ABSTRACT Objective To evaluate the cost–benefit of a PPP (Public Private Partnership) model -mortgage model- compared to traditional budgeting method funding models based on traditional public budgets (TM). Methods The economic-financial evaluation of the construction has been carried out under the PPP model of a hospital in the Northern Galicia–Portugal–Euroregion by performing a simulation analysis. This comparison involves an analysis of the life project, expressed in terms of net present value (NPV) of the costs and benefits of the project proposed compared to the costs and benefits of the provision of the service by the traditional budgeting method (TM). A simulation analysis has been also performed. Results The PPP (Public Private Partnership) project does not offer more value for money than the traditional budgeting funding model (Public Budget –TM-) – defined as an alternative to the public sector for the provision of the same services. Conclusion The best option would be the creation of a public company (Public Society of Investment –SPI-) to finance the construction and commissioning of the hospital.

ABSTRACT The blood supply chain is complex and subject to uncertain supply and demand. This paper proposes a system dynamics model that considers the correlation between the supply of different blood products. The model evaluates the long-term effect of disturbances on the shortage and wastage levels of blood. The real case of Bogota (Colombia) is used for the analysis. The results of the experiments for a demand-driven policy provide managerial insights for limiting the expected shortage and wastage levels, especially when the supply of products is correlated. The proposed model is a tool for decision-makers to estimate the effect and the sensitivity of the performance indicators to different policies on the blood supply chain.

ABSTRACT Background: Blood shortages is global health challenge. Despite its importance, the optimal number of packed red blood cell (PRBCs) required for elective cardiac surgery is still underexplored. This study aimed to evaluate a model that estimates the number of PRBCs for elective cardiac surgery. Study design and methods: Data on the actual PRBCs used and predicted by the model for patients who underwent elective cardiac surgery at the University Hospital of Siena from 2013 to 2020 were retrospectively collected. Before model development, the hospital's standard practice was to use approximately 10 blood bags per patient. Results: This study included 2,337 patients. The total number of PRBCs calculated by the model (plus 3 additional bags) and prepared for the surgeries was 13,227, compared to 23,370 bags obtained with the previous strategy. The ratio between actual PRBCs and the model predicted PRBCs was 29.2% for coronary surgery, 18.7% for valve surgery, and 41.4% for combined procedures. In contrast, with the previous strategy the ratio was 14.0%, 10.9%, and 25.8%, respectively. Conclusions: Machine-learning models like the one used in this study can improve patient blood management by accurately predicting the required number of blood bags for elective cardiac surgery.

ABSTRACT Certified nursing assistants (CNAs) provide the majority of care to a growing aging population, so with persistent caregiver workforce shortages, CNA retention is of utmost concern for long-term care agencies. The current study examines the alignment of CNA and leadership’s perception, of which workplace factors are most important to CNA’s for retention. A quantitative survey was administered to CNAs (n = 295), directors of nursing (DON) (n = 59) and nursing home administrators (NHA) (n = 59). Data were analysed using descriptive statistics to describe the sample, Likert scale means were calculated and compared across stakeholders and a one-way ANOVA with Tukey’s post-hoc analysis was conducted to examine alignment and areas of differences in stakeholder perspectives. Areas of agreement among stakeholders included CNAs valuing competitive pay, positive supervisor relationships, adequate staffing levels and a sense of teamwork. However, clear differences were also identified, such as CNAs prioritizing the ability to safely perform their job, the skilled nursing facility’s (SNF) reputation for quality care and access to continuing education, which were all areas not noted to be perceived as important to CNAs by DONs and NHAs. Enhanced understanding of what CNAs have identified as important retention factors could reduce turnover rates and, in turn, improve quality of care.

ABSTRACT Introduction Healthcare facilities are increasingly recognizing the importance of understanding patients’ perceptions to align with a value-based and patient-centered paradigm. Incorporating a population approach in healthcare performance management is a significant challenge. In this context, the Mystery Patient methodology is recognized as capable for assessing system quality from the user's perspective. This paper aims to explore the potential of patient involvement through this methodology in supporting the co-creation of value in healthcare service reviews. Materials and methods The methodology consists of three phases: Systematic Literature Network Analysis for evidence collection, framework conceptualization through a detailed design, and framework implementation adopting Multiple Criteria Decision Analysis approach in the context of Italian oncology services. Results The Mystery Patient methodology can be implemented through six steps and is recognized by scholars as valuable for measuring healthcare service quality. The measurement tool used is a questionnaire focusing on the equity of access. Survey results revealed that patients consider all criteria important, with higher relevance related to waiting times for reports and services. Discussion The methodology effectively measures the equity of access to healthcare services. This study paves the way for future research to explore its feasibility in real-world healthcare settings.

ABSTRACT The maternal mortality ratio (MMR) remains alarmingly high in South Asian countries. However, maternal healthcare service utilization (MHCSU) can significantly reduce maternal mortality and morbidity, while improving child health. Therefore, this study identifies the socio-economic and demographic factors influencing MHCSU in Afghanistan, Bangladesh, India, Maldives, Nepal and Pakistan, using data from the Demographic and Health Survey (DHS). Women who were mature (35–49 years) at the time of childbirth were more likely to receive adequate antenatal care (ANC) in Pakistan and postnatal care (PNC) in Afghanistan. Additionally, women who were educated, working, belonged to wealthier households, were aware of family planning, and had mass media exposure had higher odds of receiving MHCSU in South Asia, except in Afghanistan, where listening to the radio reduced the odds of receiving standard ANC and PNC. Notably, working mothers had lower odds of receiving ANC in Afghanistan and delivery care in Bangladesh. Additionally, women with higher childbirth orders and those lacking decision-making autonomy were less likely to receive MHCSU. A woman whose husband was educated and mature at the time of childbirth was more likely to avail MHCSU. Based on our findings, policymakers should focus on regular health education, financial incentives, adolescent-friendly health services, and enhanced e-health communication to promote MHCSU in South Asia and thereby improve maternal and child health in the region.

ABSTRACT Physician depression and anxiety increased during the COVID-19 pandemic. This study aimed to determine what pandemic-related factors might be responsible for this increase, using a cross-sectional survey of Canadian physicians. Risk factors measured included the Pandemic Experiences and Perceptions Scale (PEPS) subscales (impact, adequacy, risk perception and worklife), COVID-19 preparedness, level of contact with COVID-19, and the number of provincial COVID-19 cases. In total, 309 completed the primary outcomes, with 20.1% experiencing symptoms of depression and 43.2% of anxiety. Structural equation modeling analysis demonstrated significant relationships between risk perception and areas of worklife to anxiety and to depression. The effect of worklife quality was partially mediated through reductions in risk perception. Areas of worklife explained 6% of the variance of risk perception. The explanatory variables in the model described 33% of the variability in anxiety and 28% of the variability in depression. Areas of work-life and risk perception were both significant contributors to depression and anxiety among physicians during early stages of the pandemic. To reduce symptoms, the aim of healthcare organizations should be to ensure adequate resources, reduce risk perception, improve communication and education regarding what is known about pandemics or crises. Trial registration: ClinicalTrials.gov identifier: NCT04379063.

ABSTRACT Background: General Practitioners (GPs) play an important role in providing care to cancer patients; however, this role is not yet well defined. This study analyzed the propensity of GPs to actively participate in various aspects of cancer patient management in collaboration with oncologists. Methods: The Italian Association of Head Physicians in Oncology Departments (CIPOMO), in collaboration with the Italian Federation of Medical Associations (FNOMCeO), created macro-regional working groups composed of GPs and a CIPOMO coordinator for each Italian region. During the CIPOMO DAY 2022, these groups analyzed “simultaneous care”, “palliative care”, and “long-living/cured patients”. Results: Challenges and needs arose during the discussion on “simultaneous care”, such as the importance of proper health education for patients and caregivers, as well as effective communication between doctors and other healthcare professionals. The “palliative care” roundtable discussed concerns about the transition from early to end-of-life palliative care. In the third roundtable, GPs expressed a willingness to participate in the management of both long-living and cured patients. Conclusions: CIPOMO DAY 2022 was a useful event for identifying the obstacles related to the integration between GPs and hospital specialists. The hospital-territory transition appears feasible and we identified the necessary measures to implement it.