Disentangling organizational levers and economic benefits in transitional care programs: a systematic review and configurational analysis.

BACKGROUND: Promoting safe and efficient transitions of care is critical to reducing readmission rates and associated costs and improving the quality of patient care. A growing body of literature suggests that transitional care (TC) programs are effective in improving quality of life and reducing unplanned readmissions for several patient groups. TC programs are highly complex and multidimensional, requiring evidence on how specific practices and system characteristics influence their effectiveness in patient care, readmission reduction and costs. METHODS: Using a systematic review and a configurational approach, the study examines the role played by system characteristics (size, ownership, professional skills, technology used), the organizational components implemented, analyzing their combinations, and the potential economic impact of TC programs. RESULTS: The more organizational components are implemented, the greater the likelihood that a TC program will be successful in reducing readmission rates. Not all components have the same effect. The results show that certain components, 'post-discharge symptom monitoring and management' and 'discharge planning', are necessary but not sufficient to achieve the outcome. The results indicate the existence of two different combinations of components that can be considered sufficient for the reduction of readmissions. Furthermore, while system characteristics are underexplored, the study shows different ways of incorporating the skill mix of professionals and their mode of coordination in TC programs. Four organizational models emerge: the health-based monocentric, the social-based monocentric, the multidisciplinary team and the mono-specialist team. The economic impact of the programs is generally positive. Despite an increase in patient management costs, there is an overall reduction in all post-intervention costs, particularly those related to readmissions. CONCLUSIONS: The results underline the importance of examining in depth the role of system characteristics and organizational factors in facilitating the creation of a successful TC program. The work gives preliminary insights into how to systematize organizational practices and different coordination modes for facilitating decision-makers' choices in TC implementation. While there is evidence that TC programs also have economic benefits, the quality of economic evaluations is relatively low and needs further study.

Hospital food management: a multi-objective approach to reduce waste and costs.

Food waste contributes significantly to greenhouse emissions and represents a substantial portion of overall waste within hospital facilities. Furthermore, uneaten food leads to a diminished nutritional intake for patients, that typically are vulnerable and ill. Therefore, this study developed mathematical models for constructing patient meals in a 1000-bed hospital located in Florida. The objective is to minimize food waste and meal-building costs while ensuring that the prepared meals meet the required nutrients and caloric content for patients. To accomplish these objectives, four mixed-integer programming models were employed, incorporating binary and continuous variables. The first model establishes a baseline for how the system currently works. This model generates the meals without minimizing waste or cost. The second model minimizes food waste, reducing waste up to 22.53 % compared to the baseline. The third model focuses on minimizing meal-building costs and achieves a substantial reduction of 37 %. Finally, a multi-objective optimization model was employed to simultaneously reduce both food waste and cost, resulting in reductions of 19.70 % in food waste and 32.66 % in meal-building costs. The results demonstrate the effectiveness of multi-objective optimization in reducing waste and costs within large-scale food service operations.

Influences of women empowerment indices on demand for childcare services: Evidence from the Nigeria Demographic and Health Surveys.

This study examined the effect of various dimensions of women's empowerment on childcare use in Nigeria, utilizing information from five rounds of the National Demographic and Health Surveys. The analysis made use of both binary and multinomial logistic regression. The findings show that women who share household choices with their spouses were more likely to undertake postnatal care for their babies in either private or public hospitals compared to self-medication/others/traditional. Also, women who owned houses and those who participate in economic activities are significantly more inclined to use postnatal services for babies in health facilities. By implication, women empowerment is a significant factor to consider in improving childcare services in Nigeria. This suggests that in order to improve the health of children, women's inputs in household decision-making should be accommodated, while efforts should be made to enhance household socioeconomic position, and support mothers to have formal education. The findings also suggest that promoting women's empowerment can play a crucial role in increasing the demand for formal childcare services.

Cette étude a examiné l'effet de diverses dimensions de l'autonomisation des femmes sur le recours aux services de garde d'enfants au Nigéria, en utilisant les informations provenant de cinq séries d'enquêtes nationales sur la démographie et la santé. L'analyse a fait appel à la régression logistique binaire et multinomiale. Les résultats montrent que les femmes qui partagent les choix de ménage avec leur conjoint étaient plus susceptibles d'entreprendre des soins postnatals pour leur bébé dans des hôpitaux privés ou publics que par l'automédication/autres/traditionnels. En outre, les femmes qui possèdent une maison et celles qui participent à des activités économiques sont beaucoup plus enclines à recourir aux services postnatals pour les bébés dans les établissements de santé. Par conséquent, l'autonomisation des femmes est un facteur important à prendre en compte dans l'amélioration des services de garde d'enfants au Nigeria. Cela suggère que pour améliorer la santé des enfants, la contribution des femmes à la prise de décision au sein du ménage doit être prise en compte, tandis que des efforts doivent être déployés pour améliorer la position socioéconomique du ménage et aider les mères à suivre une éducation formelle. Les résultats suggèrent également que la promotion de l'autonomisation des femmes peut jouer un rôle crucial dans l'augmentation de la demande de services formels de garde d'enfants.

"Mind the Gap" - An overview of the role of the Extensions Community Healthcare Outcomes (ECHO) model in enhancing value in health care delivery.

The ECHO (Extensions Community Healthcare Outcomes) model of healthcare delivery has grown rapidly since its establishment and increased in popularity in recent years. This expansion has developed alongside the growing incidence of chronic diseases and the need to better manage them. The increasing uptake in ECHO has presented a requirement to assess its true value as healthcare costs are increasing globally, resulting in a growing demand by governments and policy makers to ensure chronic disease management strategies provide true value. Therefore, the aim of this review is to examine the impact that ECHO has on clinical practice and how such impacts are measured or evaluated. A narrative literature review is carried out to examine the outcomes assessed in ECHO-related studies. Three key academic databases were utilised for the literature search: Web of Science, PubMed, and Medline. Keywords relating to the review were chosen and searched for. Papers were screened using specified inclusion and exclusion criteria relating to years of publication (2000-2020), type of publication (original research, review papers and meta-analyses) and language requirements (English language only). This review found that while the ECHO model is expanding, and improving the so-called "knowledge gap" between specialists and primary care physicians, there is also a gap in the ways value is examined within ECHO. Most studies on ECHO lack an examination of patient reported health outcomes and appropriate, comparative costing methods. Current ECHO-related studies lack vital components that demonstrate the value of the model. Such components include patient reported health outcomes and detailed costing comparisons between the ECHO model and the traditional care pathway it is replacing.

Development and initial validation of the addressing client needs with social determinants of health scale (ACN: SDH).

BACKGROUND: The purpose of this study was to validate a scale that can be used by healthcare service professionals, healthcare systems, educators, and researchers to assess health service professionals' social determinants of health (SDOH) competency; with competency defined as their knowledge, awareness-biases, skills, and actual preparedness to address SDOH challenges. METHODS: An Exploratory Factor Analysis (EFA) was conducted with a sample of 220 health service professionals, and 6 factors were identified. A Confirmatory Factor Analysis (CFA) was conducted with 303 health service professionals and the 6-factor solution was supported, with 22 items. RESULTS: The reliability estimates for the 6 factors are as follows: Factor 1, Action Toward Addressing SDOH (a = .85); Factor 2, SDOH Knowledge (a = .94); Factor 3, Negative Attitude toward Addressing SDOH (a = .79); Factor 4, Systemic Accountability (a = .81); Factor 5, School Preparation (a = .86); and Factor 6, Perception of the Cause of SDOH (a = .94). CONCLUSION: The ACN:SDH scale is the first validated measure that can be used to systematically appraise health service professionals' SDOH competency.

Building community at work: An exploratory study in healthcare system management.

Recent scholarship has demonstrated that experiences in the community (i.e., a sense of community [SOC] and a SOC responsibility) can enhance employee psychological and behavioral outcomes. Recent evidence also shows that the experiences of the community are better able to predict employee outcomes compared to long-regarded management and public management constructs. However, very little empirical evidence exists on antecedent conditions that help build community experiences at work. To evaluate this gap, we conducted interviews with executive leaders, and focus groups with administrative leaders, across four major facilities in a large nonprofit healthcare system that is headquartered in Pennsylvania, United States. The study confirmed the propositions of the Community Experience Model, and explored organizational conditions that appear to build community experiences. The findings help frame factors that scholars can empirically test in future studies, and assist executives, human resource professionals, and managers throughout an organization, in building community at work.

[What about the weekend effect? Impact of the day of admission on in-hospital mortality, length of stay and cost of hospitalization]. / ¿Qué hay del efecto fin de semana? Impacto del día de ingreso sobre la mortalidad intrahospitalaria, la duración de la estancia y el coste de la hospitalización.

INTRODUCTION: There is no agreement on the existence of the weekend effect in healthcare or, if it exists, on its possible causes. The objective of the study was to evaluate the differences in healthcare outcomes between patients admitted on weekdays or weekends in a high-complexity hospital. METHODS: Observational and retrospective study of patients admitted between 2016 and 2019 in a public hospital with more than 1300 beds. Hospitalization episodes were classified according to whether admission took place between Friday at 3:00 p.m. and the following Monday at 8:00 a.m. (weekend admission) or not (admission on weekdays). Mortality, length of stay and associated costs were compared, applying their respective risk-adjustment models. RESULTS: Of the total 169,495 hospitalization episodes analyzed, 48,201 (28.44%) corresponded to the weekend, presenting an older age (54.9 years vs. 53.9; P<.001), a higher crude mortality rate (5.22% vs. 4.59%; P<0.001), and a longer average length of stay (7.42 days vs. 6.74; P<.001), than those admitted on weekdays. The median crude cost of stay was lower (€731.25 vs. €850.88; P<0.001). No significant differences were found when applying the adjustment models, with a risk-adjusted mortality ratio of 1.03 (0.99-1.08) vs. 0.98 (0.95-1.01), risk-adjusted length of stay of 1.002 (0.98-1.005) vs. 0.999 (0.997-1.002) and risk-adjusted cost of stay of 0.928 (0.865-0.994) vs. 0.901 (0.843-0.962). CONCLUSION: The results of the study reveal that the assistance provided during the weekends does not imply worse health outcomes or increased costs. Comparing the impact between hospitals will require a future homogenization of temporal criteria and risk adjustment models.

A knowledge implementation model in health system management based on the PARIHS model.

BACKGROUND: The gap between knowledge and practice, along with postponing or not implementing research findings in practice and policy-making, is one of the reasons for low-quality services. Hence, this study aimed at presenting a model of knowledge implementation in health system management in Iran. METHODS: The present two-phase study was first performed qualitatively using a directive content analysis approach based on the Promoting Action on Research Implementation in Health Services (PARIHS) model. The researchers extracted the barriers and facilitators by conducting semi-structured individual interviews. Then, in a three-stage Delphi study, 25 health experts determined the barrier removal strategies. Data were analysed using MAXQDA10 software. RESULTS:  The content analysis of the interviews led to the emergence of 1212 codes under three categories of evidence, context and facilitation. The findings indicate that health managers make fewer decisions based on research findings. Instead, they make decisions regarding the experiences of service providers and organization data. In addition to the subcategories in the PARIHS model, the researchers extracted political, social and administrative factors under the context category. The relationships between the features of evidence, context, facilitation, barriers and strategies were presented in the final model. CONCLUSION:  The presented model comprehensively emphasizes the evidence resources, context preparation, and facilitation of the knowledge implementation process.

How can big data analytics be used for healthcare organization management? Literary framework and future research from a systematic review.

BACKGROUND: Multiple attempts aimed at highlighting the relationship between big data analytics and benefits for healthcare organizations have been raised in the literature. The big data impact on health organization management is still not clear due to the relationship's multi-disciplinary nature. This study aims to answer three research questions: a) What is the state of art of big data analytics adopted by healthcare organizations? b) What about the benefits for both health managers and healthcare organizations? c) What about future directions on big data analytics research in healthcare? METHODS: Through a systematic literature review the impact of big data analytics on healthcare management has been examined. The study aims to map extant literature and present a framework for future scholars to further build on, and executives to be guided by. RESULTS: The positive relationship between big data analytics and healthcare organization management has emerged. To find out common elements in the studies reviewed, 16 studies have been selected and clustered into 4 research areas: 1) Potentialities of big data analytics. 2) Resource management. 3) Big data analytics and management of health surveillance systems. 4) Big data analytics and technology for healthcare organization. CONCLUSIONS: In conclusion is identified how the big data analytics solutions are considered a milestone for managerial studies applied to healthcare organizations, although scientific research needs to investigate standardization and integration of the devices as well as the protocol in data analysis to improve the performance of the healthcare organization.

Spanish Healthcare Sector Management in the COVID-19 Crisis Under the Perspective of Austrian Economics and New-Institutional Economics.

This is a study of Political Economy, Law & Economics, and Public Choice, applied to COVID-19 crisis management, and how the Spanish healthcare sector has operated under stressful conditions. Market and state failures are evaluated and some improvements are offered, according to the theories of Austrian Economics and New-Institutional Economics. At the macro level, the premise is the decentralization of the Spanish healthcare system a long time ago, to provide a better service to citizens, according to the idiosyncrasies of the Autonomous Communities (similar to federal states). The crisis has evidenced the failures of the Spanish system and its semi-federal model, without coordination to manage the trouble. Also, the General Government's recentralization attempt has failed too, proving Mises's theorem on the impossibility of economic calculation in intervened and coactive systems, with problems of shortages, lack of coordination, etc.; Buchanan-Tullock's theorem on the unfinished agenda of state interventionist and it suppression of private sector was also proven. At the micro level, health institutions (hospitals and health centers) have fallen into the paradox of media overexposure and the fake-news risk, because the more information they have tried to transmit, the more confusion they have caused, reducing the value of the supposed transparency and accountability, in addition to decreasing citizen wellbeing, giving way to a higher level of dissatisfaction and more risk of a syndemic. To perform the analysis of accountability and wellbeing perceived, this paper has used quantitative contrast techniques on secondary sources, such as the surveys of Centro de Investigaciones Sociológicas (part of the Public Sector) or Merco rankings (independent institution).

Hospital Professionals as Dual Agents: A Superordinate Identity to Solve Interprofessional Conflicts in Hospitals? Comment on "Dual Agency in Hospitals: What Strategies Do Managers and Physicians Apply to Reconcile Dilemmas Between Clinical and Economic Considerations?"

The inherent conflict between economic and clinical considerations, between professionalism and managerialism, and between being a manager or being a clinician is widely acknowledged in the sociology of professions. The original article by Waitzberg and colleagues focused on how hospital professionals reconcile these conflicting demands. In this commentary, we argue that their assumption that the considered hospital professionals (managers, chief financial officers [CFOs], chief physicians and practising physicians) are dual agents moves on from the unproductive debates of inherent conflicts to envisage possibilities of reconciling economic and clinical considerations. We conclude that the instrumental use of the term dual agent to include "the other" (the manager or the clinician) in a superlative and inclusive category can be considered a reframing strategy to solve inherent interprofessional conflicts and to implement more collaborative models in healthcare.

[Comprehensive management guideline for breast cancer follow-up and healthcare (2022 edition)].

In recent years, with the emphasis on breast cancer screening and the improvement of standardized diagnosis and treatment, cure rate and survival time of breast cancer patients have been significantly improved in China. Accompanied by prolonged follow-up period, patients are facing increasing cancer and other related health issues, which calls for a more accurate and long-term follow-up plan and focus on broader health risks. Health issues on cardiovascular system, bone density, blood lipid and psychology caused by anti-cancer treatment, senescence or changes in hormone levels have become new challenges in the management of patients with breast cancer, not only affecting the life quality, but also impacting disease recurrence and death. Therefore, in addition to standardized treatment, scientific and standardized follow-up, comprehensive management of patients' concomitant diseases, interdisciplinary cooperation and holistic rehabilitation are also vital links to treatment. This could improve the therapeutic efficacy of anti-cancer treatment and the quality of life of patients. Based on the current landscape of treatment and follow-up of breast cancer patients in China, the experts committee updated the "Comprehensive Management Guideline for Breast Cancer Follow-up and Concomitant Diseases (2019 edition)" and revised it as "Guidelines for breast cancer follow-up and health management in China (2022 edition)" according to the latest literature and guidelines and medical advice from interdisciplinary experts. This new guideline is composed of four parts: path diagram, follow-up management, comprehensive healthcare management, and patient reported outcome. It aims to standardize the long-term follow-up of breast cancer patients, guide clinicians to actively provide comprehensive interdisciplinary healthcare management, and further improve the prognosis and life quality of breast cancer patients in China.

How Openness Serves Innovation in Healthcare? Comment on "What Managers Find Important for Implementation of Innovations in the Healthcare Sector - Practice Through Six Management Perspectives".

The recent study of which enabling factors can facilitate the specific step of moving from idea generation to implementation in healthcare supports that managing innovation is a context-driven process that goes through six categories of change. While this research provides a general and rather comprehensives overview of what successful innovation work needs, it does not offer deeper insights into how categories of change can be operated in the context of accelerated openness in healthcare. I use the concepts of open innovation and open strategy to trying better understand how openness, in terms of greater inclusion and transparency, may or may not serve healthcare innovation through three theoretical questions: to whom, how and when to open up to foster innovation? Whilst diversity of knowledge, actors and systems are growing drivers of innovation, strategizing openness for more deliberate and impactful inclusion and transparency in healthcare management is key to coproducing better health.

The role of executive functioning, healthcare management, and self-efficacy in college students' health-related quality of life.

Objective: Examine how executive functioning (EF), healthcare management, and self-efficacy relate to college students' health-related quality of life (HRQOL). Participants: Undergraduates completed questionnaires at baseline (Time 1; n = 387) and 18-24 months later (Time 2; n = 102). Methods: Participants reported on their EF and healthcare management skills at Time 1 and self-efficacy and mental and physical HRQOL at Time 2. Results: Students with fewer EF problems reported higher mental and physical HRQOL at both timepoints and those with higher healthcare management skills had higher mental and physical HRQOL at Time 1. Higher self-efficacy mediated the relation between EF and mental HRQOL, and the relation between healthcare management and mental HRQOL. Conclusions: Findings illustrate two potential pathways by which self-management, in healthcare settings or daily living, contributes to mental HRQOL during emerging adulthood. Assessing EF and healthcare management could help identify those at risk of low HRQOL and provide information that can inform interventions in college settings.

Machine learning versus regression modelling in predicting individual healthcare costs from a representative sample of the nationwide claims database in France.

BACKGROUND: Innovative provider payment methods that avoid adverse selection and reward performance require accurate prediction of healthcare costs based on individual risk adjustment. Our objective was to compare the performances of a simple neural network (NN) and random forest (RF) to a generalized linear model (GLM) for the prediction of medical cost at the individual level. METHODS: A 1/97 representative sample of the French National Health Data Information System was used. Predictors selected were: demographic information; pre-existing conditions, Charlson comorbidity index; healthcare service use and costs. Predictive performances of each model were compared through individual-level (adjusted R-squared (adj-R2), mean absolute error (MAE) and hit ratio (HiR)), and distribution-level metrics on different sets of covariates in the general population and by pre-existing morbid condition, using a quasi-Monte Carlo design. RESULTS: We included 510,182 subjects alive on 31st December, 2015. Mean annual costs were 1894€ (standard deviation 9326€) (median 393€, IQ range 95€; 1480€), including zero-claim subjects. All models performed similarly after adjustment on demographics. RF model had better performances on other sets of covariates (pre-existing conditions, resource counts and past year costs). On full model, RF reached an adj-R2 of 47.5%, a MAE of 1338€ and a HiR of 67%, while GLM and NN had an adj-R2 of 34.7% and 31.6%, a MAE of 1635€ and 1660€, and a HiR of 58% and 55 M, respectively. RF model outperformed GLM and NN for most conditions and for high-cost subjects. CONCLUSIONS: RF should be preferred when the objective is to best predict medical costs. When the objective is to understand the contribution of predictors, GLM was well suited with demographics, conditions and base year cost.

[Expectations and problems of the healthcare management support program for public assistance recipients].

Objectives　In recent years, the importance of healthcare support for public assistance recipients has been recognized, and healthcare support measures have been implemented for them. This study aimed to investigate the expectations and problems of welfare offices, as well as their requests to the central government and prefectures about the healthcare management support program for public assistance recipients, which has been mandated since 2021.Methods　In November 2019, snowball sampling was used to select 23 welfare offices for sending self-administered questionnaires about the healthcare management support program. Respondents were asked open-ended questions about their expectations and problems regarding the program, as well as their requests to the central government and prefectures. A subsequent interview survey was conducted from November 2019 to February 2020, gathering additional information on the questionnaire survey.Results　We received consent for the questionnaire survey and interview survey from 16 welfare offices (response rate 69.6%). It was revealed that the staff in charge of the healthcare management support program at the welfare office expected the program to improve recipients' health awareness and condition and for it to be applied to other residents in the community. They reported difficulty in developing the implementation system, setting up the indicators and target population, and retaining health professionals. They requested the central government and prefectures to clarify the indicators and the criteria for evaluation, provide reference materials, introduce precedents, communicate and coordinate with welfare offices and related organizations in the community, hold meetings to share information, and secure financial resources.Conclusion　Findings from our study suggest a need to strengthen the cooperation between the central government, prefectures, and local governments and to establish a multilayered system to implement the healthcare management support program effectively in welfare offices.

Evolving pancreatic cancer treatment: From diagnosis to healthcare management.

The prognosis of pancreatic ductal adenocarcinoma is still the worst among solid tumors. In this review, a panel of experts addressed the main unanswered questions about the clinical management of this disease, with the aim of providing practical decision support for physicians. On the basis of the evidence available from the literature, the main topics concerning pancreatic cancer are discussed: the diagnosis, as the need for a pathological characterization and the role for germ-line and somatic molecular profiling; the therapeutic management of resectable disease, as the role of upfront surgery or neoadjuvant chemotherapy, the post-operative restaging and the optimal timing foradjuvant chemotherapy, the management of the borderline resectable and locally advanced disease; the metastatic disease and the role of surgery for the management of patients with isolated metastasis and the use of biomarkers of metastatic potential; the role of supportive care and the healthcare management of pancreatic ductal adenocarcinoma.

Identifying the Gaps Between Public Health Training and Practice: A Workforce Competencies Comparative Analysis.

Objectives: The study aimed to generate insights on how best to enhance the compatibility between Public Health training program competencies and the implementation of competencies required by employers to address current and emerging public health needs. Methods: A survey adapted from the WHO-ASPHER Competency Framework for the Public Health Workforce was conducted online among Israeli public health managers from August to November 2021. The survey was formulated to mirror Essential Public Health Operations. Forty-nine managers participated (37.6% response rate) in an assessment of 44 public health competencies and the core organizational public health operations. Results: Analysis of Essential Public Health Operations revealed a notably high deficiency reported for Advocacy Communication and Social Mobilization for health competencies. Collaborations and Partnership and, Leadership and System Thinking were the most reported insufficient competencies, particularly in health departments and research institutes. Governmental offices reported Organizational Literacy and Adaptability competencies being deficient. Deficiencies were more impactful as the level of expertise increased. Conclusion: There is a clear need for public health professionals to acquire versatile and innovative competencies in response to the ever-changing health threats.