Simulation analysis of an adjusted gravity model for hospital admissions robust to incomplete data.

BACKGROUND: Gravity models are often hard to apply in practice due to their data-hungry nature. Standard implementations of gravity models require that data on each variable is available for each supply node. Since these model types are often applied in a competitive context, data availability of specific variables is commonly limited to a subset of supply nodes. METHODS: This paper introduces a methodology that accommodates the use of variables for which data availability is incomplete, developed for a health care context, but more broadly applicable. The study uses simulated data to evaluate the performance of the proposed methodology in comparison with a conventional approach of dropping variables from the model. RESULTS: It is shown that the proposed methodology is able to improve overall model accuracy compared to dropping variables from the model, and that model accuracy is considerably improved within the subset of supply nodes for which data is available, even when that availability is sparse. CONCLUSION: The proposed methodology is a viable approach to improve the performance of gravity models in a competitive health care context, where data availability is limited, and especially where a the supply nodes with complete data are most relevant for the practitioner.

Health economics-informed planning of psychiatric care: A primer and curriculum framework for psychiatrists.

OBJECTIVE: Contemporary medical education lacks a strong focus on health economics which guides major decisions in private and public health services. We briefly outline the rationale, guiding principles, main analytic methods, and a suggested framework for health economics education in psychiatry. CONCLUSIONS: Health economics aims to improve the efficiency of healthcare. Some analytic methods can be harnessed by psychiatrists to better plan clinical care. Health economic methods will also assist psychiatrists in translating their expertise and clinical priorities more effectively to policy-makers, governments, and private insurers motivated by economic reasoning.

Patient engagement in healthcare planning and evaluation: A call for social justice.

Patient engagement in healthcare planning and evaluation has been promoted as a way to improve healthcare's ability to meet patients' needs. However, populations experiencing oppression and discrimination, such as racism, colonialism, sexism, heterosexism, cisnormativity, ableism, classism, and poverty, are often underrepresented in patient engagement spaces. The context and structure of patient engagement processes may systematically exclude certain populations from participating in meaningful ways or from participating at all. By excluding certain populations from active, meaningful patient engagement, we risk planning and evaluating health services on the basis of the values, needs, and preferences of the dominant population. This, in turn, will further entrench health inequities and preclude the ability to surface ideas that challenge dominant conceptualisations of health and healthcare, thereby reinforcing the status quo rather than promoting healthcare transformation. Recognising that experiences of health, healthcare, and patient engagement processes are mediated through gender, race, ability, sexual orientation, and other dimensions of diversity, it is proposed that processes for engaging patients in healthcare planning and evaluation must by intersectional, attend to systemic and power relations, and truly put patients in the driver's seat of engagement processes. Health services planners and evaluators need to create more inclusive, accessible, and appropriate patient engagement experiences in order to focus on transforming healthcare towards a more socially just system.

Minimizing Population Health Loss in Times of Scarce Surgical Capacity During the Coronavirus Disease 2019 Crisis and Beyond: A Modeling Study.

OBJECTIVES: Coronavirus disease 2019 has put unprecedented pressure on healthcare systems worldwide, leading to a reduction of the available healthcare capacity. Our objective was to develop a decision model to estimate the impact of postponing semielective surgical procedures on health, to support prioritization of care from a utilitarian perspective. METHODS: A cohort state-transition model was developed and applied to 43 semielective nonpediatric surgical procedures commonly performed in academic hospitals. Scenarios of delaying surgery from 2 weeks were compared with delaying up to 1 year and no surgery at all. Model parameters were based on registries, scientific literature, and the World Health Organization Global Burden of Disease study. For each surgical procedure, the model estimated the average expected disability-adjusted life-years (DALYs) per month of delay. RESULTS: Given the best available evidence, the 2 surgical procedures associated with most DALYs owing to delay were bypass surgery for Fontaine III/IV peripheral arterial disease (0.23 DALY/month, 95% confidence interval [CI]: 0.13-0.36) and transaortic valve implantation (0.15 DALY/month, 95% CI: 0.09-0.24). The 2 surgical procedures with the least DALYs were placing a shunt for dialysis (0.01, 95% CI: 0.005-0.01) and thyroid carcinoma resection (0.01, 95% CI: 0.01-0.02). CONCLUSION: Expected health loss owing to surgical delay can be objectively calculated with our decision model based on best available evidence, which can guide prioritization of surgical procedures to minimize population health loss in times of scarcity. The model results should be placed in the context of different ethical perspectives and combined with capacity management tools to facilitate large-scale implementation.

Acute stroke care during the first phase of COVID-19 pandemic in Norway.

OBJECTIVES: The aim of the present study was to investigate how the initial phase of the COVID-19 pandemic affected the hospital stroke management and research in Norway. MATERIALS AND METHODS: All neurological departments with a Stroke Unit in Norway (n = 17) were invited to participate in a questionnaire survey. The study focused on the first lockdown period, and all questions were thus answered in regard to the period between 12 March and 15 April 2020. RESULTS: The responder rate was 94% (16/17). Eighty-one % (13/16) reported that the pandemic affected their department, and 63% (10/16) changed their stroke care pathways. The number of new acute admissions in terms of both strokes and stroke mimics decreased at all 16 departments. Fewer patients received thrombolysis and endovascular treatment, and multidisciplinary stroke rehabilitation services were less available. The mandatory 3 months of follow-up of stroke patients was postponed at 73% of the hospitals. All departments conducting stroke research reported a stop in ongoing projects. CONCLUSION: In Norway, hospital-based stroke care and research were impacted during the initial phase of the COVID-19 pandemic, with likely repercussions for patient care and outcomes. In the future, stroke departments will require contingency plans in order to protect the entire stroke treatment chain.

Effect of COVID-19 pandemic on stroke admission rates in a Norwegian population.

OBJECTIVES: There are concerns that public anxiety around COVID-19 discourages patients from seeking medical help. The aim of this study was to see how lockdown due to the pandemic affected the number of admissions of acute stroke. METHODS: All patients discharged from Akershus University Hospital with a diagnosis of transient ischemic attack (TIA) or acute stroke were identified by hospital chart review. January 3 to March 12 was defined as before, and March 13 to April 30 as during lockdown. RESULTS: There were 21.8 admissions/week before and 15.0 admissions/week during the lockdown (P < .01). Patients had on average higher NIHSS during the lockdown than before (5.9 vs. 4.2, P = .041). In the multivariable logistic regression model for ischemic stroke (adjusted for sex, age, living alone and NIHSS ≤ 5), there was an increased OR of 2.05 (95% CI 1.10-3.83, P = .024) for not reaching hospital within 4.5 hours during the lockdown as compared to the period before the lockdown. CONCLUSION: There was a significant reduction in number of admissions for stroke and TIAs during the lockdown due to the COVID-19 pandemic in Norway.

Health monitoring among asylum seekers and refugees: a state-wide, cross-sectional, population-based study in Germany.

BACKGROUND: Health monitoring in Germany falls short on generating timely, reliable and representative data among migrants, especially transient and marginalized groups such as asylum seekers and refugees (ASR). We aim to advance current health monitoring approaches and obtain reliable estimates on health status and access to essential healthcare services among ASR in Germany's third largest federal state, Baden-Württemberg. METHODS: We conducted a state-wide, cross-sectional, population-based health monitoring survey in nine languages among ASR and their children in collective accommodation centres in 44 districts. Questionnaire items capturing health status, access to care, and sociodemographic variables were taken from established surveys and translated using a team approach. Random sampling on the level of 1938 accommodation centres with 70,634 ASR was employed to draw a balanced sample of 65 centres with a net sample of 1% of the state's ASR population. Multilingual field teams recruited eligible participants using a "door-to-door" approach. Parents completed an additional questionnaire on behalf of their children. RESULTS: The final sample comprised 58 centres with 1843 ASR. Of the total sample expected eligible (N = 987), 41.7% (n = 412) participated in the survey. Overall, 157 households had children and received a children's questionnaire; 61% (n = 95) of these were returned. Age, sex, and nationality of the included sample were comparable to the total population of asylum applicants in Germany. Adults reported longstanding limitations (16%), bad/very bad general health (19%), pain (25%), chronic illness (40%), depression (46%), and anxiety (45%). 52% utilised primary and 37% specialist care services in the previous 12 months, while reporting unmet needs for primary (31%) and specialist care (32%). Younger and male participants had above-average health status and below-average utilisation compared to older and female ASR. CONCLUSIONS: Our health monitoring survey yielded reliable estimates on health status and health care access among ASR, revealing relevant morbidities and patterns of care. Applying rigorous epidemiological methods in linguistically diverse, transient and marginalized populations is challenging, but feasible. Integration of this approach into state- and nation-wide health monitoring strategies is needed in order to sustain this approach as a health planning tool.

Heard and valued: the development of a model to meaningfully engage marginalized populations in health services planning.

BACKGROUND: Recently, patient engagement has been identified as a promising strategy for supporting healthcare planning. However, the context and structure of universalistic, "one-size-fits-all" approaches often used for patient engagement may not enable diverse patients to participate in decision-making about programs intended to meet their needs. Specifically, standard patient engagement approaches are gender-blind and might not facilitate the engagement of those marginalized by, for example, substance use, low income, experiences of violence, homelessness, and/or mental health challenges-highly gendered health and social experiences. The project's purpose was to develop a heuristic model to assist planners to engage patients who are not traditionally included in healthcare planning. METHODS: Using a qualitative research approach, we reviewed literature and conducted interviews with patients and healthcare planners regarding engaging marginalized populations in health services planning. From these inputs, we created a model and planning manual to assist healthcare planners to engage marginalized patients in health services planning, which we piloted in two clinical programs undergoing health services design. The findings from the pilots were used to refine the model. RESULTS: The analysis of the interviews and literature identified power and gender as barriers to participation, and generated suggestions to support diverse populations both to attend patient engagement events and to participate meaningfully. Engaging marginalized populations cannot be reduced to a single defined process, but instead needs to be understood as an iterative process of fitting engagement methods to a particular situation. Underlying this process are principles for meaningfully engaging marginalized people in healthcare planning. CONCLUSION: A one-size-fits-all approach to patient engagement is not appropriate given patients' diverse barriers to meaningful participation in healthcare planning. Instead, planners need a repertoire of skills and strategies to align the purpose of engagement with the capacities and needs of patient participants. Just as services need to meet diverse patients' needs, so too must patient engagement experiences.

Rapidly increasing end-of-life care needs: a timely warning.

Current trends in population ageing show that, in the near future, while more people will live longer, more will also die at any one time. Health systems, as well as individual practitioners, are only just becoming aware of the extent of this problem. Health systems will have to rapidly change practice to manage the number of people dying in the coming years, many with complex multimorbid conditions. The changes involved should include a personal recognition by all health professionals of their role in caring for the dying, and healthcare education must include end-of-life care management as part of the core curriculum. Further, health systems must improve integration between primary care and specialist clinicians to ensure the burden is shared efficiently across the system. Finally, it should be recognised that end-of-life care is not terminal care, but should be anticipated months or sometimes years ahead through advance care planning for known future complications by the patient's clinical team, as well as by patients and their main carers, to manage crises as they ariserather than react to them once they arise.Please see related article: https://bmcmedicine.biomedcentral.com/articles/ 10.1186/s12916-017-0860-2 .

Will the Need-Based Planning of Health Human Resources Currently Undertaken in Several Countries Lead to Excess Supply and Inefficiency? A Comment on Basu and Pak.

Basu and Pak (2014) argue that need-based workforce planning models would not maximize social welfare, and use of need-based models would result in inefficiency. They propose that planning be based on service utilization to incorporate preferences or other socioeconomic factors. We show that the analysis is based on inappropriate considerations of the nature of healthcare demand, a misrepresentation of need-based approaches and misunderstanding publicly funded healthcare system objectives. We explain how current levels of utilization emerge from workload and income interests of providers that underlie utilization-based models and are incompatible with public goals of maximizing health gains. Copyright © 2016 John Wiley & Sons, Ltd.

Predictors of preferred location of care in middle-aged individuals of a municipality in Japan: a cross-sectional survey.

BACKGROUND: Japan has the highest rate of aging. To contain Long-Term Care (LTC) Insurance costs, the Japanese government is attempting to increase the proportion of individuals receiving home care services. However, demand for institutional care is increasing. These circumstances will decrease the sustainability of the LTC Insurance System. The objective of the present study was to identify predictors of the location of preference for LTC (home or a facility) in middle-aged individuals in a municipality. METHODS: This was a cross-sectional study of middle-aged individuals (n = 906) in Tsukuba, Japan. Data primarily included individual or social factors (sex, age, household size, experience with caring for family, information sources about social services or municipality policy), factors about care prevention (self-reported health, efforts to promote health, motivation in life), and the preferred location of care. These variables were analysed with multiple logistic regression, using preferred location of care as the dependent variable. RESULTS: A total of 693 respondents were analysed. Of these, 440 (63.5%) preferred home and 253 (36.5%) preferred a facility. The results of logistic regression analysis showed that a preference for facility was significantly associated with female sex, younger age, experience with caring for family, fewer information sources about social services or municipality policies, selecting 'go to culture lessons/study to satisfy interests', and not selecting 'spending time happily with family' under motivation in life. CONCLUSIONS: To support the selection of receiving home care services, municipalities must consider improving policies that reduce the burdens of present middle-aged caregivers, and promote the provision of care service information from multiple sources.

Rare disease policies to improve care for patients in Europe.

Rare diseases are those with a particularly low prevalence; in Europe, diseases are considered to be rare when they affect not more than 5 in 10000 persons in the European Union. The specificities of rare diseases make the area a veritable public health challenge: the limited number of patients and scarcity of knowledge and expertise single rare diseases out as a distinctive domain of high European added-value. The Orphan Medicinal Product Regulation of 1999 was the first European legislative text concerning rare diseases, followed by many initiatives, including recommendations by the Council of Ministers of the European Union in 2009. These initiatives contributed to the development of rare diseases policies at European and national level aimed at improving care for patients with rare diseases. A review of the political framework at European level and in European countries is provided to demonstrate how legislation has created a dynamic that is progressively improving care for patients with rare diseases. This article is part of a Special Issue entitled: "Current Research on the Neuronal Ceroid Lipofuscinoses (Batten Disease)".

Palliative care and other physicians' knowledge, attitudes and practice relating to the law on withholding/withdrawing life-sustaining treatment: Survey results.

BACKGROUND: To effectively care for people who are terminally ill, including those without decision-making capacity, palliative care physicians must know and understand the legal standing of Advance Care Planning in their jurisdiction of practice. This includes the use of advance directives/living wills and substitute decision-makers who can legally consent to or refuse treatment if there is no valid advance directive. AIM: This study aimed to investigate the knowledge, attitudes and practices of medical specialists most often involved in end-of-life care in relation to the law on withholding/withdrawing life-sustaining treatment from adults without decision-making capacity. DESIGN/PARTICIPANTS: A pre-piloted survey was posted to specialists in palliative, emergency, geriatric, renal and respiratory medicine; intensive care; and medical oncology in three Australian States. Surveys were analysed using SPSS 20 and SAS 9.3. RESULTS: The overall response rate was 32% (867/2702) - 52% from palliative care specialists. Palliative care specialists and geriatricians had significantly more positive attitudes towards the law (χ42(2) = 94.352; p < 0.001) and higher levels of knowledge about the withholding/withdrawing life-sustaining treatment law (χ7(2) = 30.033; p < 0.001) than did the other specialists, while still having critical gaps in their knowledge. CONCLUSION: A high level of knowledge of the law is essential to ensure that patients' wishes and decisions, expressed through Advance Care Planning, are respected to the maximum extent possible within the law, thereby according with the principles and philosophy of palliative care. It is also essential to protect health professionals from legal action resulting from unauthorised provision or cessation of treatment.

The vascular surgery workforce: a survey of consultant vascular surgeons in the UK, 2014.

OBJECTIVE: The purpose of this study was to describe the demographics, training, and practice characteristics of consultant vascular surgeons across the UK to provide an assessment of current, and inform future prediction of workforce needs. METHODS: A questionnaire was developed using a modified Delphi process to generate questionnaire items. The questionnaire was emailed to all consultant vascular surgeons (n = 450) in the UK who were members of the Vascular Society of Great Britain & Ireland. RESULTS: 352 consultant vascular surgeons from 95 hospital trusts across the UK completed the survey (78% response rate). The mean age was 50.6 years old, the majority (62%) were mid-career, but 24% were above the age of 55. Currently, 92% are men and only 8% women. 93% work full-time, with 60% working >50 hours, and 21% working >60 hours per week. The average team was 5 to 6 (range 2-10) vascular surgeons, with 23% working in a large team of ≥8. 17% still work in small teams of ≤3. Over 90% of consultant vascular surgeons perform the major index vascular surgery procedures (aneurysm repair, carotid endarterectomy, infra-inguinal bypass, amputation). While 84% perform standard endovascular abdominal aortic aneurysm repair (EVAR), <50% perform more complex endovascular aortic therapy. The majority of vascular surgeons "like their job" (85%) and are "satisfied" (69%) with their job. 34% of consultant vascular surgeons indicated they were "extremely likely" to retire within the next 10 years. CONCLUSIONS: This study provides the first detailed analysis of the new specialty of vascular surgery as practiced in the UK. There is a need to plan for a significant expansion in the consultant vascular surgeon workforce in the UK over the next 10 years to maintain the status quo.

Integrating health leadership and management perspectives: the MESH framework for culturally informed food design thinking and well-being promotion.

PURPOSE: This study examines the social and cultural life of food innovations to inform food design thinking. The authors explore this through wellness regulating functional foods, foods scientifically modified for health benefits based on medical and nutritional claims, as a materialisation of food innovation in the marketplace. DESIGN/METHODOLOGY/APPROACH: Drawing on affordance theory, where affordance relations enable potential for consumer food well-being regulation, the authors gathered in-depth interview data from diverse consumer groups across three illustrative exemplar functional foods. FINDINGS: The research reveals how consumers engage in meaningful actions with functional foods in the experiences of their everyday lives. Four analytical themes emerge for consumer wellness regulation through functional foods: morality judgements, emotional consequences, social embedding and historicality. ORIGINALITY: Analytical themes emerging from the findings are conceptualised as MESH, a useful acronym for the social and cultural life of food innovations within the design thinking arena. The MESH framework includes dichotomous cultural affordances that overlap and entangle different cultural themes weaving together consumers' perceived possibilities for food well-being regulation. These cultural affordances reveal distinct paths that link consumer experiences and food design thinking.

Including environmental and social sustainability in the planning process of healthcare services: A case study of cancer screening programs in an inner area in Italy.

Healthcare systems plan their activities to achieve efficiency and effectiveness, without addressing environmental and social sustainability. This paper describes a new approach adopted in Italy to plan and deliver health prevention services in an inner area of the Tuscany region (in Italy) to guarantee proximity of care and environmental and social sustainability. The project examines the design and delivery of cancer screening programmes using a mobile screening unit to maximise social benefits while minimising environmental waste. A cost analysis was developed to estimate the difference in CO2 equivalent emissions, travel costs, and productivity losses, comparing the current screening programmes against the introduction of a comprehensive full-service mobile screening unit. The results indicate that the new service model reduces direct non-medical costs incurred by the population and improves environmental sustainability. This alternative can reduce, annually, over 95,000 euros in terms of travel costs and productivity losses, as well as 35 tons of CO2-equivalent travel emissions for a population of 59,000 inhabitants in a mountainous area with around 6000 people involved in the screening programme. The study supports the need to adopt a new planning methodology that considers environmental, social, and financial sustainability jointly in the provision of public health services in rural areas.

Content analysis of succession planning in nursing management: a qualitative study.

AIM: The identification and development of managerial talents for nursing manager succession in the future should be a concern for organisations, as the concept of succession planning has not been seriously addressed in nursing. This study aimed to explore managers' perceptions of the concept of succession planning in nursing management. DESIGN: This qualitative study used a conventional content analysis approach. METHODS: Participants included 15 nursing managers, who were purposively selected based on predetermined inclusion and exclusion criteria. After obtaining ethical approval, data were collected through semistructured interviews. MAXQDA software was used for data management, and data analysis was performed using the seven-stage method by Graneheim and Lundman. The credibility and dependability of the data were assessed using Guba and Lincoln's criteria. RESULTS: The main categories identified in this study were barriers to succession planning, facilitators, succession planning requirements, contextualisation, succession planning cycle, the dynamism of the successor organisation and consequences of lack of succession planning. Based on the findings of this study, it is recommended that organisations plan and adopt policies to develop qualified personnel management in nursing organisations and appoint these individuals to critical managerial positions.

Physician Workforce in Lithuania: Changes during Thirty Years of Independence.

Healthcare human resource planning is one of the biggest challenges facing the healthcare systems in many countries. Inadequate decisions in human resource planning can lead to an insufficient number of healthcare professionals then healthcare inequalities. One of the components of resource planning in the healthcare system is long-term data monitoring and the identification of potential trends. Since 1990, the number of physicians in Lithuania has decreased by 15.3% (-2266), but the decrease in the population has led to a 13.61% increase in the number of physicians per 10,000 inhabitants (5.32). During the analyzed period, the largest decrease in the number of physicians workforce by specialty was the number of medical physicians (-73.08%), epidemiology and hygiene (-69.30%), children's diseases (-49.08%), the most increased number was of family/general practitioners (GPs), geneticists, physical medicine, and rehabilitation specialists. Since 1992, the number of visits to physicians in Lithuania, which has been decreasing for a long time, began increasing, and in 2022 (9.3 visits) it has almost reached the number of visits (9.5) per capita as in 1991. The aim of this research was to collect long-term data from various databases, summarize them, and identify possible trends and the reasons for data changes. The study analyzed data from the Lithuanian healthcare system from the Declaration of Independence of Lithuania to the last 30 years. The data includes or affects the indicators of the healthcare system, changes in population and doctors, the number of visits to doctors, the number of medical students and residents, and data determining inequalities in the healthcare system. Long-term data analysis is useful for developing a model of healthcare human resource planning and for planning healthcare resources.

Development of home-based care educational programme for the family caregivers of activity limited older people: an educational programme model for community nurses.

BACKGROUND/AIM: A home-based care educational programme for family caregivers of activity-limited older people was developed and implemented to provide caregiver education and to teach basic caregiving techniques. The purpose of the home-based care educational programme was to improve the caregivers' knowledge, skills and attitudes necessary to perform the caregiving tasks with reduced physical strain. METHODS: The educational programme model comprises the knowledge and skills necessary to carry out the caretaking responsibilities of older people, especially those with limited activities. It was conducted as an interventional study recruiting two groups (n=72) as intervention (n=36) and control group (n=36), and the knowledge of the caregivers was evaluated. The teaching sessions were planned considering the adult educational learning theories and guided by a developed educational handbook. RESULTS: The pre and post mean±SD knowledge scores of the intervention group (43.78±12.41; 89.78±5.61) showed a significant difference (p<0.001), whereas the pre and post knowledge mean±SD scores of the control group (50.69±17.90; 51.43±17.79) showed no significant improvement (p>0.05). The difference between the pre-test and post-test between the two groups was significant (p<0.0001). CONCLUSIONS: At the end of the educational programme, participants valued the opportunity that they received, and the assessment of knowledge before and after the programme showed an improvement in caregivers' knowledge. The study suggests conducting home-based or community-based health education programmes for caregivers of older people with limited activities, with the involvement of responsible healthcare professionals and leaders.

Evolving role of the health system CIO: perspectives from 33 health systems.

OBJECTIVES: This study explores the evolving position of the health system chief information officer (CIO) by identifying new core roles for success. METHODS: An advisory board of industry executives and system leaders guided the study. Purposeful sampling was used to invite chief executive officer and CIOs from 65 not-for-profit US health systems to participate. Interviews were conducted with 51 executives from 33 different systems, using a comprehensive interview topic guide. Interview transcripts were analysed using NVivo software, focusing on themes related to the evolving role of the health system CIO. RESULTS: Analyses revealed three main themes, with the CIO as (1) enabler of strategic change and transformation, (2) strategic developer of technology and leadership talent and (3) driver of organisational culture. DISCUSSION: The role of CIO has undergone transformation from technology and information system management to strategic leadership within the broader health system context. It highlights the importance of comprehensive business knowledge for CIOs and the need for other C-suite executives to have a deeper understanding of information and technology. CONCLUSION: As healthcare continues to evolve, the role of the CIO is expected to expand further, requiring a blend of technical and strategic business skills. This evolution presents opportunities for health systems to enhance their leadership development programmes, preparing leaders for the complexities of the contemporary health system sector.