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Background Evidence on the health impacts of social conditions has led US healthcare systems to consider identifying and addressing social adversity—e.g. food, housing, and transportation insecurity—in care delivery settings. Social screening is one strategy being used to gather patient information about social circumstances at the point of care. While several recent studies describe the rapid proliferation of social screening activities, little work has explored either why or how to implement social screening in clinical settings. Our study objectives were to assess diverse healthcare stakeholder perspectives on both the rationale for social screening and evidence needed to inform practice and policy-relevant implementation decisions. Methods We convened five focus groups with US experts representing different stakeholder groups: patient advocates, community-based organizations, healthcare professionals, payers, and policymakers. In total, 39 experts participated in approximately 90-minute long focus groups conducted between January-March 2021. A inductive thematic analysis approach was used to analyze discussions. Results Three themes emerged from focus groups, each reflecting the tension between the national enthusiasm for screening and existing evidence on the effectiveness and implementation of screening in clinical settings: (1) ambiguity about the rationale for social screening; (2) concerns about the relavence of screening tools and approaches, particularly for historically marginalized populations; (3) lack of clarity around the resources needed for implementation and scaling. Conclusion While participants across groups described potential benefits of social screening, they also highlighted knowledge gaps that interfered with realizing these benefits. Efforts to minimize and ideally resolve these knowledge gaps will advance future social screening practice and policy.

Background Despite increasing commitment to patient engagement in research, evaluation of the impact of these efforts on research processes, products, and teams is limited. Objective To explore the impacts of engaging patients as consultants to research studies by examining the experiences, impacts, and lessons learned from a program facilitating patient engagement at a Veterans Health Administration research center. Design We developed a logic model to articulate the activities being implemented to support patient engagement and their anticipated outcomes. Then, we conducted qualitative, semi-structured interviews with participants in the local Veteran Consulting Network to qualitatively explore these outcomes. Participants Twelve researchers and eleven Veteran patients with experience working on at least one grant or funded study. Approach Interview transcripts were inductively coded using a consensus-based approach. Findings were synthesized using framework analysis and mapped back onto our logic model of expected patient engagement impacts. Key Results Patient engagement improved the perceived quality and relevance of research studies as patient consultants challenged researchers’ assumptions about patient populations and clinical contexts and gave feedback that helped improve the feasibility of proposed grants, readability of study materials, comprehensiveness of study assessments, and cultural sensitivity and relevance of interventions. Patient engagement also had personal benefits to researchers and patients. Researchers reported improved communication skills and higher job satisfaction. Patients reported a sense of purpose and satisfaction from their work with greater awareness of and appreciation for research. Conclusions Engaging patients in research can have multiple benefits to the people and work involved. Our evaluation process can serve as a template for other organizations to plan for and assess the impact of their own patient engagement programs. Creating logic models and updating them based on feedback from program users make engagement goals explicit, help verify expected mechanisms to achieve impact, and facilitate organizational learning.

Engaging patients in the research process helps to ensure researchers ask meaningful questions and generate useful evidence to inform healthcare decisions. In 2015, the Veterans Health Administration (VA) Health Services Research & Development (HSR&D) service convened a Veteran engagement workgroup, comprised of researchers, clinicians, and Veterans, to identify ways to integrate Veteran engagement into HSR&D. A subgroup was designated to explore the utility of health experiences research (research focused on enhancing understanding of people’s experiences with healthcare and illnesses) as a mechanism to complement and broaden traditional engagement mechanisms. The subgroup recommended the VA adopt the Database of Individual Patient Experiences (DIPEx) methodology for conducting and disseminating health experiences research (HER). In this paper, we describe (1) the key components of the DIPEx approach, (2) how these components complement and broaden current methods of Veteran engagement, (3) an update on VA activities using the DIPEx approach, and (4) a roadmap for future VA HER activities.

Driven by the movement of evidence-based practices, Bayesian statistical methods have become increasingly popular. This paper introduces a Bayesian approach to meta-regression, focusing on the use and implementation in prevention science research. We first compare Bayesian meta-analysis and meta-regression to a frequentist approach. Thereafter, we illustrate Bayesian methods in meta-regression, highlighting advantages, providing detailed interpretation, and presenting results. The example is completed using several R packages. We also provide annotated R code for readers as a foundation for their own research.

OBJECTIVE Severe maternal morbidity represents a "near miss" mortality and is an important measure of quality and safety. Racial inequity in maternal morbidity is stark and the reasons for this disparity are poorly understood. We aimed to identify states achieving racial equity in maternal morbidity in order to identify policies that may promote racial equity. METHODS We analyzed Medicaid deliveries from 2008 to 2009 in a sample that included 28 states and the District of Columbia. This dataset included approximately 80% of all Medicaid enrollees and 90% of minority Medicaid enrollees in the US. We determined the Non-Hispanic Black/Non-Hispanic white SMMI rate ratio for each state and categorized the states into groups by rate ratio. We described demographic features of both the general population and study population for these groups of states. RESULTS In a sample that included a total of 1,489,134 births, we found that no state/district is achieving equity in severe maternal morbidity. The severe maternal morbidity rate is higher for Non-Hispanic Black than Non-Hispanic white patients in every state included. With a rate ratio ranging from 1.14 to 2.66, there are varying degrees of inequity. States in the group with the most equitable maternal morbidity rates had less inequity across racial subgroups with respect to educational attainment and poverty. CONCLUSIONS Identifying geographic areas with varying degrees of inequity may be key to identifying policies to promote equity. Socioecological disparities and inadequate access to care may be factors in racial inequity in maternal morbidity.

BackgroundTo plan treatment and measure post-stroke recovery, frequent and time-bounded functional assessments are recommended. With increasing needs for neurorehabilitation advances, new technology based methods, such as virtual reality (VR) have emerged. Here, we developed an immersive VR version of the Action Research Arm Test (ARAT-VR) to complement neurorehabilitation.ObjectiveThis study aimed to assess the validity, usability and test–retest reliability of the ARAT-VR among individuals with stroke, healthcare professionals and healthy control subjects (HCS).MethodsAmong the 19 items of the ARAT, 13 items were selected and developed in immersive VR. 11 healthcare professionals, 30 individuals with stroke, and 25 HCS were recruited. Content validity was assessed by asking healthcare professionals to rate the difficulty of performing each item of the ARAT-VR in comparison to the classical Action Research Arm Test (ARAT-19). Concurrent validity was first measured using correlation (Spearman tests) between the ARAT-VR and ARAT-19 scores for the individuals with stroke, and second through correlation and comparison between the scores of the ARAT-VR and the reduced version of the ARAT (ARAT-13) for both individuals with stroke and HCS (Wilcoxon signed rank tests and Bland–Altman plots). Usability was measured using the System Usability Scale. A part of individuals with stroke and HCS were re-tested following a convenient delay to measure test–retest reliability (Intra-class correlation and Wilcoxon tests).ResultsRegarding the content validity, median difficulty of the 13 ARAT-VR items (0[0 to − 1] to 0[0–1]) evaluated by healthcare professionals was rated as equivalent to the classical ARAT for all tasks except those involving the marbles. For these, the difficulty was rated as superior to the real tasks (1[0–1] when pinching with the thumb-index and thumb-middle fingers, and 1[0–2] when pinching with thumb-ring finger). Regarding the concurrent validity, for paretic hand scores, there were strong correlations between the ARAT-VR and ARAT-13 (r = 0.84), and between the ARAT-VR and ARAT-19 (r = 0.83). Usability (SUS = 82.5[75–90]) and test–retest reliability (ICC = 0.99; p ConclusionThe ARAT-VR is a valid, usable and reliable tool that can be used to assess upper limb activity among individuals with stroke, providing potential to increase assessment frequency, remote evaluation, and improve neurorehabilitation.Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT04694833; Unique identifier: NCT04694833, Date of registration: 11/24/2020.

Case study methodology is widely used in health research, but has had a marginal role in evaluative studies, given it is often assumed that case studies offer little for making causal inferences. We undertook a narrative review of examples of case study research from public health and health services evaluations, with a focus on interventions addressing health inequalities. We identified five types of contribution these case studies made to evidence for causal relationships. These contributions relate to: (1) evidence about system actors’ own theories of causality; (2) demonstrative examples of causal relationships; (3) evidence about causal mechanisms; (4) evidence about the conditions under which causal mechanisms operate; and (5) inference about causality in complex systems. Case studies can and do contribute to understanding causal relationships. More transparency in the reporting of case studies would enhance their discoverability, and aid the development of a robust and pluralistic evidence base for public health and health services interventions. To strengthen the contribution that case studies make to that evidence base, researchers could: draw on wider methods from the political and social sciences, in particular on methods for robust analysis; carefully consider what population their case is a case ‘of’; and explicate the rationale used for making causal inferences.

Zusammenfassung Einleitung Beim Fast-Track(FT)-Konzept handelt es sich um multimodale, interdisziplinäre Maßnahmen zur perioperativen Patientenbetreuung zur Reduktion postoperativer Komplikationen. Trotz guter Evidenz erscheint die Umsetzung verbesserungswürdig, wobei sich nahezu alle Untersuchungen ungeachtet des interdisziplinären Aspektes auf die Implementierung der chirurgischen Module fokussieren. Die Adhärenz zu den anästhesiologischen Maßnahmen (präoperative Patientenoptimierung, Prämedikation, Volumen- und Wärmemanagement, Schmerztherapie) ist hingegen nur unzureichend untersucht. Um den Status quo zu erfassen, wurde eine Umfrage zur Umsetzung der anästhesiologischen FT-Bausteine unter den Mitgliedern der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI) durchgeführt und analysiert, wo mögliches Verbesserungspotenzial besteht. Methoden Mithilfe des Online-Umfragetools SurveyMonkey® wurden 28 Fragen zur perioperativen anästhesiologischen Versorgung kolorektalchirurgischer Patienten an die Mitglieder der DGAI verschickt und die Adhärenz zu den FT-Maßnahmen analysiert. Ergebnisse Während einige der FT-Maßnahmen (Wärmemanagement, PONV-Prophylaxe) bereits routinemäßig umgesetzt sind, gibt es bei anderen Bausteinen eine Divergenz zwischen den aktuellen Empfehlungen und der klinischen Umsetzung. Besonders betroffen sind neben der Prämedikation insbesondere interdisziplinäre Maßnahmen (Prähabilitation) sowie Maßnahmen, die mehrere Schnittstellen (OP, Aufwachraum (AWR), Station) betreffen, wie beispielsweise Volumenmanagement oder perioperative Schmerztherapie Fazit Die anästhesiologischen Empfehlungen des FT-Konzepts werden in Deutschland nur teilweise umgesetzt. Hiervon sind insbesondere die interdisziplinären Bausteine sowie Maßnahmen an den Schnittstellen OP-AWR-Station betroffen. Die Bildung eines interdisziplinären FT-Teams und die interdisziplinäre Ausarbeitung von SOP können die Adhärenz optimieren, was wiederum das kurz- und langfristige Outcome der Patienten verbessert.

Background Limited timely, cost-effective, and regional availability of healthcare data is considered one of the limiting factors for timely analyses in the field of health services research and thus for healthcare delivery to the general population. Thus, Internet search engine analyses are coming into focus in this context. Objectives What contribution can data on the volume of Internet searches for various diseases make to the health care of the German population? Where is the potential and where are the limitations? Methods A review of the current literature and a selective overview of Internet search engine analyses of dermatological, allergological, and infectious diseases published in the last 4 years in Germany were performed. Results By analyzing web search data, temporal developments such as seasonality, months with the highest interest, and geographical differences can be mapped at the national, state (Bundeslander), and city level and major points of interest (e.g., skin cancer of the eye or anal itching) regarding a certain health topic can be identified. In addition, some studies were able to show correlations between search volume and external factors (e.g., temperature, care structure) and to registered cases (e.g., skin cancer, Lyme disease). Conclusion Web search data, given the limitations noted, are able to directly provide spatiotemporal mapping regarding the needs of the Internet-using population. They are particularly useful in situations where traditional health data are limited or unavailable.

Index cholecystectomy is the standard of care for gallstone pancreatitis. Hospital-level operative resources and implementation of an acute care surgery (ACS) model may impact the ability to perform index cholecystectomy. We aimed to determine the influence of structure and process measures related to operating room access on achieving index cholecystectomy for gallstone pancreatitis. In 2015, we surveyed 2811 US hospitals on ACS practices, including infrastructure for operative access. A total of 1690 hospitals (60%) responded. We anonymously linked survey data to 2015 State Inpatient Databases from 17 states using American Hospital Association identifiers. We identified patients ≥ 18 years who were admitted with gallstone pancreatitis. Patients transferred from another facility were excluded. Univariate and multivariable regression analyses, clustered by hospital and adjusted for patient factors, were performed to examine multiple structure and process variables related to achieving an index cholecystectomy rate of ≥ 75% (high performers). Over the study period, 5656 patients were admitted with gallstone pancreatitis and 70% had an index cholecystectomy. High-performing hospitals achieved an index cholecystectomy rate of 84.1% compared to 58.5% at low-performing hospitals. On multivariable regression analysis, only teaching vs. non-teaching hospital (OR 2.91, 95% CI 1.11–7.70) and access to dedicated, daytime operative resources (i.e., block time) vs. no/little access (OR 1.93, 95% CI 1.11–3.37) were associated with high-performing hospitals. Access to dedicated, daytime operative resources is associated with high quality of care for gallstone pancreatitis. Health systems should consider the addition of dedicated, daytime operative resources for acute care surgery service lines to improve patient care.

Zusammenfassung Hintergrund In Deutschland gibt es bisher keine Gesundheitsberichterstattung zu sektorenübergreifenden Versorgungsverläufen im Kontext einer Notaufnahmeversorgung. Das Projekt INDEED (Inanspruchnahme und sektorenübergreifende Versorgungsmuster von Patienten in Notfallversorgungsstrukturen in Deutschland) erhebt Routinedaten aus 16 Notaufnahmen, die mit ambulanten Abrechnungsdaten der Jahre 2014 bis 2017 personenbezogen zusammengeführt werden. Ziel der Arbeit Die methodischen Herausforderungen der Planung der internen Zusammenführung von klinischen und administrativen Routinedaten aus Notaufnahmen in Deutschland bis zur finalen Datenextraktion werden hier gemeinsam mit Lösungsansätzen dargestellt. Methodik Die Auswahl der Notaufnahmedaten erfolgte in einem iterativen Prozess unter Berücksichtigung der Forschungsfragen, medizinischen Relevanz und angenommenen Datenverfügbarkeit. Nach einer Vorbereitungsphase zur Klärung der Rahmenbedingungen (u. a. Datenschutz, Ethik), zur Prüfung von Testdaten und ggf. Korrekturen, erfolgte die verschlüsselte und pseudonyme Datenausleitung. Ergebnisse Die Daten der 16 kooperierenden Notaufnahmen stammten in der Regel aus dem Notaufnahme- und dem Krankenhausinformationssystem. Die Datenlage war sehr heterogen. Nicht alle Variablen waren in jeder Notaufnahme verfügbar, da sie beispielsweise nicht standardisiert und digital vorlagen oder der Extraktionsaufwand als zu hoch bewertet wurde. Schlussfolgerung Relevante Daten aus Notaufnahmen liegen unterschiedlich strukturiert und in mehreren IT-Systemen vor. Die notwendige Bildung eines klinikübergreifenden vergleichbaren Datensatzes erfordert erhebliche Ressourcen auf Seiten der Kliniken sowie der datenaufbereitenden Stelle. Dies muss für zukünftige Projekte großzügig kalkuliert werden.

To assess the potential benefit from the implementation of the Kaiser Permanente early-onset sepsis calculator (EOS-C), in terms of antibiotic use and requested laboratory tests, in a network of neonatal intensive care units (NICUs) in Greece, and to determine the incidence of early-onset sepsis (EOS) in Greek NICUs, a prospective surveillance study was conducted in 7 NICUs between April 2018 and June 2019. Data were collected for all newborns ≥ 34 weeks’ gestation receiving empiric antibiotic therapy within the first 3 days of life. The number of live births and positive blood or cerebrospinal fluid cultures within the first 3 days of life were used for calculation of EOS incidence. Evaluation of possible impact of implementing the calculator was done by comparing the clinicians’ recorded management to the calculator’s suggested course of action. The unit-specific incidence of culture-proven EOS ranged between 0 and 2.99/1000 live births. The weighted incidence rate for all 7 units was 1.8/1000 live births. Management of EOS guided by the calculator could lead to a reduction of empiric antibiotic initiation up to 100% for the group of “well-appearing” neonates and 86% for “equivocal,” lowering exposure to antibiotics by 4.2 and 3.8 days per neonate, respectively. Laboratory tests for blood cultures drawn could be reduced by up to 100% and 68%, respectively. Sensitivity of the EOS-C in identifying neonates with positive blood cultures was high. Conclusion: Management strategies based on the Kaiser Permanente neonatal sepsis calculator may significantly reduce antibiotic exposure, invasive diagnostic procedures, and hospitalizations in late preterm and term neonates.

Self-harm is a common behavior in adolescents presenting for treatment of mental illness. This article reviews aspects of the clinical impact of youth self-harm that are of import to practicing psychologists and allied clinicians. Specific therapeutic approaches to engaging youth are described including the use of therapy commitment strategies, reinforcement of change behaviors, and involving caregivers in various stages of treatment. Description of evidence-based assessment (behavioral assessment and functional assessment) and treatment (identifying potential replacement behaviors and motivational factors) are reviewed while building on existing crisis safety planning interventions. The authors present a framework for self-harm cessation in adolescent youth whereby assessment and behavioral treatment inform each other to reduce and ultimately stop self-harm behavior.

Scabies is one of the most common and, in terms of burden of disease, one of the most significant skin diseases worldwide. In Germany, an increase in cases is currently being discussed, for which reliable data have been lacking until now.The goal is to clarify the prevalence and treatment of scabies in Germany.Multisource analyses of treatment data from a nationwide statutory health insurance company, the Federal Statistical Office and company skin screenings.In Germany, the number of cases of scabies has been rising since 2009 and especially since 2014. In the outpatient setting, there was an increase of 52.8% to around 128,000 treatment cases between 2010 and 2015. Currently, more than 11,000 inpatient cases are documented annually in Germany with scabies as the main diagnosis (ICD-10 B86). The increase between 2010 and 2016 was about 306%. The main outpatient specialist groups providing care are dermatologists and general practitioners, while in the inpatient sector treatment is provided by departments of dermatology, paediatrics and internal medicine.Due to the aforementioned development of prevalence and incidence, the need for care will remain at a high level in the future, which suggests an increased need for education and early detection.HINTERGRUND: Skabies stellt weltweit eine der häufigsten und hinsichtlich der Krankheitslast bedeutendsten Hautkrankheiten dar. In Deutschland wird derzeit eine Zunahme von Fällen diskutiert, wofür bisher belastbare Zahlen fehlten.Häufigkeit und Versorgungsmerkmale der Skabies in Deutschland.Multi-Source-Analysen aus Versorgungsdaten einer bundesweiten gesetzlichen Krankenversicherung, des Statistischen Bundesamtes und von betrieblichen Hautscreenings.In Deutschland weist Skabies seit 2009 und insbesondere seit 2014 eine steigende Versorgungsprävalenz auf. Im ambulanten Bereich findet sich ein Anstieg zwischen 2010 und 2015 von 52,8 % auf etwa 128.000 Behandlungsfälle. Stationär werden in Deutschland derzeit jährlich über 11.000 Fälle mit Skabies als Hauptdiagnose (ICD-10 B86) dokumentiert. Der Anstieg zwischen 2010 und 2016 betrug etwa 306 %. Hauptversorgende ambulante Fachgruppen sind Dermatologen und Hausärzte, im stationären Bereich Fachabteilungen für Dermatologie, Pädiatrie und Innere Medizin.Der Versorgungsbedarf wird zukünftig aufgrund der vorgenannten Entwicklung von Prävalenz und Inzidenz weiter auf einem hohen Niveau bleiben, was einen erhöhten Aufklärungs- und Früherkennungsbedarf nahelegt.

To identify patient-level barriers and facilitators to completion of patient-reported outcomes measures (PROMs) in a hand and upper extremity clinic in Baltimore, Maryland. We conducted 12 h of direct observation of PROM completion (October–November, 2020). Ethnographic observation memos were qualitatively analyzed for barriers and facilitators using rapid thematic analysis. Informed by observation findings, we conducted 17 semi-structured interviews with mixed-literacy patients, caregivers, and clinic staff to understand the patient experience when completing PROMs (November 2020–March 2021). We identified initial themes through inductive and deductive framework analysis and validated findings through subsequent interviews with member-checking. We identified nine patient-level factors that influence PROM completion: platform design, print literacy, health literacy, technology literacy, language proficiency, physical functioning, vision, cognitive functioning, and time. There are multiple distinct patient-level factors that affect PROM completion. Failure to consider these factors in PROM design and implementation may lower completion rates or prevent accurate completion, undermining PROM validity. Because certain factors affect minority populations at disproportionate rates, this may also contribute to existing health disparities.

The conservative and surgical treatment of children is a fundamental pillar of the urological specialist training program and represents one of the core competencies within urological healthcare. The loss of this expertise has been a reoccurring topic within urologic occupational policy. The aim of this study is to analyse actual case numbers and to compare the distribution and dynamics of pediatric urologic surgeries between the specialist departments of urology and pediatric surgery in Germany.We defined the surgical treatments of maldecensus testis, hypospadias, and vesicoureteral reflux (VUR) as index interventions. Using the tool reimbursement.INFO (RI Innovation GmbH, Hürth, Germany) we analysed publicly available quality report data of German hospitals between 2006 and 2019.While orchidopexy was more commonly performed in the field of urology, the correction of hypospadias and the surgical treatment of VUR showed higher case numbers in the field of pediatric surgery. Proportionally, there was no relevant shift between urologic and pediatric surgical clinics for orchidopexy and surgical VUR therapy during the study period. For hypospadias corrections, the proportion of surgeries performed in pediatric surgical units is increasing (p 0.0001). In pediatric surgery 84-93% of the analyzed procedures are performed in high-volume units, while this proportion is 56-73% in urology. In particular, a high proportion of VUR therapy in urology is performed as an occasional procedure (30% very low volume).The quality report data enable the compilation of case numbers and the analysis of the distribution between urology and pediatric surgery in Germany. Merely the correction of hypospadias has shown a relevant shift towards pediatric surgery. The causes and possible consequences for professional policy of this preliminary investigation are complex and require further analysis.HINTERGRUND: Die konservative und chirurgische Behandlung von Kindern ist in der urologischen Facharztweiterbildung fest verankert und stellt eine Kernkompetenz der urologischen Versorgung dar. Berufspolitisch wird seit vielen Jahren ein zunehmender Verlust dieses Schwerpunkts befürchtet. Ziel dieser Studie ist es, reale Fallzahlen und eine mögliche Dynamik in der Verteilung kinderurologischer Eingriffe auf die Fachabteilungen für Urologie und Kinderchirurgie in Deutschland zu prüfen.Als Index-Eingriffe definierten wir Operationen des Hodenhochstands, der Hypospadie und des vesikoureteralen Refluxes (VUR). Mithilfe der Software reimbursement.INFO (RI Innovation GmbH, Hürth) werteten wir die öffentlich zugänglichen Qualitätsberichtsdaten der deutschen Krankenhäuser von 2006 bis 2019 aus und wiesen sie den entsprechenden Fachrichtungen zu.Die Orchidopexie erfolgt häufiger in der Urologie, wohingegen die Hypospadiekorrektur und die operative Therapie des VUR häufiger in der Kinderchirurgie durchgeführt werden. Anteilig zeigte sich für die Orchidopexie und die operative Refluxtherapie keine relevante Verschiebung zwischen urologischen und kinderchirurgischen Kliniken im Untersuchungszeitraum. Bei den Hypospadiekorrekturen nimmt der Anteil der Operationen in kinderchirurgischen Einheiten zu (p 0,0001). In der Kinderchirurgie erfolgen 84–93 % der analysierten Eingriffe in High-volume-Abteilungen während dieser Anteil in der Urologie bei 56–73 % liegt. Insbesondere die operative Refluxtherapie in der Urologie erfolgt zu einem hohen Anteil als Gelegenheitseingriff (30 % „very low volume“).Die Qualitätsberichtsdaten ermöglichen die Erfassung der Fallzahlen und die Analyse der Verteilung zwischen Urologie und Kinderchirurgie in Deutschland. Dabei ist für die Hypospadiekorrektur eine relevante Verschiebung in Richtung der Kinderchirurgie zu beobachten. Die Ursachen und möglichen berufspolitischen Konsequenzen dieser ersten Erhebung sind komplex und bedürfen weiterer Analysen.

Background Health services research often relies on quasi-experimental study designs in the estimation of treatment effects of a policy change or an intervention. The aim of this study is to compare some of the commonly used non-experimental methods in estimating intervention effects, and to highlight their relative strengths and weaknesses. We estimate the effects of Activity-Based Funding, a hospital financing reform of Irish public hospitals, introduced in 2016. Methods We estimate and compare four analytical methods: Interrupted time series analysis, Difference-in-Differences, Propensity Score Matching Difference-in-Differences and the Synthetic Control method. Specifically, we focus on the comparison between the control-treatment methods and the non-control-treatment approach, interrupted time series analysis. Our empirical example evaluated the length of stay impact post hip replacement surgery, following the introduction of Activity-Based Funding in Ireland. We also contribute to the very limited research reporting the impacts of Activity-Based-Funding within the Irish context. Results Interrupted time-series analysis produced statistically significant results different in interpretation, while the Difference-in-Differences, Propensity Score Matching Difference-in-Differences and Synthetic Control methods incorporating control groups, suggested no statistically significant intervention effect, on patient length of stay. Conclusion Our analysis confirms that different analytical methods for estimating intervention effects provide different assessments of the intervention effects. It is crucial that researchers employ appropriate designs which incorporate a counterfactual framework. Such methods tend to be more robust and provide a stronger basis for evidence-based policy-making.

Introduction Since hospitals play an important role in dealing with disaster victims, this study was conducted to audit the functional preparedness of the selected military hospital in response to incidents and disasters. Materials and methods This applied action research was conducted in all wards of a military hospital from September 2020 to September 2021. The functional preparedness of the hospital was assessed using a functional preparedness checklist containing 17 domains and the weaknesses of the hospital were identified. Then, during the hospital audit cycle, a plan was developed to improve work processes and the functional preparedness of different wards of the hospital in response to incidents and disasters using the FOCUS-PDCA model. The functional preparedness of the hospital was compared before and after the intervention and analyzed using SPSS22. Results The relative mean score of hospital preparedness in response to disasters was 508 out of 900 (56.44%) before the intervention, which was moderate. The relative mean score of the hospital preparedness in response to disasters was 561 (63.63%) after the intervention, which was good. The highest preparedness was related to risk assessment (85%) and the lowest preparedness was related to victims’ dead bodies (44%). Conclusion Considering the effect of action research on improving the hospital’s functional preparedness in response to disasters, other healthcare facilities are encouraged to incorporate auditing into their work plans.

Valid measures of behavioral health integration have the potential to enable comparisons of various models of integration, contribute to the overall development of high-quality care, and evaluate outcomes that are strategically aligned with standard improvement efforts. The Practice Integration Profile has proven to discriminate among clinic types and integration efforts. We continued the validation of the measure’s internal consistency, intra-rater consistency, and inter-rater consistency with a separate and larger sample from a broader array of practices. We found that the Practice Integration Profile demonstrated a high level of internal consistency, suggesting empirically sound measurement of independent attributes of integration, and high reliability over time. The Practice Integration Profile provides internally consistent and interpretable results and can serve as both a quality improvement and health services research tool.

With the recognition of different population behavior and relevance of socio-cultural factors in health, health services and public health program contexts, qualitative research is increasingly being used in health research, including clinical trials. Qualitative research follows an inductive framework to explore and gain an in-depth understanding of the phenomena, especially why and how aspects, through techniques including interviews, focus groups and observations. It analyzes the textual data collected following one of the common analysis approaches: grounded theory, phenomenology, ethnography or participatory action research. Despite the divergence in principles, mixed methods research designs systematically combine the quantitative and qualitative methods for a comprehensive understanding on the issue. The commonly used mixed methods designs variably combine the purpose, priority, sequence, embedding and data integration. Mixed methods analysis requires strategic synthesis of the results to gain comprehensive knowledge for appropriate clinical or public health action.

It is estimated that 50–75% of adults have been exposed to one re more forms of interpersonal violence (IV), defined as violence directed between family members, intimate partners, acquaintances, strangers, or members of a community. IV often involves repeated exposure to traumatic stressors and other forms of adversity, particularly when it is first experienced during childhood. The experience of IV is also associated with negative effects across domains of functioning that can be varied and complex. Accordingly, psychological assessment of IV and its impact will be most beneficial if it is approached multidimensionally and takes into account the diversity of diagnostic categories and psychosocial domains that are impacted by exposure to IV. In this article we provide practical strategies and recommendations for assessing IV and its impact, including guidance on how to conduct a comprehensive assessment with an emphasis on involving clients collaboratively in the process. Specific recommendations are provided for setting the assessment frame, assessing strengths and needs, and providing feedback on results.

In the modern era, concerns over school-related gun violence are as high as ever. In their clinical work, psychologists who work with youth may encounter reports of real threats of gun violence at school. In this article, the author presents a case vignette in which a middle-school client reports having documented knowledge that a peer brought a gun to school. The author explores the ethical decision-making and other practical considerations in choosing to intervene and report the gun possession to school personnel. The author outlines not only measures to protect the client but also considerations in protecting and advocating for the student who actually brought the gun to school.

Implicit bias and health-related stigma can impact patient-provider communication, particularly related to pediatric chronic conditions that are currently increasing in incidence. This paper highlights the intersection of stigma and bias in health care using a complex clinical vignette to illustrate ethical problem-solving and patient-centered communication through motivational interviewing. Motivational interviewing may improve patient-centered communication and assist in navigating ethical considerations for youth facing stigmatizing conditions such as obesity, chronic pain, and major depression. Clinical considerations for health service psychologists are provided and tailored for gender identity, race/ethnicity, and other relevant sociocultural considerations. Psychologists play an important role in providing education and training to other health professionals on motivational interviewing strategies to facilitate ethical problem-solving and foster more effective patient-provider communication for youth facing stigma in health care settings.

Firefighters are chronically exposed to trauma as well as occupational and relational stressors. Furthermore, firefighters are faced with cultural and structural barriers in accessing psychological treatment services. Symptoms of posttraumatic stress disorder, depression, anxiety, and alcohol use disorder are prevalent, and suicidal ideation and behavior pose a significant public health concern. Awareness of fire culture is necessary for developing and enhancing evidence-based treatment services and increasing treatment initiation and adherence in this resilient, vulnerable, and understudied population. An overview of the mental health landscape of the fire service is provided, and major assessment and treatment issues are explored.

BACKGROUND Long lags exist in adoption and uptake of evidence-based interventions into real-world clinical practice based on oncology clinical trial results. Implementation science (IS) is a distinct field of health services research that aims to understand the barriers related to adoption of evidence-based guidelines and research in clinical practice. METHODS Use of IS study design, methods, and outcomes can be elusive to surgical oncologists despite the tremendous need for the application of IS to bridge the evidence-to-practice gap. This report describes key components of high-quality IS. RESULTS Herein, we illustrate how IS can be used in surgical oncology practice. Examples from implementation of the breast cancer Short Stay Program (SSP) in Netherlands is used to illustrate IS methods. Specific funding and training opportunities in implementation science are described in detail. CONCLUSION Use of IS in surgical oncology can help improve the uptake of evidence based medicine.

To introduce Random Forest (RF), a machine learning method, in an accessible way for health services researchers and highlight its unique considerations when applied to health administrative data. Physician claims’ data from the universal public insurer linked with the Canadian Community Health Survey for the Canadian province of Quebec. We describe in detail how RF can be useful in health services research, provide guidance on data set up, modeling decisions and demonstrate how to interpret results. We also highlight specific considerations for applying RF to health administrative data. In a working example, we compare RF with logistic regression, Ridge regression and LASSO in their ability to predict whether a person has a regular medical doctor. We use survey responses to “do you have a regular medical doctor” from three cycles of the Canadian Community Health Survey (2007, 2009, 2011). Responses are linked with physician claims’ data from 2002 to 2012. We limit our cohort to persons 40 years and older at the time of responding to the survey. We discuss the strengths and weaknesses of using RF in a health services research setting in comparison to using more conventional modeling techniques. Applying a RF model in a health services research setting can have advantages over conventional modeling approaches and we encourage health services researchers to add RF to their toolbox of predictive modeling methods.

Purpose To provide the first Norwegian EQ-5D-5L and EQ VAS population norms for the adult general population. Methods Postal survey of a random sample of 12,790 Norwegians identified through the National Registry of the Norwegian Tax Administration. Norms, weighted for Norwegian general population characteristics, are shown for the five EQ-5D-5L dimensions, EQ-5D index, and EQ VAS scores for seven age categories, females, males, and education level. Results There were 3200 (25.9%) respondents to 12,263 correctly addressed questionnaires. The EQ-5D-5L dimensions, EQ VAS, and background questions were completed by 3120 (24.6%) respondents. The mean age (SD) was 50.9 (21.7) and range was 18–97 years. The youngest age group of 18–29 years and oldest of 80 years and over had the highest (n = 691) and lowest (n = 239) number of respondents, respectively. Compared to the general population, the respondents comprised a greater number of females, younger and older ages, and had a higher education level. 32% of respondents reported no health problems on the EQ-5D-5L. From the youngest to oldest age groups, there was a general decline in health as assessed by the EQ-5D-5L. The exception was for anxiety/depression, where the youngest age groups had the poorest health. Apart from self-care, women reported poorer health than men, as assessed by the EQ-5D-5L; EQ VAS scores were similar for men and women. Higher levels of health (EQ-5D index, EQ VAS scores) were found with increasing levels of education. Conclusion The population norms will improve interpretation of EQ-5D-5L and EQ VAS scores in Norwegian applications including clinical practice, clinical and health services research, and national quality registers where EQ-5D-5L is the most widely used patient-reported instrument.

Religious practices can raise the sense of merit and hope through overcoming the feeling of isolation. Studies conducted in this area have indicated that patients may desire to have their spiritual needs met. Nonetheless, sufficient attention has not been paid to these special needs. Therefore, this study aimed to identify the barriers to the provision of spiritual care for hospitalized patients. This is an action research study in which a total of 11 nurses and 76 hospitalized patients were recruited using purposive and convenience sampling, respectively. Data were collected using a combination of qualitative and quantitative methods. In the action cycles, the participants' concerns were examined, constructed, then evaluated, and re-constructed using reflective assessment. The qualitative and quantitative data were analyzed using the content analysis approach and the Mann–Whitney U, Chi-squared, and t-tests, respectively. At the first stage, the results of the content analysis showed the lack of professional knowledge and the existence of organizational barriers in the provision of spiritual care for patients. Reflection in the final stage led to the discovery of four concepts including (a) perceived advantages of change in performance, (b) being capable of providing spiritual care, (c) getting positive feedback, and (d) preparation for improving the provision of spiritual care. The results of the quantitative analysis indicated a significant increase in the mean score of patient satisfaction after the provision of spiritual care (p = .001). The results of this study led the authors to a deeper understanding of various dimensions of spiritual care among patients hospitalized in the cardiology ward and ultimately improved the patients and their families' level of satisfaction.

Background Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality. Methods Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist. Results Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies. Conclusion Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing.

Background To provide high quality services in increasingly complex, constantly changing circumstances, healthcare organizations worldwide need a high level of resilience, to adapt and respond to challenges and changes at all system levels. For healthcare organizations to strengthen their resilience, a significant level of continuous learning is required. Given the interdependence required amongst healthcare professionals and stakeholders when providing healthcare, this learning needs to be collaborative, as a prerequisite to operationalizing resilience in healthcare. As particular elements of collaborative working, and learning are likely to promote resilience, there is a need to explore the underlying collaborative learning mechanisms and how and why collaborations occur during adaptations and responses. The aim of this study is to describe collaborative learning processes in relation to resilient healthcare based on an investigation of narratives developed from studies representing diverse healthcare contexts and levels. Methods The method used to develop understanding of collaborative learning across diverse healthcare contexts and levels was to first conduct a narrative inquiry of a comprehensive dataset of published health services research studies. This resulted in 14 narratives (70 pages), synthesised from a total of 40 published articles and 6 PhD synopses. The narratives where then analysed using a thematic meta-synthesis approach. Results The results show that, across levels and contexts, healthcare professionals collaborate to respond and adapt to change, maintain processes and functions, and improve quality and safety. This collaboration comprises activities and interactions such as exchanging information, coordinating, negotiating, and aligning needs and developing buffers. The learning activities embedded in these collaborations are both activities of daily work, such as discussions, prioritizing and delegation of tasks, and intentional educational activities such as seminars or simulation activities. Conclusions Based on these findings, we propose that the enactment of resilience in healthcare is dependent on these collaborations and learning processes, across different levels and contexts. A systems perspective of resilience demands collaboration and learning within and across all system levels. Creating space for reflection and awareness through activities of everyday work, could support individual, team and organizational learning.

Introduction Alliance for Clinical Trials in Oncology (Alliance) coordinated trials utilize Medidata Rave® (Rave) as the primary clinical data capture system. A growing number of innovative and complex cancer care delivery research (CCDR) trials are being conducted within the Alliance with the aims of studying and improving cancer-related care. Because these trials encompass patients, providers, practices, and their interactions, a defining characteristic of CCDR trials is multilevel data collection in pragmatic settings. Consequently, CCDR trials necessitated innovative strategies for database development, centralized data management, and data monitoring in the presence of these real-world multilevel relationships. Having real trial experience in working with community and academic centers, and having recently implemented five CCDR trials in Rave, we are committed to sharing our strategies and lessons learned in implementing such pragmatic trials in oncology. Methods Five Alliance CCDR trials are used to describe our approach to analyzing the database development needs and the novel strategies applied to overcome the unanticipated challenges we encountered. The strategies applied are organized into 3 categories: multilevel (clinic, clinic stakeholder, patient) enrollment, multilevel quantitative and qualitative data capture, including nontraditional data capture mechanisms being applied, and multilevel data monitoring. Results A notable lesson learned in each category was (1) to seek long-term solutions when developing the functionality to push patient and non-patient enrollments to their respective Rave study database that affords flexibility if new participant types are later added; (2) to be open to different data collection modalities, particularly if such modalities remove barriers to participation, recognizing that additional resources are needed to develop the infrastructure to exchange data between that modality and Rave; and (3) to facilitate multilevel data monitoring, orient site coordinators to the their trial’s multiple study databases, each corresponding to a level in the hierarchy, and remind them to establish the link between patient and non-patient participants in the site-facing NCI web-based enrollment system. Conclusion Although the challenges due to multilevel data collection in pragmatic settings were surmountable, our shared experience can inform and foster collaborations to collectively build on our past successes and improve on our past failures to address the gaps.

Background Resilient healthcare research studies how healthcare systems and stakeholders adapt and cope with challenges and changes to enable high quality care. Team leaders are seen as central in coordinating clinical care, but research detailing their contributions in supporting adaptive capacity has been limited. This study aims to explore and describe how leaders enable adaptive capacity in hospital teams. Methods This article reports from a multiple embedded case study in two Norwegian hospitals. A case was defined as one hospital containing four different types of teams in a hospital setting. Data collection used triangulation of observation and interviews with leaders, followed by a qualitative content analysis. Results Leaders contribute in several ways to enhance their teams’ adaptive capacity. This study identified four key enablers; (1) building sufficient competence in the teams; (2) balancing workload, risk, and staff needs; (3) relational leadership; and (4) emphasising situational understanding and awareness through timely and relevant information. Conclusion Team leaders are key actors in everyday healthcare systems and facilitate organisational resilience by supporting adaptive capacity in hospital teams. We have developed a new framework of key leadership enablers that need to be integrated into leadership activities and approaches along with a strong relational and contextual understanding.

Background Knowledge mobilisation is a term used in healthcare research to describe the process of generating, sharing and using evidence. ‘Co’approaches, such as co-production, co-design and co-creation, have been proposed as a way of overcoming the knowledge to practice gap. There is a need to understand why researchers choose to adopt these approaches, how they achieve knowledge mobilisation in the management of health conditions, and the extent to which knowledge mobilisation is accomplished. Methods Studies that explicitly used the terms co-production, co-design or co-creation to mobilise knowledge in the management of health conditions were included. Web of Science, EMBASE via OvidSP, MEDLINE via OvidSP and CINHAL via EBSCO databases were searched up to April 2021. Quality assessment was carried out using the Joanna Briggs Institute qualitative quality assessment checklist. Pluye and Hong’s seven steps for mixed studies reviews were followed. Data were synthesised using thematic synthesis. Results Twenty four international studies were included. These were qualitative studies, case studies and study protocols. Key aspects of ‘co’approaches were bringing people together as active and equal partners, valuing all types of knowledge, using creative approaches to understand and solve problems, and using iterative prototyping techniques. Authors articulated mechanisms of action that included developing a shared understanding, identifying and meeting needs, giving everyone a voice and sense of ownership, and creating trust and confidence. They believed these mechanisms could produce interventions that were relevant and acceptable to stakeholders, more useable and more likely to be implemented in healthcare. Varied activities were used to promote these mechanisms such as interviews and creative workshops. There appeared to be a lack of robust evaluation of the interventions produced so little evidence in this review that ‘co’approaches improved the management of health conditions. Conclusion Those using ‘co’approaches believed that they could achieve knowledge mobilisation through a number of mechanisms, but there was no evidence that these led to improved health. The framework of key aspects and mechanisms of ‘co’approaches developed here may help researchers to meet the principles of these approaches. There is a need for robust evaluation to identify whether ‘co’approaches produce improved health outcomes. Trial Registration PROSPERO CRD42020187463.

Purpose Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. Methods We analysed administrative case–based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression. Results The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures. Conclusion Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

Sweeping reviews will be conducted once the COVID-19 pandemic concludes to support public health system strengthening. Unfortunately, these reviews will find what past reviews on public health in Canada have found: limited evidence on the organization, financing, and delivery of public health services. This is due to inattention to the field of public health services and systems research (PHSSR) in Canada. To avoid this pandemic becoming "just another public health crisis," PHSSR must be prioritized by public health and health service research associations, funders, and scholars.RéSUMé: Des révisions en profondeur seront menées à la conclusion de la COVID-19 pour appuyer le renforcement du système de santé publique. Malheureusement, ces révisions constateront les mêmes conclusions que les revues antérieures sur la santé publique au Canada : les preuves sur l’organisation, le financement et la prestation des services de santé publique sont limitées. Cela est dû au manque d’attention au domaine de la recherche sur les systèmes et les services de santé publique (RSSSP) au Canada. Afin d’éviter que cette pandémie ne devienne « rien qu’une autre crise de santé publique », la RSSSP doit être une priorité pour les associations de recherche, les donateurs et les universitaires de la santé publique et des services de santé.

Complex posttraumatic stress disorder (C-PTSD) can result from ongoing and repeated exposure to trauma, particularly in childhood. The trauma is frequently in the form of physical, emotional, or sexual abuse perpetrated by those in a position of trust such as a parent or other relative, teacher, caregiver, or clergyman. Treating those with C-PTSD is centered on the formation of a strong therapeutic alliance. This article examines how to diagnose C-PTSD and how the therapeutic alliance can be built with patients who have had their trust betrayed by the very people who should have protected them. It also covers a three-part approach to therapy that focuses on (1) coping in the here and now, (2) addressing the root cause of trauma, and (3) moving forward.

Chronic kidney disease (CKD) affects 15% of the United States (US) population (or 1 in 7 adults), yet many psychologists have limited training in the psychological treatment of CKD as well as how CKD impacts other behavioral health issues. Having a foundational understanding of the pathophysiology of CKD can facilitate psychological treatment options between the clinician and patient with CKD. In addition, it is helpful to use a conceptual framework such as the Stages of Change (Transtheoretical Model/TTM) to select the most appropriate, patient-centered intervention. We outline common contextual issues that may occur in patients with CKD and present examples of phrases that can be used with patients hesitant to engage in psychological treatment.

Psychogastroenterology is the specialty treatment of patients living with chronic illnesses that affect the digestive tract using evidence-based methods, the most often being cognitive behavioral therapy tailored to the digestive illness and gut-directed hypnotherapy. While patients with all digestive conditions are referred for services, the most common are irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Clinical interventions target disease processes, including visceral hypersensitivity and autonomic nervous system arousal, while leveraging resilience and coping strategies to enhance patient self-management of their disease. Opportunities exist for psychologists both in integrated gastroenterology clinics and in private practice settings. The protocols and clinical process of working with the patient are described in detail.

Adverse childhood experiences (ACEs) have been associated with increased mental health difficulties across a lifespan. Given increased health disparities among Indigenous populations compared to non-Indigenous populations, screening for ACEs is particularly relevant as it can inform future preventative care and treatment approaches. There has been no literature to date about how to best integrate these practices into routine psychological assessment with Indigenous clients. We describe five recommendations for assessing ACEs with Indigenous clients that are based on anecdotal research and clinical practices but aligned with standard evidence-based assessment practices. The preliminary recommendations for ACE assessment are: (1) determine the relevance of the assessment, (2) convey a sense of purpose and meaning during assessment, (3) use therapeutic assessment techniques, (4) use the ACE model for further client psychoeducation, and (5) use culturally relevant measurement techniques. These suggestions may provide a more meaningful and culturally relevant psychological assessment, but research is needed to support them.

A multi-dimensional construct of Catholic health care is examined using a bibliometric analysis of 181 scientific studies from the Web of Science database. Medical ethics, religion, and health services research by 418 authors from 26 countries reveals developments in the Catholic health care domain since 1973. Using VOSviewer, we map keyword clusters to reveal the structure of research on Catholic health care that transcends religious and secular literatures. The clusters mostly reflect clinical and ethical issues of reproductive health and the end of life, as well as the essence and the future of the Catholic identity from the theological and empirical perspectives.

Background Data suggest that there were disparities in H1N1 vaccine uptake, and these may inform COVID-19 vaccination efforts. We conducted a systematic review to evaluate disparities in H1N1 vaccine uptake, factors contributing to disparities, and interventions to reduce them. Methods We searched English-language articles in MEDLINE ALL, PsycINFO, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials from database inception through May 8, 2020. Observational studies examining H1N1 vaccine uptake by race/ethnicity, socioeconomic status, rurality, and disability status in US settings were included. Two reviewers independently assessed study eligibility. Single-reviewer data abstraction was confirmed by a second reviewer. We conducted independent dual quality assessment, and collective strength of evidence assessment. Results We included 21 studies. African American/Black, Latino, and low-socioeconomic status participants had disproportionately lower H1N1 vaccination rates (low- to moderate-strength evidence). However, Latinos were more likely than Whites to intend to be vaccinated, and African American/Blacks and participants with lower-socioeconomic status were just as likely to intend to be vaccinated as their White and higher-socioeconomic status counterparts (low-strength evidence). Vaccine uptake for other groups has been insufficiently studied. Factors potentially contributing to disparities in vaccine uptake included barriers to vaccine access, inadequate information, and concerns about vaccine safety and efficacy. Studies were largely cross-sectional. Many of the studies are a decade old and were conducted in the context of a different pandemic. The categorization of racial and ethnic groups was not consistent across studies and not all groups were well-studied. Discussion Efforts to avoid disparities in COVID-19 vaccination uptake should prioritize vaccine accessibility and convenience in African American/Black, Latino, and low-SES communities; engage trusted stakeholders to share vaccine information; and address concerns about vaccine safety and efficacy. Primary Funding Source Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development. Protocol Registration PROSPERO CRD42020187078 Supplementary Information The online version contains supplementary material available at 10.1007/s11606-021-06715-7.

This study aimed to evaluate health service utilization in Spain among long-term breast cancer survivors and to compare it with that among women with no history of breast cancer. Study based on the SURBCAN cohort includes a sample of long-term breast cancer survivors and a sample of women without breast cancer from 5 Spanish regions. Healthcare utilization was assessed through primary care, hospital visits, and tests during the follow-up period (2012 to 2016) by using electronic health records. Annual contact rates to healthcare services were calculated, and crude and multivariate count models were fitted to estimate the adjusted relative risk of healthcare services use. Data were obtained from 19,328 women, including 6512 long-term breast cancer survivors. Healthcare use was higher among breast cancer survivors (20.9 vs 16.6; p 10 years of survival. Breast cancer survivors who underwent a mastectomy were more likely to have a primary care visit (RR = 3.10 95% CI 3.08–3.11). Five to ten years survivors were more likely to have hospital inpatient visits and imaging test compared to women without breast cancer (RRa = 1.35 95% CI 1.30–1.39 and RRa = 1.27 95% CI 1.25–1.29 respectively). This study shows higher use of health services in long-term breast cancer survivors than in women without breast cancer regardless of survival time. These results help to estimate the health resources needed for the growing group of breast cancer survivors and to identify risk factors that drive higher use of health services.

Background Evidence on patient medication knowledge and associated factors within primary care patients is limited, especially in developing countries. Objective To estimate the prevalence and investigate the role of individual and contextual factors on insufficient medication knowledge among primary care patients. Setting Public community pharmacies in a health pole city (234,937 inhab.) in Minas Gerais State, Brazil. Methods Exit-survey conducted with a representative sample of 1221 patients (≥ 18 years) interviewed after dispensing. Data collected for medicines included its name, therapeutic indication, dosage, time of administration, treatment duration, side effects and warnings. Information were compared to the prescription and official guidelines. Descriptive statistics and logistic regression analysis were applied. Main outcome measure Insufficient patient medication knowledge. Results Prevalence of insufficient medication knowledge was 30.1%. Side effects (96.3%) and warnings (71.1%) had the highest percentage of misses. Musculoskeletal system drugs presented the lowest knowledge score (mean = 5.9; SD = 1.9). Significant determinants of insufficient medication knowledge with respective odds ratio (OR) were: level of education (≤ 3 years, OR 1.50; 95% CI 1.06–2.11 and 4–7 years, OR 1.37; 95% CI 1.02–1.84), number of comorbidities (≤ 2, OR 1.36; 95% CI 1.04–1.77), use of prescription drugs in the last 15 days (no, OR 2.22; 95% CI 1.31–3.76) and number of people able to lend money (no person, OR 1.34; 95% CI 1.04–1.74). Conclusion Counselling and monitoring practices should be tailored to patients with less schooling, that are initiating treatment and with low disease burden. Equally important is the need to implement strategies to increase the patient’s level of social capital to improve treatment knowledge.

Objective International Classification of Diseases (ICD) codes in electronic health records (EHRs) are increasingly used for health services research, in spite of unknown diagnostic accuracy. The accuracy of ICD codes to identify bronchopulmonary dysplasia (BPD) is unknown. Study design Retrospective cohort study in a single-center NICU (n = 166) to evaluate sensitivity and specificity of ICD-10 codes for the diagnosis of BPD. Analysis of large insurance claims database (n = 7887) to determine date of assignment of the code. Results The sensitivity of any BPD-related ICD codes ranged from 0.82 to 0.95, while the specificity ranged from 0.25 to 0.36. In a large national insurance database, the most common date of ICD-9 or ICD-10 code assignment was the day of birth, which is inconsistent with the clinical definition. Conclusions ICD codes registered for BPD are unlikely to accurately reflect the current clinical definition and should be interpreted with caution.

Purpose Photodynamic diagnosis using hexaminolevulinate (HAL)—guided BL-TURB may reduce the recurrence risk in non-muscle invasive BCa compared to standard WL-TURB due to more sensitive tumor detection. The impact of the initial use of WL- vs. BL-TURB on follow-up costs was evaluated in this real-world data analysis. Methods Anonymous claims data of German statutory health insurances (GKV) from 2011 to 2016 were analyzed in a primary and adjusted study population. Selection criteria included five quarters before enrolment, one index quarter (InQ) of initial TURB and BCa diagnosis, either within two years for the primary analysis or within four years for the adjusted analysis, and a follow-up period (FU) of either eleven or three quarters, respectively. Results In the primary analysis (n = 2331), cystectomy was identified as an important cost driver masking potential differences between cohorts. Therefore, patients undergoing cystectomy (InQ + FU) were excluded from the adjusted study population of n = 4541 patients (WL: 79%; BL: 21%). Mean total costs of BL-TURB were initially comparable to WL-TURB (WL: EUR 4534 vs. BL: EUR 4543) and tended to be lower compared to WL-TURB in the first two quarters of FU. After one year (3rd FU quarter), costs equalized. Considering total FU, mean costs of BL-TURB were significantly lower compared to WL-TURB (WL: EUR 7073 vs BL: EUR 6431; p = 0.045). Conclusion This retrospective analysis of healthcare claims data highlights the comparability of costs between BL-TURB and WL-TURB.

Misophonia is a condition characterized by marked distress following the perception of innocuous sounds and is often accompanied by behavioral avoidance. This presentation is currently absent from the Diagnostic and Statistical Manual of Mental Disorders, as it remains poorly understood and understudied. Despite these limitations, there have been recent efforts to develop empirically supported assessment tools and intervention. Interventions for misophonia predominantly incorporate principles of cognitive-behavioral interventions. This article describes in detail the assessment and intervention process of working with an individual with misophonia.

Depression and anxiety are common disorders in older adults. For some, even after a combination of pharmacological and psychological treatments, residual symptoms and periodic relapse persist throughout the lifespan. This pattern can lead to pessimism, as well as an increasing deficit in euthymia. Well-Being Therapy is an innovative approach to addressing depression and anxiety symptoms that are often influenced and accompanied by low levels of psychological well-being. The core principles of well-being therapy, as well as the related concepts of euthymia, eudaimonia, and psychological well-being, are described and illustrated.

A prolonged time from first presentation to cancer diagnosis has been associated with worse disease-related outcomes. This study evaluated potential determinants of a long diagnostic interval among symptomatic breast cancer patients. This was a population-based, cross-sectional study of symptomatic breast cancer patients diagnosed in Ontario, Canada from 2007 to 2015 using administrative health data. The diagnostic interval was defined as the time from the earliest breast cancer-related healthcare encounter before diagnosis to the diagnosis date. Potential determinants of the diagnostic interval included patient, disease and usual healthcare utilization characteristics. We used multivariable quantile regression to evaluate their relationship with the diagnostic interval. We also examined differences in diagnostic interval by the frequency of encounters within the interval. Among 45,967 symptomatic breast cancer patients, the median diagnostic interval was 41 days (interquartile range 20–92). Longer diagnostic intervals were observed in younger patients, patients with higher burden of comorbid disease, recent immigrants to Canada, and patients with higher healthcare utilization prior to their diagnostic interval. Shorter intervals were observed in patients residing in long-term care facilities, patients with late stage disease, and patients who initially presented in an emergency department. Longer diagnostic intervals were characterized by an increased number of physician visits and breast procedures. The identification of groups at risk of longer diagnostic intervals provides direction for future research aimed at better understanding and improving breast cancer diagnostic pathways. Ensuring that all women receive a timely breast cancer diagnosis could improve breast cancer outcomes.

Children notice race from an early age. They also observe and can understand injustices among people. However, research shows that not all caregivers discuss race, identity, and racism. Some avoid the topic altogether. There are significant repercussions when we do not provide space for these formative conversations. Silence allows stereotypes, biases, and racism to be reinforced. There is a role and a responsibility for mental health practitioners to undertake these sometimes difficult conversations and practices with patients and parents. Illustrative examples to use with children of different ages are presented as a means of supporting parents in their discussion of race and racism with their children.

Most adherence studies only consider treatment following a first prescription. Using an extended follow-up, we found that 60% of seniors starting oral bisphosphonate therapy were exposed for ≥ 3 years (48% for ≥ 5 years). Studies are needed to examine the benefits and harms of continuing bisphosphonate therapy beyond 3 years. The purpose of this study was to identify and describe patterns of long-term oral bisphosphonate use among seniors using a novel methodological approach that considers extended follow-up. Among Ontarians aged 66 years or older, we identified subjects with a first dispensing of alendronate or risedronate between November 2000 and December 2016. We followed them until death or December 2019 to identify patients with ≥ 3 years of bisphosphonate use, defined as a proportion of days covered ≥ 80%, using 3-year rolling windows. We calculated the proportion of patients with long-term therapy (≥ 3 years of use) using Kaplan-Meier estimates. We described patterns of long-term use and compared patient characteristics between patients with and without long-term therapy. We identified 260,784 eligible seniors initiating bisphosphonate therapy. Of these, 60% continued therapy ≥ 3 years (77% women), and 48% continued ≥ 5 years. Characteristics did not meaningfully differ between patients with or without long-term therapy. The median length of long-term therapy was 7.0 (IQR 5.1) years for women and 6.1 (IQR 4.3) years for men. Only 20% experienced a treatment gap before long-term therapy, yet 50% experienced a treatment gap of ≥ 120 days after a median 5.3 years of therapy. Eighty-one percent who returned to therapy following a treatment gap re-initiated an oral bisphosphonate, with 18% switching to denosumab. Among seniors initiating oral bisphosphonates, we found that 60% receive at least 3 years of therapy when using an extended follow-up. Studies are needed to examine the benefits and harms of continuing bisphosphonate therapy beyond 3 years.