition program, implemented using a pragmatic adjunctive model, was adopted by many of the patients who underwent arthroplasty, regardless of demographics. The nutrition program was generally well-accepted by those who participated in it. Considerations around perceived cost need to be addressed in future implementations of the program.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1555209"},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002053","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":"Adverse event reporting and patient safety: the role of a just culture.","authors":"Augustine Kumah","doi":"10.3389/frhs.2025.1581516","DOIUrl":"10.3389/frhs.2025.1581516","url":null,"abstract":"<p><p>Reporting adverse events is essential for ensuring patient safety and fostering a culture of continuous improvement in healthcare. Adverse events, defined as unintended injuries or complications arising from healthcare management, offer crucial insights into systemic weaknesses that, if addressed, can prevent future harm. However, underreporting such events remains a significant challenge, often driven by fear of punitive actions, reputational damage or legal repercussions. To address these concerns and promote a robust reporting culture, healthcare organisations must adopt a just culture by implementing standardised frameworks for evaluating errors and establishing robust reporting systems. A culture that emphasises accountability and learning over punitive measures. Leadership commitment, psychological safety, and fair accountability are foundational to fostering a just culture in healthcare. While each theme presents specific requirements and challenges, their integration is essential for building a resilient and learning-oriented healthcare system.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1581516"},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002028","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":"Nurse leaders' perceptions of leadership development needs for strengthening the nursing workforce: a South African pilot study.","authors":"Mirriam Matandela, Goitsemang Lucy Chisale, Vhothusa Edward Matahela","doi":"10.3389/frhs.2025.1634563","DOIUrl":"10.3389/frhs.2025.1634563","url":null,"abstract":"<p><strong>Background: </strong>Nurses are central to South Africa's healthcare system, yet the sector faces ongoing challenges, including workforce shortages, high workloads, limited career progression, and weak institutional support. These issues are exacerbated by the absence of a structured leadership development framework. In response, the national Department of Health, through the South African Nursing Leadership Initiative, launched a pilot study to explore nurse leaders' perceptions of leadership development needs prior to the development of a national Nursing Leadership Competency Framework. This study explored nurse leaders' perceptions of the leadership capacity required to strengthen the nursing workforce and support national health priorities.</p><p><strong>Methods: </strong>A qualitative, exploratory study was conducted between May and July 2024, involving 153 purposively selected nurse leaders from four provinces. Data were collected through structured group narrative sessions, using semi-structured questionnaires aligned with global frameworks. A deductive thematic narrative analysis guided by Braun and Clarke's six-phase framework (2006) was employed to identify themes.</p><p><strong>Results: </strong>Three central themes emerged consistently across the pilot provinces. (1) <i>Workforce planning and career pathway development</i> revealed persistent nursing shortages and limited opportunities for career advancement. (2) <i>Capacity building through continuing professional development</i> highlighted the need for structured in-service education and leadership training to address skills gaps. (3) <i>Organisational support and leadership for retention</i> underscored high workloads, inadequate institutional support and the absence of psychological safety, all contributing to poor retention and morale.</p><p><strong>Conclusion: </strong>This pilot study provides contextual insights into the leadership development needs of a limited group of nurse leaders, which will inform the refinement of data collection tools and the design of a larger, national study. The findings are not generalisable but offer valuable direction for developing a contextually grounded Nursing Leadership Competency Framework and supporting strategic leadership capacity-building aligned with South Africa's health system strengthening goals.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1634563"},"PeriodicalIF":2.7,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12405266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145002005","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 contribution of a person-centred model of Lean Six Sigma to the development of a healthful culture of health systems improvement.","authors":"Seán Paul Teeling, Deborah Baldie, Ailish Daly, Anne Marie Keown, Aileen Igoe, Ciara Dowling, Martin McNamara","doi":"10.3389/frhs.2025.1621233","DOIUrl":"10.3389/frhs.2025.1621233","url":null,"abstract":"<p><strong>Background: </strong>A failure to distinguish between person-centredness, person-centred care, and person-centred cultures can result in improvement initiatives focusing solely on improvement initiative metrics and outcomes, excluding the authentic experiences of patients and staff. Building on the foundational work of Dewing and McCormack, we have designed, piloted, and implemented the Person-centred Lean Six Sigma (PCLSS) model in public and private acute and community healthcare settings across Ireland. This model uses Lean Six Sigma, a widely adopted improvement methodology, through a person-centred lens with which improvement practitioners and healthcare staff can inspect their Lean Six Sigma practice and critically evaluate whether, to what extent, and how it is synergistic with person-centred approaches.</p><p><strong>Aim: </strong>This paper explores the deployment of the PCLSS model across four clinical study sites and examines its alignment with McCance and McCormack's conceptual work on healthful cultures, evaluating its contribution to creating cultures that support sustainable improvement, compassion, and respect.</p><p><strong>Methods: </strong>The PCLSS model was embedded within a university-accredited education programme for healthcare staff. The model was applied across four distinct healthcare settings in Ireland: a public acute teaching hospital, a private full-service acute hospital, an integrated ophthalmology service bridging hospital and community care, and a public rehabilitation hospital. A case study methodology was used to examine implementation and impact.</p><p><strong>Results: </strong>Across all four sites, the PCLSS model facilitated improvements in operational efficiency, staff and patient engagement, interprofessional collaboration, and reflective practice. The model supported leadership at all levels, fostered sustainable change, and successfully mapped onto key domains associated with healthful cultures, as articulated in the work of McCance and McCormack.</p><p><strong>Conclusion: </strong>The PCLSS model represents a sustainable, values-based approach to improvement that aligns operational excellence with person-centred principles. Its application contributes meaningfully to the development of healthful cultures in healthcare organisations.</p>","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1621233"},"PeriodicalIF":2.7,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12400856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144994651","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":"Editorial: Climate change, human health, and health systems.","authors":"Munyaradzi Saruchera, Morenike Oluwatoyin Folayan, Bethuel S Ngcamu, Walter Musakwa, Margaret Kaseje, Godfred O Boateng","doi":"10.3389/frhs.2025.1615206","DOIUrl":"10.3389/frhs.2025.1615206","url":null,"abstract":"","PeriodicalId":73088,"journal":{"name":"Frontiers in health services","volume":"5 ","pages":"1615206"},"PeriodicalIF":2.7,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12394615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980862","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}