BMC Health Services Research最新文献

{"title":"A Lean-based Digital Twin model for planning and governance in secondary and tertiary hospital networks.","authors":"Jeroni Salabert Carreras, Rodolfo De Castro Vila, Marc Sales I Coll","doi":"10.1186/s12913-026-15332-1","DOIUrl":"10.1186/s12913-026-15332-1","url":null,"abstract":"<p><strong>Background: </strong>Healthcare systems face growing pressure and recurrent capacity-demand imbalances across hospital networks. While Lean Healthcare improves patient flow, most implementations remain confined to departmental silos and individual facilities. Simultaneously, Digital Twin (DT) applications in healthcare predominantly focus on precision medicine or isolated unit optimization, leaving a gap in system-level resource management. This study aims to propose a Lean-grounded DT model to support integrated activity and capacity planning across multi-provider hospital networks.</p><p><strong>Methods: </strong>Situated within the planning phase of a broader Action Research approach, this study translated Lean process-based frameworks into formal DT requirements. The model's scope and functional capabilities were derived from a longitudinal synthesis of Lean improvement projects conducted in over 50 hospitals. To strengthen structural integrity and practical relevance, the framework underwent expert-informed review with a purposeful panel of senior healthcare leaders, including CEOs and Medical Directors with more than 20 years of experience, to iteratively refine the decision-support layer and ensure alignment with territorial governance challenges.</p><p><strong>Results: </strong>We propose a four-layer conceptual DT architecture operating at both individual-hospital and network management level. The model represents four interrelated macro-processes (ambulatory, surgical, inpatient, and emergency) that function as interconnected systems across the territorial network. It standardizes core entities, operational variables (demand, activity, capacity and performance), and cross-process transition probabilities into a unified virtual representation. The resulting decision-support layer enables scenario analysis for medium-term tactical contracting, bottleneck detection, and strategic resource allocation across multiple providers.</p><p><strong>Conclusions: </strong>By integrating Lean process orientation with the DT paradigm, this model contributes to extending hospital management beyond traditional hospital-centric optimization. It offers a data-driven framework intended to support territorial health authorities in shifting from reactive, historically based contracting to more proactive, value-based network management. This model provides an architectural basis for future empirical implementations of Digital Twins in complex territorial health networks.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863511","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 economics of implementing Magnet^® designation: relevant parameters for a cost-benefit analysis in the German hospital context.","authors":"Carolin Gurisch, Julia Köppen, Claudia B Maier, Joan Kleine, Reinhard Busse","doi":"10.1186/s12913-026-15346-9","DOIUrl":"https://doi.org/10.1186/s12913-026-15346-9","url":null,"abstract":"<p><strong>Background: </strong>The U.S. Magnet^® model is an organizational intervention that aims to improve quality of care and patient outcomes by improving the hospital work environment for nurses. Its financial impact on German hospitals remains unclear. This study aimed to identify parameters for conducting a cost-benefit analysis for German hospitals seeking Magnet^® designation and assess availability of relevant data.</p><p><strong>Method: </strong>The hospital organizational perspective was adopted. A scoping review was conducted in January 2024 using Medline, CINAHL, Web of Science Social Sciences Citation Index and Cochrane Reviews to identify potential costs and cost-saving opportunities for hospitals implementing Magnet^®. Interviews with six key informants from nursing management from five German hospitals, participating in the Magnet4Europe study, were conducted in September and October 2024 to contextualize these findings for German hospitals. Market prices for each cost-saving potential were researched; further parameters to conduct a cost-benefit analysis were specified. The reporting of the economic components of the study adhered to the consolidated health economic evaluation reporting standards.</p><p><strong>Results: </strong>Potential costs include (i) fees of the American Nurses Credentialing Center, (ii) fees for benchmarking, (iii) expenses for professional development and staff and (iv) expenses for supporting resources, data management and innovations. In contrast to existing economic studies, German hospitals underlined potential expenses related to nurses' academization as part of nurses' professional development, and data management of nurse-sensitive indicators. Possible cost savings were identified from improvements in (i) nurse-sensitive indicators, (ii) nursing personnel indicators, and (iii) hospital performance. In contrast to existing studies, German hospitals stressed potential cost savings related to hospital performance. The possible cost-savings identified as relevant for the German hospitals were assigned market prices, although no values for injurious falls, pressure injuries category 2-4, and turnover costs were identified for the German healthcare system.</p><p><strong>Conclusion: </strong>Potential key expenses and cost-saving opportunities for implementing Magnet^® designation in hospitals were identified and contextualized for German hospitals. Substantial data gaps currently impede a cost-benefit analysis and underscore critical implementation-relevant evidence gaps that require further research.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787857","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":"Strengthening the patient perspective in quality development: a mixed-methods observational study on suitability of the PROMIS GH-10 in Swiss inpatient rehabilitation.","authors":"Marie Utsch, Gavin Brupbacher, Gaia Garuffi, Anke Scheel-Sailer, Stephan Tobler, Manuela Marquardt","doi":"10.1186/s12913-026-15291-7","DOIUrl":"10.1186/s12913-026-15291-7","url":null,"abstract":"<p><strong>Objective: </strong>Healthcare systems increasingly use patient-reported outcome measures (PROMs) to complement traditional clinical and performance-based outcomes by capturing health outcomes from the patient perspective and supporting quality improvement and patient-centred care. In Switzerland, the National competence centre for quality measurements in hospitals and clinics ANQ performs the external quality development program. We conducted a nationwide pilot study in inpatient rehabilitation using the generic PROMIS GH-10 to assess its suitability as an outcome for quality development by evaluating its responsiveness and feasibility of implementation in everyday clinical practice.</p><p><strong>Methods: </strong>Our study applied a mixed-method observational design. In a multi-stage expert-based selection process, the PROMIS GH-10 was selected for piloting. In total, 28 rehabilitation clinics recruited patients during the study period and asked them to fill in the PROMIS GH-10 digitally or paper-based at admission and discharge. After the survey, healthcare professionals (HCPs) were asked to document the level of assistance required by patients. Mean T-scores and effect sizes (Cohen's d) were calculated. Assistance requirements were analysed using descriptive statistics. Additionally, qualitative interviews were completed with HCPs to assess facilitating factors and barriers to implementation.</p><p><strong>Results: </strong>A sample of 2,083 patients was included, resulting in 1,217 complete pre-post measurements. Mean T-scores (SD) for PROMIS GH-10 subscales physical health (PHS) and mental health (MHS) significantly improved (p < 0.001) from admission to discharge (total sample PHS: 39.3(7.4); 44.4(7.6); d = 0.68; MHS: 44.9(8.0); 48.7(7.5); d = 0.48). Effect sizes on PHS ranged from d = 0.50-0.95 and on MHS from d = 0.33-1.19. Overall, 41% of patients required assistance in answering the PROM. Barriers to implementation from HCP perspective included uncertainties about the benefit of a generic PROM and the lack of staff resources. Facilitators were the questionnaire's brevity and the value of including the patient perspective.</p><p><strong>Conclusions: </strong>PROMIS GH-10 showed significant pre-post effects on physical and mental health in Swiss inpatient rehabilitation. Nonetheless, barriers such as increased time needed for assistance in special patient groups should be considered before national implementation.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787888","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":"Service users' perspectives on acute, outreach and outpatient psychiatric crisis interventions with and without peer support: results of a qualitative study.","authors":"Lena-Katharina Oeltjen, Georg Knigge, Maike Schulz, Imke Heuer, Timm Neeland, Jasmina Schmidt, Claudia Römer, Kay Bultmann, Jörg Utschakowski, Candelaria Mahlke, Ansgar Gerhardus","doi":"10.1186/s12913-026-15319-y","DOIUrl":"https://doi.org/10.1186/s12913-026-15319-y","url":null,"abstract":"<p><strong>Background: </strong>Crisis intervention teams assist individuals in acute mental health crises. If unavailable or situations escalate, the police may be involved, and compulsory admissions may be initiated in case of risk to self or others. - measures often perceived as stigmatizing and traumatizing. Respectful, empathetic interactions can prevent escalation and reduce coercion. Peer support, by individuals with lived experience, can enhance recovery, improve quality of life, and reduce coercive measures. In the city of Bremen, the Crisis Intervention Service (CIS) handles emergencies via mobile teams or outpatient consultations. The \"PeerIntervent\" project integrated trained peer support workers (PSW) into two regional Crisis Intervention Service (CIS) teams. This study examines how individuals with severe mental health conditions experience care during acute, outreach and outpatient psychiatric crises.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with 25 individuals recently affected by psychiatric crisis interventions and analysed using qualitative content analysis.</p><p><strong>Results: </strong>CIS was involved in all cases; PSW in six cases, police in eight. Empathic listening, calm communication, transparent explanations, and involvement in decision-making were described as supportive. Confrontational communication or insufficient information was experienced as distressing. Structural factors, including staff continuity and the waiting environment, also shaped overall experiences. Peer support was largely perceived positively, with the sharing of lived experience associated with authenticity and hope. Experiences with police were described ambivalently, ranging from reassuring and supportive to intrusive and escalating.</p><p><strong>Conclusion: </strong>Findings highlight the importance of calm, empathic, and transparent communication for trust and perceived safety, supporting the need to strengthen targeted training for all crisis care providers, including police. In line with prior research, PSW may complement crisis care by providing experiential credibility and hope, but their use should remain context-sensitive and requires further study.</p><p><strong>Trial registration: </strong>The study was approved by the Ethics Committee of the University of Bremen on June 20, 2022 (reference: 2022-09) and was registered in the German Clinical Trials Register (DRKS) on July 4, 2022 (DRKS00029377).</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13479813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787886","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":"Exploration of the relationships between health literacy and experience of care integration in parents of children with special healthcare needs: a cross-sectional study.","authors":"Rachel Skoss, Rachel Collins, Peter Jacoby, Katherine Langdon, Thom Nevill, Zhenmei Yeap, Jessica Keeley, Jenny Downs","doi":"10.1186/s12913-026-15340-1","DOIUrl":"10.1186/s12913-026-15340-1","url":null,"abstract":"<p><strong>Objective: </strong>This study sought to identify health literacy profiles of Australian parents of children with special health care needs (SHCN), and explore the relationships between health literacy, experiences of health care integration, and parent stress.</p><p><strong>Methods: </strong>A cross-sectional study design was used. Anonymous data were collected via an online survey including the Health Literacy Questionnaire (HLQ), a modified version of the Pediatric Integrated Care survey (PICS), parent perceived stress, and additional child and family demographic questions including child quality of life using the EQ-5D-Y. We performed a cluster analysis using the HLQ to identify health literacy profiles, and used descriptive statistics to examine relationships between health literacy profiles, health care integration and parent perceived stress.</p><p><strong>Results: </strong>A total of 126 Australian parents of children with varied special health care needs participated, with needs predominantly related to disability (53.7%) and/or respiratory conditions (38.9%). Cluster analysis identified three health literacy profiles, which illustrated different health literacy strengths and gaps. The health literacy profiles were similar in terms of demographic characteristics but the profile with higher health literacy was associated with better experiences of health care integration and lower levels of parent stress.</p><p><strong>Conclusion: </strong>Parents of children with SHCN have specific health literacy strengths along with skills and knowledge gaps, which are associated with how health care is experienced and perceived stress managing their child's health. Consideration of parent health literacy can provide valuable information to inform more effective models of care and family supports.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13615571/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058174","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":"Correction: Changes and backlogs in the provision and utilization of essential health services in Afghanistan during and after the COVID-19 pandemic.","authors":"Narges Neyazi, Ali Mirzazadeh, Abdul Ghani Ibrahimi, Mirwais Ahmadzai, Jamshed Ali Tanoli","doi":"10.1186/s12913-026-14229-3","DOIUrl":"10.1186/s12913-026-14229-3","url":null,"abstract":"","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705305","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":"Caregiver-reported experience of integrated care for children with special health care needs and its sociodemographic, health- and network-related correlates in Germany: Cross-sectional results from the PART-CHILD cohort.","authors":"Kerstin Bohnert, Angélique Herrler, Freia De Bock, Vera Araújo-Soares, Michael Eichinger","doi":"10.1186/s12913-026-15276-6","DOIUrl":"10.1186/s12913-026-15276-6","url":null,"abstract":"<p><strong>Background: </strong>Children with special health care needs (CSHCN) often rely on cross-sectoral care networks involving medical, therapeutic, educational, and social services. However, key dimensions of integrated care, including cross-sectoral communication and attention to family impact, remain challenging. Understanding factors that shape caregiver-reported experience of integrated care can inform program development to strengthen integrated care. We aimed (1) to quantify caregiver-reported experience of integrated care and (2) to examine associations between dimensions of caregiver-reported experience of integrated care and sociodemographic, health- and network-related correlates.</p><p><strong>Methods: </strong>We analyzed cross-sectional data from the nationwide PART-CHILD cohort. Caregivers of CSHCN with predominantly neurological, developmental, and behavioral conditions were recruited in specialized outpatient facilities in Germany and completed questionnaires. Caregiver-reported experience of integrated care was assessed using the German Pediatric Integrated Care Survey, yielding composite scores for Team quality and communication and Attention to family impact. Associations with sociodemographic characteristics, reason for seeking care, unmet needs, and care network size were examined using multivariable linear regression models.</p><p><strong>Results: </strong>Caregivers of CSHCN (n = 459) reported moderate Team quality and communication (mean 4.1 ± 1.1) and low Attention to family impact (2.3 ± 1.1). Higher unmet needs were associated with lower Team quality and communication (1-4 unmet needs: β = -0.28, 95% CI: -0.52 to - 0.04; ≥5 unmet needs: β = -0.83, 95% CI: -1.28 to - 0.38; reference: none). Cognitive impairment (β = 0.36, 95% CI: 0.03 to 0.69; reference: physical impairment) and larger care networks (4 - 5 providers: β = 0.33, 95% CI: 0.08 to 0.58; 6 - 10 providers: β = 0.38, 95% CI: 0.07 to 0.70; reference: 2-3 providers) were associated with higher Attention to family impact.</p><p><strong>Conclusion: </strong>Strengthening integrated care for CSHCN may require greater attention to family-level concerns, which were rated low in this sample. The association between unmet needs and Team quality and communication suggests a close link between perceived integration and needs-based service delivery. Correlates of Attention to family impact, including impairment type and care network size, warrant further investigation and may help identify target groups for interventions to strengthen family-centered services.</p><p><strong>Trial registration: </strong>The study was prospectively registered in the German Clinical Trials Register on 16 November 2018 (ID: DRKS00015054).</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705282","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":"Factors associated with inpatient medical record data quality in hospital settings: a systematic review.","authors":"Pinwen Liao, Wentong Jing, Guangcheng Luo, Xiao Huang, Zunirah Binti Mohd Talib, Khairil Rafik Bin Musa","doi":"10.1186/s12913-026-15333-0","DOIUrl":"10.1186/s12913-026-15333-0","url":null,"abstract":"<p><strong>Background: </strong>Inpatient medical record data are an important source of information for clinical care, hospital management, clinical coding, and reimbursement. Poor-quality record data may lead to incomplete documentation, coding errors, inaccurate performance assessment, and distorted reimbursement. In this review, data quality mainly refers to the accuracy, completeness, consistency, timeliness, and validity of inpatient medical record data, including front-page or home-page information and diagnosis/procedure coding data. Evidence on factors associated with these dimensions is scattered across studies of clinical documentation, coding practice, information systems, quality-control, and payment reform. This systematic review aims to synthesise the key associated factors and provide evidence for quality improvement in healthcare organisations.</p><p><strong>Methods: </strong>This review followed the PRISMA 2020 reporting guideline and was registered in PROSPERO (CRD420251244232). PubMed, Scopus, CNKI, and Wanfang Data were searched for English and Chinese studies published from 1 January 2021 to 7 November 2025. Two reviewers independently screened records, extracted data, and appraised methodological quality using Joanna Briggs Institute tools. Because of heterogeneity in designs, outcomes, and measurements, findings were synthesised narratively.</p><p><strong>Results: </strong>A total of 29 primary empirical studies were included in the narrative synthesis. Most studies were cross-sectional or retrospective hospital audits, and the overall methodological quality was mainly moderate. Six categories of factors associated with inpatient medical record data quality were identified: clinical documentation and physician-related factors (16 studies), coding staff capacity and professional competence (18 studies), institutional and quality-control mechanisms (19 studies), information-system support (14 studies), training and feedback (20 studies), and external policy or reimbursement pressure (7 studies). The evidence suggests that record quality is shaped by interactions between the data-generation process, coding transformation, organisational governance, technological support, and external incentives.</p><p><strong>Conclusion: </strong>The available evidence suggests that improving inpatient medical record data quality requires coordinated action across clinical documentation, coding capacity, quality-control mechanisms, information systems, training, and the external policy or reimbursement context. However, because much of the evidence comes from cross-sectional studies and is subject to language restrictions and search-field limitations, causal interpretation should remain cautious. This review provides a structured synthesis to inform future empirical studies and hospital quality-improvement work.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036516","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":"Characterisation and management of therapy-interrupting system errors associated with the use of the HomeChoice cycler for automated peritoneal dialysis.","authors":"Annemarie Albert, Stefan Richter, Rainer Peter Woitas, Philipp Stieger, Rüdiger C Braun-Dullaeus, Christian Albert","doi":"10.1186/s12913-026-15289-1","DOIUrl":"10.1186/s12913-026-15289-1","url":null,"abstract":"<p><strong>Background: </strong>Methodological and technical education of nurses is required to address challenges of technology integration in peritoneal dialysis (PD). We analysed the nature of therapy interrupting system errors in automated peritoneal dialysis (APD) cyclers of a German PD reference care centre and provide applicable resolution proposals.</p><p><strong>Methods: </strong>We documented therapy interrupting system errors of HomeChoice Pro and HomeChoice Claria cyclers (Baxter, BX, Unterschleißheim, Germany) including the years 2015-2023. We systematically characterise and suggest resolution strategies to these errors based on routinely collected health data and user experience to safely guide nephrology professionals and patients during troubleshooting. The 'reporting of studies conducted using observational routinely collected health data' (RECORD)-statement was considered.</p><p><strong>Results: </strong>We identified 49 different therapy interrupting system errors which were assigned to eight major categories: Errors associated to the pressure chamber (N=18), the Digitalboard/EEPROM (N=18, Electrically Erasable Programmable Read Only Memory), air in set (N=3), opening of the set's door (N=3), those associated to the energy system (N=3), the heater system (N=3) and a variety of errors resulting in an abrupt termination or non-commencement of the treatment session without clear group assignment (undefined, N=1) or without sufficient documentation. In total, 138 error incidents were documented during the observational timeframe. In frequential order errors were attributed to the pressure chamber (21.74%,), and air in set (19.57%) where specifically error 2240 occurred in 17.39% of total cases, the Digitalboard/EEPROM (17.39%), the energy or battery (16.67%; No. 1032 in 19/23 cases), the set's door (7.25%) and the heater (4.35%). In 17 cases (12.32%) no error number was documented by the patient or staff. One error cause was registered as undefined (0.72%). Overall, errors were rarely occurring in <0.25% of treatment sessions performed in the observational timeframe.</p><p><strong>Conclusion: </strong>These findings may be useful to guide training purposes for nephrology personnel and persons doing APD. For the manufacturer, the information provided may be helpful to improve error management and information transmission to the persons doing APD with the HomeChoice devices.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13452097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148696996","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":"Feasibility, acceptability, and preliminary impact of the WHO-Caregiver skill training (CST) in a low-income clinical setting: a mixed-methods evaluation.","authors":"Surafel Worku Megersa, Sandra Dehning, Selamawit Alemayehu Tessema, Andrea Jobst","doi":"10.1186/s12913-026-15313-4","DOIUrl":"10.1186/s12913-026-15313-4","url":null,"abstract":"<p><strong>Background: </strong>The intensive demands of caring for children with developmental disorders (DDs) result in diminished quality of life (QoL) and increased family burden, particularly in low- and middle-income countries (LMICs), such as Ethiopia, where access to specialized healthcare and caregiver support is limited. This study aimed to evaluate the feasibility, acceptability, and preliminary impact of the World Health Organization-Caregiver skill training (WHO-CST) within a clinical setting.</p><p><strong>Methods: </strong>A convergent parallel mixed-methods study design was employed. The qualitative data included 19 caregiver interviews and three focus group discussions with 20 facilitators examining program acceptability and implementation barriers, and the data were analyzed thematically. The quantitative data included 127 caregivers who completed pre- and post-intervention assessments, which were analyzed using paired t-tests and regression models (p < .05).</p><p><strong>Results: </strong>The qualitative analysis revealed four main themes: program acceptability, implementation challenges, effective strategies and recommendations. After the intervention, the caregivers exhibited better self-care and reduced their reliance on physical punishment. They also reported improvements in their children's communication skills and adaptive and challenging behaviors. Factors such as resource shortage and time constraints were identified as implementation barriers. Among those who completed the follow-up, 100% attended seven sessions or more. The quantitative analysis showed significant improvements in the psychological (Mdiff =3.01, t (126) =2.37, p = .019) and environmental (Mdiff =4.97, t (126) =4.19, p< .001) domains. However, the improvement in the overall quality of life (QoL) (Mdiff =1.74, t (126) =1.96, p= .052) and the reduction in the overall burden score (Mdiff = -.86, t (126) = -1.09, p= .277) were marginal and did not reach statistical significance.</p><p><strong>Conclusion: </strong>The WHO-CST is a feasible and acceptable intervention in Ethiopian clinical setting. It is associated with potential improvements in parenting style, self-care, and selected QoL domains among caregivers. By utilizing psychiatry residents as facilitators, the study implemented a service integration and capacity-building model to address gaps in a resource-limited setting. The findings may inform future implementation strategies and policy development in similar low-resource settings. Future evaluations should explore the cost-effectiveness and institutional support required to maintain the WHO-CST as standard care.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":"26 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705310","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}