BMC Health Services Research最新文献

{"title":"Trauma team members' perceptions of the effectiveness of the current trauma care system in Addis Ababa, Ethiopia: a phenomenological study.","authors":"Eyayalem Melese Goshu, Zodwa Margaret Manyisa","doi":"10.1186/s12913-025-12611-1","DOIUrl":"10.1186/s12913-025-12611-1","url":null,"abstract":"<p><strong>Background: </strong>Trauma is a leading cause of mortality and disability in low- and middle-income countries (LMICs). Among African nations, Ethiopia has one of the highest trauma fatality rates at 26.7% per 100,000 population, significantly exceeding rates in many other LMICs. Most trauma cases occur in the capital, Addis Ababa. Despite this significant burden, the effectiveness and quality of trauma care in Addis Ababa vary widely across hospitals, driven by disparities in available resources and the knowledge levels of trauma team members.</p><p><strong>Objective: </strong>This qualitative study aimed to explore trauma team members' perceptions of the effectiveness of the current trauma care system in Addis Ababa, Ethiopia.</p><p><strong>Methods: </strong>This study used a qualitative phenomenological design to analyze trauma care team members' perceptions of the current trauma care system in Addis Ababa, Ethiopia. The population included trauma team members, healthcare personnel, hospital leaders and coordinators from nine hospitals. The data were collected through semi-structured interviews and focus group discussions. The study used the Colaizzi approach and ATLAS.ti 23 software for data analysis. An inductive-deductive strategy, alternating between data analysis and emergent concepts and theories to identify patterns. Memos and display matrices were generated for in-depth analysis.</p><p><strong>Results: </strong>This study identified several challenges with the trauma care system in Addis Ababa, Ethiopia, including a lack of effective leadership, coordination, and teamwork spirit; insufficient referral connections in the trauma care system; knowledge gaps among health-care professionals; and poor organization of the emergency room and trauma center. In addition, participants perceived that factors such as insufficient pharmaceutical and medical equipment and ineffective ambulance services may have contributed to the increased number of deaths and disabilities among trauma patients in the country.</p><p><strong>Conclusion: </strong>The qualitative report highlights the gaps in Ethiopia's emergency trauma care system and recommends strategies for improvement, including clear leadership, policies, resources, communication, and continuous training.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"472"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750765","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":"Are unmet health related social needs associated with emergency department utilization among Medicare beneficiaries?","authors":"Ethan E Abbott, Shameeke Taylor, Carmen Vargas-Torres, Kevin Petrozzo, David G Buckler, Lynne D Richardson, Alexis M Zebrowski","doi":"10.1186/s12913-025-12554-7","DOIUrl":"10.1186/s12913-025-12554-7","url":null,"abstract":"<p><strong>Background: </strong>Health-related social needs (HRSN) are increasingly recognized as important factors influencing healthcare outcomes and utilization. This study examined the association between unmet HRSNs and emergency department (ED) utilization among Medicare beneficiaries.</p><p><strong>Methods: </strong>We conducted a retrospective, survey-weighted cohort analysis of the 2015-2016 Medicare Current Beneficiary Survey (MCBS) linked with Medicare fee-for-service claims. The study included beneficiaries aged ≥ 65 years enrolled in fee-for-service Medicare who completed the MCBS. The primary predictor was having ≥ 1 unmet HRSN (food insecurity, delaying care due to cost, or difficulty accessing medical care). Primary outcomes included an index ED visit (1 ED visit) and any ED revisit within one year (≥ 2 ED visits); hospital admission from these ED visits was a secondary outcome. We fit multivariable logistic regression models adjusted for demographic, socioeconomic, and clinical factors. Interactions were tested using adjusted Wald tests.</p><p><strong>Results: </strong>Among 16,990 beneficiaries, 6.2% (n = 1,046) reported one or more unmet HRSNs. Within one year of completion of the survey, 27.7% (n = 4,702) had an 1 ED visit, with 9.03% of all beneficiaries (n = 1,535) requiring admission to the hospital. In adjusted analyses, beneficiaries with unmet HRSN had significantly higher odds of ≥ 2 ED visits (OR 1.47, 95% CI 1.12-1.91) compared to those without unmet HRSNs, but not for index ED visit. The oldest age category (85 + years) showed significantly increased odds of both index ED visits and revisits. Unmet HRSN were not significantly associated with risk of subsequent hospital admission for both index ED visit and ED revisit.</p><p><strong>Conclusion: </strong>Self-reported unmet HRSNs were associated with significantly increased odds of ≥ 2 ED visits but not an 1 ED visit within one year of the MCBS survey. These findings highlight the importance of improved and standardized data collection of HRSNs to understand the impacts on ED utilization. Oldest age patients had increased odds of index ED visits and revisits. Further investigation should focus on strategies to reduce ED recidivism in vulnerable older populations.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"477"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750435","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 economic evaluation of Autism Adapted Safety Plans: findings on feasibility of tools from a pilot randomised controlled trial.","authors":"Nawaraj Bhattarai, Jane Goodwin, Mirabel Pelton, Isabel Gordon, Jacqui Rodgers, Sarah Cassidy, Janelle Wagnild, Colin Wilson, Phil Heslop, Emmanuel Ogundimu, Rory C O'Connor, Sheena E Ramsay, Ellen Townsend, Luke Vale","doi":"10.1186/s12913-025-12642-8","DOIUrl":"10.1186/s12913-025-12642-8","url":null,"abstract":"<p><strong>Background: </strong>Autism Adapted Safety Plans (AASP) have been proposed to help prevent self-harm and suicidality among autistic adults. The introduction of such plans not only needs to be clinically effective but also cost-effective. The aim of this work was to establish how the cost-effectiveness of AASP could be assessed. Specifically, whether tools and techniques used to collect data for health economic evaluation of the intervention are feasible and acceptable to autistic people.</p><p><strong>Methods: </strong>A feasibility and external pilot randomised controlled trial of the AASP intervention was conducted. Autistic adults recruited from diverse locations in England and Wales were randomised to either: AASP and usual care, or usual care only. Health economics tools (bespoke and adapted) were developed and focus groups were undertaken with participants, including autistic adults (n = 15), their family members/carers (n = 5), and service providers (n = 10), to determine their acceptability and feasibility. Tools considered worth further exploration were interviewer administered to participants during the pilot trial at baseline and at 6 months. Interviewer notes were used to record any issues reported while completing the tools. Response rates on the questions and completeness of the tools, along with participant feedback in the interviewer notes was assessed.</p><p><strong>Results: </strong>Standard Gamble and Time-Trade Off approaches to measure health status were judged inappropriate to measure health outcomes with autistic adults experiencing suicidal ideation and with a history of self-harm. Contingent valuation and discrete choice experiments were also considered inappropriate, due to the heavy cognitive burden on respondents. The EQ-5D-5L/VAS, resource utilisation questionnaire and time-travel questionnaire were considered acceptable by participants. Response and completion rates (as a percentage of all returned questionnaires) for resource utilisation questionnaire (> 85%), time-travel questionnaire (> 79%), EQ-5D-5L (> 96%) and EQ-5D-VAS (> 87%) were good in general. Participants needed clear guidance and interviewer support to enable questionnaire completion.</p><p><strong>Conclusions: </strong>It is feasible and acceptable to collect relevant data on resource utilisation, and costs of accessing care and the EQ-5D-5L in a future definitive trial. Clear guidance and interviewer support on how to complete the questionnaires and explanations of the importance of questions to the research would help autistic participants completing the health economic tools.</p><p><strong>Trial registration: </strong>ISRCTN70594445; Trial Registration Date: 06/07/2020.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"473"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750532","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":"Improving transitions in care for children and youth with mental health concerns: implementation and evaluation of an emergency department mental health clinical pathway.","authors":"Alexandra Tucci, Paula Cloutier, Christine Polihronis, Allison Kennedy, Roger Zemek, Clare Gray, Sarah Reid, Kathleen Pajer, William Gardner, Nicholas Barrowman, Mario Cappelli, Mona Jabbour","doi":"10.1186/s12913-025-12524-z","DOIUrl":"10.1186/s12913-025-12524-z","url":null,"abstract":"<p><strong>Background: </strong>Emergency departments (EDs) are often the first access point for children and youth seeking mental health (MH) and addiction care. However, many EDs are unprepared to manage large volumes of pediatric MH patients. In addition, the fragmented Canadian MH system is challenged in connecting youth seen in the ED for follow-up community services. A provincial Emergency Department Mental Health Clinical Pathway (EDMHCP) for children and youth presenting to the ED with MH concerns was developed to address these challenges. The objective of the current study was to determine if EDMHCP implementation resulted in: (1) pathway use, (2) more patients discharged with MH recommendations, (3) MH service recommendations that aligned with patients' risk assessments, and (4) changes in service outcomes, including ED length of stay (LOS), revisits, and admissions/transfers.</p><p><strong>Methods: </strong>We implemented the pathway at four ED sites from 2018 to 2019 using the Theoretical Domains Framework to develop a tailored strategy at each site. We conducted chart reviews retrospectively in 2017-2018 (pre-implementation) and prospectively in 2019-2020 (post-implementation). Non-parametric tests examined differences in service outcomes between the implementation periods.</p><p><strong>Results: </strong>Pathway use varied widely across sites, ranging from 3.1% at site 4 to 83.0% at the lead site (site 2). More referrals to community MH agencies (p <.001) were made at discharge during post-implementation at the lead site compared to pre-implementation, and mixed results were obtained regarding whether clinicians' risk assessments aligned with MH service recommendations. LOS significantly increased at the lead site (p <.001) and non-lead sites (sites 1, 3, 4; p =.02) between pre- and post-implementation. Revisits and admissions/transfers did not change significantly at any site.</p><p><strong>Conclusion: </strong>Implementation was partially successful at the lead site, showing high pathway use and greater referrals to community MH agencies. These findings emphasize the complexity of implementing pathways in various ED settings. Successful implementation requires integration into existing workflows.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov (NCT02590302). Registered on 29 October 2015.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"475"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750833","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":"Differences of patient empowerment between elective and contracted physicians in internal medicine in Austria: a quantitative content analysis.","authors":"Bettina Simetsberger, Manfred Pferzinger, Martin K J Waiguny","doi":"10.1186/s12913-025-12635-7","DOIUrl":"10.1186/s12913-025-12635-7","url":null,"abstract":"<p><strong>Background: </strong>Physicians impact and promote patient empowerment at various levels. Elective or contracted physicians uniquely provide specialised ambulatory care in Austria. The difference between the two groups is due to the contractual relationship with the social health insurance providers. This paper researches whether there are differences in the promotion of patient empowerment between elective and contracted physicians in internal medicine in Vienna based on four dimensions of patient empowerment.</p><p><strong>Methods: </strong>A quantitative content analysis analyses the comments on DocFinder.at to identify the differences between the two groups. A deductive-inductive approach based on literature and comments from DocFinder.at led to a codebook with seven categories and forty-eight variables. We collected a total of 1,153 comments, and 912 of them are relevant for further analysis. Differences between elective and contracted physicians became evident through defined dimensions of patient empowerment.</p><p><strong>Results: </strong>In the health literacy dimension, elective physicians apply relationship-relevant factors more effectively. They are also more successful in ensuring that patients feel adequately informed. No significant differences were found in the dimension of shared decision-making, but the discussion of treatment options correlated strongly with the amount of time spent by a physician. In the self-management dimension, elective physicians provide more precise and detailed explanations, highlighting their ability to foster better self-management. Differences in the communication dimension favour elective physicians at both factual and interpersonal levels, although there are no significant differences in patient's ability to ask questions and receive answers. Across all dimensions, the time spent with patients emerges as a crucial factor influencing patient empowerment.</p><p><strong>Conclusions: </strong>The findings open up several avenues for further research, offering an initial understanding of the differences in patient empowerment between elective and contracted physicians. The results reveal that elective physicians are more likely to create a supportive environment for patient empowerment, underscoring the crucial role of physician-patient interactions in this process. However, given the limitations of the current methods, future research could explore these differences through alternative approaches, such as surveys or interviews, to provide a more comprehensive understanding.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"476"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750506","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":"Crisis management in Finnish hospital pharmacies during the COVID-19 pandemic.","authors":"S Latonen, A M Juppo, H Seeck, M Airaksinen","doi":"10.1186/s12913-025-12643-7","DOIUrl":"10.1186/s12913-025-12643-7","url":null,"abstract":"<p><strong>Background: </strong>Although hospital pharmacies have played a central role in managing the COVID-19 pandemic, there is a lack of crisis management theory-based empirical research on the topic. The purpose of this study was to fill this gap in the Finnish context and identify areas for development to improve future crisis preparedness.</p><p><strong>Methods: </strong>A national cross-sectional survey was developed based on crisis management process models and sent to all hospital pharmacy heads (n = 21) during the second wave of the pandemic in October-November 2020. Descriptive statistics were calculated, and qualitative data from open-ended responses were studied using deductive content analysis. The results were confirmed and enriched through data triangulation with six semi-structured interviews of purposively selected hospital pharmacy heads in March-May 2021.</p><p><strong>Results: </strong>The response rate was 57% (n = 12). Following the onset of the pandemic, the risk perception of a crisis concerning pharmaceutical supply chain rose from 58 to 100%. A pre-existing pandemic preparedness plan was available in four (25%) pharmacies. Seven (58%) pharmacies developed a new plan. A pandemic crisis team was established in four (33%) pharmacies. Changes in internal communication and management (92%), clinical pharmacy services (67%), medicine supply (58%), procurement (42%), and pharmaceutical production operations (25%) were implemented. Collaboration with peers or other actors in the pharmaceutical supply chain increased or improved in nine (75%) hospital pharmacies, whereas in three (25%), it decreased or was unchanged. Mandatory reserve stockpiles provided a buffer for the increased need for emergency medicines. Positive and negative experiences of the pharmaceutical supply chain's crisis response indicated an unequal distribution of medicines and crisis management-related information.</p><p><strong>Conclusions: </strong>Crisis management process models provided a holistic framework for analysing the pandemic response in hospital pharmacies. The study provided an alternative data collection approach by utilising process models in the development of the survey instrument. Preparedness of hospital pharmacies could be improved with pre-established crisis teams and plans, and data management systems providing easily accessible information to support decision-making. Developing prerequisites for coordinated information sharing and equitable distribution of medicines is essential to ensure effective crisis response, equitable medicine availability among hospitals and patient safety.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"474"},"PeriodicalIF":2.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11956274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750359","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":"Using nominal group technique to identify and prioritize barriers to decentralizing HIV care to primary health centers in Lima, Peru.","authors":"David Oliveros, Kelika A Konda, Lynn M Madden, Juan José Montenegro-Idrogo, Karla T Tafur Quintanilla, Karin Sosa Barbarán, Benjamin M Nikitin, Matthew Ponticiello, Carlos M Benites, Jorge Sánchez, Frederick L Altice","doi":"10.1186/s12913-025-12618-8","DOIUrl":"https://doi.org/10.1186/s12913-025-12618-8","url":null,"abstract":"<p><strong>Background: </strong>Decentralizing HIV services is an evidence-based strategy recommended by the World Health Organization to expand healthcare access by shifting most HIV care from specialty (SHCs) to primary health centers (PHCs) with the goal of maximizing health outcomes. To accelerate Peru Ministry of Health's 2020 priority to transition from specialty to primary health centers, we assessed multilevel stakeholders' perspectives on barriers and opportunities for scaling-up decentralization of HIV care.</p><p><strong>Methods: </strong>Between January and March 2024, we used nominal group technique (NGT), a mixed-methods research strategy, to rapidly identify barriers and rank potential solutions to decentralizing HIV services among two groups of patients (N = 16) and four groups of healthcare providers (N = 49) in Lima, Peru. Patient groups were those who: (1) were established in HIV care at a SHC; and (2) transferred from a SHC to a PHC. Three provider groups were mixed and included individuals from PHCs and SHCs while one was from a SHC in Central Lima. After listing all perceived barriers and solutions, participants in each group rank-ordered responses to generate potentially actionable responses.</p><p><strong>Results: </strong>Among 195 votes from 65 participants, multilevel HIV stigma was the highest priority barrier to decentralizing HIV care among both patients and providers (34.4%). While patients and providers prioritized different issues, all NGT groups highlighted a general lack of confidence in the expertise of PHCs (21.0%), system-level or transfer logistic challenges (19.0%), insufficient infrastructure and capacity of PHCs to provide HIV treatment (15.9%), and a lack of patient-level support (9.7%) as other major barriers to HIV decentralization.</p><p><strong>Conclusions: </strong>While the Peruvian Ministry of Health has prioritized HIV care decentralization, achieving this goal remains challenging. Identified barriers require a range of implementation strategies to achieve decentralization goals, such as process improvement strategies to address stigma and logistical barriers to transferring patients, while educational meetings, including tele-mentoring or expert feedback, may address a lack of confidence in provider expertise at PHCs. Deployment of hub-and-spoke treatment models could enhance communication between experts at SHCs and PHCs and ensure that patient continuity of care is achieved.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"466"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742218","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's a challenging environment' health worker perspectives on domestic violence presentations to emergency departments in New South Wales hospitals in the context of the COVID-19 pandemic.","authors":"Janani Shanthosh, Elena Lynch, Patricia Cullen, Amanda Henry, Viola Korczak","doi":"10.1186/s12913-025-12597-w","DOIUrl":"10.1186/s12913-025-12597-w","url":null,"abstract":"<p><strong>Background: </strong>Domestic and family violence (DFV) is a significant issue in Australia, with one in four women experiencing DFV in their lifetime. Emergency departments (EDs) within public hospitals are a priority setting for identifying, treating, and referring those at risk through sensitive clinical inquiry. However, there remains a dearth of evidence regarding health staff's knowledge, skills, and confidence in addressing the burden of DFV from their perspective. This research aims to address the evidence gap from the perspectives of health workers working within a diverse range of public hospital EDs in New South Wales (NSW), Australia, at the time of the COVID-19 pandemic.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted online, adhering with COVID-19 restrictions at the time, and thematic analysis performed.</p><p><strong>Results: </strong>While EDs within NSW hospitals are often a first port of call for those experiencing DFV, clinician health staff perceive overwhelmingly, that they lack the capacity individually and institutionally to appropriately address presentations and had little knowledge of existing policies and procedures.</p><p><strong>Conclusions: </strong>Policy and programmatic solutions to the capacity gap need to be current, highly feasible for an ED environment and ongoing to account for rotating staff and the evolving nature of DFV presentations. The preparedness of EDs within public hospitals in NSW will be crucial to the success of strategic initiatives and recent historic law reforms in supporting victim-survivors and preventing DFV.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"467"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742179","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":"Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China.","authors":"Xiaoyu Dong, Huaizhi Cheng, Ruotong Tian, Lingxiao Gao, Wenpei Lyu, Jiaqi Zhang, Doudou Huang, Bin Guo","doi":"10.1186/s12913-025-12631-x","DOIUrl":"10.1186/s12913-025-12631-x","url":null,"abstract":"<p><strong>Background: </strong>Globally, Out-of-pocket (OOP) payments as a share of Total Health Expenditure (THE) has always been a focus of attention in the field of health economics, which affects the economic burden of medical treatment for residents. At present, countries around the world have widely used spatial econometric models to conduct in-depth discussions and analyses of their own OOP, exploring the spatial distribution characteristics and influencing factors of OOP in different regions. However, in China, research in this area is relatively scarce, and few studies have been conducted from a macro perspective and space-time dimension.</p><p><strong>Methods: </strong>Based on the panel data of 31 provinces in China, the spatiotemporal distribution characteristics of the proportion of OOP payments in China from 2013 to 2022 were analyzed using spatial autocorrelation. The spatial Durbin model (SDM) was employed to explore the factors influencing OOP payments as a share of THE in China.</p><p><strong>Results: </strong>The results indicate that the proportion of OOP in China shows a decreasing trend, and there is a significant spatial positive correlation. The change in spatial agglomeration is relatively stable, and only some provinces have a slight change. SDM shows that the main factors affecting the inter-provincial differences in the OOP proportion in China include the elderly dependency ratio (direct effect - 0.181, indirect effect - 0.585), the child dependency ratio (direct effect 0.292, indirect effect 0.686), per capita GDP(direct effect 11.235), and the proportion of government health expenditure to fiscal expenditure (direct effect - 0.254, indirect effect - 0.994), the average number of medical visits per year (direct effect - 0.444), the expenditure of basic medical insurance (direct effect - 1.519, indirect effect - 3.940), and the average medical cost of outpatients (direct effect 3.142, indirect effect - 10.064). These factors collectively influence the spatial variation in OOP payments across provinces in China.</p><p><strong>Conclusion: </strong>The spatial distribution difference of OOP proportion in China is obvious. Factors such as demographics, economics, policy, and health service utilization can all significantly influence OOP. The government should further implement differentiated medical security policies, optimize the allocation structure of health resources, enhance the capacity of primary medical services, promote cross-provincial medical cooperation, and ensure that local residents can enjoy equal access to high-quality medical services and reduce their medical burden.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"471"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742203","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":"Supporting managerial decisions: a comparison of new robotic platforms through time-driven activity-based costing within a value-based healthcare framework.","authors":"Stefano Landi, Gianluca Maistri, Luca Piubello Orsini, Chiara Leardini, Sarah Malandra, Alessandro Antonelli","doi":"10.1186/s12913-025-12598-9","DOIUrl":"10.1186/s12913-025-12598-9","url":null,"abstract":"<p><strong>Background: </strong>The advent of novel robotic platforms requires that managers base their decisions on the value these platforms generate. This study showcases how micro-costing methodologies can assist managers in the decision-making process regarding the implementation of new robotic platforms within the value-based healthcare (VBHC) framework.</p><p><strong>Methods: </strong>We applied time-driven activity-based costing (TDABC) to evaluate cost disparities between the da Vinci and Hugo robotic systems for robot-assisted radical prostatectomy (RARP). Data were collected from consecutively enrolled patients with organ-confined prostate cancer. Basic cost information was gathered from Azienda Universitaria Integrata di Verona's finance and pharmacy departments. We conducted cost and sensitivity analyses to evaluate the most cost-sensitive parameters.</p><p><strong>Results: </strong>The da Vinci system incurred higher total costs for RARP than the Hugo system (€4,97.21 vs. € 3,511.73, p-value < 0.001) However, excluding surgical kit costs, the da Vinci platform proved less expensive (€1,481.18 vs. €1,926.18, p-value < 0.001). Sensitivity analyses identified surgical kit costs as the most influential parameter, followed by surgical duration and platform costs.</p><p><strong>Conclusions: </strong>This study highlights the importance of micro-costing practices in supporting managerial decisions within a VBHC framework. When clinical outcomes are equivalent, the value of robotic platforms is related to cost savings. By using TDABC and sensitivity analyses, managers can pinpoint critical activities and parameters to optimize the effective adoption of new platforms.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"470"},"PeriodicalIF":2.7,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954269/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742216","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}