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A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Quality and Patient Safety".

Deadline for manuscript submissions: closed (31 May 2024) | Viewed by 17654

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Dr. Carine Milcent

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Guest Editor

Behavior Work Group, Paris School of Economics, 75014 Paris, France
Interests: healthcare system; inequity; hospital and reimbursement system; insurance model; artificial intelligence in healthcare system; electronic medical record

Special Issue Information

Dear Colleagues,

Healthcare systems take many different forms depending on the country. In some countries, the healthcare system is publicly financed, such as in many European countries. A single insurance company is at the heart of the health system in countries such as France, while the system can be built mostly around public healthcare providers, as in the UK. In some countries, private insurers compete with each other by ensuring standard minimum care for all. How do these differences affect access to care for patients and their care? Healthcare providers can be for-profit, non-profit or public. What can explain these differences between countries and the impact on the efficiency of each health system? The introduction of DRG-based pricing has allowed for competition between institutions. At the same time, the health crisis has led to mergers between institutions and strengthened health groups. How does this affect the supply of care and the demand for care? Above all, healthcare systems have to tackle common challenges: the demographic change of the population, a growing share of the population affected by chronic disease, and the increased role of prevention, which has been revealed more acutely with the COVID-19 health crisis, as well as the rapid evolution of innovations and their associated costs in patient care and the role of digital health as an answer to the lack of healthcare supply.

All these questions mean that there is a great variety of research topics in the field of healthcare systems. This Special Issue is open to relevant research on healthcare systems. The keywords listed below outline some of the possible areas of interest.

Dr. Carine Milcent
Guest Editor

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Keywords

Providers’ ownership
change in demand
inequality and evolution
DRG and reimbursement systems
healthcare access
geographic and healthcare systems
competition and mergers
prevention and public health
health electronic record and medical informatics
insurance and insurers
healthcare management
artificial intelligence
data analytics
data science
database management COVID-19

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Published Papers (11 papers)

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Research

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17 pages, 1597 KiB

Open AccessArticle

Frailty Indicator over the Adult Life Cycle as a Predictor of Healthcare Expenditure and Mortality in the Short to Midterm

by Carine Milcent

Healthcare 2024, 12(20), 2038; https://doi.org/10.3390/healthcare12202038 - 15 Oct 2024

Viewed by 475

Abstract

Background: Assessing frailty from middle age onward offers valuable insights into predicting healthcare expenditures throughout the life cycle. Objectives: This paper examines the use of physical frailty as an indicator of healthcare demand across all age groups. The originality of this work lies in extending the analysis of frailty indicators beyond the typical focus on individuals under 50 years old to include those in mid-life and older. Methods: For this study, we used a database where frailty was measured in 2012 in a sample of individuals aged 15 to over 90. These individuals were tracked for their healthcare expenditures from 2012 to 2016. Results: Among the sample of 6928 individuals, frailty in 2012 resulted in a statistically significant increase in costs at the 5% level for the population aged 15 to 65. We applied multilevel linear regression models with year fixed effects, controlling for demographic factors, education level, precarity, social dimensions, lifestyle factors (e.g., vegetable consumption), physical activity, emotional well-being, and medical history. A Hausman test was conducted to validate the model choice. For mortality rate analysis, Cox models were used. Conclusions: Our findings demonstrate that physical frailty provides valuable information for understanding its impact on healthcare expenditure. The effect of frailty on mortality is particularly significant for the elderly population. Moreover, frailty is a predictor of healthcare costs not only in older adults but also across the entire life cycle. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

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9 pages, 1293 KiB

Open AccessArticle

“Mind the Gap”—Differences between Documentation and Reality on Intensive Care Units: A Quantitative Observational Study

by Florian Jürgen Raimann, Cornelius Johannes König, Vanessa Neef and Armin Niklas Flinspach

Healthcare 2024, 12(15), 1481; https://doi.org/10.3390/healthcare12151481 - 26 Jul 2024

Cited by 1 | Viewed by 777

Abstract

Introduction: Digitalization in medicine is steadily increasing. Complex treatments, scarce personnel resources and a high level of documentation are a constant burden on healthcare systems. The balancing between correct manual documentation in the digital records and limited staff resources is rarely successful. The aim of this study is to evaluate the adherence between documentation and lack of documentation in the treatment of critical care patients. Material and Methods: For the evaluation, data from the hospital information system (HIS) of several intensive care units (ICU) were examined in conjunction with data collected from a checklist. All boluses of sedatives, analgesics and catecholamines were documented paper based across all shifts and all weekdays and compared with corresponding digital data from the HIS (2019–2022) of previous years. Results: 939 complete digital patient records revealed a massive under-documentation of the medication administration compared to that applied according to the checklist. Only 12% of all administered catecholamines, 11% of α₂-agonists, 33% of propofol, 92% of midazolam and 46% of opioids were found in the digital recordings. In comparison, the effect was more pronounced on weekdays compared to weekends. In addition, the highest documentation gap was found in the comparison of early shifts. Comparing neurosurgical vs. internal vs. anesthesiologic ICUs there was a highly significant difference between anesthesiologic ICUs compared with other disciplines (p < 0.0001). Discussion: Our data shows that there is a remarkable documentation gap and incongruence in the area of applied boli. Automated documentation by connecting syringe pumps that enter data directly into the HIS can not only reduce the workload, but also lead to comprehensive and legally required documentation of all administered medication. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

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14 pages, 264 KiB

Open AccessArticle

Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans

by Saad Zbiri, Patrick Rozenberg and Carine Milcent

Healthcare 2024, 12(10), 1007; https://doi.org/10.3390/healthcare12101007 - 14 May 2024

Viewed by 971

Abstract

This study aimed to investigate the effect of hospital staffing resources on medical practice in public versus private hospitals. We used exhaustive delivery data from a French district of 11 hospitals over an 11-year period, from 2008 to 2018, including 168,120 observations. We performed multilevel logistic regression models with hospital fixed or random effects, while controlling for factors known to influence obstetric practice. We found that hospital staff ratios of obstetricians and that of midwives affected caesarean rates, but with different effects depending on the hospital sector. In public hospitals, the higher the ratio of obstetricians and that of midwives, the lower the probability of planned caesareans. In private hospitals, the higher the ratio of obstetricians, the greater the probability of planned caesareans. Indeed, in public hospitals, obstetricians and midwives, both salaried employees, do not have financial or organizational incentives to perform more caesareans. In private hospitals, obstetricians, who are independent doctors, may have such incentives. Our results underline the importance of having an adequate supply of health professionals in healthcare facilities to ensure appropriate care, with specific regard to the different characteristics of the public and private sectors. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

12 pages, 655 KiB

Open AccessArticle

Creating and Validating a Questionnaire for Assessing Dentists’ Self-Perception on Oral Healthcare Management—A Pilot Study

by Silviu Catalin Tibeica, Elena Raluca Baciu, Iulian Costin Lupu, Carina Balcos, Ionut Luchian, Dana Gabriela Budala, Andreea Tibeica, Zinovia Surlari and Elena Mihaela Carausu

Healthcare 2024, 12(9), 933; https://doi.org/10.3390/healthcare12090933 - 1 May 2024

Cited by 2 | Viewed by 1118

Abstract

Background and Objectives: Questionnaires designed to test knowledge and self-perception can be valuable tools for diagnosing a dentist’s understanding of the management and administration of a practice. The objective of this study was to create and authenticate a questionnaire for assessing dentists’ self-perception on oral healthcare management developed from discussions with experts in this field. Material and Methods: In order to create and verify a questionnaire survey, a cross-sectional, descriptive, and analytical study was carried out. Participants’ personal information and 31 statements across four categories made up the final questionnaire form. The answers to the questionnaire were in the form of a Likert scale. After refining the initial version, a total of 36 interviews were conducted at dental offices to verify the validity. For the Exploratory Factor Analysis (EFA), we used the Kaiser–Meyer–Olkin (KMO) index, the Bartlett sphericity test, and also Cronbach alpha coefficient for the validity of the questionnaire. Results: The accuracy of the instrument was measured by intrarater and interrater reliability. For the EFA, all the communalities exceeded the threshold of 0.05. With a Cronbach’s alpha coefficient of 0.898, the questionnaire has sufficient internal consistency. Conclusions: The questionnaire demonstrates robust reliability and validity, thereby affirming its suitability for its intended purpose. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

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17 pages, 9289 KiB

Open AccessArticle

Diagnostic Technology: Trends of Use and Availability in a 10-Year Period (2011–2020) among Sixteen OECD Countries

by Manuela Martella, Jacopo Lenzi and Maria Michela Gianino

Healthcare 2023, 11(14), 2078; https://doi.org/10.3390/healthcare11142078 - 20 Jul 2023

Cited by 2 | Viewed by 1401

Abstract

Background. Overuse of imaging results in cost increases, with little to no benefit to patients. The purpose of this study is to evaluate imaging tests and radiology equipment over a ten-year period in 16 Organisation for Economic Co-operation and Development (OECD) countries. Methods. Twelve countries were included in a time-trend analysis based on OECD indicators on diagnostic imaging (computer tomography [CT], magnetic resonance imaging [MRI], and positron emission tomography [PET]). These annual indicators included the number of exams per 1000 population, the number of devices per million population, and the number of exams per device. Average annual percent change was used to measure country-specific trends. Results. Most countries saw a rise in the exam-to-scanner ratio for CT, MRI, and PET, demonstrating a faster increase in exam volume than device volume. Italy exhibited an increase in CT, MRI, and PET equipment units during the same period, but not in exams, most likely due to a reduction in medical procedures during the pandemic. Only in Luxemburg, CT and PET examinations increased despite a reduction in scanners. Conclusions. Considering the expected increasing demand for diagnostics due to the evolving needs of the population, proper governance and resource allocation are necessary requirements for cost-efficient health systems. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

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10 pages, 215 KiB

Open AccessArticle

An Assessment of Knowledge, Attitudes and Practices on Pureed Diet Preparation (KAP DYS-PUREE) among Food Handlers in Malaysian Hospitals for Dysphagia Management

by Aizul Azri Azizan, Suzana Shahar, Zahara Abdul Manaf, Hasnah Haron, Nurul Fatin Malek Rivan and Nurul Huda Razalli

Healthcare 2023, 11(14), 2026; https://doi.org/10.3390/healthcare11142026 - 14 Jul 2023

Viewed by 1688

Abstract

This study aims to assess the knowledge, attitude, and practice towards pureed diet preparation among food handlers using a newly developed questionnaire for dysphagia management. A descriptive cross-sectional design study with purposive sampling was conducted in three government hospitals in the Klang Valley, Malaysia. A newly developed questionnaire, comprised of 40 quantitative items, was used and distributed to 161 food handlers from three hospitals who were directly involved in preparing pureed diets. The results demonstrated a low to moderate knowledge score among food handlers (57.54 ± 12.33), with scoring at 1.95% (very low), 28.6% (low), and 68.3% (moderate). Only 1.2% scored well in the knowledge section on pureed diet preparation. The attitude among food handlers showed that they were referred to the right source of reference before preparing the pureed diet (3.97 ± 1.35). The findings also clearly showed that the practice of using the right equipment (4.41 ± 1.19) is essential for pureed diet preparation. In conclusion, this study serves as a prognosis for future improvement in knowledge, attitude, and practice among food handlers toward pureed diet preparation. Knowledge among food handlers needs to be enhanced, and a comprehensive guideline and reference module will aid in refining dysphagia management, specifically in food preparation by food handlers. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

20 pages, 2569 KiB

Open AccessArticle

A Comprehensive Research on the Prevalence and Evolution Trend of Orthopedic Surgeries in Romania

by Flaviu Moldovan, Liviu Moldovan and Tiberiu Bataga

Healthcare 2023, 11(13), 1866; https://doi.org/10.3390/healthcare11131866 - 27 Jun 2023

Cited by 18 | Viewed by 2017

Abstract

Accurate knowledge of the prevalence and trends of orthopedic surgeries can facilitate the design of medical plans for effective treatments. The National Endoprosthetic Registry (NER) in Romania provides statistics on endoprosthetic activity (hip, knee), cases of fractures and bone tumors as a result of the legal obligations to report interventions performed by all orthopedic traumatology hospitals/wards in the country. The aim of this study is to describe the annual volumes of orthopedic surgeries between 2001 and 2022 in Romania and analyze the current and future evolution trends of the studied surgeries, gender differences and regional differences based on a complete survey carried out at a national level. For the period 2001–2022, we extracted from the NER the annual volumes of orthopedic interventions performed. With these data, we studied the prevalence and estimated, with the support of an original calculation methodology, the variation trends of orthopedic surgeries in two situations: over the entire 21-year period, respectively, and over the period 2001–2020, which does not include the pandemic period. For hip replacement surgery and knee replacement surgery, we showed the prevalence by subcategory of interventions, gender distribution, regional prevalence and regional density calculated by the annual averages of the total number of cases reported per 100,000 people in the 40 counties of the country and the capital, Bucharest. We also determined the variations in hip and knee arthroplasty revision burdens, calculated as a percentage between the number of revisions and the number of primary interventions in the same period. We determined the regional densities of revision burdens. The total number of orthopedic surgeries in the period 2001–2022 was 1,557,247, of which 189,881 were hip replacement surgeries; 51,035 were knee replacement surgeries; 11,085 were revision hip arthroplasty; 1497 were revision knee arthroplasty; 541,440 were operated fractures; and 16,418 were operated bone tumors. The growth rates of surgical interventions are hip replacement surgery, +8.19%; knee replacement surgery, +19.55%; revision hip arthroplasty, +9.43%; and revision knee arthroplasty, +28.57%. With these data, we have estimated a doubling of the volume of primary and revision interventions of the hip until 2034 and the knee until 2027, respectively. Operated bone tumors register an annual decrease of −4.52% thanks to modern treatments. There are clear gender differences; for primary hip interventions, the proportion of women is 58.82%, and for knee interventions, the proportion of women is 76.42%. This is the first research that, with the support of exhaustive data from the NER, analyzes for the period 2001–2022 the annual number of orthopedic surgeries in Romania. It allows knowledge of the large, anticipated increases in orthopedic surgery and provides a quantitative basis for future policy decisions related to the need for medical personnel and material resources. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

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16 pages, 730 KiB

Open AccessArticle

The Relationship between Nursing Practice Environment and Pressure Ulcer Care Quality in Portugal’s Long-Term Care Units

by Katia Furtado, Jaco Voorham, Paulo Infante, Anabela Afonso, Clara Morais, Pedro Lucas and Manuel Lopes

Healthcare 2023, 11(12), 1751; https://doi.org/10.3390/healthcare11121751 - 14 Jun 2023

Cited by 2 | Viewed by 2895

Abstract

Background: The morbidity associated with ageing has contributed to an increase in the prevalence of Pressure Ulcers (PUs) in all care settings. The impact of these on people’s quality of life and the extent of the associated economic and social burden constitutes today, by their importance, a serious public health problem. This study aims to describe the nursing work environment in Portuguese long-term care (LTC) units and to assess how this environment relates to the quality of PU care. Methods: A longitudinal study among inpatients with PUs was conducted in LTC units. The Nursing Work Index-Revised Scale (NWI-R) was sent to all nurses in these units. Cox proportional hazard models were used to relate the satisfaction degree with the service (measured by the NWI-R-PT items) to the healing time of the PUs, adjusting for confounders. Results: A total of 165 of 451 invited nurses completed the NWI-R-PT. Most were women (74.6%) and had 1 to 5 years of professional experience. Less than half (38.4%) had education in wound care. Of the 88 patients identified with PUs, only 63 had their PU documented, highlighting the difficulties in updating electronic records. The results showed that the level of concordance with Q28 “Floating so that staffing is equalised among units” is strongly associated with a shorter PU healing time. Conclusion: A good distribution of nursing staff over the units will likely improve the quality of wound care. We found no evidence for possible associations with the questions on participation in policy decisions, salary level, or staffing educational development and their relationship with PUs healing times. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

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10 pages, 267 KiB

Open AccessArticle

Obstetric Violence among Pregnant Jordanian Women: An Observational Study between the Private and Public Hospitals in Jordan

by Omar A. Azzam, Amer Mahmoud Sindiani, Maysa M. Eyalsalman, Mira K. Odeh, Kenda Y. AbedAlkareem, Sara A. Albanna, Elaf M. Abdulrahman, Weaam Q. Abukhadrah, Haitham O. Hazaimeh, Ashraf Ahmed Zaghloul and Samir S. Mahgoub

Healthcare 2023, 11(5), 654; https://doi.org/10.3390/healthcare11050654 - 23 Feb 2023

Cited by 1 | Viewed by 2111

Abstract

Background: Obstetric Violence (OV) is a public health matter that affects women and their children with an incidence rate between 18.3–75.1% globally. The delivery institution of public and private sectors represents a potential factor contributing to OV. This study aimed to assess OV existence among sample of pregnant Jordanian women and its risk factors domains between public and private hospitals. Methodology: This is a case-control study including 259 recently delivered mothers from Al-Karak Public and Educational Hospital and The Islamic Private Hospital. A designated questionnaire including demographic variables and OV domains was used for data collection. Results: A significant difference was seen between patients delivering in the public sector compared to patients delivering the private sector in education level, occupation, monthly income, delivery supervision and overall satisfaction. Patients delivering in the private sector showed a significantly less physical abuse by the medical staff compared to patients delivering in the public sector, and patients delivering in a private room also showed a significantly less OV and risk of physical abuse compared to patients delivering in shared room. In public settings, medications information was lesser versus the private ones, additionally, there is significant association between performing episiotomy, physical abuse by staff and the delivery in shared rooms in private settings. Conclusion: This study showed that OV was less susceptible during childbirth in private settings compared to public settings. Educational status, low monthly income, occupation are risk factors for OV; also, features of disrespect and abuse like obtaining consent for episiotomy performance, delivery provision updates, care perception based on payment ability and medication information were reported. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

20 pages, 3377 KiB

Open AccessArticle

Analysis of Home Healthcare Practice to Improve Service Quality: Case Study of Megacity Istanbul

by Rabia Çevik İnaç and İsmail Ekmekçi

Healthcare 2023, 11(3), 319; https://doi.org/10.3390/healthcare11030319 - 20 Jan 2023

Cited by 2 | Viewed by 1870

Abstract

Home healthcare services are public or private service that aims to provide health services at home to socially disadvantaged, sick, needy, disabled, and elderly individuals. This study aims to increase the quality of home healthcare practice by analyzing the factors affecting it. In Megacity Istanbul, data from 1707 patients were used by considering 14 different input variables affecting home healthcare practice. The demographic, geographic, and living conditions of patients and healthcare professionals who take an active role in home healthcare practice constituted the central theme of the input parameters of this study. The regression method was used to look at the factors that affect the length of time a patient needs home healthcare, which is the study’s output variable. This article provides short planning times and flexible solutions for home healthcare practice by showing how to avoid planning patient healthcare applications by hand using methods that were developed for home health services. In addition, in this research, the AB, RF, GB, and NN algorithms, which are among the machine learning algorithms, were developed using patient and personnel data with known input parameters to make home healthcare application planning correct. These algorithms’ accuracy and error margins were calculated, and the algorithms’ results were compared. For the prediction data, the AB model showed the best performance, and the R² value of this algorithm was computed as 0.903. The margins of error for this algorithm were found to be 0.136, 0.018, and 0.043 for the RMSE, MSE, and MAE, respectively. This article provides short planning times and flexible solutions in home healthcare practice by avoiding manual patient healthcare application planning with the methods developed in the context of home health services. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

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Review

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18 pages, 530 KiB

Open AccessReview

Can ‘What Is Known’ about Social Isolation and Loneliness Interventions Sufficiently Inform the Clinical Practice of Health Care and Social Service Professionals Who Work with Older Adults? Exploring Knowledge-to-Practice Gaps

by Salinda Horgan, Jeanette Prorok, David Conn, Claire Checkland, John Saunders, Bette Watson-Borg and Lisa Tinley

Healthcare 2024, 12(11), 1111; https://doi.org/10.3390/healthcare12111111 - 29 May 2024

Cited by 1 | Viewed by 1177

Abstract

Establishing intervention effectiveness is an important component of a broader knowledge translation (KT) process. However, mobilizing the implementation of these interventions into practice is perhaps the most important aspect of the KT cycle. The purpose of the current study was to conduct an umbrella review to (a) identify promising interventions for SI&L in older adults, (b) interpret (translate) the findings to inform clinical knowledge and practice interventions in different settings and contexts, and (c) highlight research gaps that may hinder the uptake of these interventions in practice. The broader purpose of this study was to inform evidence-based clinical practice guidelines on SI&L for HCSSPs. In line with other reviews, our study noted variations in methods and intervention designs that prohibit definitive statements about intervention effectiveness. Perhaps, the most significant contribution of the current review was in identifying knowledge-to-practice gaps that inhibit the implementation of interventions into practice-based realities. Full article

(This article belongs to the Special Issue Assessment and Analysis of Healthcare Systems)

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