Factors influencing deceased organ donation rates in OECD countries: a panel data analysis.

OBJECTIVES: This study aims to investigate factors with a significant influence on deceased organ donation rates in Organisation for Economic Co-operation and Development (OECD) countries and determine their relative importance. It seeks to provide the necessary data to facilitate the development of more efficient strategies for improving deceased organ donation rates. DESIGN: Retrospective study. SETTING: Publicly available secondary annual data. PARTICIPANTS: The study includes 36 OECD countries as panel members for data analysis. OUTCOME MEASURES: Multivariable panel data regression analysis was employed, encompassing data from 2010 to 2018 for all investigated variables in the included countries. RESULTS: The following variables had a significant influence on deceased organ donation rates: 'opt-in' system (ß=-4.734, p<0.001, ref: 'opt-out' system), only donation after brain death (DBD) donors allowed (ß=-4.049, p=0.002, ref: both DBD and donation after circulatory death (DCD) donors allowed), number of hospital beds per million population (pmp) (ß=0.002, p<0.001), total healthcare employment pmp (ß=-0.00012, p=0.012), World Giving Index (ß=0.124, p=0.008), total tax revenue as a percentage of gross domestic product (ß=0.312, p=0.009) and percentage of population aged ≥65 years (ß=0.801, p<0.001) as well as high education population in percentage (ß=0.118, p=0.017). CONCLUSIONS: Compared with the promotion of socioeconomic factors with a positive significant impact on deceased organ donation rates, the following policies have been shown to significantly increase rates of deceased organ donation, which could be further actively promoted: the adoption of an 'opt-out' system with presumed consent for deceased organ donation and the legal authorisation of both DBD and DCD for transplantation.

Intended and Actual Participation in the Colorectal Cancer Screening Program­a Prospective Cohort Study With AOK Insurees.

BACKGROUND: The public generally has a positive view of colorectal cancer screening, but there is still room for improvement in participation rates. The aim of this study was to identify factors that are associated with intended and actual participation. METHODS: We conducted a prospective cohort study of a random sample of insurees of the AOK (a statutory health insurance carrier) in the German federal state of Lower Saxony. 50-year-old men and 55-year-old women who were eligible for their first screening colonoscopy received a written questionnaire in June 2020, three weeks after being invited to undergo colorectal cancer screening. For those who intended to do so, we used multivariable logistic regression analysis to determine any statistical associations between sociodemographic and medical characteristics and participation rates within 30 months. RESULTS: 82.7% of the respondents (239/298) intended to participate, and 43.3% (129/298) actually did so within 30 months. The participation rates among persons who had already decided to have a stool test or a colonoscopy were 50.7% (36/71) and 55.2% (58/105), respectively; the participation rate among undecided persons was 33.3% (19/57). The strongest association in the regression model was with an already made appointment (OR = 11.1, 95% confidence interval: [3.9; 31.8]). After exclusion of the existing-appointment variable from the regression model, living in a smaller town (OR = 2.41 [1.08; 5.35]) and a stated preference for colonoscopy (OR = 2.52; [1.20; 5.27]) were positively associated with participation. Insurees with a parent affected by colorectal cancer participated less frequently, even after adjustment for prior colonoscopies (OR = 0.31 [0.12; 0.80]). CONCLUSION: The wide gap between intended and actual participation implies that there is potential for improvement in the prevention of colorectal cancer, and that certain groups of people could benefit from targeted support in making their intention to undergo screening a reality. Because of the methodological limitations of this initial investigation, its findings need to be confirmed by further studies.

Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study.

Purpose: Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance. Participants and Methods: N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression. Results: The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (ß = 0.301) and planning (ß = 0.201) showed associations with compliance for nurses only. Conclusion: The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.

Subgroup analyses and patterns of multiple sclerosis health service utilisation: A cluster analysis.

Background: Previous investigations of multiple sclerosis (MS)-related healthcare have focused on utilisation of specific individual health services (e.g. hospital care, office-based neurologists) by people with MS (PwMS). Meanwhile, little is known about possible patterns of utilisation across health services and their potential differences across patient characteristics. Objective: To comprehensively analyse and identify patterns of MS-related health service utilisation and detect patient characteristics explaining such patterns. Methods: In 2021, we invited all PwMS insured by the largest insurance company in Lower Saxony, Germany, to take part in an online survey. We merged respondents' survey and health insurance claims data. We analysed MS-related health service utilisation and defined individual characteristics for subgroup analyses based on Andersen's Behavioural Model. We executed non-parametric missing value imputation and conducted hierarchical clustering to find patterns in health service utilisation. Results: Of 6928 PwMS, 1935 responded to our survey and 1803 were included in the cluster analysis. We identified four distinct health service utilisation clusters: (1) regular users (n = 1130), (2) assistive care users (n = 443), (3) low users (n = 195) and (4) special services users (n = 35). Clusters differ by patient characteristics (e.g. age, impairment). Conclusion: Our findings highlight the complexity of MS-related health service utilisation and provide relevant stakeholders with information allowing them to tailor healthcare planning according to utilisation patterns.