Management of anticoagulation and direct oral ancticoagulants in patients with atrial fibrillation treated in Spanish Internal Medicine outpatient clinics.

Bridging the gap in autism care: A qualitative analysis of policies, practices, and family experiences.

ABSTRACT Whilst the policy purpose of prisons is containment and rehabilitation, prisons must also provide a range of services to people who are incarcerated. Researchers have examined how service provision is complicated by features of the prison environment directed at safety and security, but less attention has been paid to the impact of managerialist practices focused on economic efficiency, service quality and resource allocation. Largely imported from the private sector, these practices seek to drive efficiency by managing input costs and positioning service users as customers, but they may impede service provision in prisons as they do outside prisons. The aim of the current study was to explore how these challenges are experienced by women and service providers in women's prisons in Queensland, Australia. It drew on data from workshops involving 75 mothers in prison and 24 service providers. Transcripts were subject to inductive thematic analysis. Participants reported that they perceived service provision as hampered by a lack of resources and by slow, convoluted, opaque, and unreliable administrative processes, although there were also examples of responsive services. Women responded to barriers by attempting to influence service provision within or outside rules or by withdrawing from services altogether. Their withdrawal decreases demand and reduces pressure on staff to make rationing decisions. However, this also obscures the lack of supply of essential services enabling administrative barriers to persist. Any attempt to improve service delivery in women's prisons can only succeed if services are appropriately and consistently resourced and accessible.

The purpose of the study is to explore the scientific theories describing economic sanctions and their impact, as well as relevance of their provisions. Events of 2022 have seriously influenced the understanding of restrictions as an instrument of foreign economic policy, which necessitates a revision of fundamental concepts, identification of existing “blind spots” and promising scientific inquiries directions. Through a step-by-step analysis and generalization of the contents of fundamental and applied works of the most cited foreign and Russian scientists who have contributed to the understanding of sanctions, the possible level of their impact on its object, as well as its specific factors and indicators, the following conclusions are drawn. The results of the conducted research are the identified features of the modern theoretical understanding of economic sanctions, as well as the formulated proposals for improving future scientific works in terms of the methodology used and the most relevant thematic areas. Most of the studies establish noneconomic and economic criteria as a determinant of economic sanctions. Methodology concerned, the majority of them are based either on the analysis of databases in which episodes of the application of restrictions are recorded, or on individual case studies. Right now, there is no consensus in the scientific community regarding the assessment of the effectiveness of restriction tools as such. All the new phenomena of sanctions policy, such as secondary and targeted sanctions, cannot fully be considered within the existing theoretical framework. In terms of coverage and consideration of potential influencing factors, the economic component of its understanding is currently inferior to its political science part. However, this drawback is rather temporary, since the scientific field in question continues to be in a stage of active development and comprehension of a significant number of applied works in 2022-2025 timeframe, which can become the basis for conducting new fundamental research based on their data. The study concludes that the influence of non-market administrative barriers on the economy of the object is undisputable. It is noted that the most promising studies today are those that focus on studying new manifestations of restrictive policy (secondary and targeted sanctions) and the impact of restrictions on individual sectors of the economy and their representatives. In this case, the methodological basis should consist of tools for assessing the state and dynamics of both macroeconomic indicators and intra- and inter-industry processes, which make it possible, among other things, to determine the impact of sanctions in the context of individual areas.

Against the backdrop of global economic digital transformation and the rapid flow of creative factors, innovation spaces, as the key carriers of inventive activities, drive high-quality development in urban agglomerations. This study develops a three-dimensional framework of “Spatial Structure–Factor Synergy–Institutional Drivers” to uncover the evolution of innovation spaces and industrial shifts in the Beijing–Tianjin–Hebei urban agglomeration, China. Methodologically, spatial econometric techniques were applied to capture both the overall concentration and spatial disparities of innovation. Spatial Gini and variation coefficients measured innovation clustering, while standard deviation ellipses and location entropy identified spatial linkages among high-tech innovation clusters. Geographically weighted regression models explored spatial heterogeneity in influencing factors, and a policy intensity index was constructed to assess the effectiveness of differentiated policy interventions in optimizing innovation resources. Key findings include the following: (1) Innovation spaces are spatially polarized in a “core–periphery” pattern, yet require cross-regional collaboration. Concurrently, high-tech industries demonstrate a gradient structure: central cities leading in R&D, sub-central cities driving industrial applications, and node cities achieving specialized development through industrial transfer. (2) The driving mechanisms exhibit significant spatial heterogeneity: economic density shows diminishing returns in core areas, whereas R&D investment and ecological quality demonstrate increasingly positive effects, with foreign investment’s role evolving positively post-institutional reforms. (3) Regional innovation synergy has formed a preliminary framework, but strengthening sustainable policy mechanisms remains pivotal to advancing market-driven coordination and dismantling administrative barriers. These findings underscore the importance of integrated policy reforms for achieving balanced and high-quality innovation development in administratively coordinated urban agglomerations like BTH.

This article explores the normative-institutional discrepancy between the declarative nature of Article 833 of the Indonesian Civil Code and the administrative practices of financial institutions in the execution of inheritance rights within Indonesia’s national legal system. Legally, heirs acquire their rights automatically upon the decedent’s death, without requiring court confirmation or formal recognition. In practice, however, banks often impose excessive procedural requirements, such as requesting additional documents or withholding funds without a clear legal basis. This study adopts a normative legal method, analyzing statutory provisions, doctrinal interpretations, and illustrative case studies. The findings highlight the urgent need for regulatory harmonization between inheritance law and financial administrative procedures in Indonesia. The article also emphasizes the strategic role of notaries as legal intermediaries who ensure the enforceability of inheritance rights through authentic documentation. It concludes that heirs’ legal protection must be strengthened by upholding the principles of legality and substantive justice within the financial sector.

Atmospheric particulate matter (PM), classified into PM2.5 (particles 2.5 micrometers) and PM10 (particles 10 micrometers), represents a major environmental and health issue. These particles, originating from sources such as smog, soot, industrial dust, and agricultural residues, remain suspended in the atmosphere for extended periods, contributing to air pollution, ecosystem degradation, and respiratory and cardiovascular problems. Vegetation plays a key role in reducing PM concentrations by capturing and retaining particles on leaf surfaces, but the burning of agricultural residues and intensive farming practices remain significant sources of emissions. In the European Union, agriculture contributes approximately 15% of PM2.5 and 22% of PM10 emissions, particularly through plowing, harvesting, and open biomass burning. In Romania, PM levels vary regionally, being higher in areas with intensive agricultural activity. Strategies to reduce PM include promoting precision agriculture, optimizing fertilizer use, and adopting clean technologies. However, implementing these measures is challenging due to economic and administrative barriers. In this paper, we analyzed suspended particulate emissions (PM2.5 and PM10) reported in Romania during the period 2010 - 2022. The study aimed to correlate emission levels with the agricultural area cultivated with various crops, including grain cereals, grain legumes, oil plants, soybeans, sugar beets, potatoes, vegetables, perennial fodder, and forage roots. Through this analysis, we aimed to identify how agricultural activities contribute to atmospheric particulate matter levels and assess their impact on agricultural productivity. Data on PM2.5 and PM10 emissions were collected from official air quality reports and correlated with statistical data on the cultivated area and agricultural production for each type of crop analyzed. The study results highlighted a significant relationship between particulate matter emission levels and the intensity of agricultural activities, especially in areas with large surfaces cultivated with grain cereals, soybeans, and oil plants. Additionally, it was found that variations in agricultural productivity can be influenced by crop exposure to air pollution, particularly in regions with high PM emissions. The relationship between air quality and agricultural productivity highlights the need for sustainable policies and better management of agricultural waste. In Romania, support from the Common Agricultural Policy (CAP) facilitates the adoption of eco-friendly practices, but the agricultural sector faces challenges related to competitiveness in the European and global markets. Effective measures to reduce PM emissions are crucial for protecting human health and the environment while ensuring food security.

This study examines access and uptake of COVID-19 vaccines among refugees and migrants in Ecuador, including those with regular and irregular migration status. Conducted in Quito, Manta, and Huaquillas with 344 participants, the article reports on the survey data to assess vaccination access, barriers, and enablers. Findings show that 94% of respondents received at least one vaccine dose, despite 69% having irregular status. However, gaps remained in second and booster dose uptake, which was linked to misinformation and administrative barriers such as lack of documentation, discrimination and stigma, especially from healthcare and security personnel at vaccine sites. Key facilitators included receiving support from non-governmental organizations, mobile health brigades, and pressure from international organizations. The study concludes that although Ecuador made vaccines accessible to migrants, systemic challenges, such as data gaps, xenophobia, and insufficient outreach, hindered equitable coverage and limited the rights of migrants and refugees. Improved communication, flexibility in relation to documentation are recommended to ensure equitable access vaccines.

New Delhi metallo-β-lactamase (NDM)-producing Enterobacterales represent a major therapeutic challenge due to their resistance to nearly all β-lactams and frequent co-resistance to other antibiotic classes, leaving clinicians with few effective options. These challenges are amplified in orthopedic infections with hardware involvement, where biofilm formation and the need for prolonged antimicrobial therapy limit success. We describe a 55-year-old female with a history of right type 3 open pilon fracture complicated by hardware failure and revision, who presented with septic tibial nonunion and chronic drainage. During this admission, she underwent irrigation and debridement with hardware removal and intramedullary nail placement. Cultures grew Enterobacter cloacae complex resistant to meropenem, ceftazidime–avibactam, meropenem–vaborbactam, and cefiderocol, as well as Candida parapsilosis. Molecular testing confirmed NDM production, while reference testing showed susceptibility to aztreonam–avibactam (ATM-AVI). The patient was treated with ATM-AVI plus micafungin, achieving clinical stability within three days. Due to outpatient administration barriers with ATM-AVI, the patient was transitioned to eravacycline and micafungin. At eight-week follow-up, the patient remained clinically improved without relapse or adverse effects. This case highlights ATM-AVI as a critical therapy for NDM-producing orthopedic infections involving hardware and supports eravacycline as a feasible step-down option in outpatient management.

Biologic medications are essential for treating chronic diseases but come with high costs, prompting interest in biosimilars as more affordable alternatives. Biosimilars are highly similar to FDA-approved biologics in terms of safety and efficacy, though not identical. Managed Care Organizations (MCOs), especially those contracted by Medicaid in New York, play a key role in formulary management and cost containment. Despite over 600 approved biologics, only approximately 69 biosimilars are available, and their adoption varies widely. This study evaluates cost and clinical outcomes across three disease states-Rheumatoid Arthritis (RA), Crohn's Disease (CD), and Type 1 Diabetes Mellitus (DM)-using biologic-biosimilar pairs: Adalimumab (Cyltezo), Infliximab (Avsola), and Insulin Glargine (Semglee). We aim to understand pricing discrepancies and the lag in biosimilar uptake within MCO formularies through cost-effectiveness analysis. Findings will inform whether clinical equivalence translates into formulary preference and support efficient resource allocation while maintaining patient access and treatment outcomes. A formulary review identified high-cost biologics with FDA-approved biosimilars used in managed care. RA, CD, and T1DM were selected based on prevalence and cost impact. Biologics included Humira, Remicade, and Lantus, with biosimilars Cyltezo, Avsola, and Semglee. Selection was based on FDA approval, formulary access, and clinical relevance. Efficacy and safety were confirmed through trial review and real-world data. Cost-effectiveness was assessed using ICER, calculated from annual treatment costs and clinical outcomes, with a $50,000 willingness-to-pay threshold. Biosimilars demonstrated strong cost-effectiveness compared to their reference biologics. Cyltezo showed better clinical response than Humira (69% vs 64.5%) at a much lower annual cost ($6600 vs $107,992.82), yielding an ICER of -$2.25 million. Avsola was also more effective than Remicade (68.1% vs 59.1%) and significantly cheaper ($24,000 vs $50,500), with an ICER of -$297,752.81. Semglee and Lantus had equivalent outcomes, but Semglee cost less ($1775.76 vs $4896), supporting a cost-minimization approach. Despite favorable outcomes, biosimilars were often placed on equal or higher formulary tiers than reference biologics due to rebate contracts, limited interchangeability, and provider hesitancy. Biosimilars offer equal or better clinical outcomes at much lower costs in RA, CD, and T1DM. Cyltezo and Avsola were dominant in both efficacy and cost, yet their formulary placement remains inconsistent due to rebate-driven incentives, provider hesitancy, and administrative barriers. To improve adoption, MCOs and PBMs should prioritize value-based formulary decisions, enhance transparency, and support provider and patient education. Pharmacists can help lead biosimilar use through counseling and substitution protocols. Greater alignment between clinical evidence and formulary practices can lower costs, improve access, and promote sustainable care.

The subject of the research is current measures of tax incentives for information technology (hereinafter referred to as IT) companies in an unstable economic situation and the transformation of the digital market in the Russian Federation. The relevance of the research is due to the need to integrate the IT industry into global technological processes and follow current trends. The aim of the work is to develop proposals to increase the investment attractiveness of this industry through fiscal support tools, to create a differentiated approach to tax benefits for specialized companies, depending on the scale and specialization of the IT business. As a result of the study, measures are presented to improve the system of tax incentives for IT sector entities in the Russian Federation, and it is necessary to develop a different tax regime for the industry that can offset the artificial restraint on the growth of medium-sized companies in order to preserve preferential preferences. It was noted that there is a need to introduce more flexible tax incentive mechanisms for technology companies to solve current problems in the industry, such as a shortage of qualified personnel, high administrative barriers to benefits, and an increase in budget revenue shortfalls. In order to modernize tax incentives to support businesses, adjustments to tax benefits discussed at the state level were considered. The authors conclude that there is a positive fiscal effect on the budget from the development and implementation of a special tax regime for income from intellectual property and the effectiveness of implementing tools to support small high-tech companies in order to promote the development of the IT industry.

Reducing administrative barriers: Evidence from China's county-to-district reform on export product quality

Objectives. To understand the experiences of families with low income in California with pandemic safety net support expansions and retractions, including barriers to program access. Methods. Using open-ended questions, we explored the self-reported experiences of pandemic-era safety net expansions and expirations between January and June 2023 among a group of caregivers of young children (n = 44). We used the Immersion-Crystallization technique to analyze the data, creating a codebook and identifying themes as they emerged. Results. We identified 4 main themes, including appreciation for safety net expansions, varied experiences because of the timing of supports, challenges meeting basic needs after expirations, and administrative burdens significantly impairing program access. Conclusions. The study themes highlighted how expansions to policies like the Child Tax Credit and Supplemental Nutrition Assistance Program improved food and housing security, and that unpredictable benefits, although appreciated, also added stress. Public Health Implications. State and federal policymakers should consider the poverty reduction and food and housing security benefits of expansions to pandemic-era supports that have expired when crafting future policy. They should pay special attention to addressing administrative barriers to reduce poverty-related health inequities. (Am J Public Health. 2025;115(11):1836-1847. https://doi.org/10.2105/AJPH.2025.308201).

This study examines the effectiveness of national health law policies in ensuring accessibility to eyeglasses through health insurance mechanisms and identifies the legal, administrative, and social barriers faced by insurance participants in obtaining reimbursement rights. The purpose of this study is to assess the extent to which national health law policies are able to meet public access to eyeglasses and formulate solutions to existing obstacles. The research method used is normative legal research with legislative, conceptual, and case approaches, and processing secondary data in the form of regulations, scientific literature, and related court decisions. The results show that although national regulations provide a fairly strong legal framework, their implementation still faces significant obstacles in the distribution of facilities, complicated claims procedures, limited subsidy values, and low literacy among insurance participants. Sociocultural and economic factors also influence the utilization of the right to reimbursement rights for eyeglasses. Proposed solutions include harmonizing national regulations with international human rights norms, simplifying administrative procedures through digitalization, and increasing public education and outreach. In conclusion, health law policies must be strengthened and optimized to ensure fair and equitable access to eyeglasses through the national health insurance system.

This study aims to explore the perspectives of both the educational supervisor and the subject specialist regarding the reality of implementing school sports activities in Mosul schools. This is examined through three dimensions: The role of school administration in promoting school sports activities. The role of the physical education teacher in promoting school sports activities. The administrative and financial barriers preventing the start of school sports activities. Methodology: The researchers used the descriptive–analytical method. The study sample included 62 supervisors (educational and subject specialists) working in the Nineveh Directorate of Education. The researchers developed a questionnaire that covered three main areas: the role of school administration, the role of physical education teachers, and the administrative and financial obstacles to activating school sports activities. The questionnaire featured 23 items and was based on a four-point Likert scale. After confirming the validity and reliability of the questionnaire, it was distributed to the study participants. Findings: Through this analysis, the researchers concluded the following: The school administration's role in supporting the necessary requirements to activate school sports activities is weak. Physical education teachers are essential in promoting school sports activities. There is a shortage of sufficient financial and human resources needed to support school sports activities effectively. Many schools lack playgrounds for sports and sufficient sports equipment and tools.

BackgroundThe digital transformation of society and public health has created an urgent need for new competencies to address evolving and contemporary public health challenges. While some public health institutions and schools worldwide have begun responding through various training programs and approaches, many have yet to do so. A clearer understanding of the current training landscape can inform more coordinated efforts to update curricula and strengthen digital competency within the public health workforce.ObjectiveThis study aimed to map and describe existing digital public health (DPH) training programs, identifying common curricula content, disciplinary involvement, and training approaches. It also aimed to identify gaps and opportunities for curricular adaptation.MethodsThis environmental scan was conducted in 2 stages, drawing on guidance from studies by Rowel et al and Wilburn et al. First, we performed a systematic search of DPH training programs, followed by interviews with selected program directors to explore their program design and implementation. The scan emphasized a transdisciplinary lens, consistent with the evolving nature of DPH. Between March and May 2023, we searched Google and public health association directories to identify degree programs and courses (as part of degree awarding programs) focused on building capacity for using digital technologies in public health. We then conducted semi-structured interviews with 4 directors of identified programs exploring program characteristics and the inter- or transdisciplinary partnerships essential to their design. Search data were summarized using narrative synthesis, while content analysis was applied to the interview data.ResultsOverall, 58 DPH training programs were identified, categorized into 3 groups: public health data science (29/58, 50%), public health informatics (16/58, 28%), and a mix of programs exploring digital competencies (13/58, 22%) related to project management and addressing the digital determinants of health. Interviews revealed that motivation for developing interdisciplinary DPH programs stemmed from the need to meet evolving job market demands and respond to calls for curricular renewal among professional bodies. Effective design and delivery were supported by academic–industry partnerships, which aimed to cultivate professionals with depth in public health and breadth in digital competencies. These programs drew on diverse disciplinary perspectives from academia, the public sector, and private industry. However, sustaining such partnerships was challenged by the need to negotiate shared priorities, reconcile differing viewpoints, and secure ongoing funding.ConclusionsThis global scan of DPH training programs found a strong focus on data-centric competencies, with less emphasis on digital skills for health promotion, leadership, and addressing digital determinants of health. Bridging these gaps requires a stepwise approach: integrating digital competencies into existing curricula, offering stand-alone programs for specialized skills, and strengthening partnerships to navigate funding and administrative barriers while promoting equity-driven, interdisciplinary collaboration.

The article is devoted to the analysis of the influence of international standards on the development of national legislation, in particular the mechanisms of their implementation, the problems of harmonization of legal norms and ways of improving the legislative system of Ukraine in accordance with international obligations. Particular attention is paid to the analysis of the mechanisms of implementation of international standards into national legislation, the problems of harmonization of Ukrainian law with international norms and ways of increasing the efficiency of the legislative process in the context of international obligations. The purpose of the study is to determine the influence of international standards on the formation and development of national legislation and to suggest ways of increasing the efficiency of their implementation in Ukraine. In the course of the scientific research, general scientific methods of cognition were used, in particular: analysis and synthesis; comparative law; the method of abstraction and generalization; logical and systemic methods for forming conclusions and proposals for improving the legal system. The results of the study show that international standards play a key role in the development of national legislation, contributing to the harmonization of legal norms with international requirements, but the process of their implementation is often complicated by legislative conflicts, insufficient legal culture, and administrative barriers. Effective adaptation of international norms requires a systematic approach, modernization of legislative techniques and active participation of civil society institutions. The concept and classification of international standards in the field of law are considered. The mechanisms for implementing international norms into domestic legislation are substantiated. The role in harmonizing national legal systems and integration into the international legal environment is studied. The main mechanisms of the influence of international norms and principles on the formation of national legislation are determined. The forms and stages of implementing international treaties, conventions and recommendations into domestic law are studied. Barriers to the implementation of international norms into national legislation are systematized. Ways of improving the legislative process are proposed in order to more effectively take into account international standards in the national legal system.

The unwinding of Medicaid's continuous coverage provision, beginning in April 2023, disenrolled more than 25 million people. Effects on overall insurance coverage-including reenrollment in Medicaid-and affordability of care remain unclear. To estimate variation in coverage losses during unwinding of the Medicaid continuous coverage provision by state and demographic groups and evaluate trends in new Medicaid applications before, during, and after the COVID-19 public health emergency. In this cross-sectional study, using administrative data from the US Centers for Medicare & Medicaid Services (CMS), state-level Medicaid terminations as a share of pre-unwinding Medicaid enrollment were estimated during the first year of unwinding and new application rates were examined. CMS administrative enrollment data were compared with quarterly estimates from the National Health Insurance Survey (2019-2023), examining demographic changes in self-reported Medicaid, uninsurance, and cost-related barriers to care among low-income individuals in the second half of 2023 using an interrupted time series. A nationally representative sample of US residents younger than 65 years applying to and enrolled in Medicaid in federal survey data was included. Subgroup analyses were conducted by health status, race and ethnicity, education, pregnancy status, and age. Survey data were collected from January 2019 to December 2023, administrative data were collected from January 2019 to April 2024, and data were analyzed from November 2024 to July 2025. The unwinding of the Medicaid continuous coverage provision, under which people could maintain program enrollment even if their eligibility status changed. Enrollment in Medicaid (administratively reported and self-reported), percentage uninsured, cost-related delays in care, and new applications to Medicaid in states with high and low procedural termination rates. As a share of pre-unwinding Medicaid enrollment, the median (range) state termination rate during unwinding in 2023 was 26.6% (8.3-55.3). Net enrollment decreases, including new and returning enrollees, were smaller (median [range] decrease, 13.9% [-15.0 to 30.2]). New applications fell 29.8% (from a mean [SD] of 27 914.20 [3669.97] to 19 589.61 [2622.08]) during the COVID-19 pandemic but increased 29.0% (from a mean [SD] of 19 589.61 [2622.08] to 25 273.11 [3650.18]) during unwinding. Gaps between administratively measured and survey-measured enrollment grew during the COVID-19 pandemic but narrowed during unwinding. During unwinding, survey-reported Medicaid enrollment decreased among women (-2.74 percentage points; 95% CI, -4.82 to -0.66), healthier individuals (-2.65 percentage points; 95% CI, -4.84 to -0.46), young adults (-3.37 percentage points; 95% CI, -6.32 to -0.42), recently pregnant adults (-8.19 percentage points; 95% CI, -16.35 to -0.03), and White individuals (-2.85 percentage points; 95% CI, -5.36 to -0.34). Changes in uninsurance overall were modest but rose significantly among healthier individuals. Cost-related barriers to care rose among White individuals, college-educated individuals, and healthier individuals. In this cross-sectional study, millions lost Medicaid during unwinding (with wide state variation), but survey data indicated smaller coverage reductions. Re-enrollment after termination and unawareness of COVID-19 pandemic coverage partially explain this discrepancy. Coverage losses were concentrated among certain demographic groups, with some evidence of reduced care affordability. These results may inform expectations about recent Medicaid proposals that would increase administrative barriers to coverage.

The study analyzes public policies aimed at promoting procedural celerity in alimony proceedings processed in a Justice of the Peace in East Lima. The purpose of the study is to evaluate the effectiveness of the measures implemented to guarantee timely justice and effective compliance with the right to alimony. In the Peruvian context, these processes are imperative for safeguarding the well-being of children and adolescents. However, significant delays persist that affect access to justice and protection for beneficiaries. A qualitative approach, bolstered by a meticulous documentary analysis and a systematic review of sources indexed in Scopus and Redalyc, was employed to identify the primary structural, regulatory, and administrative barriers impeding the efficient processing of files. The findings indicate deficiencies in inter-institutional coordination, inadequate human and technological resources, and an inconsistent implementation of the digital mechanisms established by the Judiciary. The proposed strategies encompass a multifaceted approach, including the comprehensive digitalization of processes, the continuous training of judicial personnel, and the institutionalization of alternative dispute resolution mechanisms. The implementation of these measures would facilitate the optimization of judicial management and the enhancement of access to justice in matters pertaining to maintenance. This, in turn, would contribute to the adherence to the principle of the best interests of the child.

Miscommunication is the leading cause of hospital medical error, most occurring during patient care handoffs. Even with successful implementation of a standardized handoff methodology, our hospital experienced continued handoff problems in the perioperative space. No studies have yet examined barriers to effective perioperative handoff communication. This study aims to identify and understand the barriers to effective perioperative handoffs that persist despite quality improvement efforts to improve handoff communication. We initiated a qualitative study using thematic analysis of semistructured face-to-face interviews with nurses and physicians from perioperative units. Interviews were coded into themes and then categories. The barriers were categorized into administration, communication, and personnel. Administration involves knowledge and interpretation of administrative processes. Communication refers to forms and components of handoff communication and the environment where handoffs occur. Personnel refers to individual roles and responsibilities, and also as a quantitative resource. Specific quality improvement initiatives were proposed based on our study results. Our findings suggest that successful handoff communication between perioperative areas requires identification of critical administrative, communication, and personnel barriers. Hospitals can conduct similar interview-based studies to discover barriers to effective handoffs, and implement policies and procedures to improve safety in the perioperative space.