Impact of an innovative bundled payment to TB health care providers in China: an economic simulation analysis.

BACKGROUND: Tuberculosis is the second most deadly infectious disease after COVID-19 and the 13th leading cause of death worldwide. Among the 30 countries with a high burden of TB, China ranks third in the estimated number of TB cases. China is in the top four of 75 countries with a deficit in funding for TB strategic plans. To reduce costs and improve the effectiveness of TB treatment in China, the NHSA developed an innovative BP method. This study aimed to simulate the effects of this payment approach on different stakeholders, reduce the economic burden on TB patients, improve the quality of medical services, facilitate policy optimization, and offer a model for health care payment reforms that can be referenced by other regions throughout the world. METHODS: We developed a simulation model based on a decision tree analysis to project the expected effects of the payment method on the potential financial impacts on different stakeholders. Our analysis mainly focused on comparing changes in health care costs before and after receiving BPs for TB patients with Medicare in the pilot areas. The data that were used for the analysis included the TB service claim records for 2019-2021 from the health insurance agency, TB prevalence data from the local Centre for Disease Control, and health care facilities' revenue and expenditure data from the Statistic Yearbook. A Monte Carlo randomized simulation model was used to estimate the results. RESULTS: After adopting the innovative BP method, for each TB patient per year, the total annual expenditure was estimated to decrease from $2,523.28 to $2,088.89, which is a reduction of $434.39 (17.22%). The TB patient out-of-pocket expenditure was expected to decrease from $1,249.02 to $1,034.00, which is a reduction of $215.02 (17.22%). The health care provider's revenue decreased from $2,523.28 to $2,308.26, but the health care provider/institution's revenue-expenditure ratio increased from -6.09% to 9.50%. CONCLUSIONS: This study highlights the potential of BPs to improve medical outcomes and control the costs associated with TB treatment. It demonstrates its feasibility and advantages in enhancing the coordination and sustainability of medical services, thus offering valuable insights for global health care payment reform.

Framework Development for Reducing Attrition in Digital Dietary Interventions: Systematic Review and Thematic Synthesis.

BACKGROUND: Dietary behaviors significantly influence health outcomes across populations. Unhealthy diets are linked to serious diseases and substantial economic burdens, contributing to approximately 11 million deaths and significant disability-adjusted life years annually. Digital dietary interventions offer accessible solutions to improve dietary behaviors. However, attrition, defined as participant dropout before intervention completion, is a major challenge, with rates as high as 75%-99%. High attrition compromises intervention validity and reliability and exacerbates health disparities, highlighting the need to understand and address its causes. OBJECTIVE: This study systematically reviews the literature on attrition in digital dietary interventions to identify the underlying causes, propose potential solutions, and integrate these findings with behavior theory concepts to develop a comprehensive theoretical framework. This framework aims to elucidate the behavioral mechanisms behind attrition and guide the design and implementation of more effective digital dietary interventions, ultimately reducing attrition rates and mitigating health inequalities. METHODS: We conducted a systematic review, meta-analysis, and thematic synthesis. A comprehensive search across 7 electronic databases (PubMed, MEDLINE, Embase, CENTRAL, Web of Science, CINAHL Plus, and Academic Search Complete) was performed for studies published between 2013 and 2023. Eligibility criteria included original research exploring attrition in digital dietary interventions. Data extraction focused on study characteristics, sample demographics, attrition rates, reasons for attrition, and potential solutions. We followed ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and used RStudio (Posit) for meta-analysis and NVivo for thematic synthesis. RESULTS: Out of the 442 identified studies, 21 met the inclusion criteria. The meta-analysis showed mean attrition rates of 35% for control groups, 38% for intervention groups, and 40% for observational studies, with high heterogeneity (I²=94%-99%) indicating diverse influencing factors. Thematic synthesis identified 15 interconnected themes that align with behavior theory concepts. Based on these themes, the force-resource model was developed to explore the underlying causes of attrition and guide the design and implementation of future interventions from a behavior theory perspective. CONCLUSIONS: High attrition rates are a significant issue in digital dietary interventions. The developed framework conceptualizes attrition through the interaction between the driving force system and the supporting resource system, providing a nuanced understanding of participant attrition, summarized as insufficient motivation and inadequate or poorly matched resources. It underscores the critical necessity for digital dietary interventions to balance motivational components with available resources dynamically. Key recommendations include user-friendly design, behavior-factor activation, literacy training, force-resource matching, social support, personalized adaptation, and dynamic follow-up. Expanding these strategies to a population level can enhance digital health equity. Further empirical validation of the framework is necessary, alongside the development of behavior theory-guided guidelines for digital dietary interventions. TRIAL REGISTRATION: PROSPERO CRD42024512902; https://tinyurl.com/3rjt2df9.

Environmental effects on perishable product quality and trading under OBOR supply chain different route scenarios.

The world becomes advance rapidly, and the demand of perishable food increases in the global market. Food firms perceive the cheapest supply chain process for the delivery of products to end consumers. Apart from that, consumer demands high quality and safe products with competitive price. In the global intense competition, China introduced One Belt One Road (OBOR) advanced feature supply chain management system to cut the cost of production for these product firms as well as functionally deliver high quality and green products to end consumer without affecting from high environment temperature. Respectively, the graphical research model and the multi-objective method were developed to examine the estimated perishable product trading figures with consideration to quality, which is achieved by accumulating the advanced transportation features offered by OBOR supply chain management as compared to ancient rail route supply chain. To prove this, "simulation optimization function was applied to measure the probability of time-saving for perishable product quality from environmental effects and its influences over product demand." Some perishable products were selected, and their trading figures and demand value were measured by comparing both rail route environmental effects over demand, weights of products, and trade. The results declare perishable food quality and trading volume increased due to fast delivery of products to numerous countries, having cold supply chain feature under OBOR supply chain management and estimated 25 days of time-saving. Comparative analysis discloses the coherent picture of both trading routes used for delivering the products. "The findings show large amount of time-saving maximizes perishable product quality from environmental influence" estimated 3 times higher with fast train supply chain. Conceptually, perceived from the idea, when and if maglev train 600 km over an hour will be used for perishable product supply chain purpose in the near future, the estimated quality of perishable products and trading is considered to be more than 5 times higher as compared to ancient supply chain route. The study suggests future research direction on topics, food quality along with supply chain management system, and environmental impact measurement policy under different supply chain routes.

Visualizing Knowledge Evolution Trends and Research Hotspots of Personal Health Data Research: Bibliometric Analysis.

BACKGROUND: The recent surge in clinical and nonclinical health-related data has been accompanied by a concomitant increase in personal health data (PHD) research across multiple disciplines such as medicine, computer science, and management. There is now a need to synthesize the dynamic knowledge of PHD in various disciplines to spot potential research hotspots. OBJECTIVE: The aim of this study was to reveal the knowledge evolutionary trends in PHD and detect potential research hotspots using bibliometric analysis. METHODS: We collected 8281 articles published between 2009 and 2018 from the Web of Science database. The knowledge evolution analysis (KEA) framework was used to analyze the evolution of PHD research. The KEA framework is a bibliometric approach that is based on 3 knowledge networks: reference co-citation, keyword co-occurrence, and discipline co-occurrence. RESULTS: The findings show that the focus of PHD research has evolved from medicine centric to technology centric to human centric since 2009. The most active PHD knowledge cluster is developing knowledge resources and allocating scarce resources. The field of computer science, especially the topic of artificial intelligence (AI), has been the focal point of recent empirical studies on PHD. Topics related to psychology and human factors (eg, attitude, satisfaction, education) are also receiving more attention. CONCLUSIONS: Our analysis shows that PHD research has the potential to provide value-based health care in the future. All stakeholders should be educated about AI technology to promote value generation through PHD. Moreover, technology developers and health care institutions should consider human factors to facilitate the effective adoption of PHD-related technology. These findings indicate opportunities for interdisciplinary cooperation in several PHD research areas: (1) AI applications for PHD; (2) regulatory issues and governance of PHD; (3) education of all stakeholders about AI technology; and (4) value-based health care including "allocative value," "technology value," and "personalized value."

Parental perceptions of human papillomavirus vaccination in central China: the moderating role of socioeconomic factors.

Background: The huge gap in adolescent human papillomavirus (HPV) uptake between China (< 2%) and developed countries (> 60%) indicates the necessity of comprehensive examination on the modifiable factors for parents' decision-making. The present study investigated parental perceptions of HPV vaccination for children in China from a socio-economic perspective. Methods: Parents of 9-to-14-year-old adolescents who understood the HPV vaccination (n = 925) completed our questionnaire survey in Fall 2017. Based on the structural equation modeling, we examined the relationship among knowledge, awareness, and intentions of 20 items by 7-point Likert scale, the moderating effects also were tested among 5 socioeconomic variables. Results: Parents of female students have more positive intention about the HPV vaccination than male students' parents (3.74 vs 2.80, p < 0.001). Parents of 12-14-years old students have higher average scores in knowledge (p = 0.006) and intention (p < 0.001) than that of 9-11-years old students' parents. The average score of mothers on knowledge (p = 0.018) and awareness (p < 0.001) was lower than that of fathers. The elder parents (≥ 50 years) performed significantly better on knowledge (p < 0.001) and awareness (p < 0.001) than the other two subgroups. Annual household income is an important factor in determining the knowledge (p = 0.0017), awareness (p < 0.001), and intention (p < 0.001). Knowledge and awareness were considered as the positive determinant of intention, and awareness was partial mediator. Child gender (P = 0.046), child age (P = 0.004), parent gender (P = 0.043) and parental age (P = 0.021) were significant moderators. Conclusion: To improve the acceptability of HPV vaccination among Chinese adolescents, policymakers should develop positive strategies for their parents.

Trust collapse caused by the Changsheng vaccine crisis in China.

BACKGROUND: The public acceptance and implementation of vaccination programs is essential to prevent infectious diseases. However, vaccine adverse events may cause public panic and eventually lead to an increasing number of populations who were hesitant or refuse to participate in these vaccination programs. In 2018, the Changsheng vaccine crisis broke out in mainland China, and 252,600 unqualified DTP vaccines were reported to be used for child vaccination. In this study, we observed media and public reactions toward the vaccine crisis. METHODS: This study conducted Internet surveillance by four mainstream indicators from July 15th to August 7th, including social media (WeChat, Sina Weibo), online news and Baidu search index. We also analyzed the emotional perceptions of people in crisis through an online questionnaire survey. RESULTS: During the crisis, huge number of articles emerged on Internet, 125,882,894 articles (including forwarding) on WeChat friends circle, 1,877,660 Sina Weibo posts, 648,265 online news and 4,986,521 Baidu search indexes. Most of these articles were negative and expressed the public's weak confidence to the China-made vaccines. Public confidence in vaccines was undermined by the actions of the manufacturer and the government. CONCLUSIONS: The DTP vaccine crisis led to panic about immunization and eroded trust in the immunization program and in the government. Restoring public confidence in Chinese-made vaccines will take a long time, and meticulous management in vaccine production, and strict government regulation will help to alleviate public anxiety about vaccine safety and ultimately restore confidence.

Factors influencing behavior intentions to telehealth by Chinese elderly: An extended TAM model.

BACKGROUND AND PURPOSE: Telehealth bring significant benefits including improved quality of healthcare, efficiency and cost containment, especially for chronic patients and the elderly. China is the second largest country of investment in telemedicine systems, but the acceptance and behavioral intentions of the technology are still low in the elderly. The objective of this study is to explain the micro-mechanism that determines the behavioral intentions to use telemedicine systems from the perspective of elderly patients based on an extended Technology Acceptance Model. METHODS: A sample consisting of 436 elderlies selected through multistage cluster sampling from four cities in mainland China. The empirical study was conducted to examine the proposed model by two aspects: measurement model and structural model. RESULTS: The study determined that medical service satisfaction (t = 6.770, ß = 0.332), ease of use (t = 5.200, ß = 0.179), information quality (t = 12.540, ß = 0.639) had a significant impact on the elderly patients' acceptance to telehealth, and the acceptance had a significant impact (t = 14.356, ß = 0.697) on the elderly patients' behavior intentions of telehealth. The results also show that the variable of acceptance has significant mediating effects among the theoretical model. CONCLUSIONS: This study confirms the applicability of the extended Technology Acceptance Model in the behavioral intentions among elderly people in China using telehealth systems. The results indicate that relationship between telehealth systems and physical medical services are mutually reinforcing rather than alternative. The study will help technology developers better understand the behavioral characteristics of the elderly and encourage healthcare providers to better understand the true need of telehealth systems. These findings provide valuable information to telehealth system developers, governments, investors, and hospitals to promote the use of this technology by elderly patients.

Predicting behavioral intentions to children vaccination among Chinese parents: an extended TPB model.

Parental behavioral intentions play a key role in children vaccination. The present study looks at how parental expectations for the vaccination influence their attitudes and behavioral intentions toward children's immunization. The theoretical model is developed on TPB model and empirically tested with sample data from 380 children aged 0-7 years in mainland China. The structural equation modeling and multi-group analysis were used in the model to demonstrate the impact of the vaccination services quality, vaccination promotions and public opinions on attitudes and vaccination behavioral intention. Results support the study's hypotheses and indicate that Vaccination Services Quality (VSQ), Vaccination Promotions (VAP) and Public Opinions (PUO) have positive effects on Attitudes (ATT) and Vaccination Behavioral Intention (VAI), VSQ has the strongest standardized path (.594) while PUO has the least influence (.131), and Attitude is complete mediation in all paths. Attitude is key factor that determine the parental behavioral intentions, and the internal perception comes from the vaccination services quality and the external influence comes from the social environment affect the parental attitude. Governments should implement effective policies and improve vaccination services quantity to eliminate parental misunderstandings.