scholarly journals Effects of Vertical Integration Reform on Primary Healthcare Institutions in China: Evidence From a Longitudinal Study

2021 ◽  
Author(s):  
Shasha Yuan ◽  
Fengmei Fan ◽  
Dawei Zhu
Keyword(s):  
Vertical Integration ◽  
Primary Healthcare ◽  
Diabetes Care ◽  
Longitudinal Design ◽  
Patient Flow ◽  
Outpatient Service ◽  
Three Dimensions ◽  
The Impact ◽  
Tight Integration

Background: Integrated care is a global trend in international healthcare reform, particularly for piloting vertical integration involving hospitals and primary healthcare institutions (PHIs). However, evidence regarding the impact of vertical integration on primary healthcare has been mixed and limited. Our study aims to evaluate the empirical effects of vertical integration reform on PHIs in China, and examines variations across integration intensity (tight integration vs. loose collaboration). Methods: This study used a longitudinal design. The time-varying difference-in-difference (DID) method with a fixed-effect model for panel data was adopted. A total of 370 PHIs in the eastern, central, and western areas of China from 2009 to 2018 were covered. Outcome measures included the indicators at three dimensions regarding inpatient and outpatient service volume, patient flow between PHIs and hospitals and quality of chronic disease care (hypertension and diabetes). Results: Significant increases in absolute (the number) and relative (the ratio between PHIs and hospitals) volume of inpatient admissions have been found after reform under tight integration, peaking at 183% and 15.0% respectively, in the third reform year. The quality of hypertension and diabetes care (by indicators of control rate of blood pressure and blood glucose) showed significant improvements under both types of vertical integration after reform. It was much more distinct for the PHIs under tight integration, which had the most significant increase of 34.0% and 22.8% under tight integration for the control rate of hypertension and diabetes compared to the peak of 21.2% and 22.1% respectively under loose collaboration. Conclusion: Our findings suggest that vertical integration (especially tight integration) in China significantly contributed to strengthening primary healthcare in terms of inpatient services and quality of hypertension and diabetes care, providing empirical evidence to other countries on integrating primary healthcare-based health systems.

scholarly journals The impact of general practitioners’ gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e027296 ◽  
Author(s):  
Nóra Kovács ◽  
Orsolya Varga ◽  
Attila Nagy ◽  
Anita Pálinkás ◽  
Valéria Sipos ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Cross Sectional Study ◽  
Gender Effect ◽  
Sectional Study ◽  
Cross Sectional ◽  
Process Indicators ◽  
Wide Cross ◽  
The Impact

ObjectivesThe objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact.Study designA nation-wide cross-sectional study was performed in 2016.Setting and participantsThe study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners.Main outcome measuresMultilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated.Results48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations.ConclusionFemale GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.

scholarly journals Assessment of anxiety and quality of life in fibromyalgia patients

2004 ◽  
Vol 122 (6) ◽  
pp. 252-258 ◽  
Author(s):  
Tathiana Pagano ◽  
Luciana Akemi Matsutani ◽  
Elisabeth Alves Gonçalves Ferreira ◽  
Amélia Pasqual Marques ◽  
Carlos Alberto de Bragança Pereira
Keyword(s):  
Quality Of Life ◽  
Outpatient Service ◽  
Test Group ◽  
Control Group ◽  
Control Groups ◽  
Sf 36 ◽  
Significant Difference ◽  
And Control ◽  
The Impact

CONTEXT: Fibromyalgia is a syndrome characterized by chronic, diffuse musculoskeletal pain, and by a low pain threshold at specific anatomical points. The syndrome is associated with other symptoms such as fatigue, sleep disturbance, morning stiffness and anxiety. Because of its chronic nature, it often has a negative impact on patients' quality of life. OBJECTIVE: To assess the quality of life and anxiety level of patients with fibromyalgia. TYPE Of STUDY: Cross-sectional. SETTING: Rheumatology outpatient service of Hospital das Clínicas (Medical School, Universidade de São Paulo). METHODS: This study evaluated 80 individuals, divided between test and control groups. The test group included 40 women with a confirmed diagnosis of fibromyalgia. The control group was composed of 40 healthy women. Three questionnaires were used: two to assess quality of life (FIQ and SF-36) and one to assess anxiety (STAI). They were applied to the individuals in both groups in a single face-to-face interview. The statistical analysis used Student's t test and Pearson's correlation test (r), with a significance level of 95%. Also, the Pearson chi-squared statistics test for homogeneity, with Yates correction, was used for comparing schooling between test and control groups. RESULTS: There was a statistically significant difference between the groups (p = 0.000), thus indicating that fibromyalgia patients have a worse quality of life and higher levels of anxiety. The correlations between the three questionnaires were high (r = 0.9). DISCUSSION: This study has confirmed the efficacy of FIQ for evaluating the impact of fibromyalgia on the quality of life. SF-36 is less specific than FIQ, although statistically significant values were obtained when analyzed separately, STAI showed lower efficacy for discriminating the test group from the control group. The test group showed worse quality of life than did the control group, which was demonstrated by both FIQ and SF-36. Even though STAI was a less efficient instrument, it presented significant results, showing that fibromyalgia patients presented higher levels of anxiety, both on the state and trait scales. Thus, patients with fibromyalgia had higher levels of tension, nervousness, preoccupation and apprehension, and higher propensity towards anxiety. CONCLUSION: The three instruments utilized showed efficiency in evaluating fibromyalgia patients. FIQ was found to be the most efficient instrument for discriminating and assessing the impact of fibromyalgia on their quality of life. It can be concluded that such patients have a worse quality of life and higher levels of anxiety.

The F–PEC Scale of Family Influence: Construction, Validation, and Further Implication for Theory

2005 ◽  
Vol 29 (3) ◽  
pp. 321-339 ◽  
Author(s):  
Sabine B. Klein ◽  
Joseph H. Astrachan ◽  
Kosmas X. Smyrnios
Keyword(s):  
Competitive Advantage ◽  
Family Business ◽  
Theory Development ◽  
Three Dimensions ◽  
Family Influence ◽  
Factor Analytic ◽  
Confirmatory Factor ◽  
The Family ◽  
The Impact

For a solution to the family business definition dilemma, we propose the application of a scale that assesses the extent and the quality of family influence via the measurement of three dimensions: Power, Experience, and Culture. The Family Influence on Power, Experience, and Culture (F–PEC) scale is tested rigorously, utilizing a sample of more than 1,000 randomly selected companies, through the application of exploratory and confirmatory factor analytic techniques. The scale demonstrates high levels of reliability. F–PEC has been applied in a number of studies, contributing to theory development, particularly in terms of the impact of family influence on distinct resources, and as a source of competitive advantage.

scholarly journals Impact of Pay-for-performance Incentives for Contracted Family Doctor Service among Primary Healthcare Providers on Diabetes Care in China

2021 ◽  
Author(s):  
Yinzi Jin ◽  
Wenya Tian ◽  
Yahang Yu ◽  
Wen Pan ◽  
Beibei Yuan
Keyword(s):  
Blood Glucose ◽  
Performance Assessment ◽  
Primary Healthcare ◽  
Diabetes Care ◽  
Health Workers ◽  
Family Doctor ◽  
Coordination Of Care ◽  
Overall Performance ◽  
Outcome Performance ◽  
The Impact

Abstract Background: As the first step towards building a gatekeeping system in China, the governments have introduced a contracted family doctor service (CFDS) policy in primary healthcare (PHC) facilities since 2016. The impact of performance-based salary (PBS) system incentive on performance remained unknown. This study was to examine the association between the PBS adding incentive for CFDS and the performance indicators of diabetes care. Methods: We conducted a cross-sectional study in 72 PHC facilities in 6 cities that piloted the CFDS, extracting 827 PHC health workers and 420 diabetes patients. The PHC health workers’ performance on delivery of diabetes care focused on the continuity and coordination of care. The outcome performance of diabetes care was measured by patients’ utilization of diabetes care and control of blood glucose reported by patients.Results: PHC health workers whose performance on contracted service was included in the overall performance assessment had 0.279 (95% CI 0.031-0.526) more score of the continuity of care, and had 92.6% (OR 1.926, 95% CI 1.160-3.197) higher likelihood of good coordination of care. PHC health workers whose performance linked with increased income were 168.1% (OR 2.681, 95% CI 1.502-4.788) and 78.0% (OR 1.780, 95% CI 1.220-2.597) more likely to have good continuity and coordination of care, respectively. The facility level analysis showed that additional one-point percentage of PHC health workers whose performance on contracted service was included in the overall performance assessment, and additional one-point percentage of whose performance assessment increased their income was associated with 7.192 (OR 8.192, 95% CI 1.903-35.266) times and 52.2% (OR 1.522, 95% CI 1.055-2.196) higher probability of having their patients with control of blood glucose. Additional one-point percentage of PHC health workers whose performance assessment increased their income was associated with 0.559 (95% CI 0.139-0.979) more score on patients’ utilization of diabetes care.Conclusions: Inclusion of the requirements on CFDS into the assessment criteria, and adding the incentives rewarding better performance on contracted family doctors into PBS system for PHC health workers were associated with better delivery process and outcome performance on diabetes care.

scholarly journals Implementing a weight-specific quality-of-life tool for young people in primary healthcare

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0052
Author(s):  
Yemi Oluboyede ◽  
Sarah Hill ◽  
Suzanne McDonald ◽  
Emily Henderson
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Young People ◽  
General Practitioners ◽  
Primary Healthcare ◽  
Global Public Health ◽  
Framework Analysis ◽  
Primary Care Clinicians ◽  
The Impact

BackgroundObesity is thought to be one of the most serious global public health challenges of the 21st century. The primary care setting is important in terms of the diagnosis, education and management of obesity in children and young people. This study explored the views of primary care clinicians on the implementation of a quality of life (QoL) tool to help young people and their families identify the impact of weight on QoL.AimTo assess the acceptability and feasibility of implementing the Weight-specific Adolescent Instrument for Economic-evaluation (WAItE) QoL tool for young people aged 11–18 years in primary care.MethodOne-to-one, semi-structured interviews were conducted with a purposive sample of primary healthcare clinicians working in practices located in areas of varying deprivation in Northern England, UK. Interview transcripts were coded and analysed using Framework Analysis in NVivo 10.ResultsParticipants (n=16 General Practitioners; n=4 practice nurses) found the WAItE tool acceptable for them and their patients and believed it was feasible for use in routine clinical practice. It was important to primary care clinicians that the tool would provide an overall QoL score that would be easy for General Practitioners and nurses to interpret, to help them identify patients most in need of specialist help.ConclusionsThis study has developed a platform for further research around QoL in overweight and obese young people. A future feasibility study will focus on implementing the tool in a small number of primary healthcare practices.

The Impact of an Online Mindfulness Program on Self-Compassion, Prosocial Behavior, and Trait Mindfulness

2021 ◽  
Author(s):  
Neil Bailey ◽  
Whitney Comte ◽  
Richard Chambers ◽  
Larissa Bartlett ◽  
Sherelle Connaughton ◽  
...  
Keyword(s):  
Prosocial Behavior ◽  
Longitudinal Design ◽  
Mindfulness Practice ◽  
Trait Mindfulness ◽  
Face To Face ◽  
Self Compassion ◽  
Prosocial Attitudes ◽  
Survey Responses ◽  
The Impact

Online mindfulness programs have gained traction in recent years due to their increased accessibility and feasibility compared to face-to-face programs. Although much research has demonstrated that face-to-face mindfulness programs can increase trait mindfulness, self-compassion and prosocial attitudes, fewer studies have explored these outcomes in online mindfulness programs. Additionally, the relative importance of formal and informal facets of mindfulness practice (i.e., practicing formal sitting meditation or practicing informally by bringing more awareness to daily activities) has not been extensively examined in either face-to-face or online contexts. This study aimed to test whether participating in a free 4-week online mindfulness program improved trait mindfulness, self-compassion and prosocial behavior, and whether improvements were related to self-reported quality and quantity of mindfulness practice. Using a longitudinal design, a total of 209 matched pre- and post-program survey responses were analysed. Results suggested that participation in the mindfulness program improved participants’ levels of trait mindfulness, self-compassion and prosociality (all p < 0.01). Exploratory analysis indicated the mindfulness program had a significantly greater impact upon prosociality scores for males (p < 0.05). Results also suggested that there was an association between the quality of formal mindfulness practice in the last week of the program and improvements in self-compassion and trait mindfulness (p < 0.01), but this relationship was not present for prosociality, nor for the quality of informal practice or quantity of formal practice. Lastly, exploratory mediation analysis suggested the association between quality of formal practice and self-compassion was mediated by changes in trait mindfulness (p < 0.05). These results suggest participating in an online mindfulness program can lead to improved trait mindfulness, self-compassion, and prosociality. Our results also indicate that practice quality is related to improved trait mindfulness, and that the changes to trait mindfulness mediate improved self-compassion.

scholarly journals The impact of concordant and discordant comorbidities on patient-assessed quality of diabetes care

2013 ◽  
Vol 18 (5) ◽  
pp. 1621-1632 ◽  
Author(s):  
Eindra Aung ◽  
Maria Donald ◽  
Joseph Coll ◽  
Jo Dower ◽  
Gail M. Williams ◽  
...  
Keyword(s):  
Diabetes Care ◽  
Quality Of Diabetes Care ◽  
The Impact

scholarly journals The association between the transfer of emergency department admitted patients to inpatient hallways and outcomes of oncology patients

2015 ◽  
Vol 4 (2) ◽  
pp. 1 ◽  
Author(s):  
Charles Lim ◽  
Matthew C. Cheung ◽  
Maureen E. Trudeau ◽  
Kevin R. Imrie ◽  
Ben De Mendonca ◽  
...  
Keyword(s):  
Emergency Department ◽  
Length Of Stay ◽  
Patient Flow ◽  
Vital Signs ◽  
Medication Administration ◽  
Oncology Patients ◽  
Flow Quality ◽  
Ed Crowding ◽  
The Impact

Objective: A protocol was implemented to ease Emergency Department (ED) crowding by moving suitable admitted patients into inpatient hallway beds (HALL) or off-service beds (OFF) when beds on an admitting service’s designated ward (ON) were not available. This study assessed the impact of hallway and off-service oncology admissions on ED patient flow, quality of care and patient satisfaction.Methods: Retrospective and prospective data were collected on patients admitted to the medical oncology service from Jan 1 to Dec 31, 2011. Data on clinician assessments and time performance measures were collected. Satisfaction surveys were prospectively administered to all patients. Results: Two hundred and ninty-seven patients (117 HALL, 90 OFF, 90 ON) were included in this study. There were no significant differences between groups for frequency of physician assessments, physical exam maneuvers at initial physician visit, time to complete vital signs or time to medication administration. The median (IQR) time spent admitted in the ED prior to departure from the ED was significantly longer for HALL patients (5.53 hrs [1.59-13.03 hrs]) compared to OFF patients (2.00 hrs [0.37-3.69 hrs]) and ON patients (2.18 hrs [0.15-5.57 hrs]) (p < .01). Similarly, the median (IQR) total ED length of stay was significantly longer for HALL patients (13.82 hrs [7.43-20.72 hrs]) compared to OFF patients (7.18 hrs [5.72-11.42 hrs]) and ON patients (9.34 hrs [5.43-14.06 hrs]) (p < .01). HALL patients gave significantly lower overall satisfaction scores with mean (SD) satisfaction scores for HALL, OFF and ON patients being 3.58 (1.20), 4.23 (0.58) and 4.29 (0.69) respectively (p < .01). Among HALL patients, 58% were not comfortable being transferred into the hallway and 4% discharged themselves against medical advice. Conclusions: The protocol for transferring ED admitted patients to inpatient hallway beds did not reduce ED length of stay for oncology patients. The timeliness and frequency of clinical assessments were not compromised; however, patient satisfaction was decreased.

scholarly journals Evaluation of an Algorithm for Automatic Grading of Forum Messages in MOOC Discussion Forums

2021 ◽  
Vol 13 (16) ◽  
pp. 9364
Author(s):  
Raquel L. Pérez-Nicolás ◽  
Carlos Alario-Hoyos ◽  
Iria Estévez-Ayres ◽  
Pedro Manuel Moreno-Marcos ◽  
Pedro J. Muñoz-Merino ◽  
...  
Keyword(s):  
Online Courses ◽  
Research Work ◽  
Massive Open Online Courses ◽  
Three Dimensions ◽  
Future Research ◽  
Discussion Forums ◽  
Automatic Assessment ◽  
Automatic Grading ◽  
The Impact

Discussion forums are a valuable source of information in educational platforms such as Massive Open Online Courses (MOOCs), as users can exchange opinions or even help other students in an asynchronous way, contributing to the sustainability of MOOCs even with low interaction from the instructor. Therefore, the use of the forum messages to get insights about students’ performance in a course is interesting. This article presents an automatic grading approach that can be used to assess learners through their interactions in the forum. The approach is based on the combination of three dimensions: (1) the quality of the content of the interactions, (2) the impact of the interactions, and (3) the user’s activity in the forum. The evaluation of the approach compares the assessment by experts with the automatic assessment obtaining a high accuracy of 0.8068 and Normalized Root Mean Square Error (NRMSE) of 0.1799, which outperforms previous existing approaches. Future research work can try to improve the automatic grading by the training of the indicators of the approach depending on the MOOCs or the combination with text mining techniques.

scholarly journals Student’s Satisfaction of the Quality of Online Learning in Higher Education: An Empirical Study

2021 ◽  
Vol 13 (21) ◽  
pp. 11960
Author(s):  
Carmen Jiménez-Bucarey ◽  
Ángel Acevedo-Duque ◽  
Sheyla Müller-Pérez ◽  
Luis Aguilar-Gallardo ◽  
Miguel Mora-Moscoso ◽  
...  
Keyword(s):  
Higher Education ◽  
Online Learning ◽  
Service Quality ◽  
Student Satisfaction ◽  
Structural Equation ◽  
Digital Transformation ◽  
Three Dimensions ◽  
Technical Service ◽  
The Impact

Higher education institutions (HEIs) have been facing a digital transformation in online learning as a result of the restrictions generated by COVID-19. Therefore, identifying which are the elements that influence student satisfaction will allow HEIs to establish strategies to ensure the quality of the digital transformation. This study proposes a model that measures student satisfaction considering three dimensions: teacher quality, technical service quality and service quality. Then, the impact of each dimension on student satisfaction is estimated using a Partial Least Squares Structural Equation Model (PLS-SEM), and finally an Importance-Performance Map Analysis (IPMA) was performed to identify the improvements that should be made to increase student satisfaction. When analyzing the responses of 1430 students at the School of Medicine, it was found that the quality of technical service should be improved, specifically training, and encouraging teachers to use strategies that allow student participation.

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