scholarly journals Patients’ Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey

2021 ◽  
Vol 6 (2) ◽  
pp. 238146832110456
Author(s):  
Marc S. Piper ◽  
Brian J. Zikmund-Fisher ◽  
Jennifer K. Maratt ◽  
Jacob Kurlander ◽  
Valbona Metko ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Screening Colonoscopy ◽  
Perceived Threat ◽  
Physician Recommendation ◽  
Regional Survey ◽  
Scarce Resources ◽  
Factors Associated ◽  
Care Systems ◽  
Multivariable Regression ◽  
Race Ethnicity

Background. In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods. We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results. Despite a physician recommendation to stop screening, 29% of respondents reported being “not at all likely” to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion. Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources.

HSR19-105: The Role of Chemotherapy in Elderly Colorectal Cancer Survivors: An Observational Study

2019 ◽  
Vol 17 (3.5) ◽  
pp. HSR19-105
Author(s):  
Pamala A. Pawloski ◽  
Gabriela Vazquez-Benitez ◽  
Jeanette Y. Ziegenfuss ◽  
Terese A. DeFor ◽  
Elisabeth M. Seburg
Keyword(s):  
Colorectal Cancer ◽  
Observational Study ◽  
Cancer Survivors ◽  
Health Care Systems ◽  
Cancer Registries ◽  
Factors Associated ◽  
Colon Cancers ◽  
Chart Abstraction ◽  
Care Systems ◽  
Chemotherapy Initiation

Background: Older patients diagnosed with colorectal cancer are not routinely included in clinical trials and are frequently treated with less aggressive chemotherapy. To identify factors associated with treatment initiation in older adults, we conducted an observational study of patients diagnosed with stage I–IV colon or rectal cancer at 65 years and older between 2010 and 2014 across 6 integrated health care systems. Methods: Data were obtained from cancer registries based on chart abstraction and medical records. Time from diagnosis to surgery, chemotherapy, and radiation was measured in weeks and censored when disenrollment, death, or the end of the study period occurred. We assessed patient factors associated with time to chemotherapy initiation using survival analysis methods. Results: Among 8,088 patients diagnosed after the age of 65 with colon cancer, the mean age at diagnosis was 76 years (SD 7.7), 4,150 (51%) were female, and 34% were stage 3 or greater. More than half, 55% (n=4,434) of colon cancers were right-sided (RCC), 23% (n=1833) were left-sided (LCC), and 19% (n=1,559) were rectal cancers. Two-thirds (n=5,201) had moderately differentiated disease. Most (57%) received surgery within 4 weeks and 89% within 6 months of diagnosis (median, 3.4 weeks). At 6 months following diagnosis, 33% of patients had received chemotherapy, and only 4% received radiation. Factors associated with the receipt of chemotherapy were assessed in a multivariable survival model that included age, gender, stage, and site. Patients of older age were less likely to receive chemotherapy (HR, 0.49; 95%CI, 0.45–.53 for 75–79 vs 65–69 years), and more likely for advanced stage, and rectal site. No difference was observed between men and women. Refusal of chemotherapy was reported for only 6% of patients and was associated with age, stage, and site. Six month mortality was 13.3%. Conclusions: Factors associated with the receipt of treatment among older cancer survivors are similar to those in the general population.

scholarly journals On the Front (Phone) Lines: Results of a COVID-19 Hotline in Northeast Ohio

2020 ◽  
Author(s):  
David Margolius ◽  
Mary Hennekes ◽  
Jimmy Yaho ◽  
Douglas Einstadter ◽  
Douglas Gunzler ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Care ◽  
Smoking Status ◽  
Health Care Systems ◽  
Patient Characteristics ◽  
Care Practice ◽  
Scarce Resources ◽  
Wide Range ◽  
Care Systems ◽  
At Home

ABSTRACT Importance: Severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the associated coronavirus disease of 2019 (COVID-19) have presented immense challenges for health care systems. Many regions have struggled to adapt to disruptions to health care practice and employ systems that effectively manage the demand for services. Objective: To examine the effectiveness of the first five weeks of a 24/7 physician-staffed COVID-19 hotline. Design: Cohort study using electronic health records. Setting: A single large health care system in Northeast Ohio. Participants: During 5 weeks of operation, 10,112 patients called the hotline (callers) and were evaluated by a registered nurse (RN) using standardized protocols. Of these, 4,213 (42%) were referred for a physician telehealth visit (telehealth patients). The mean age of callers was 42 years. 67% were female, 51% white, and 46% were on Medicaid or uninsured. Intervention: Physician telehealth visits for COVID-19. Main Outcomes and Measures: We describe clinical diagnosis, patient characteristics (age, sex race/ethnicity, smoking status, insurance status), and visit disposition. We use logistic regression to evaluate associations between patient characteristics, visit disposition and subsequent emergency department use, hospitalization, and SARS-Cov-2 PCR testing. Results: Common caller concerns included cough, fever, and shortness of breath. Most telehealth patients (79%) were advised to self-isolate at home, 14% were determined to be unlikely to have COVID-19, 3% were advised to seek emergency care, and 4% had miscellaneous other dispositions. A total of 287 (7%) patients had a subsequent ED visit, and 44 (1%) were hospitalized with a COVID-19 diagnosis. Of the callers, 482 (5%) had a COVID-19 test reported with 69 (14%) testing positive. Among patients advised to stay at home, 83% had no further face-to-face visits. In multivariable results, only a physician recommendation to seek emergency care was associated with emergency room use (OR=4.73, 95%CI 1.37-16.39, p=.014). Only older age was associated with having a positive test result. Conclusions and Relevance: Robust, physician-directed telehealth services can meet a wide range of needs during the acute phase of a pandemic, conserving scarce resources such as personal protective equipment and testing supplies and preventing the spread of infections to patients and health care workers.

The Health Care Economics of Automating Health Care Systems

2018 ◽  
Vol 4 (01) ◽  
Author(s):  
A. Johnson ◽  
J. Miller
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Health Care Systems ◽  
Dosage Level ◽  
Societal Impact ◽  
Health Care Economics ◽  
Pharmaceutical Supply Chain ◽  
Factors Associated ◽  
Care Systems ◽  
Implementation Costs

In today's environment health care has become a key issue. Initiatives such as BCMA, RFID, CPOE, and EHR that require expensive automation implementations are being scrutinized. This research transcript describes a process for: 1) evaluating health care economic societal impact, 2) evaluating the implementation costs for automation such as barcodes and RFID into the pharmaceutical supply chain, 3) evaluating the risk factors associated with integration of multiple healthcare automation initiatives. The research results to date describe lot control of track-able capsules from manufacturer, to dosage level administration in hospitals, and ingestion confirmation for at-home patients.

scholarly journals Indigenous factors relevant for Safe Birth in Cultural Safety among Nancue ñomndaa communities in Guerrero, Mexico

2019 ◽  
Vol 14 (2) ◽  
pp. 7-18 ◽  
Author(s):  
Ivan Sarmiento
Keyword(s):  
Health Care Systems ◽  
Cultural Safety ◽  
Intercultural Dialogue ◽  
Factors Associated ◽  
Analysis Process ◽  
Academic Researchers ◽  
Care Systems ◽  
Level Of Understanding ◽  
Initial Results ◽  
Relevant Factors

Culturally unsafe approaches have governed the study of Indigenous birthing systems in the South of Mexico. The actions that these approaches promote tend to perpetuate the dominance of Western views in the shaping of health care systems; thus, reducing their cultural pertinence and quality. In this protocol, we propose a methodology to understand the most relevant factors associated with safe birth according to the knowledge of traditional Indigenous midwives. We propose to use conversations as a methodology to promote intercultural dialogue. Conversations recognize mutual interaction and construction of meaning, thus allowing for Western and Indigenous practitioners to interchange knowledge and mutually enrich each other. Three experienced traditional midwives will participate in one-to-one conversations with an indigenous researcher. They will provide the first level of understanding on the meaning of relevant factors for safe birth in their communities. A group of non-indigenous Academic researchers will participate in the process sharing their knowledge about the issue and support the analysis process. These initial results will go to a group session with traditional midwives and their apprentices to check the content, suggest additional elements and share the knowledge among them. This study is part of a bigger effort to support and strength the practices of the traditional midwives in these communities.

scholarly journals Factors associated with the extent of information technology use in Ontario hospitals

2021 ◽  
Author(s):  
Catherine Ka Yan Chow
Keyword(s):  
Information Technology ◽  
Technology Use ◽  
Health Care Systems ◽  
Hospital Type ◽  
Hospital Size ◽  
Factors Associated ◽  
Information Technology Use ◽  
Urban Hospitals ◽  
Relative Extent ◽  
Care Systems

Patients, providers and society are demanding more from health care systems worldwide. As health systems evolve, the use of health information technology is one method to deliver safer, more efficient, and more effective patient care. This paper presents analysis that explores whether location, hospital type, hospital size are factors in determing the extent that IT is used in Ontario hospitals.The results show that urban hospitals use IT more extensively than non-urban hospitals. Hospital type does not have an effect on the relative extent that IT is used. Larger hospitals are likely to use IT more than smaller hospitals. Key implications for having location and size determine a hospital's use of IT are the increasing divide between urban and non-urban hospitals and the proliferation of smaller "have not" hospitals in Ontario.

Legitimate Decision Making: The Achilles' Heel of Solidaristic Health Care Systems

2000 ◽  
Vol 5 (2) ◽  
pp. 122-126 ◽  
Author(s):  
Nicholas Mays
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Systems ◽  
Health Care Systems ◽  
Scarce Resources ◽  
The Future ◽  
Care Systems

The future sustainability of ‘solidaristic’ or universal publicly financed health systems is frequently said to be threatened by lack of resources as rising demand collides with the growing reluctance of the better-off to pay for services mainly used by others. Competitive health care arrangements are also regarded as threatening solidarity. By contrast, I argue that the main threat to the sustainability of such systems lies in the inability of so-called ‘advanced’ societies to develop institutions that are capable of acceptably reconciling inevitably scarce resources with individual and collective desires to have all the health care we want. Many ‘advanced’ societies lack, or fail to incorporate into their health systems, the range of intermediate institutions that could potentially help in more effectively reconciling individual wants with collectively determined levels of resources.

scholarly journals Factors Associated with Outpatient Satisfaction in Tertiary Hospitals in China: A Systematic Review

2020 ◽  
Vol 17 (19) ◽  
pp. 7070
Author(s):  
Yuping Li ◽  
Weijuan Gong ◽  
Xiang Kong ◽  
Olaf Mueller ◽  
Guangyu Lu
Keyword(s):  
Systematic Review ◽  
Waiting Time ◽  
Service Providers ◽  
Health Care Systems ◽  
Factors Associated ◽  
Community Health Systems ◽  
Outpatient Procedures ◽  
Education Levels ◽  
Tertiary Hospitals ◽  
Care Systems

Outpatient care is made up of medical procedures, tests, and services that can be provided to the patient in a setting that doesn’t involve an overnight hospital stay. In China, tertiary hospitals are medical services centers of health care systems, and some tertiary hospitals had more than 20,000 outpatient visits per day. However, a systematic review of existed evidence on factors influencing the outpatient satisfaction in tertiary hospitals in China could inform the efforts and does not yet exist. Therefore, in order to better understand the outpatient satisfaction provided by tertiary hospitals in China, we carried out a systematic review following PRISMA guidelines. Studies reporting on the level of and factors associated with outpatient satisfaction in Chinese tertiary hospitals were systematically searched in both Chinese and English electronic databases. A total of 36 articles reported 35 studies that met the inclusion criteria. Out of these eight were household surveys covering 12,119 residents, and another 27 directly interviewed 45,930 outpatients during their hospital visits from 185 hospitals. The included studies generally used self-designed questionnaire and indicated there is a lack of standardized questionnaire for investigating outpatient satisfaction in China. The outpatients showed the highest satisfaction with the doctors and nurses and the lowest satisfaction with the hospital hygiene and outpatient procedures, especially with the long waiting time. The socio-demographic characteristics (e.g., age, marital status, income and education levels), professional skills and service attitudes of medical staff were reported to be associated with outpatient satisfaction. The results indicated that in China, the outpatient satisfaction can be largely improved. Firstly, the attitude of medical service providers, especially the pre-diagnosis nurses, registration officers, and pharmaceutical counters should be improved. Furthermore, to shorten the waiting time, policies should be developed to guide patients with common diseases and slight discomforts to community health systems to alleviate the overload in tertiary hospitals. Considering the strained relations between the doctors and patients in the clinical practice, improving patient satisfaction in China deserves more attention and research.

scholarly journals Trust, threats, and consequences of the COVID-19 pandemic in Norway and Sweden – a comparative survey

2020 ◽  
Author(s):  
Lise Helsingen ◽  
Erle Refsum ◽  
Dagrun Kyte Gjøstein ◽  
Magnus Løberg ◽  
Michael Bretthauer ◽  
...  
Keyword(s):  
Health Care Systems ◽  
Control Measures ◽  
Educational Institutions ◽  
Perceived Threat ◽  
Web Based ◽  
Infection Control Measures ◽  
Care Systems ◽  
Comparative Survey ◽  
And Control ◽  
And Training

Abstract Background Norway and Sweden have similar populations and health care systems, but different reactions to the COVID-19 pandemic. Norway closed educational institutions, and banned sports and cultural activities; Sweden kept most institutions and training facilities open. We aimed to compare peoples’ attitudes towards authorities and control measures, and effects on life in Norway and Sweden.Methods Anonymous web-based surveys for individuals age 15 or older distributed through Facebook using the snowball method, in Norway and Sweden from mid-March to mid-April, 2020. The survey contained questions about perceived threat of the pandemic, views on infection control measures, and impact on daily life. We performed descriptive analyses of the responses and compared the two countries.Results 3,508 individuals participated in the survey (Norway 3000; Sweden 508). 79% were women, the majority were 30–49 years (Norway 60%; Sweden 47%), and about 45% of the participants in both countries had more than four years of higher education.

scholarly journals Telemonitoring for Patients With COVID-19: Recommendations for Design and Implementation (Preprint)

2020 ◽  
Author(s):  
Anna V Silven ◽  
Annelieke H J Petrus ◽  
María Villalobos-Quesada ◽  
Ebru Dirikgil ◽  
Carlijn R Oerlemans ◽  
...  
Keyword(s):  
Health Care ◽  
Care Pathway ◽  
Health Care Systems ◽  
Tertiary Care ◽  
Suspected Case ◽  
Care Hospital ◽  
Scarce Resources ◽  
Design And Implementation ◽  
Care Systems ◽  
Care Capacity

UNSTRUCTURED Despite significant efforts, the COVID-19 pandemic has put enormous pressure on health care systems around the world, threatening the quality of patient care. Telemonitoring offers the opportunity to carefully monitor patients with a confirmed or suspected case of COVID-19 from home and allows for the timely identification of worsening symptoms. Additionally, it may decrease the number of hospital visits and admissions, thereby reducing the use of scarce resources, optimizing health care capacity, and minimizing the risk of viral transmission. In this paper, we present a COVID-19 telemonitoring care pathway developed at a tertiary care hospital in the Netherlands, which combined the monitoring of vital parameters with video consultations for adequate clinical assessment. Additionally, we report a series of medical, scientific, organizational, and ethical recommendations that may be used as a guide for the design and implementation of telemonitoring pathways for COVID-19 and other diseases worldwide.

scholarly journals Factors associated with the extent of information technology use in Ontario hospitals

2021 ◽  
Author(s):  
Catherine Ka Yan Chow
Keyword(s):  
Information Technology ◽  
Technology Use ◽  
Health Care Systems ◽  
Hospital Type ◽  
Hospital Size ◽  
Factors Associated ◽  
Information Technology Use ◽  
Urban Hospitals ◽  
Relative Extent ◽  
Care Systems

Patients, providers and society are demanding more from health care systems worldwide. As health systems evolve, the use of health information technology is one method to deliver safer, more efficient, and more effective patient care. This paper presents analysis that explores whether location, hospital type, hospital size are factors in determing the extent that IT is used in Ontario hospitals.The results show that urban hospitals use IT more extensively than non-urban hospitals. Hospital type does not have an effect on the relative extent that IT is used. Larger hospitals are likely to use IT more than smaller hospitals. Key implications for having location and size determine a hospital's use of IT are the increasing divide between urban and non-urban hospitals and the proliferation of smaller "have not" hospitals in Ontario.

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