BMC Health Services Research最新文献

{"title":"Preferences for postoperative exercise in patients after total hip or knee arthroplasty: a discrete choice experiment.","authors":"Yue Wang, Mengnv Zhou, Jie Wu, Qiongling Zhan, Caixia Liu, Zhen Wang, Yifei Cheng, Qiangqiang Han, Hui Lu","doi":"10.1186/s12913-026-15211-9","DOIUrl":"10.1186/s12913-026-15211-9","url":null,"abstract":"<p><strong>Background: </strong>Postoperative exercise is associated with important benefits for patients undergoing total hip or knee arthroplasty, yet adherence to prescribed exercise programs remains suboptimal. Understanding patient preferences is essential for designing patient-centered interventions. This study aimed to assess patient preferences for postoperative rehabilitation exercise programs and determine the relative importance of specific program attributes.</p><p><strong>Methods: </strong>From March to July 2025, we conducted a cross-sectional survey using a discrete choice experiment (DCE) design at the Department of Joint Surgery, First Affiliated Hospital of the University of Science and Technology of China. A total of 295 patients who had undergone primary elective THA or TKA were included. The survey was administered from postoperative day 2 onwards, at which point participants had already commenced rehabilitation. Participants were asked to choose between hypothetical rehabilitation scenarios defined by five attributes: pain severity experienced during rehabilitation exercises, presence of a healthcare provider, exercise intensity, frequency, and duration. Conditional logit and mixed logit models were employed to estimate preference weights and investigate preference heterogeneity across subgroups.</p><p><strong>Results: </strong>Pain severity during rehabilitation exercises was identified as the most critical determinant of choice, with patients strongly preferring mild or moderate pain over severe pain (OR: 2.41, 95% CI: 1.76-3.07 and OR: 3.84, 95% CI: 2.88-4.79, respectively). This was followed by the presence of a healthcare provider (OR: 1.44, 95% CI: 1.24-1.63) and exercise intensity. Patients expressed a strong preference for rehabilitation programs characterized by mild-to-moderate pain, professional guidance, and moderate exercise intensity. Conversely, exercise frequency and duration had a relatively limited impact on decision-making. Subgroup analyses stratified by gender and age showed largely consistent preference patterns across populations, with variations in effect magnitude.</p><p><strong>Conclusions: </strong>Patients prioritize safety-driven rehabilitation protocols that balance functional recovery with physical comfort, specifically favoring effective pain management and professional support. These findings provide empirical evidence to guide the development of patient-centered, precision-oriented rehabilitation pathways that may enhance long-term adherence and clinical outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A scoping review and systems thinking synthesis of scale-up frameworks.","authors":"Cole Hooley, Katherine E Marçal, Kayden Barlow, Mia T Vogel","doi":"10.1186/s12913-026-15107-8","DOIUrl":"10.1186/s12913-026-15107-8","url":null,"abstract":"<p><strong>Background: </strong>There is a pressing need to scale-up health and human services. While there are many scale-up frameworks in the broader literature, most of the general scale-up frameworks treat scale-up as a linear process. There are calls to bolster research viewing scale-up as a dynamic process. The purpose of this review is to consolidate and apply systems thinking to existing scale-up frameworks to illustrate feedback relationships among the drivers of scale-up.</p><p><strong>Methods: </strong>We used a scoping review informed by hermeneutic principles to search the literature for scale-up determinants. We searched six scholarly databases (Medline, Web of Science, Embase, CINAHL, PsycInfo, and Google Scholar) for review articles of scale-up frameworks that yielded key determinants of scale-up. We also included other scale-up papers that yielded determinants. Articles that did not meet these criteria were excluded during the title/abstract and full-text screening process. Two coders assessed each article before it was excluded. Two coders extracted the scale-up determinants and definitions. We used thematic analysis to code and consolidate the determinants. Then we used an ex-post development approach to create a causal loop diagram (CLD) visualizing the scale-up determinants and feedback structures.</p><p><strong>Results: </strong>Our search yielded 2693 articles which resulted in a usable sample of 40 articles after the screening process. The 40 articles contained 1053 scale-up determinants. Our coding procedures and CLD reduced these determinants to 25 in our model. There are six reinforcing loops and three balancing loops that are at play in scale-up efforts depicted in the final CLD. Among the determinants, motivation, capacity, enabling environment, and alignment were prominent.</p><p><strong>Conclusions: </strong>The resulting interpretation and CLD provide a dynamic conceptualization of scale-up complexity, highlighting key leverage points in the scale-up process.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a comprehensive sickle cell center leads to improved access to care and decreased acute care use.","authors":"Julie Kanter, Allison Plaxco, Najibah Galadanci, Gerhard Helleman, Rachel Klein, Jeffrey Lebensburger","doi":"10.1186/s12913-026-15206-6","DOIUrl":"https://doi.org/10.1186/s12913-026-15206-6","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease (SCD) is a lifespan condition associated with substantial morbidity, premature mortality, and high healthcare utilization, particularly due to acute pain crises and other severe complications. Evidence-based guidelines emphasize the importance of comprehensive, multidisciplinary care for optimal outcomes; however, implementation of such models for adults with SCD remains inconsistent, contributing to fragmented care and reliance on emergency services. The primary aim of the study is to evaluate the implementation and impact of a National Alliance of Sickle Cell Centers (NASCC) aligned comprehensive adult SCD center on outpatient engagement, infusion therapy utilization, and acute care use.</p><p><strong>Methods: </strong>The University of Alabama at Birmingham implemented a multidisciplinary adult SCD center beginning in 2019. We conducted a retrospective, population-based evaluation comparing care engagement and utilization before (January 2017-December 2018) and after (January 2022-December 2024) center implementation, excluding the COVID-19 period. Electronic medical record data were used to identify adults with SCD and capture outpatient clinic visits, infusion therapy unit use, emergency department (ED) visits, and hospitalizations. Nonparametric statistical tests were used to compare outcomes across periods.</p><p><strong>Results: </strong>The adult SCD clinic population increased more than three-fold, reaching 810 patients by 2024, alongside substantial expansion of clinical space, staffing, and infusion capacity. By 2024, nearly 90% of patients with SCD were seen annually in the outpatient clinic. Infusion therapy visits increased fifteen-fold, providing an alternative to ED-based pain management. Mean acute care visits per person per year decreased significantly from 2.11 to 1.26, while mean routine outpatient visits per person per year increased from 2.65 to 5.32 (p < 0.001). Reductions in ED visits and hospitalizations were observed despite a marked increase in the total population served.</p><p><strong>Conclusions: </strong>Implementation of a NASCC-aligned comprehensive adult SCD center was associated with improved outpatient engagement, expanded access to preventive and infusion-based care, and significant reductions in acute care utilization. These findings provide real-world evidence that comprehensive, multidisciplinary SCD centers are an effective structural strategy to improve care delivery and outcomes for adults living with SCD and support broader adoption of this model to advance equity and value-based care.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13474837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Having and eating the cake? The centralisation paradox in decentralised healthcare governance: a scoping review.","authors":"Mikael Ohrling","doi":"10.1186/s12913-026-15162-1","DOIUrl":"10.1186/s12913-026-15162-1","url":null,"abstract":"<p><strong>Background: </strong>Decentralisation in healthcare governance is widely promoted to enhance managerial autonomy, responsiveness, and performance. However, empirical evidence suggests that managers operating in decentralised systems continue to rely on centrally coordinated organisational structures. This interdependence remains insufficiently conceptualised in existing research.</p><p><strong>Methods: </strong>A scoping review was conducted to synthesise empirical studies examining how central coordination in organisational systems shapes managers' effective decision space in decentralised healthcare organisations. Searches were performed in PubMed and CINAHL, complemented by snowballing. The review followed PRISMA-ScR guidelines. Data were analysed using a conceptual synthesis approach informed by paradox theory and the decision space framework.</p><p><strong>Findings: </strong>Four interrelated themes were identified: (1) delegated authority and experienced autonomy, (2) the role of organisational capacity in enabling decision space, (3) persistent central coordination within decentralised systems, and (4) autonomy dependent on coordination. The findings show that while decentralisation expands formal decision-making authority, the effective exercise of this authority depends on centrally coordinated enabling systems, including digital infrastructure, administrative support, and financial management. This interdependence reflects a consistent pattern across contexts.</p><p><strong>Conclusions: </strong>The study proposes the concept of a centralisation paradox, demonstrating that managerial autonomy in decentralised healthcare governance is contingent upon central coordination. By extending the decision space model, the study proposes a dual-domain conceptualisation distinguishing between professional decision-making and enabling systems. This reframing advances theoretical understanding of decentralised governance and offers practical insights for designing healthcare organisations that balance local autonomy with system-wide coordination.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13397811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148583516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Untangling standardization and administrative burden as microfoundations of agility in healthcare.","authors":"Pierre-Luc Fournier, Mira Thoumy, Patrick Groulx, Desirée H van Dun, Kevin J Johnson","doi":"10.1186/s12913-026-15179-6","DOIUrl":"10.1186/s12913-026-15179-6","url":null,"abstract":"<p><strong>Background: </strong>The capability of healthcare organizations to provide high-quality care is in part determined by their workers' ability to adapt to a complex and uncertain environment. Since healthcare operations are often highly standardized and bureaucratized, adapting and responding to internal and external changes is no small feat. This study investigates these tensions as determinants of individual agility.</p><p><strong>Methods: </strong>Using survey data collected from 2,173 Canadian nurses along with structural equation modelling, the study assesses a hypothetical model to understand how process standardization and administrative burden influence individual agility and, in turn, the quality of care provided to patients.</p><p><strong>Results: </strong>The results show that the quality of care provided by nurses to their patients is increased by their internal and external individual agility. These, in turn, are positively influenced by process standardization but inhibited by administrative burden.</p><p><strong>Conclusion: </strong>This study extends current literature on the microfoundations of agility in healthcare by providing theoretical and practical contributions on the impact of enabling and coercive bureaucracy.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dialoguing with algorithms: experiences of generative AI use in navigating complex health decisions among older adults with multimorbidity: a qualitative study.","authors":"Qin Lin, Mengxue Fu, Pei Chen, Jiaorong Zhao, Yanhua Liu, Yanping Niu, Minmin Jiang, Jijun Wu","doi":"10.1186/s12913-026-15158-x","DOIUrl":"10.1186/s12913-026-15158-x","url":null,"abstract":"<p><strong>Background: </strong>Generative AI has reshaped healthcare, yet multimorbid older adults face digital divide barriers limiting its safe application. Existing qualitative evidence on their AI-assisted complex health decision-making remains scarce, lacking integrated theoretical interpretation.</p><p><strong>Objectives: </strong>Guided by an integrated framework combining the Technology Acceptance Model, Senior Technology Acceptance Model and Burden of Treatment Theory, this study explored older adults' perceived usefulness and ease of generative AI for health decisions, mobilizable personal-social resources, and how technology perceptions shape dynamic usage behaviors and decision quality.</p><p><strong>Methods: </strong>From September to December 2025, 16 multimorbid seniors were recruited via purposive maximum variation sampling from an urban community health center in eastern China. Face-to-face semi-structured interviews were conducted, with reflexive thematic analysis following COREQ guidelines.</p><p><strong>Results: </strong>Based on interviews with 16 participants, four themes were identified: (1) Perceived usefulness, which was mainly reflected in four dimensions: initial situational triggers prompting AI consultation, convenient access to information, integrated support for multimorbidity management, and enhanced decision-making confidence. (2) Perceived ease of use: Participants' perceptions of the ease of use of generative AI showed significant individual differences and context dependence. (3) Resource mobilization: Successful use of generative AI rarely depended on independent individual effort but required the mobilization of diverse personal resources and social support. (4) Behavioral intention and actual use: The generative AI usage behavior of older adults with multimorbidity exhibited dynamic evolutionary characteristics; its trajectory was not linear acceptance and continuous use, but a complex process involving attempts, interruptions, resumption, or permanent abandonment.</p><p><strong>Conclusions: </strong>This study reveals that AI use among older adults with multimorbidity is not merely a technology adoption behavior, but an adaptive strategic choice made under the pressure of managing multiple chronic conditions. Only by fully considering the special needs of patients with multimorbidity in technology design and service provision can the safe and effective application of generative AI in elderly chronic disease management be truly realized.</p><p><strong>Trial registration number: </strong>Not applicable. This study did not involve clinical trials.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mobile applications for ophthalmology: a quantitative and qualitative analysis.","authors":"Shahla Faramarzi, Kosar Ghaddaripouri, Parmida Sanaei, Zahra Zare, Azita Yazdani","doi":"10.1186/s12913-026-15199-2","DOIUrl":"https://doi.org/10.1186/s12913-026-15199-2","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the quality of ophthalmology-related mobile health applications (mHealth apps) available in Persian and English across Android and iOS platforms.</p><p><strong>Method: </strong>A structured review of apps related to ophthalmology was conducted in four mobile app stores (Cafe Bazaar, Google Play, App Store, Myket) from July 31 to August 15, 2024, using relevant English and Persian keywords. The quality of selected apps was independently assessed by three reviewers using the Mobile App Rating Scale (MARS). Clinical evidence was also searched in PubMed, Scopus, and Google Scholar.</p><p><strong>Result: </strong>Out of 4,968 ophthalmology-related apps initially identified, 37 apps met the inclusion criteria for final quality assessment-4 in Persian and 33 in English. According to the MARS scale, the Functionality domain had the highest average score (4.24), followed by Aesthetics (3.70), Engagement (3.22), and Information (3.13). Clinical effectiveness evidence was found for the \"WHO eyes\" app. The Persian app \"چشم یار\" achieved the highest average score of 4.42, and the English app \"Eye Patient\" received the highest average score of 4.83.</p><p><strong>Conclusion: </strong>This study demonstrates that the quality of ophthalmology-related apps meets acceptable criteria according to the MARS scale; however, user engagement and the quality of the information provided remain suboptimal. These results highlight the need for improving interactive features, motivational design elements, and evidence-based educational content to enhance the overall effectiveness of ophthalmology-related mHealth apps.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of the synthetic index of palliative care integration into primary health care.","authors":"Carolina Muñoz Olivar, Juan Sebastián Gomez Quintero, Fernando Pastrana Rendon, Carla Taramasco Toro, Miguel Antonio Sanchez-Cardenas, Carlos Javier Avendaño-Vásquez","doi":"10.1186/s12913-026-15191-w","DOIUrl":"https://doi.org/10.1186/s12913-026-15191-w","url":null,"abstract":"<p><strong>Background: </strong>Integrating palliative care (PC) into primary health care (PHC) is essential to achieve universal health coverage and equity. However, most countries lack concise and validated tools to monitor this process. This study developed and validated a composite index to measure the degree of PC integration into PHC at the departmental level in Colombia.</p><p><strong>Methods: </strong>An ecological, cross-sectional study was conducted across 33 territorial units in Colombia (32 departments plus Bogotá D.C.) in 2024. Eight of 15 candidate indicators were retained to construct the index. Each indicator was normalized using a Min-Max linear transformation [0-1] and analyzed through principal component analysis with varimax rotation. The Synthetic Index of Palliative Care Integration into Primary Health Care (SIPCI) was built using a hierarchical weighting scheme combining domain-level and within-domain weights. Stability was assessed through jackknife leave-one-out, alternative normalizations methods, and four robustness scenarios including Monte Carlo perturbations. External validity was examined through correlations with socioeconomic and service-related variables.</p><p><strong>Results: </strong>SIPCI scores ranged from 0.04 to 0.71 (mean 0.38, SD 0.13). Overall, 52% of departments showed low or medium-low integration, while 48% showed medium-high or high integration. A clear spatial gradient was observed, with higher integration in central departments and Bogotá, and lower integration in Amazon and Orinoquia regions. Sampling adequacy was good (KMO = 0.742). Information loss was low (NMSE = 0.13; 0.10 after indicator reduction). Leave-one-out analyses showed strong concordance with the baseline index (Spearman [Formula: see text]; Kendall [Formula: see text]). Five subcomponents were identified, which rural accessibility and undergraduate PC training contributing most. The correlation between SIPCI and departmental income was positive but moderate, indicating that economic capacity may facilitate, but does not determine integration.</p><p><strong>Conclusions: </strong>The SIPCI provides a reproducible, system-level measure for monitoring and benchmarking territorial patterns of palliative care integration within primary health care in Colombia. The findings describe marked geographic heterogeneity and support the use of SIPCI for routine monitoring and planning, without implying causal mechanisms or patient-level effects. Although the index showed good internal coherence and robustness, further studies may help strengthen its construct validity and assess its applicability in other settings.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Temporal-spatial analysis and driving factors of coupling coordination between population and health services systems in China, 2010-2022.","authors":"Linbin Luo, Ruibo He, Yiqing Xing, Weicun Ren, Liang Zhang","doi":"10.1186/s12913-026-15196-5","DOIUrl":"https://doi.org/10.1186/s12913-026-15196-5","url":null,"abstract":"<p><strong>Background: </strong>Demographic transitions are reshaping health needs and challenging the sustainability of health governance, with the coordination of population and health services systems closely connected to these processes. This study investigates China's population and health services systems from 2010 to 2022, aiming to explore the spatiotemporal evolution and key driving factors of their coupling coordination.</p><p><strong>Methods: </strong>Data were obtained from the China Statistical Yearbook and China Health Statistics Yearbook, covering 31 provinces from 2010 to 2022. An evaluation model was developed to assess the coupling coordination degree (CCD) between the population and health services systems. Spatial autocorrelation analysis was employed to examine spatial dependence, and a Spatial Durbin Model (SDM) was applied to identify key driving factors.</p><p><strong>Results: </strong>From 2010 to 2022, the development indices of China's population and health services systems rose steadily, with the CCD increasing from 0.407 to 0.835, indicating a progression from initial imbalance toward advanced coordination. Regionally, the pattern of \"east-strong, central-rising, west-weak\" persisted, though disparities have diminished as central and western regions steadily caught up. Spatial analysis confirmed significant dependence and stable in provincial CCD, with patterns dominated by \"high-high\" clusters in the Yangtze River Delta and Beijing-Tianjin-Hebei region, which gradually extended into central provinces, and by persistent \"low-low\" clusters in the west and northeast, alongside several outliers. Spatial econometric results identified government health expenditure, health insurance coverage, digital and transport infrastructure as significant positive drivers, with government health expenditure and digital development showing stronger cross-regional spillovers.</p><p><strong>Conclusion: </strong>Coordination between the population and health services systems improved substantially, although regional disparities persisted. Further progress requires closer alignment between demographic change and health service capacity. Differentiated regional strategies are therefore needed: economically and resource-advantaged regions could harness agglomeration and spillover effects through cross-regional collaboration; central provinces should consolidate their catch-up momentum and strengthen their regional service capacity; and western and other low-coordination regions, facing population mobility and ageing pressures, should prioritise targeted fiscal transfers, workforce retention incentives and improved service accessibility to promote more equitable and sustainable development.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488232/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"It depends on where you stand on screening: health professionals' awareness, perspectives, and approaches to overdiagnosis in cancer screening - a qualitative interview study.","authors":"Veerle Piessens, Emelien Lauwerier, John Brandt Brodersen, Melissa Ceuterick, Alexandra Brandt Ryborg Jønsson, Ann Van den Bruel, Stefan Heytens","doi":"10.1186/s12913-026-15194-7","DOIUrl":"10.1186/s12913-026-15194-7","url":null,"abstract":"<p><strong>Background: </strong>Overdiagnosis is a major challenge in screening, leading to healthy individuals being diagnosed and treated for conditions that would never have caused harm. While evidence on overdiagnosis is growing, little is known about how health professionals (HPs) understand and engage with this phenomenon in practice. This study examines health professionals' awareness, understanding and approaches to overdiagnosis in breast, lung, and prostate cancer screening.</p><p><strong>Methods: </strong>This is a qualitative study with semi-structured interviews, using Positioning Theory as an analytical lens, among HPs involved in breast, prostate, or lung cancer screening in Flanders, Belgium, both in public health settings and in individual clinical care. 34 HPs, of whom 21 were purposively invited, because of their professional role, research background or public advocacy related to screening. In addition, 13 clinicians were randomly recruited from a list of registered physicians (GPs, gynaecologists, urologists and pneumologists).</p><p><strong>Results: </strong>Few participants spontaneously mentioned overdiagnosis as a harm of screening, although most recognised it, primarily in relation to prostate cancer screening. Some HPs demonstrated a thorough understanding of overdiagnosis, but did not necessarily perceive it as a relevant harm. HPs' perceptions and corresponding approaches depended primarily on their overall position regarding screening. The participating HPs articulated three different storylines to motivate their positions: (1) routine screening, where HPs accept screening as self-evident and are largely unaware of overdiagnosis, (2) determined screening, where HPs emphasise the evidence-based benefits of screening and acknowledge overdiagnosis, which they try to mitigate, but also de-problematise, and (3) cautious screening, where HPs question the evidence base and benefits of screening and consider overdiagnosis one of the reasons for adopting a reluctant position towards screening.</p><p><strong>Conclusions: </strong>Participants rarely identify overdiagnosis as a harm of screening, despite being (passively) aware of it. HPs' broader position on screening shapes how they understand, interpret, and respond to overdiagnosis and is primarily based on their knowledge of screening benefits, and influenced by professional contexts and personal characteristics. Regardless of their level of enthusiasm for screening, HPs with a more comprehensive understanding of its benefits and harms tend to adopt more deliberate and carefully considered - albeit divergent- approaches to overdiagnosis.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13508208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}