BMC Health Services Research最新文献

{"title":"Multi-faceted strategies to advance health equity in colorectal cancer screening in primary care setting: quality improvement project.","authors":"Einas Batarseh, Elizabeth Onyechi, Omar Arman, Gregory Gudleski, Jessica L Reynolds, Smita Bakhai","doi":"10.1186/s12913-024-11928-7","DOIUrl":"10.1186/s12913-024-11928-7","url":null,"abstract":"<p><strong>Background: </strong>The aim of this quality improvement (QI) project was to increase Colorectal Cancer (CRC) screening in patients ages 50-75 years from a baseline of 27-40% within 12 months in a primary care clinic in limited resource communities.</p><p><strong>Methods: </strong>The multidisciplinary QI-team applied the Plan-Do-Study-Act method and developed stakeholder analysis, an Ishikawa fish bone diagram, a process flow map, and a driver diagram. Major barriers to suboptimal CRC screening included limited health literacy, language preferences, absence of stool test options, and knowledge gaps among patients and providers. The outcome measure was CRC screening rates, while stool test and colonoscopy completion rates served as process measures. Major interventions included the use of a patient-navigator, leveraging digital health technology to create a novel CRC screening data dashboard, educating patients and providers, patient centered-shared decision making, and creating messages and educational videos in patient's preferred languages. We used monthly run charts and statistical process control charts (SPC) for data analysis.</p><p><strong>Results: </strong>We observed a sustainable, steady increase in CRC screening rates from baseline rates of 27.0-40.0% (n = 1304/3271) during the study period and 45.6% (n = 1493/3,271) six months post-study, with median rates of 34.0% in the run chart and mean rates of 43.0% in the SPC chart. Furthermore, we observed an increase in colonoscopy completion rates during the study and six months post-study to 65.0% (n = 411/631) and 72.9% (n = 461/631) respectively, from a baseline rate of 25.0%, with a median of 63.0% in the monthly run chart.</p><p><strong>Conclusion: </strong>The increase in CRC screening rates highlights the effectiveness of addressing barriers such as health literacy, language preferences, and knowledge gaps. This underscores the value of a multifaceted approach and the role of a patient navigator in enhancing preventive, patient-centered care. This project focused on population health and addressing social determinants of health to overcome disparities and improve CRC screening in a primary care setting. Continued emphasis on these strategies is likely to further advance colorectal cancer screening efforts.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1422"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572305/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667414","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":"Exploring what works well and less well in a community-based drop-in hub providing health and wellbeing services for people experiencing homelessness: a participatory action evaluation of service coordination.","authors":"Emma A Adams, Sheena E Ramsay","doi":"10.1186/s12913-024-11897-x","DOIUrl":"10.1186/s12913-024-11897-x","url":null,"abstract":"<p><strong>Background: </strong>People experiencing homelessness often face obstacles accessing health and social care support. Challenges are further exacerbated when support provision for multiple unmet needs are not integrated or coordinated. To overcome these challenges, there has been growing attention on integrating and co-locating health and wellbeing services for people experiencing homelessness. In an urban area of North East England, a long-standing Hub or 'drop-in centre' offers a range of health and wellbeing support by bringing together the different health and care system agencies in one space. However, little is known about the perspectives of providers on what works well and less well in how the different services are coordinated.</p><p><strong>Methods: </strong>Using a participatory action research approach, a qualitative service evaluation was undertaken between June and September 2023. Fourteen interviews were conducted with providers who work in a paid or voluntary capacity operating some of their service offerings or support in the Hub. Interview transcripts were analysed using inductive reflexive thematic analysis.</p><p><strong>Results: </strong>Three themes were evident from the evaluation: 1) location and space matter, 2) co-location and relationships make a difference, and 3) service consistency and flexibility are paramount.</p><p><strong>Conclusion: </strong>Co-locating support to cover the breadth of health and care needs has the potential to increase engagement and access for people experiencing homelessness, and to enhance trust with service users and between agencies. This model provides a unique example of co-location and integration of support, particularly with it being operated by a community housing organisation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1423"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667412","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":"Forecasting the future of smart hospitals: findings from a real-time delphi study.","authors":"Florian Jovy-Klein, Susan Stead, Torsten Oliver Salge, Jil Sander, Anke Diehl, David Antons","doi":"10.1186/s12913-024-11895-z","DOIUrl":"10.1186/s12913-024-11895-z","url":null,"abstract":"<p><strong>Background: </strong>In concert with other digital technologies, artificial intelligence (AI) is shaping the vision of smart hospitals. The transformation into smart hospitals, however, is all but trivial due to the lack of financial and human resources, digital skills, and supporting policies. Thus, the extent to which the vision of smart hospitals will eventually become reality is uncertain. In this context, our study provides a multidimensional conceptualization of the immediate future of smart hospitals to 2042.</p><p><strong>Methods: </strong>This study employs an iterative mixed-methods approach, including expert workshops and a Delphi study. We conducted a real-time Delphi study to forecast the evolution of smart hospitals in 5-year steps from 2027 to 2042. A total of 39 experts in healthcare, artificial intelligence, and management participated.</p><p><strong>Results: </strong>Our understanding of a technology-enabled smart hospital in this study includes four dimensions: artificial intelligence (AI), sustainability, ecosystems, and human-centeredness. Our findings underscore the critical need to address the shortage of hospital staff and general practitioners that models predict will peak by 2032. Additionally, our results show a significant shift to individualized medicine and home care. This shift indicates that smart hospitals are expected to leverage AI and digital technologies to tailor care to each patient. Furthermore, the roles and responsibilities of hospital staff will undergo significant changes. Healthcare personnel will have to adapt to new technologies that facilitate more efficient workflows and improve patient engagement in evolving healthcare environments. The results of our study suggest a shift in care to individualized medicine and home care, with corresponding changes in the roles and responsibilities of hospital staff who will employ new technologies.</p><p><strong>Conclusions: </strong>The findings from our real-time Delphi study suggest that the vision of smart hospitals is gradually becoming reality over the next 20 years. Advancements in artificial intelligence should enhance operational efficiency and patient-centric care, while facilitating the integration of sustainability practices and fostering collaborative ecosystems. However, addressing challenges such as staff shortages, ethical considerations, and the need for robust digital skills will be essential. A deep pool of expert healthcare practitioners, clear ethical guidelines, and robust digital skills are essential to fully realize this vision and ensure that smart hospitals can meet the evolving needs of healthcare delivery.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1421"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667431","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":"Perspectives of patients with type 1 and type 2 diabetes on barriers to diabetes care: a qualitative study.","authors":"Sweta Shrestha, Sujata Sapkota, Khagendra Acharya, Sabin Chaulagain, Matina Sayami, Abhinav Dahal, Rajani Shakya, Biraj Man Karmacharya","doi":"10.1186/s12913-024-11925-w","DOIUrl":"10.1186/s12913-024-11925-w","url":null,"abstract":"<p><strong>Background: </strong>Diabetes care incorporates multiple integrated elements like self-care practices, patient education and awareness, societal support, equitable access to healthcare facilities and trained healthcare professionals, commitment from the diabetes associations and government policies. There is a dearth of research exploring the barriers experienced by both People with Type 1 diabetes (PwT1D) and People with Type 2 diabetes (PwT2D) in accessing the holistic elements of diabetes care. This study thus aimed at exploring the perceived barriers among PwT1D and PwT2D in accessing diabetes care services in urban and rural areas of Nepal.</p><p><strong>Method: </strong>This study was a qualitative research using phenomenological approach where an in-depth interview with 23 participants on insulin was conducted. This included 15 PwT1D and 8 PwT2D, residing in the capital and rural areas and attending the hospitals and clinic in the urban and semi-urban regions in Nepal. A semi-structured questionnaire was used for the interview. The interviews were transcribed verbatim and deductive thematic analysis was done.</p><p><strong>Results: </strong>Majority were female participants and most had received a formal education and were visiting the hospitals located in capital city. Mean age for PwT1D was (27.86 ± 1.85) years whereas the median age for PwT2D was [47.5 (IQR, 16.5)] years. Seven themes were generated from the study representing key barriers from patient's perspective. These were: Theme (1) Double stigma: Diabetes diagnosis and insulin use, Theme (2) Non-adherence to insulin and Self-Monitoring of Blood Glucose (SMBG), Theme (3) Logistic challenges in rural areas: Scarcity of healthcare professionals and other healthcare facilities, Theme (4) Dissatisfaction with healthcare services, Theme (5) Patients seeking alternative treatment strategies over allopathic treatment, Theme (6) Limitations of health insurance scheme and Theme (7) Limited role of national diabetes organizations.</p><p><strong>Conclusion: </strong>There is a need in raising awareness among general public especially on T1DM to address the issue of diabetes stigma. An effort in implementation of policies supporting diabetes care and refinement of National Health Insurance Scheme is equally essential. Similarly, strengthening of Health Care System by ensuring availability of insulin, laboratory facilities and trained healthcare professionals in rural areas should be focused to address the inequity in access to healthcare in rural and urban sectors.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1420"},"PeriodicalIF":2.7,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11572125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646984","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":"Assessing the performance of non-specialised private hospitals in Malaysia - an upper-middle-income medical tourism destination country using the Pabón-Lasso model.","authors":"Mohd Fauzy Samsudin, Yin Cheng Lim, Thinni Nurul Rochmah, Maznah Dahlui","doi":"10.1186/s12913-024-11768-5","DOIUrl":"10.1186/s12913-024-11768-5","url":null,"abstract":"<p><strong>Background: </strong>The government has rapidly promoted the privatisation of healthcare to improve systemic performance, based on the theory that markets improve efficiency. This study aims to measure the efficiency of private hospitals following their expansion and venture into the medical tourism industry through extensive governmental support.</p><p><strong>Methods: </strong>Inpatient utilisation of 101 private, non-specialised hospitals in Malaysia in 2014 and 2018 from the Health Informatics Centre, Ministry of Health Malaysia database was studied using paired samples t-test, analysis of variance (ANOVA), and the Pabón-Lasso model.</p><p><strong>Results: </strong>Better quantitative performance was found among larger hospitals, those with hospital accreditation, and those participating in medical tourism activities. There is a scale effect of efficiency between smaller and larger hospitals. However, when compared within respective size categories, Category 1 (small hospitals with less than 100 beds) has the highest percentage of efficient hospitals (39.3 per cent in 2014 and 35.7 per cent in 2018 in Sector 3 of the Pabón Lasso graphs).</p><p><strong>Conclusion: </strong>This study has found that a higher bed occupancy rate (BOR) and longer average length of stay (ALoS) are associated with larger private hospitals, hospital accreditation, and participation in medical tourism activities in Malaysia. There is a need to expedite strategic hospitals partnership for resource optimisation and capacity pooling towards producing better performance.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1414"},"PeriodicalIF":2.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643380","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":"Assessing the interdependency among effectiveness, satisfaction and efficient use of the Lightwave Health Information Management System (LHIMS) by health professionals in Ghana.","authors":"Edward Agyemang, Addae Boateng Adu-Gyamfi, Emmanuel Kusi Achampong, Kobina Esia-Donkoh","doi":"10.1186/s12913-024-11883-3","DOIUrl":"10.1186/s12913-024-11883-3","url":null,"abstract":"<p><strong>Background: </strong>The success of an electronic health records (EHR) system is dependent on the effectiveness, satisfaction, and efficient use of these systems by health professionals. This paper explores the interdependency among effectiveness, satisfaction, and efficient use of Lightwave Health Information Management Systems (LHIMS) which is an EHR by health professionals.</p><p><strong>Methods: </strong>A non-interventional descriptive cross-sectional study design was employed for this research. The study used stratified random sampling for the selection of participants. The population for the study was all the health professionals in the Central Region of Ghana. The number of health professionals who responded to the questions was 1126.</p><p><strong>Results: </strong>The findings suggest that understanding the interdependency of efficiency, effectiveness and satisfaction is crucial for the successful implementation and adoption of LHIMS in healthcare organisations. The study investigated the interdependence among effectiveness, satisfaction, and efficient use of the LHIMS by health professionals, and found a positive but weak significant relationship between these factors.</p><p><strong>Conclusion: </strong>In conclusion, this study aimed to assess the interdependency among effectiveness, satisfaction, and efficient use of LHIMS by health professionals. The. results support a positive but weak significant relationship between satisfaction, effectiveness, and efficient use of the LHIMS. These findings have implications for policymakers and hospital management in their efforts to improve the use of LHIMS. Policymakers can focus on any one of the three usability areas to enhance LHIMS use, with visible effects across the other two domains.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1418"},"PeriodicalIF":2.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643360","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 novel way to integrate economic information into clinical practice guidelines.","authors":"Juha E Ahonen, Elisa Rissanen, Raija Sipilä, Jorma Komulainen, Eila Kankaanpää","doi":"10.1186/s12913-024-11891-3","DOIUrl":"10.1186/s12913-024-11891-3","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidelines are widely used to support clinical decision making, so they could also provide economic information about medical interventions to promote cost-conscious health care. We developed a new way to integrate economic information into the Finnish Current Care Guidelines.</p><p><strong>Methods: </strong>Our development team consisted of clinical guideline specialists and health economists. We first looked at integration of economic information in clinical guidelines of other countries. Our key principle was that economic information should be integrated only to mutually exclusive medical interventions where the extensive choice of one the options will yield a significant cost differences on the national level. For the comparative effectiveness information of the interventions, we primarily looked for network meta-analyses. We then combined the effectiveness information presented as number needed to treat with prices or costs for the interventions and present the result as a cost per responder, which reflects both effectiveness and price or costs.</p><p><strong>Results: </strong>We introduce a process to integrate and present the economic information of the selected interventions in tables in the Current Care Guidelines.</p><p><strong>Conclusions: </strong>Our novel way to integrate economic information into the Current Care Guidelines is an effort to support cost-conscious clinical decision making to promote cost-effective health care in Finland. This process is general and could be used in clinical guidelines in other countries as well.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1415"},"PeriodicalIF":2.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643344","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":"Predictors of the continuous use of an infectious disease self-management app for epidemiological investigations: a survey of young and middle-aged adults in South Korean citizens.","authors":"Mi Jung Rho, Jihwan Park","doi":"10.1186/s12913-024-11937-6","DOIUrl":"10.1186/s12913-024-11937-6","url":null,"abstract":"<p><strong>Background: </strong>In the wake of the coronavirus disease-19 (COVID-19) pandemic, research on the difficulties faced by epidemiologists conducting epidemiological investigations has been progressing steadily. However, few studies have developed applications (apps) that can directly support epidemiological investigations via information and communication (ICT) technology, and conducted usability evaluations on them via user responses. This has caused difficulties when developing such technologies. We introduced and evaluated two mobile apps that support epidemiological investigations. This study attempted to identify the predictors affecting the acceptance of infectious disease self-management apps.</p><p><strong>Methods: </strong>We developed two infectious disease self-management smartphone apps for epidemiological investigations: KODARI (the Korean version) and MEDARI (in English version). We collected data from 248 users of KODARI by surveying Korean citizens. This study was conducted from November 15 to December 14, 2022. We used multiple regression analysis to identify the variables that affected continuous intention to use the KODARI app. We conducted two independent-samples t-tests to determine whether there were any differences in the perception of each variable in relation to demographic and COVID-19-related user characteristics.</p><p><strong>Results: </strong>The factors that affected continuous intention to use the KODARI app, in order of relative importance, were: price value, satisfaction, performance expectancy, and facilitating conditions. Overall, male participants were more satisfied with the KODARI app than female ones, and more willing to continue using it. The male participants also evaluated facilitating conditions more positively than the female ones did. Married participants rated the app higher than single ones in terms of price value, performance expectancy, and continued intention to use.</p><p><strong>Conclusions: </strong>The study suggests factors that increase the use of health apps and suggests that use of these apps may increase further in the event of a future pandemics. These results are expected to help researchers study other infectious disease apps in the context of public health surveillance.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1419"},"PeriodicalIF":2.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643437","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":"Health service provider views on measuring patient involvement in healthcare: an interview study with researchers, clinicians, service managers, and policymakers.","authors":"Bente Skovsby Toft, Trine Ellegaard, Berit Kjærside Nielsen, Camilla Blach Rossen, Jens Thusgaard Hørlück, Mette Spliid Ludvigsen, Hilary Louise Bekker, Lotte Ørneborg Rodkjær","doi":"10.1186/s12913-024-11904-1","DOIUrl":"10.1186/s12913-024-11904-1","url":null,"abstract":"<p><strong>Background: </strong>There are several strategies used to assess involvement in their healthcare across service providers. However, there is no consensus on the most appropriate measurement tool to use when evaluating patient involvement initiatives. This qualitative study aimed to explore the perspectives of stakeholders from micro, meso, and macro levels within the Danish healthcare system on measuring patient involvement in their healthcare.</p><p><strong>Methods: </strong>This descriptive, explorative study employed semi-structured interviews with open-ended questions to elicit participants' views and experiences of patient involvement and measurement tools. A purposeful sample of participants was identified, to include decision makers, researchers, and health professionals (n = 20) with experiences of measuring patient involvement in healthcare at micro, meso, and macro levels across Danish organizations. Data underwent reflexive thematic analysis.</p><p><strong>Results: </strong>Three main themes were identified: 1) Determining the purpose of patient involvement practices and measurement alignment; 2) Reflecting on the qualities, fit, and usefulness of measures; 3) Recognizing conflicting stakeholder paradigms. Despite the interest in and positive attitudes toward patient involvement innovations, views on the meaning and value of evaluating involvement varied; in part, this was attributable to challenges in selecting criteria, methods, and measures for evaluation.</p><p><strong>Conclusion: </strong>The findings indicate the need to integrate the perspectives of all key stakeholders in designing the evaluation of patient involvement initiatives. The application of a multiple stakeholder approach and co-production of a multidimensional evaluation may provide some common ground for selecting evaluation criteria and measurement tools in the healthcare setting.</p><p><strong>Trial registration: </strong>Danish Data Protection Agency (1-16-02-400-21) 15 October 2021.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1417"},"PeriodicalIF":2.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643431","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 consensus-based agreement on a definition of a process variable: findings from a New Zealand nominal group technique study.","authors":"Daniel Harvey, Steve White, Duncan Reid, Chad Cook","doi":"10.1186/s12913-024-11909-w","DOIUrl":"10.1186/s12913-024-11909-w","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal pain and disability are leading causes of reduced health and significant economic costs worldwide. Individualised, and evidence-based treatment approaches for specific musculoskeletal conditions aimed at improving patient outcomes and costs have not been successful. Recently authors have suggested that the 'process' of how care is implemented within a health system needs to be considered as an influencer on patient outcomes. With the rising prevalence of musculoskeletal conditions and the burgeoning costs associated with their treatment, it seems timely that new research focusing on process variables and their influence on patients with musculoskeletal conditions is explored. Before such studies can take place, a modern definition of a process variable within a musculoskeletal care pathway is needed to anchor future research endeavours. Therefore, the aim of this study was to establish a consensus-based definition of a process variable within a musculoskeletal care pathway, based on a New Zealand setting.</p><p><strong>Methods: </strong>This study used a virtual nominal group technique and took place in July 2023 using a Microsoft Teams platform. A nominal group technique employs a structured approach to generate information and solutions to problems that can then be prioritised through group discussion and consensus. It is unique because it allows expert participants to explore using in-depth inquiry, areas previously unidentified or not yet investigated. There was an inclusion criterion and the participants completed pre-work before the two-hour five stage virtual meeting. The Auckland University of Technology Ethics Committee (AUTEC) approved this study (AUTEC 23/94).</p><p><strong>Results: </strong>The study included eight participants (five male, three female) who had extensive experience with the New Zealand ACC insurance scheme and the design, implementation, and administration of musculoskeletal care pathways. The consensus definition was 'A health process variable is any modifiable factor in a health process or pathway that can be quantified and measured and that if varied may achieve a different operational or patient outcome'.</p><p><strong>Conclusions: </strong>This study of New Zealand-based experts has formed a consensus-based agreement for a definition of a process variable in a musculoskeletal care pathway. This is an important first step in developing our understanding of process variables, and further research is needed to establish the link between process variables and their influence on the outcomes of patients with musculoskeletal conditions.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"24 1","pages":"1416"},"PeriodicalIF":2.7,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11568557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643338","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}