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  • 刊频： Quarterly
  • NLM标题： Inquiry
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  • 1.

    【2hr】An Economic Model of Optimal Penalty for Health Care WorkplaceViolence

    包量

    机译 卫生保健工作场所最佳罚款的经济模型暴力
    摘要：This article provides an economic model on the optimal penalty of health care workplace violence based on health care workplace classification and cost structure, aiming to deter potential offenders. By developing an EIP (externality, identifiability, and preventability) analytical method, we distinguish the characteristics of different workplaces and find that the health care workplace is the combination of externality, low identifiability, and low preventability. Besides the private cost to victims for ordinary workplace violence, the cost structure of health care workplace violence includes social costs like externality-related public safety cost, defensive medicine cost, and specific factors cost. When the optimal penalty corresponding to different levels of health care workplace violence increases, the threshold level of punishable violence decreases after incorporating the social costs into analysis. Our model shows that public safety costs are positively correlated with the importance of health care workplace in the service network, and a higher public safety cost should be matched with a greater optimal penalty.
  • 2.

    【2hr】Which Matters More for Medication Adherence Among Disabled People in Shanghai, China: Family Support or Primary Health Care?

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    机译 在中国上海，残障人士对药物依从性的关注程度更高：家庭支持还是初级卫生保健？
    摘要：Most disabled people have poor health status. They often have multiple diseases requiring continual medication. This study aimed to explore the factors associated with medication adherence among disabled people, with a particular focus on the factors associated with family and primary health care support. A questionnaire survey was conducted among 226 disabled individuals. The analysis was performed using an ordered logistic regression model, including 4 categories of predictor variables. We found that the community health service center played a positive role in improving medication adherence, whereas the role played by the participant’s family was more complicated. Specifically, those obtaining a brochure were more likely to have higher medication adherence (odds ratio [OR] = 2.732, 95% confidence interval [CI] = 1.349-5.532). Compared with those who were married, widowed participants (OR = 0.207, 95% CI = 0.069-0.620) and divorced participants (OR = 0.330, 95% CI = 0.057-1.914) had lower odds of having greater adherence, whereas the odds of having greater adherence for single participants were 1.679 times the same odds for married participants (OR = 1.679, 95% CI = 0.668-4.224). The odds of having greater medication adherence for participants receiving help with prescriptions from a family member were almost 60% lower than these odds for those who did not receive this kind of help (OR = 0.460, 95% CI = 0.216-0.979). Thus, the role played by participants’ family members was both protective and damaging, whereas the role of the community health service center was clearer. These findings merit further exploration.
  • 3.

    【2hr】Reduction in Hospitals’ Readmission Rates: Role of Hospital-Based Skilled Nursing Facilities

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    机译 降低医院的再入院率：基于医院的熟练护理机构的作用
    摘要：Hospital readmission within 30 days of discharge is an important quality measure given that it represents a potentially preventable adverse outcome. Approximately, 20% of Medicare beneficiaries are readmitted within 30 days of discharge. Many strategies such as the hospital readmission reduction program have been proposed and implemented to reduce readmission rates. Prior research has shown that coordination of care could play a significant role in lowering readmissions. Although having a hospital-based skilled nursing facility (HBSNF) in a hospital could help in improving care for patients needing short-term skilled nursing or rehabilitation services, little is known about HBSNFs’ association with hospitals’ readmission rates. This study seeks to examine the association between HBSNFs and hospitals’ readmission rates. Data sources included 2007-2012 American Hospital Association Annual Survey, Area Health Resources Files, the Centers for Medicare and Medicaid Services (CMS) Medicare cost reports, and CMS Hospital Compare. The dependent variables were 30-day risk-adjusted readmission rates for acute myocardial infarction (AMI), congestive heart failure, and pneumonia. The independent variable was the presence of HBSNF in a hospital (1 = yes, 0 = no). Control variables included organizational and market factors that could affect hospitals’ readmission rates. Data were analyzed using generalized estimating equation (GEE) models with state and year fixed effects and standard errors corrected for clustering of hospitals over time. Propensity score weights were used to control for potential selection bias of hospitals having a skilled nursing facility (SNF). GEE models showed that the presence of HBSNFs was associated with lower readmission rates for AMI and pneumonia. Moreover, higher SNFs to hospitals ratio in the county were associated with lower readmission rates. These findings can inform policy makers and hospital administrators in evaluating HBSNFs as a potential strategy to lower hospitals’ readmission rates.
  • 4.

    【2hr】Insurance Coverage, and Having a Regular Provider, and Utilization ofCancer Follow-up and Noncancer Health Care Among Childhood CancerSurvivors

    包量

    机译 保险范围，拥有正规服务提供商以及儿童癌症中的癌症随访和非癌症保健生还者
    摘要：The objective of this study was to assess the role of health insurance coverage on patterns of health care utilization and access to cancer-related follow-up and non-cancer care among childhood cancer survivors (CCS). Cross-sectional survey design was used. Childhood cancer survivors were from 2 large hospitals in Los Angeles County. In all, 235 were identified through the Los Angeles Cancer Surveillance Program, diagnosed between the ages of 5 and 18 in 2000-2007 with any cancer type except Hodgkin lymphoma. At data collection in 2009-2010, participants were between 15 and 25 years old. Study exposure was health insurance coverage (private, public, and uninsured). Main outcomes and measures were respondents’ regular source of care for cancer follow-up, noncancer care, and both; and having a cancer follow-up visit, primary care visit, and hospital emergency department visit in the past 2 years. Compared with those with private insurance, the uninsured were less likely to have a regular source for cancer follow-up (odds ratio [OR] = 4.3, 95% confidence interval [CI] = 1.9-9.4), less likely to have a source for noncancer care (OR = 3.3, 95% CI 1.6-6.9), and less likely to have a source of care for both (OR = 5.3, 95% CI = 2.1-13.5). Furthermore, uninsured CCS were less likely to have made visits to cancerspecialists (OR = 4.5, 95% CI = 2.1-9.50) and were less likely to have seen aprimary care physician in the past 2 years (OR = 3.9, 95% CI = 1.8-8.2). Inaddition, those with public (vs private) insurance were less likely to have aregular provider for primary care (OR = 2.5, 95% CI = 1.1-5.4) and less likelyto have made a primary care visit in the past year (OR = 2.8, 95% CI =2.1-13.5). Uninsured CCS are at risk of not obtaining cancer follow-up care, andthose with public (vs. private) insurance have less access to primary care.Policies that ensure continuity of coverage for survivors as they age intoadulthood may result in fewer barriers to needed care, which may lead to fewerhealth problems for CCS in the future.
  • 5.

    【2hr】High Medicaid Nursing Homes: Organizational and Market Factors Associated With Financial Performance

    包量

    机译 高级医疗补助疗养院：与财务绩效相关的组织和市场因素
    摘要：High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services’ (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed.
  • 6.

    【2hr】Nursing Home Quality and Financial Performance: Is There a Business Case for Quality?

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    机译 疗养院质量和财务绩效：质量是否存在商业案例？
    摘要：This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects. The dependent variable, financial performance, consisted of the operating margin. The independent variables comprised nursing home quality measures that capture the three dimensions of Donabedian’s structure-process-outcomes framework: structure Registered Nurse (RN) hours per resident day, Licensed Practical Nurse (LPN) hours per resident day, Certified Nursing Assistant (CNA) hours per resident day, RN skill mix), process (facility-acquired restraints, facility-acquired catheters, pressure ulcer prevention, and restorative ambulation), and outcomes (facility-acquired contractures, facility-acquired pressure ulcers, hospitalizations per resident, rehospitalizations, and health deficiencies). Control variables included size, average acuity index, market competition, per capita income, and Medicare Advantage penetration rate. This study found that the operating margin was lower in nursing homes that reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggest that there is a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.
  • 7.

    【2hr】The Impact of Neighborhood Environment on Women’s Willingness to Havea Second Child in China

    包量

    机译 邻里环境对妇女生育意愿的影响在中国的第二个孩子
    摘要：In recent years, the Chinese government has changed the one-child policy that was implemented more than 3 decades ago and has began encouraging couples to have 2 children. However, this cannot quickly change people’s reproductive concepts after more than 30 years of low fertility rate and birth control. In this context, the aim of our study was to assess the effect of neighborhood environment on Chinese women’s fertility-willingness for a second child. Our results show that there is a statistically significant relationship between neighborhood environment and women’s fertility-willingness for a second child. Women living in affluent neighborhoods with better living environments have lower fertility-willingness for a second child than those in poor neighborhoods. However, childcare institutions (such as kindergartens) provide shared childcare and improve women’s fertility-willingness. We suggest that to encourage more couples to have a second child, it is necessary to increase the number of neighborhood kindergartens. In addition, local governments must improve the social welfare of migrant households and loosen the requirements for migrant households to obtain local hukou, which will allow migrant children to enjoy local public services, especially education services.
  • 8.

    【2hr】Factors Affecting the Choice of National and Public Hospitals Among Outpatient Service Users in South Korea

    包量

    机译 影响韩国门诊用户中国立和公立医院选择的因素
    摘要：The present study analyzed factors underlying outpatient service users’ choice of national and public (rather than private) hospitals. Based on Andersen’s Behavioral Model, we developed a framework that covered needs, enabling, and personal factors. Data of outpatient service usage were obtained from the Korean medical panel survey during 2008 to 2013. Logistic regression analyses were conducted, and results revealed that the rate of national and public hospital use was very low (5.57%), and our model adequately explained variance in service use. Specifically, several demographic factors—older age, low income, national merit and medical care, being chronically ill, and having a disability—were predictive of whether an individual is likely to choose national and public hospitals. We discuss the need to strengthen national and public hospitals’ medical services in order to better manage care for low-income vulnerable groups.
  • 9.

    【2hr】The Provision of Health Care by Family Physicians in Taiwan as Illustrated With Population Pyramids

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    机译 人口金字塔说明台湾家庭医生的医疗保健
    摘要：Family physicians serve as personal doctors for individuals and their families and also act as gatekeepers of the health care system. If no special status is accorded to family physicians, however, then the rates at which health care recipients utilize their service might be affected. In the present cross-sectional study, representative claims data sets for 2010 from Taiwan’s National Health Insurance program, a health care system in which beneficiaries are not required to register with a family physician, were used to investigate the provision of health care to the population by family physicians. Among 919 206 beneficiaries with a total of 13 713 199 ambulatory visits, 49.1% had visited family physicians, 34.1% had visited internists, 24.3% had visited pediatricians, and 38.9% had visited otolaryngologists. Women (χ2(1) = 538, P < .001) and patients aged 65 and above (χ2(1) = 16 000, P < .001) had a higher proportion of visiting family physicians rather than visiting other specialties. The onion-shaped population pyramid with family medicine visits was compatible with the general population, and the proportion of visiting family physicians increased with increasing age. Among 112 289 patients with essential hypertension, 63 379 patients with diabetes mellitus, and 80 090 patients with hyperlipidemia, only 35.3%, 32.0%, and 31.1%, respectively, had visited family physicians. The age and sex distributions of these patients were illustrated with population pyramids for data visualization and direct comparisons. Taken together, the results of this study indicate that the utilization of family physicians in Taiwan and the effectiveness of their associated role in chronic disease management still have room for improvement.
  • 10.

    【2hr】Estimated Costs of a Reinsurance Program to Stabilize the Individual Health Insurance Market: National- and State-Level Estimates

    包量

    机译 稳定个人健康保险市场的再保险计划的估计成本：国家和州一级的估计
    摘要：Reinsurance, an insurance product designed to protect health insurers against the financial risk of covering high-cost enrollees, has attracted bipartisan policy interest as a mechanism to stabilize individual health insurance markets. Three states—Alaska, Minnesota, and Oregon—have implemented state-based reinsurance programs under the Affordable Care Act’s 1332 State Innovation Waivers, and reinsurance waivers have been approved though not yet enacted in Maine, Maryland, New Jersey, and Wisconsin. In this article, we estimate the costs of implementing national and state-based reinsurance programs using health spending data from the 2007-2016 Medical Expenditure Panel Survey and state demographic and health insurance coverage data from the 2015-2017 Current Population Survey Annual Social and Economic Supplement. We project that a reinsurance program with an 80% payment rate for expenditures between $40,000 and $250,000 would cost $30.1 billion from 2020-2022. We observed considerable variation in reinsurance programs and estimated costs between the 4 states we examined: California, Florida, Illinois, and Texas. Our projections provide updated estimates of the costs of implementing federal reinsurance programs for the individual health insurance market.
  • 11.

    【2hr】Simulation of Quality Death Spirals based on Human ResourcesDynamics

    包量

    机译 基于人力资源的质量死亡螺旋模拟动力学
    摘要：Although the hospital managers always try to improve the quality of the medical services, sometimes their efforts might affect reversely and push the system in what is so commonly called as “the death spirals of quality.” The most important reason of falling into these spirals is the lack of a systemic thought that considers the feedback relationships between the numerous effective variables in the system performance, such as human resources service capacity. In this regard, the purpose of the present research is to design and simulate a dynamic human resources service capacity–based model to demonstrate the death spirals of quality phenomenon based on the service time per service and the possibility of error generation along with identifying the policies to cope with them. The system dynamics simulation approach is used to show the dynamics of the capacity of service from the standpoint of human resources. A model is simulated for the services of a hospital clinic as a case study. The simulation results of the designed dynamic model express that applying the desired policies for the case study can provide a good basis for fighting these spirals in a dynamic situation.
  • 12.

    【2hr】Determinants of Hip and Knee Replacement: The Role of Social Support and Family Dynamics

    包量

    机译 髋关节和膝关节置换的决定因素：社会支持和家庭动态的作用
    摘要：The objective of this study was to examine variations in the determinants of joint replacement (JR) across gender and age, with emphasis on the role of social support and family dynamics. We analyzed data from the US Health and Retirement Study (1998-2010) on individuals aged 45 or older with no prior receipt of JR. We used logistic regression to analyze the probability of receiving knee or hip replacement by gender and age (<65, 65+). We estimated the effect of demographic, health needs, economic, and familial support variables on the rate of JR. We found that being married/partnered with a healthy spouse/partner is positively associated with JR utilization in both age groups (65+ group OR: 1.327 and <65 group OR: 1.476). While this finding holds for men, it is not statistically significant for women. Among women younger than 65, having children younger than 18 lowers the odds (OR: 0.201) and caring for grandchildren increases the odds (1.364) of having a JR. Finally, elderly women who report availability of household assistance from a child have higher odds of receiving a JR as compared with elderly women without a child who could assist (OR: 1.297). No effect of available support from children was observed for those below 65 years old and elderly men. Our results show that intrafamily dynamics and familial support are important determinants of JR; however, their effects vary by gender and age. Establishing appropriate support mechanisms could increase access to cost-effective JR among patients in need of surgery.
  • 13.

    【2hr】Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

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    机译 与私人保险患者相比，医疗补助患者在安排医疗护理方面的难度更大：一项荟萃分析
    摘要：Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.
  • 14.

    【2hr】Analysis of the Effect of the Elderly’s Labor Status on Care Cost at the End of Life

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    机译 寿命末期老年人的劳动状况对护理费用的影响分析
    摘要：This study quantitatively analyzes the effects of employment patterns at the time of death of the elderly on the utilization of medical care before death using the cohort data from the National Health Insurance Corporation, controlling mortality to obtain more accurate results. Gender was coded as 0 for males and 1 for females, and average monthly household income was taken as a logarithm to approximate a normal distribution. Care cost at the end of life was defined as the sum of the national health insurance contributions and statutory self-contributions. To measure proximity to death, deceased elderly were divided by the period from last hospital visit to death (except any hospital visit at time of death). We distinguished regular workers, irregular workers, self-employed and employers, unpaid family workers, and unemployed. The data used in this study are sample cohort data from the National Health Insurance Corporation. We examined the relationships between variables through 4 models using negative binomial regression. The effects of employment status on health status were analyzed and adjusted for demographic characteristics, socioeconomic status, and proximity to death. As the dependent variable, medical expenses were taken for 1 year before death. In this study, care costs at end of life were higher when children were economically independent and when the respondent was more educated, had high economic level, and had high average monthly household income. In addition, employment security also had a significant impact on care cost at end of life: Irregular workers spent significantly less than regular workers. The fact that care cost at end of life is differentiated according to employment status suggests that individuals’ health exists within a social context, which may also constrain it: There is a risk that people’s health status will become determined by socioeconomic status.
  • 15.

    【2hr】Limited Consequences of a Transition From Activity-Based Financing toBudgeting: Four Reasons Why According to Swedish HospitalManagers

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    机译 从基于活动的融资过渡到基于活动的融资的有限后果预算：瑞典医院的四个理由管理人员
    摘要：Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body’s use of other management controls did not change; (4) incentives bypassing the purchasing body’s controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.
  • 16.

    【2hr】Does Public Health Insurance Coverage Lead to Better Health Outcomes? Evidence From Chinese Adults

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    机译 公共健康保险承保范围会导致更好的健康结果吗？来自中国成年人的证据
    摘要：This article examines the impacts of public health insurance on the health of adults through use of data from the China Health and Nutrition Survey. We use the endogenous treatment effects model to infer the causal effects of public health insurance on health. We find that public health insurance significantly improves the physical and mental health status of health insurance beneficiaries after controlling for other covariates. Among the 2 types of voluntary public health insurance, the Urban Resident Basic Medical Insurance has the greater impact in improving health than the New Cooperative Medical Scheme. Moreover, the health effect appears to be stronger for middle-aged individuals, the elderly, and those with lower incomes than for their counterparts. The positive health effects may result from few channels, including the increase of health care utilization, the improvement of health-related behaviors, and the fact that individuals with public health insurance are more likely to use higher level care providers. This study provides implications on reforming China’s health care system.
  • 17.

    【2hr】Community Health Impact Assessment in Ghana: Contemporary Conceptsand Practical Methods

    包量

    机译 加纳的社区健康影响评估：当代概念和实用方法
    摘要：It has long been recognized that health and its determinants are strongly influenced by policies, programs, and projects outside of the health care sector. Few countries have introduced health impact assessments (HIA) to try and ensure that probable impacts on health are considered. An appropriate health impact assessment regime will identify negative and positive impacts of proposed health policies and programs on health, enable the interpretation of health risk and potential health gain, and present the information to assist in decision making. These HIAs are often generic and rapid desk–based appraisals characterized by the use of information and evidence that is already available or easily accessible and generally undertaken by administrators in an organization to gain a snapshot of the health impacts to inform proposal direction. Rapid and generic desk–based assessments require less-intensive effort and resources and draws on existing data sources from scientific peer-reviewed and gray literature to analyze potential health impacts. However, both sources can also be used to determining whether a more detailed review is necessary. The Community HIA model proposed by this work departs from the generic and rapid desk–based appraisals and is intended to provide practicalevidence to give higher priority to people’s viewpoints, promote participation,understanding and incorporate community voices to help shape future policy,programs, and practice. A comprehensive review of Ghana’s National HealthInsurance Scheme (NHIS) was carried out using the generic desk–based HIAapproach. This was followed by a practical qualitative community field work. Inthis research, we have demonstrated how community HIA is to be conducted throughan actual case study in the Ghanaian West African context. The scope of thiswork is wide and incorporates the consideration of key concepts and possiblemethods for carrying out HIA at the community level.
  • 18.

    【2hr】Factors Influencing Residents’ Willingness to Contract With GeneralPractitioners in Guangzhou, China, During the GP Policy Trial Phase: ACross-Sectional Study Based on Andersen’s Behavioral Model of Health ServicesUse

    包量

    机译 影响居民与一般人签约的因素全科医生政策试用阶段中国广州的从业人员：A基于安徒生卫生服务行为模型的跨部门研究采用
    摘要：This study aimed to investigate the current contract rate and residents’ willingness to contract with general practitioner (GP) services in Guangzhou, China, during the policy trial phase, and also to explore the association of behavior contract and contract willingness with variables based on Andersen’s Behavioral Model of Health Services Use (ABM). In total, 160 residents from community health centers (CHCs) and 202 residents from hospitals were recruited in this study. The outcome variables were behavior contract and contract willingness. Based on the framework of ABM, independent variables were categorized as predisposing factors, enabling factors, need factors, and CHC service utilization experiences. Univariate and multivariate logistic regression analysis models were applied to explore the associated factors. Out of 362 participants, 14.4% had contracted with GP services. For those who had not contracted with GP services, only 16.4% (51 out of 310) claimed they were willing to do so. The contract rate for community-based participants was significantly higher than that for hospital-based participants. Major reasons for not choosing to contract were perceiving no benefit from the service and concerns about the quality of CHCs. Community health center experiences andsatisfaction were significantly associated with contracting among hospital-basedparticipants. A need factor (diagnosed with hypertension or diabetes) and CHCservice utilization experiences (have gotten services from the same doctor inCHCs) were significantly associated with contract willingness among CHC-basedparticipants. Intervention to improve awareness of GP services may help topromote this service. Different intervention strategies should be used forvarying resident populations.
  • 19.

    【2hr】Impact of the Health Transformation Plan on the Number of Surgical Operations and Their Cancelation

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    机译 健康转型计划对手术数量及其取消的影响
    摘要：Operation cancelations are a serious problem with undesirable consequences. The Health Transformation Plan was launched in the health system of Iran on May 5, 2014, to enhance the efficiency and quality of services in public hospitals. Comprehensive coverage of patients’ basic treatment needs and reduction of patients’ out-of-pocket expenditures through insurance for all are other objectives of Health Transformation Plan as well. Then, the present study aimed to determine the impact of the Health Transformation Plan on the number of surgical operations and the cancelation of elective surgeries within public hospitals of Iran. This retrospective comparative study was conducted in 2017 within 2 tertiary public hospitals in the South-East of Iran. Using systematic random sampling method and census, 8138 scheduled surgical files and all canceled operations files were reviewed from April 2012 to March 2017, respectively. A standard checklist was used for data collection. The data were analyzed using χ2 test and a logistic regression model in SPSS, version 21. The study population was 8138 patients with mean age of 33 ± 19 years. Female patients comprised about 51% of the study population (n = 4115), and nearly two-third of them were married (n = 5192 [63.79%]). Coverage by Iranian health insurance was reported in more than half of patients (n = 4415 [54.79%]). The common reason for surgeries was injury and poisoning (n = 2814 [34.52%]) followed by delivery (n = 1747 [21.46%]). The number of operations increased from 26 677 before Health Transformation Plan (cancelation rate = 1.5%) to 33 190 after Health Transformation Plan (cancelation rate = 2.0%). The cancelation rate had a significant relationship with age (odds ratio = 1.009; confidence interval: 1.00-1.01), health insurance status (odds ratio = 2.12; confidence interval: 1.33-3.38), outpatient service referrals (odds ratio = 0.5; confidence interval: 0.43-0.62), inpatient service referrals (odds ratio = 1.5; confidence interval: 1.36-1.77), and surgical types (P < .05). In general, the Health Transformation Plan was markedly associated with a rise in the number of surgeries and cancelation rate in the public hospitals. The information obtained in the present study concerning the causes of operation cancelations can be used to decrease the number of future cancelations.
  • 20.

    【2hr】What Are the Risk Factors of Negative Patient Experience? ACross-Sectional Study in Chinese Public Hospitals

    包量

    机译 负面患者经历的风险因素有哪些？一个中国公立医院的跨学科研究
    摘要：Hospitals are struggling to involve patients and learn from their experience. The risk factor of patient experience is increasingly recognized as a critical component in improving patient experience. Our study explored risk factors of negative patient experience in order to improve the health-service quality of public hospitals. We conducted a cross-sectional study in Hubei province, China. A total of 583 respondents were surveyed by the Outpatient Experience Questionnaire with good validity and reliability in July 2015. T-tests were conducted to compare the experience scores among different outpatient groups. Multiple linear regression was performed to determine the significant factors that influenced the outpatient experience. Outpatients between 18 and 44 years old had the lowest experience scores (65.89 ± 0.79), whereas outpatients completely paying out-of-pocket had the lowest experience scores (64.68 ± 0.81) among all participants. Outpatients with poor self-rated health status had the lowest experience scores (66.14 ± 1.61) among different self-rated health status groups. While age, type of payment, and self-rated health status were significantly risk factors that influenced outpatient experience in the multiple linear regression. Thus, health-careproviders should pay more attention to outpatients who are young (age <45),completely out-of-pocket and poor health status, and provide precision healthcare to improve outpatient experience.
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