Emotional Labor Is Associated With the Mental Health of Respiratory Therapists in Hospitals.

BACKGROUND: Respiratory therapists (RTs) play important roles in providing ventilator support to patients in hospitals. They are on the front line in respiratory cases and work with physicians to help patients survive. However, questions remain regarding whether the mental health conditions at work are protected and secured for RTs. This study aimed to explore the risk factors of mental illness for RTs and to design an app to allow individual RTs to seek assistance at an earlier stage. METHODS: A total of 642 RTs from 107 two-tiered hospitals in Taiwan were randomly selected to complete a 44-item, 5-category questionnaire regarding emotional labor and mental health in 2019. Exploratory factor analysis, the Rasch model, descriptive statistics, the nonparametric Mann-Whitney U test, the Kruskal-Wallis test for unpaired t test, and one-way analysis of variance were performed to examine the demographic characteristics and emotional labor and mental health factors that influence RTs' mental health. An app was then designed to evaluate their mental health status. RESULTS: A total of 352 questionnaires were eligible, with a return rate of 54.8% (352 of 642). About 62.8% came from medical centers and 37.2% from regional hospitals. There were 311 (88.4%) women and 41 (11.6%) men, with a mean ± SD age of 37 ± 9.5 y. Six construct factors were extracted from the responses. The overall reliability of the emotional labor and mental health questionnaire for each subscale beyond 0.70 was evident based on internal consistency and stability in the data. Four risk factors (ie, basic emotional expression, superficial emotional control, emotional diversity extent, and weekly work hours) influenced RT mental health. All findings were applied to design an app for RTs to evaluate their mental health at work. CONCLUSIONS: Four risk factors were verified to influence RT mental health. An app was developed to detect their mental health and allow them to seek assistance at an earlier stage.

The Impacts of the Hierarchical Medical System on National Health Insurance on the Resident's Health Seeking Behavior in Taiwan: A Case Study on the Policy to Reduce Hospital Visits.

Objective: This study investigated the impacts of the hierarchical medical system under the national health insurance program on residents' healthcare-seeking behavior in Taiwan. Background: Healthcare authorities in Taiwan initiated an allowance reduction for outpatient visits at regional hospitals and higher hierarchical hospitals in 2018. The ultimate goal is to implement a hierarchical medical system to provide residents accessible as well as consistent medical services. Methods: This research was conducted through a questionnaire survey, and data were collected between August and December 2018 from the records of subjects who had recently sought medical attention. A total of 1340 valid questionnaires were returned. Results: A principal finding was that there were significant differences in the knowledge of new policies by age, marital status, annual income, education level, and occupation (p < 0.001). Regarding the effects on healthcare-seeking behavior, there were significant differences from persons aged 40-49 years (p < 0.1), in junior high school (p < 0.05), not aware of the policy (p < 0.001), and awareness of both the hierarchical medical system and the policy to reduce outpatient visits to large hospitals (p < 0.001). Conclusion: The health administration authorities should devote more effort into promoting knowledge of the policy in order to better inform the public about the hierarchical medical system.

The exploration of medical resources utilization among inguinal hernia repair in Taiwan diagnosis-related groups.

BACKGROUND: This study centered on differences in medical costs, using the Taiwan diagnosis-related groups (Tw-DRGs) on medical resource utilization in inguinal hernia repair (IHR) in hospitals with different ownership to provide suitable reference information for hospital administrators. METHODS: The 2010-2011 data for three hospitals under different ownership were extracted from the Taiwan National Health Insurance claims database. A retrospective method was applied to analyze the age, sex, length of stay, diagnosis and surgical procedure code, and the change in financial risk of medical costs in IHR cases after introduction of Tw-DRGs. The study calculated the cost using Tw-DRG payment principles, and compared it with estimated inpatient medical costs calculated using the fee-for-service policy. RESULTS: There were 723 IHR cases satisfying the Tw-DRGs criteria. Cost control in the medical care corporation hospital (US$764.2/case) was more efficient than that in the public hospital (US$902.7/case) or nonprofit proprietary hospital (US$817.1/case) surveyed in this study. For IHR, anesthesiologists in the public hospital preferred to use general anesthesia (86%), while those in the two other hospitals tended to administer spinal anesthesia. We also discovered the difference in anesthesia cost was high, at US$80.2/case on average. CONCLUSIONS: Because the Tw-DRG-based reimbursement system produces varying hospital costs, hospital administrators should establish a financial risk assessment system as early as possible to improve healthcare quality and financial management efficiency. This would then benefit the hospital, patient, and Bureau of National Health Insurance.

Transparency of Mandatory Information Disclosure and Concerns of Health Services Providers and Consumers.

BACKGROUND: This study analyzed differences between transparency of information disclosure and related demands from the health service consumer's perspective. It also compared how health service providers and consumers are associated by different levels of mandatory information disclosure. METHODS: We obtained our research data using a questionnaire survey (health services providers, n = 201; health service consumers, n = 384). RESULTS: Health service consumers do not have major concerns regarding mandatory information disclosure. However, they are concerned about complaint channels and settlement results, results of patient satisfaction surveys, and disclosure of hospital financial statements (p < 0.001). We identified significant differences in health service providers' and consumers' awareness regarding the transparency of information disclosure (p < 0.001). CONCLUSIONS: It may not be possible for outsiders to properly interpret the information provided by hospitals. Thus, when a hospital discloses information, it is necessary for the government to consider the information's applicability. Toward improving medical expertise and information asymmetry, the government has to reduce the burden among health service consumers in dealing with this information, and it has to use the information effectively.

Application of genetic algorithm to hexagon-based motion estimation.

With the improvement of science and technology, the development of the network, and the exploitation of the HDTV, the demands of audio and video become more and more important. Depending on the video coding technology would be the solution for achieving these requirements. Motion estimation, which removes the redundancy in video frames, plays an important role in the video coding. Therefore, many experts devote themselves to the issues. The existing fast algorithms rely on the assumption that the matching error decreases monotonically as the searched point moves closer to the global optimum. However, genetic algorithm is not fundamentally limited to this restriction. The character would help the proposed scheme to search the mean square error closer to the algorithm of full search than those fast algorithms. The aim of this paper is to propose a new technique which focuses on combing the hexagon-based search algorithm, which is faster than diamond search, and genetic algorithm. Experiments are performed to demonstrate the encoding speed and accuracy of hexagon-based search pattern method and proposed method.

Consumption of national health insurance medical resources by hepatocellular carcinoma patients treated using radiofrequency ablation therapy.

AIM: This study analyzed the health-care resources consumed in cancer treatment to provide important reference guidance to national governments with regard to their health-care policy prioritization and efficient health-care resource allocation. METHODS: Researchers used a retrospective observational approach to study medical resources consumed by hospitalized hepatocellular carcinoma (HCC) patients who underwent radiofrequency ablation (RFA) treatment in Taiwan between 2002 and 2006. RESULTS: A systemic analysis of the results showed a mean patient age of 65.3 and average medical costs per patient of US$1403. Higher incidence of HCC was evident in rural areas in Taiwan, however smaller hospitals treated fewer patients diagnosed with HCC due to many patients seeking treatment at larger hospitals, usually in urban areas. Consumption of medical resources at regional hospitals was significantly higher than at medical centers in terms of costs of X-rays and special materials as well as for the overall cost of treatment (P < 0.001). The average medical costs for hospitalized cancer patients who underwent RFA treatment were lower than for those that received other treatments such as surgical resection, TACE, radiotherapy or chemotherapy. This study further found an upward trend in the number of HCC patients receiving RFA treatments. CONCLUSION: Taiwan operates a national insurance global budget payment system. Health-care system budgetary pressures are exacerbated by increases in the costs of cancer treatment. While the cost of RFA for HCC may represent value for money, with cost savings in other treatment areas, it nonetheless places strain on Taiwan NHI global budget payment system.

Continuous quality improvement of nursing care: case study of a clinical pathway revision for cardiac catheterization.

BACKGROUND: : Taiwan's Bureau of National Health Insurance (BNHI) has been gradually introducing Taiwan diagnosis related groups (Tw-DRGs) for inpatient cases since 2010. Challenged to adapt to payment system changes, hospitals must implement necessary management control systems or measures to maintain both fiscal soundness and medical care quality. PURPOSE: : This study investigated the outcome of management participation in work to revise cardiac catheterization clinical pathway operating procedures. METHODS: : BNHI-qualified cases for Tw-DRGs 125 payment principles were recruited as study subjects to revise the cardiac catheterization clinical pathway. Researchers compared pre- and postrevision values in terms of mean medical care fees, patient volumes, healthcare quality, and length of hospital stay, as well as financial risk. RESULTS: : Significant differences were observed in precardiac catheterization nursing care completion rates, mean lengths of hospital stay, diagnosis numbers, surgical treatment numbers, and numbers of complications or comorbidities. Medical utilization was also significantly lower (p < .05) after revision implementation. CONCLUSIONS: : Clinical pathway revision involves organization, procedural flows, and performance management. The revision successfully improved hospital finances and promoted medical care quality.

Establishment of an integrated management model for the secondary prevention of cervical cancer - an experience in taiwan hospital.

In the present study, secondary data analysis was utilized to evaluate the efficiency of the integrated management model (IMM) on the Pap smear test for screening of women's uterine cervical cancer. The data of female patients receiving a Pap smear test were collected both before (from July to December, 2006) and after (from January to June, 2007) introducing the IMM in a regional hospital in Tainan. The result revealed an increment of participation rate from 5.1% to 15.4% (p < 0.001) among the female patients in the OPD (out-patient department), although the post-IMM participation rate was still much lower than that of general hospital data in Taiwan. Since IMM has proved efficacious for the management of various diseases, improvement in our IMM for the female uterine cervical cancer's prevention and management is conceivable. Studies on influencing factors should be carried out to allow strategies for resolution of problems to be designed, documented and implemented.