BMC Health Services Research最新文献

{"title":"Analysis of factors affecting the engagement of pharmacists with the organization working in public health facilities: a quantitative study in Vietnam.","authors":"Huong V T M, Hung N P, Minh N T T, Minh T N, Duyen L T N, Vinh N P, Chau T N N, Anh N V, Quynh H T T, Quoc L M","doi":"10.1186/s12913-025-12236-4","DOIUrl":"https://doi.org/10.1186/s12913-025-12236-4","url":null,"abstract":"<p><strong>Background: </strong>Pharmacists are among the most crucial resources, playing a pivotal role in the establishment and growth of any medical organization. Therefore, the engagement of pharmacists with the organization is an important factor that influences the stability and development of medical organizations in general and public medical facilities in particular.</p><p><strong>Objective: </strong>The study aims to analyze the factors affecting the engagement of pharmacists working in public health facilities in the Mekong Delta with their organizations.</p><p><strong>Methods: </strong>The data for this study were collected either through a pre-designed set of questions or via a Google Form distributed to pharmacists working in public health facilities.</p><p><strong>Results: </strong>Three out of forty variables were eliminated after conducting the Cronbach's Alpha test. The Kaiser-Meyer-Olkin (KMO) coefficient, ranging from 0.91 to 0.972, indicated that the data were statistically significant and met the criteria for Exploratory Factor Analysis. The results satisfied the requirements for total variance extracted (> 50%), and the Eigenvalue coefficients were all greater than 1 (ranging from 2.828 to 20.962, p < 0.05). Confirmatory Factor Analysis and Structural Equation Modeling were consistent with market data on factors affecting pharmacist engagement. The analysis revealed that six factors had a positive and statistically significant impact on engagement (p < 0.05), while one factor was eliminated due to its influence level not reaching statistical significance (p > 0.05).</p><p><strong>Conclusion: </strong>According to the survey, public medical facilities consistently prioritize the well-being and needs of pharmacists, fostering conditions related to salaries, legal policies, work benefits, etc., to make them feel more integrated into their organization.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"464"},"PeriodicalIF":2.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742056","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":"The relationship between teamwork and the workload of nurses with missed nursing care in intensive care units in Iran: a cross-sectional study.","authors":"Ali Safdari, Fahimeh Ramezani, Erfan Ayubi, Efat Sadeghian","doi":"10.1186/s12913-025-12583-2","DOIUrl":"10.1186/s12913-025-12583-2","url":null,"abstract":"<p><strong>Background: </strong>Missed nursing care (MNC) is a major challenge faced by nurses working in intensive care units (ICU). Workplace characteristics, including teamwork and workload, can affect the extent of missed nursing care. Examining the relationship between these variables can help create strategies to enhance care. Thus, this study aimed to explore the connection between teamwork, workload, and missed nursing care in the intensive care units of hospitals in Iran.</p><p><strong>Methods: </strong>This descriptive cross-sectional study was conducted from August to November 2023 on 219 nurses working in the intensive care units of teaching hospitals affiliated with Hamadan University of Medical Sciences. Participants were selected through multi-stage sampling after meeting the inclusion criteria. Data were collected using the General Characteristics questionnaire, the Team-STEPPS^® Teamwork Perception Questionnaire (T-TPQ), the National Aeronautics and Space Administration Task Load Index (NASA-TLX), and the MISSCARE survey. Data analysis was performed using Stata software version 14.</p><p><strong>Results: </strong>Out of 219 returned questionnaires (92.79% response rate), 194 valid responses were analyzed. Missed nursing care showed a significant negative correlation with overall teamwork (r = -0.538, P < 0.001) and its subcomponents, including team structure (r = -0.472), leadership (r = -0.303), situation assessment (r = -0.486), mutual support (r = -0.325), and communications (r = -0.517). Tenure was also significantly related to missed nursing care (p = 0.040), with nurses having less than 2 years of experience reporting the lowest missed care scores. No significant relationships were found between workload scores and demographic variables.</p><p><strong>Conclusion: </strong>The relationship between teamwork, nurse workload, and missed nursing care is complex. The findings of this study emphasize the importance of effective teamwork and manageable workloads in reducing missed nursing care. However, contextual differences in nurses' work environments are of great importance in different countries.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"440"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143717897","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":"Provision of respectful care for human dignity in health care service and associated factors in South Gondar hospitals, northwest, Ethiopia, multicenter study.","authors":"Gebrie Kassaw Yirga, Moges Wubneh Abate, Yeshiambaw Eshetie Ayenew, Yirgalem Abere, Tadila Dires, Kirubel Shiferaw","doi":"10.1186/s12913-025-12532-z","DOIUrl":"10.1186/s12913-025-12532-z","url":null,"abstract":"<p><p>Providing compassionate and respectful care is essential to quality health care, and it is the backbone of our health care system. This study was conducted to assess the provision of respectful care and human dignity and its associated factors among healthcare providers in South Gondar hospitals in 2024. A cross-sectional study design was conducted from March 18 to April 18, 2024. From 1177 care providers, 420 study units were selected by the simple random sampling technique. The collected data was entered into Epi Data version 3.1, and it was exported to Statistical Package for Social Sciences version 26 Windows statistical software for analysis. Factors that have a p-value ≤ 0.25 in binary logistic regression were a candidate for multivariate logistic regression. Factors with a p-value < 0.05 were considered predictors of the outcome variable. Respectful care among health care providers was reported as 52.4%. Income (P = 0.039), professional attitude (P < 0.001), and training (P = 0.032) were significantly associated with respectful care. In this study, about half of the health care providers had good, respectful practices. Healthcare providers should have a positive attitude towards respectful care according to strategy; different stakeholders in health sectors should be involved by providing supplies, facilitating training, and performing continuous monitoring and evaluation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"453"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728372","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":"Stressful and potentially traumatic events and healthcare utilization: the 7^th Tromsø survey.","authors":"Jens C Thimm, Kamilla Rognmo, Ingunn Skre, Catharina E A Wang","doi":"10.1186/s12913-025-12604-0","DOIUrl":"10.1186/s12913-025-12604-0","url":null,"abstract":"<p><strong>Background: </strong>Stressful and potentially traumatic life events (SLEs/PTEs) can have a profound negative impact on the individual's mental and physical wellbeing and health. Consequently, an association of SLEs/PTEs with increased healthcare utilization has been found. However, most studies have been conducted in selected samples (e.g., veterans), and there is a paucity of studies in the general population. The present study examined the associations between SLEs/PTEs and the utilization of healthcare services in the general population using data from the seventh survey of the Tromsø study (Tromsø7).</p><p><strong>Methods: </strong>The sample comprised 20,069 participants aged 40 years and above (52.5% female, mean age 57.3 years, SD = 11.4 years) who completed measures of SLE/PTE exposure in childhood/adolescence and adulthood (including a question about mental preoccupation with SLEs/PTEs), utilization of a variety of healthcare services (general practitioner, medical specialist, hospital, emergency room, mental health services, physiotherapist, and complementary and alternative medicine provider) in the previous year, and self-reported feeling of being anxious or depressed.</p><p><strong>Results: </strong>The results showed that SLE/PTE exposure is associated with an increased use of all healthcare services, especially mental health professionals. Exposure to physical and emotional neglect in childhood/adolescence, violence, and sexual abuse showed the strongest associations with the utilization of mental health services. The strength of the associations with health service utilization increased with the number of SLEs/PTEs. Finally, mental preoccupation with the event(s) moderated the associations between SLE/PTE exposure and the utilization of healthcare services but not self-reported feeling of being anxious or depressed.</p><p><strong>Conclusion: </strong>It is concluded that the prevention of SLEs/PTEs and screening for SLE/PTE exposure in healthcare services to provide trauma-informed care should be a prioritized public health focus.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"455"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728374","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":"Evaluation of comprehensive abortion care service in University of Gondar Comprehensive Specialized Hospital in Northwest Ethiopia: mixed case study design.","authors":"Birtukan Demis Getaneh, Nigusu Worku, Kaleb Assegid Demissie, Tesfahun Zemene Tafere, Melak Jejaw","doi":"10.1186/s12913-025-12579-y","DOIUrl":"10.1186/s12913-025-12579-y","url":null,"abstract":"<p><p>Despite Ethiopia's substantial progress in comprehensive abortion care, the consequences of abortion remain a major public health challenge. This study aimed to assess the implementation status and its determinants of comprehensive abortion care service at University of Gondar Comprehensive Specialized Hospital. A facility-based single case study with convergent parallel mixed-method evaluation was conducted from March 28 to April 28, 2023. Availability, patient-centered care, timeliness, and compliance dimensions with 35 indicators were used. A total of 379 exit interviews, five key informant interviews, six in-depth interviews, 411 medical charts reviewed, and 17 observations were done. Stata version 17 was used. Binary logistic regression analysis was computed to identify eligible variables for the multivariable logistic regression, and a variable with p-value < 0.05 at adjusted odds ratio with a 95% confidence interval was declared as statistically significant. The qualitative data were recorded through a tape recorder, transcribed in Amharic and translated to English, and analyzed thematically.The overall implementation status of comprehensive abortion care (CAC) was found to be 65.1%, which is considered fair according to judgment parameters. Availability of CAC resources, compliance of service providers, timeliness, and patient-centered care contributed scores of 85.7% (very good), 72.6% (fair), 40.6% (poor), and 61.3% (fair), respectively. Urban dwellers, married women, had family support, privacy to access abortion care, and those who communicated on medication were positive predictors of patient-centered care. There were stock outs of essential emergency drugs, shortages of equipment and trained manpower, and poor infrastructure. Besides, none of the providers comply with hand washing protocols and used personal protective equipment, and there were delays in providing abortion services. The overall CAC program service implementation needs urgent improvements, especially in timeliness, which was notably poor and needs major enhancements. Thus, to improve CAC services, the hospital should ensure the availability of essential drugs, equipment, and infrastructure. The Ministry of health should improver providers' compliance with CAC guidelines by providing training and enhancing continuous professional development programs. Moreover, policymakers and planners should focus on enhancing providers' communication skills and family involvement in care decisions, and warranting patient privacy and confidentiality according to established protocols.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"449"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728030","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":"Evaluation of the implementation of an insulin patient decision aid for patients with type 2 diabetes in an academic primary care clinic in Malaysia: a mixed method study.","authors":"Wen Ting Tong, Chirk Jenn Ng, Yew Kong Lee, Ping Yein Lee","doi":"10.1186/s12913-025-12588-x","DOIUrl":"10.1186/s12913-025-12588-x","url":null,"abstract":"<p><strong>Background: </strong>Literature surrounding patient decision aid (PDA) focus on testing effectiveness such as measuring patient or practice outcomes, while few studies looked into evaluation of implementation outcomes. It is important to assess implementation outcomes because in order for PDA to deliver its intended effects, they should first be effectively implemented. This study aimed to evaluate the implementation of an insulin PDA in an academic primary care clinic specifically measuring implementation outcomes.</p><p><strong>Methods: </strong>A mixed-methods sequential explanatory design was used. This study was conducted at a primary care clinic in an academic hospital from April - November 2018. The insulin PDA was implemented using a tailored implementation intervention, which comprised of 11 strategies aiming to overcome 13 prioritised implementation barriers. Evaluation data were collected from: healthcare administrators such as the head of department, the clinic coordinator, and the nursing officer who oversees the clinic operations, doctors whose tasks were to deliver the insulin PDA to patients, nurses who were responsible for making sure the insulin PDAs were available, and patients with type 2 diabetes who were offered the insulin PDA. The study commenced with the quantitative approach to assess 'Reach', 'Adoption', 'Implementation' and 'Maintenance'of the insulin PDA. Subsequently, qualitative approach was employed and qualitative interviews were conducted with the relevant stakeholders to explain the quantitative outcomes. A total of six IDIs and six FGDs were conducted with healthcare providers (healthcare policymakers: 3, doctors: 35, and staff nurses: 5), and 62 IDIs were conducted with patients.</p><p><strong>Results: </strong>For 'Reach', 88.9% (n = 48/54) of doctors and 55% (n = 11/20) of nurses attended the insulin PDA training workshops. This was attributed to their self-motivation and the mandate from the Head of Department. The PDA reached 387 patients and was facilitated by the doctors who delivered the PDA to them and their own desire to know more about insulin. Doctors' 'Adoption' of the PDA was high (83.3%, n = 45/54) due to the positive personal experience with the usefulness of the PDA. Only 65.7% (n = 94/143) of patients who received the PDA read it. The degree of 'Implementation' of the PDA varied for different tasks (ranged from 19.2 to 84.9%) and was challenged by patient and system barriers. For 'Maintenance', 80% of the doctors were willing to continue using the PDA due to its benefits.</p><p><strong>Conclusion: </strong>This study highlighted that the implementation of an insulin PDA in a primary care setting is promising. Addressing the issues of social hierarchy, and healthcare providers' roles and responsibilities can further improve implementation outcomes.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"450"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728357","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":"Change of primary health care service provider model in Vantaa: the impact on mortality and causes of death among older adults - a register-based follow-up study.","authors":"Aina Enckell, Hanna-Maria Roitto, Hannu Kautiainen, Mika T Lehto, Kaisu H Pitkälä, Timo Kauppila, Merja K Laine","doi":"10.1186/s12913-025-12595-y","DOIUrl":"10.1186/s12913-025-12595-y","url":null,"abstract":"<p><strong>Background: </strong>Access to primary health care (PHC) has declined in Finland in recent years. To address this, the city of Vantaa, Finland, transitioned from a named general practitioner (GP) model to a restricted-list GP model in 2011 to increase access to named GPs for the most vulnerable population. This study evaluates the impact of this model change on mortality rates and causes of death among older adults.</p><p><strong>Methods: </strong>This register-based follow-up study was conducted in Vantaa, Finland, using data from the electronic health records. The study included all patient contacts aged 75 and older between 1 September 2004 and 31 August 2018. The primary outcome was the Standardised Mortality Ratio (SMR). We calculated excess deaths and examined cause-specific mortality trends before and after the restricted-list GP model implementation.</p><p><strong>Results: </strong>During the study period, 32,034 PHC contacts were recorded. The SMR remained stable during the named GP model years but began to decrease during the restricted-list GP model, falling below expected levels from 2016 onward. Excess deaths decreased from 615 in 2004 in the named GP model to -29 by 2018, when the restricted-list GP model was in operation. Leading causes of death were circulatory diseases (41.1%), cancers (20.4%) and neurological conditions (17.8%), with a decrease in circulatory disease deaths and an increase in cancer and dementia-related deaths over time.</p><p><strong>Conclusions: </strong>The transition to the restricted-list GP model was associated with a lower SMR and fewer excess deaths in older adults. These findings highlight the importance of ongoing assessment of PHC models to ensure they meet evolving healthcare demands.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"458"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727872","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":"Raising awareness and preparation for what may come: next of kin experiences of advance care planning with frail, home-dwelling older adults in geriatric units.","authors":"Karin Berg Hermansen, Rigmor Einang Alnes, Trygve Johannes Lereim Saevareid, Reidar Pedersen, Siri Faerden Westbye, Maria Romøren, May Helen Midtbust","doi":"10.1186/s12913-025-12609-9","DOIUrl":"10.1186/s12913-025-12609-9","url":null,"abstract":"<p><strong>Background: </strong>Acutely ill and frail older adults and their next of kin are often poorly involved in planning of decisions regarding treatment and care during the final phase of life. Although advance care planning is a well-documented tool to strengthen patient autonomy and involve next of kin, it remains underused in hospital settings. We present a qualitative sub-study embedded in a cluster-randomized controlled trial, whose purpose was to implement advance care planning in Norwegian geriatric units. Frail, home dwelling older adults acutely admitted to geriatric hospital units were invited to participate in advance care planning together with their next of kin. The aim of this study was to explore next of kin experiences of advance care planning.</p><p><strong>Methods: </strong>The study has a qualitative design, based on individual semi-structured interviews with 13 next of kin. A purposive sampling was used to select next of kin who had recently participated in advance care planning from five geriatric units in the intervention arm. The analysis was conducted using reflexive thematic analysis by Braun and Clarke.</p><p><strong>Results: </strong>Four themes were developed from the analysis; (1) Being informed and involved through open communication; (2) Getting prepared for what's to come; (3) The importance of the next of kin role in providing support and facilitation; (4) The need for documentation and collaboration across service levels.</p><p><strong>Conclusion: </strong>Advance care planning appears to provide a sense of security among next of kin by addressing their information needs regarding the patient's prognosis, encouraging discussions on possible courses of action, and clarifying the patient's end-of-life preferences. Next of kin played a crucial role in supporting the patient's autonomy, and they considered the hospital stay as an ideal time for advance care planning. Increased awareness of their role as next of kin seems to enhance agreement and trust when confronting challenging situations and existential questions.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier NTCT05681585. Registered 03.01.23.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"454"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728373","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":"The extent to which medical specialists provide Clinical Work-Integrating Care (CWIC) and their perceived role-responsibility: a mixed-methods study.","authors":"Lana Kluit, Astrid de Wind, Annechien Beumer, Coen A M van Bennekom, Angela G E M de Boer","doi":"10.1186/s12913-024-12137-y","DOIUrl":"10.1186/s12913-024-12137-y","url":null,"abstract":"<p><strong>Background: </strong>Awareness among medical specialists about patient work concerns is important because work and health are linked. In Clinical Work-Integrating Care (CWIC), specialists adopt the notion that work can affect health, and medical actions can affect work participation, and they act according to that notion. This study aims to assess the extent to which specialists provide CWIC and to obtain perceptions of medical specialists about their professional role-responsibility in providing CWIC.</p><p><strong>Methods: </strong>This cross-sectional mixed-methods study involved quantitative questionnaires and qualitative interviews with medical specialists. The self-developed 18-item questionnaire evaluated the extent and type of CWIC provision (rating scale 0-4; Never = 0 to Always = 4) and how role-responsibility was perceived, while the interviews offered more in-depth insights. Descriptive statistics for the questionnaire data and thematic analyses for the interview data were applied.</p><p><strong>Results: </strong>We attained 160 questionnaires (female 64%, 93% non-surgical specialists) and 11 interviews (female 64%, 91% non-surgical specialists). Specialists often asked patients about work (mean score 3.1), sometimes about work history (mean score 2.2) and the conversation about work was usually started by the specialist (mean score 2.9). Conversations about work often concerned the influence of work on disease (2.4) and the influence of disease (2.5) or treatment (2.1) on work ability, but rarely about the legal aspects related to sick leave (1.5). The specialists' perceived role-responsibility was summarized in three themes: 1) understanding that work and health (problems) are linked including asking patients about work and investigating work factors, 2) supporting work participation within a specialist's expertise including focus on patients' health and prevention of sick leave, and 3) possibilities and limitations of the healthcare system including work participation as treatment goal and cooperation with occupational health care.</p><p><strong>Conclusions: </strong>Medical specialists in our survey usually asked about patients' work, but they often did not take a work history. Limitations within the healthcare system hinder comprehensive work-integrating support by specialists, defining the boundaries of CWIC to within hospital care.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"448"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728375","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 comparative study of neuro-fuzzy and neural network models in predicting length of stay in university hospital.","authors":"Birgül Yabana Kiremit, Elif Dikmetaş Yardan","doi":"10.1186/s12913-025-12623-x","DOIUrl":"10.1186/s12913-025-12623-x","url":null,"abstract":"<p><strong>Background: </strong>The time a patient spends in the hospital from admission to discharge is known as the length of stay (LOS). Predicting LOS is crucial for enhancing patient care, managing hospital resources, and optimizing the use of patient beds. Therefore, this study aimed to predict the LOS for patients hospitalized in various clinics using different artificial intelligence (AI) models.</p><p><strong>Methods: </strong>The study analyzed 162,140 hospitalized patients aged 18 and older at various clinics of a university hospital in northern Türkiye from 2012 to 2020. Three soft computing methods-Artificial Neural Networks (ANN), Adaptive Neuro-Fuzzy Inference Systems (ANFIS), and Multiple Linear Regression Analysis (MLR)-were employed to estimate LOS using inputs such as medical and imaging services (number of CT, USG, ECG, hemogram tests, medical biochemistry, and number of direct x-rays), demographic, and diagnostic data (patients' age, sex, season of hospitalization, type of hospitalization, diagnosis, and second diagnosis). The LOS predictions utilized single and double-hidden layer ANNs with various training algorithms (Levenberg-Marquardt-LM, Bayesian Regularization-BR and Scaled Conjugate Gradient-SCG) and activation functions (tangent-sigmoid, purelin), ANFIS with Grid Partitioning (ANFIS-GP), and MLR. Model performance was evaluated using the Coefficient of Determination (R²), Root Mean Square Error (RMSE) and Mean Absolute Error (MAE).</p><p><strong>Results: </strong>Of the patients, 54% were male and 43.5% were treated in surgical clinics. The mean age was 55.1 years, with 32.9% of participants aged 65 years or older. Hospital stays were 2-7 days for 39.7% of patients, over 7 days for 30.9%, and 1 day for 29.4%. Neoplasm-related diagnoses (ICD codes) accounted for 25.1% of admissions. Variables influencing LOS were identified through feature selection from patients in various hospital wards. The most significant factors affecting LOS include second diagnosis, the number of hemogram tests, computerized tomography scans (CT), ultrasonography (USG), and direct X-rays. Utilizing these factors, 12 models with varied input variables were developed and analyzed. The double hidden layer ANN model with the Levenberg-Marquardt (LM) training algorithm outperformed the others, achieving R² values of 0.854 for training and 0.807 for the test dataset, with RMSE values of 2.397 days and 2.774 days and MAE values of 1.787 days and 1.994 days, respectively. Following ANN-LM, the best results were obtained with ANFIS-GP, while MLR exhibited the lowest performance.</p><p><strong>Conclusions: </strong>Various AI models can effectively predict LOS for patients in different hospital units. Accurate LOS predictions can help health managers allocate resources more equitably across units.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"25 1","pages":"446"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143728311","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}