Administrative Burden Research Articles

Challenges and strategies in the treatment of neovascular age-related macular degeneration

Neovascular age-related macular degeneration (nAMD) is a leading cause of blindness in the elderly, and anti-vascular endothelial growth factor (VEGF) therapy is currently the primary treatment approach. However, the real-world effectiveness of nAMD treatment is not always satisfactory and faces various challenges. Frequent administration and follow-up burdens can lead to decreased patient compliance during long-term treatment, resulting in suboptimal outcomes. Some lesions exhibit poor or no response to anti-VEGF treatment, leading to difficulties in maintaining or even declining visual acuity. Factors such as lesion fibrosis and tissue atrophy can contribute to visual deterioration. Therefore, standardizing and individualizing treatment plans, along with enhancing comprehensive monitoring and management throughout the disease course, are crucial improvement measures. The evidence-based guidelines for diagnosis and treatment of age-related macular degeneration in China, released in 2023, provide guidance for standardized clinical diagnosis and treatment. Meanwhile, research and development of new drugs and administration methods are anticipated for the future.

The Benefit of an Umbrella Protocol: Reducing Challenges in Orthopedic Oncology Research.

Background: Orthopedic oncology research is hindered by the scarcity of musculoskeletal tumors and research administrative inefficiencies. This paper introduces observational research through an innovative institution-specific methodology-termed an umbrella protocol. This protocol outlines a comprehensive standard procedure to expedite ethical approval for future aligned studies, reducing administrative barriers to research. Methods: We developed an umbrella protocol at an academic center, involving meticulous methodological identification and coordination with the institutional review board (IRB) to adhere to local guidelines. The protocol encompasses identifying investigators, research objectives, study goals, and data and safety monitoring frameworks necessary for typical standards. Results: Implementation of the umbrella protocol took 110 days to achieve exemption status, following multiple discussions with the IRB and extensive revisions. At the authors institution, this protocol significantly reduces protocol review times from an average of six-to-eight weeks to nearly instantaneous, facilitating a streamlined research process. Additionally, we established a dedicated orthopedic oncology patient registry to enhance future research endeavors. Conclusions: The adoption of umbrella protocols represents a pioneering strategy in orthopedic oncology. This approach mitigates research administrative burdens and broadens research scope in the field. It underscores the necessity of IRB collaboration, methodological precision, and stringent data management. The article also reflects on the ethical implications and potential biases introduced by emerging technologies like artificial intelligence, advocating for diligent ethical oversight. The establishment of an umbrella protocol marks a significant step towards more efficient research methodologies, ultimately aiming to improve patient care and outcomes for individuals with rare musculoskeletal conditions.

How Primary Care Clinicians Process Patient Death: Logistics, Emotions, and Opportunities for Structural Support

BackgroundNavigating the logistics and emotional processing of a patient’s death is an inevitable part of many physicians’ roles. While research has primarily examined how inpatient clinicians cope with patient loss, little work has explored how primary care clinicians (PCCs) handle patient death in the outpatient setting, and what support resources could help PCCs process loss.ObjectiveTo explore PCCs’ experiences with the logistics and emotional processing of patient deaths and suggestions for supportive resources.DesignQualitative study using semi-structured interviews conducted between March and May 2023.ParticipantsRecruitment emails were sent to 136 PCCs (physicians and nurse practitioners) at three San Francisco academic primary care clinics. Twelve clinicians participated in the study.ApproachThis study used a template analysis approach. Interview transcripts were analyzed in an iterative fashion to identify themes for how PCCs navigate patient death.ResultsParticipants (n=12) described outpatient death notification as inconsistent, delayed, and rife with uncertainty regarding subsequent actions. They felt various emotions, notably sadness and guilt, especially with deaths of young, vulnerable patients or those from preventable illnesses. Participants identified strategies for emotional processing and recommended improvements including clear procedural guidance, peer debriefings, and formal acknowledgements of deceased patients.ConclusionsInterviewing PCCs about their experiences following a patient death revealed key themes in logistical and emotional processing, and clinic resource recommendations to better support PCCs. Given the distinct characteristics of primary care—such as enduring patient relationships, greater isolation in ambulatory settings compared to inpatient environments, and rising burnout rates—enhancing guidance and support for PCCs is crucial to mitigate administrative burdens and grief after patient loss.

Comparison of prior authorization across insurers: cross sectional evidence from Medicare Advantage

ObjectiveTo measure and compare the scope of US insurers’ policies for prior authorization (PA), a process by which insurers assess the necessity of planned medical care, and to quantify differences...

Bureaucratic sludge: Bureaucratic tasks and procedures leading to experiences of strain

AbstractIn light of the recent conceptual debate about the administrative burdens framework, this article introduces the ‘bureaucratic sludge framework’ as a complementary theoretical approach for social policy and public administration research. The framework enable researchers to pursue novel research questions about for instance the interplay between administrative procedures, informal bureaucratic practices and public employees' experiences of strain and thus addresses a conceptual gap in the field. The article presents a non‐normative conceptualisation, proposing a typology of bureaucratic tasks—information seeking, assessment, implementation, and emotional labour—that may impose cognitive‐affective strain. Finally, a research agenda is outlined, and the bureaucratic task typology is proposed as a conceptual point of departure for researchers to empirically explore and audit practical instances of bureaucratic sludge in their contexts to further theorise and advance our understanding of the phenomenon. Social welfare is considered as an especially fruitful context within which to pursue this research agenda.

Frontline employees' responses to citizens' communication of administrative burdens

Executive SummaryThe literature on administrative burdens demonstrates that citizens may experience different kinds of administrative burdens when interacting with the state. However, we know little about whether citizens' communication of these experiences affects how frontline employees implement compliance demands. Building on the street‐level bureaucracy and administrative burden literature, we hypothesize that citizens' communication of direct and indirect psychological costs affects frontline employees' inclination to accommodate citizens. Furthermore, we expect this effect to be stronger for members of the ethnic majority than for ethnic minority members. We test these expectations using a preregistered survey experiment on a sample of 1048 Danish public caseworkers from 32 employment agencies. Results show that frontline employees are indeed more willing to reduce demands and help citizens that communicate their experiences of direct and indirect psychological costs. Further, we find some evidence that frontline employees are more responsive to citizens from the ethnic majority.

The Causes and Consequences of Administrative Burdens in the Canadian Private Sponsorship of Refugees Program

This article explores the administrative burdens that refugee sponsors experience in their interaction with the state in the context of the Canadian Private Sponsorship of Refugees Program. Drawing on primary and secondary qualitative data, we show that over four decades of program implementation, the sponsorship application process has become more complex, resource intensive, and time-consuming for sponsors, subverting otherwise positive sponsorship experiences. Our findings contribute to theoretical debates in administrative burdens research and indicate an acute need for administrative changes that would simplify the application process for sponsors, thus sustaining and nurturing the broad public interest in the program.

Beyond empathy training for practitioners: Cultivating empathic healthcare systems and leadership.

Empathic care benefits patients and practitioners, and empathy training for practitioners can enhance empathy. However, practitioners do not operate in a vacuum. For empathy to thrive, healthcare consultations must be situated in a nurturing milieu, guided by empathic, compassionate leaders. Empathy will be suppressed, or even reversed if practitioners are burned out and working in an unpleasant, under-resourced environment with increasingly poorly served and dissatisfied patients. Efforts to enhance empathy must therefore go beyond training practitioners to address system-level factors that foster empathy. These include patient education, cultivating empathic leadership, customer service training for reception staff, valuing cleaning and all ancillary staff, creating healing spaces, and using appropriate, efficiency saving technology to reduce the administrative burden on healthcare practitioners. We divide these elements into environmental factors, organisational factors, job factors, and individual characteristics.

Overview of the current situation of embryo donation in Belgian fertility centers

ObjectivesThe aim of this study is to survey the current situation in Belgium regarding embryo donation (ED) practices and to explore the potential reasons for not offering this treatment option. Study designA questionnaire was sent to all fertility centers in Belgium that are allowed to perform IVF regarding whether or not they perform ED for third parties, their overall experience with ED and the possible reasons for not doing it. The questionnaire was divided into three different sections, depending on whether the center currently performs ED for third parties, has never performed it or once performed it but no longer does. All respondents were anonymized. ResultsThe questionnaire was returned by 16 out of 18 centers.Only three out of 16 centers currently perform ED. All these centers require additional actions before ED can be performed. Sometimes ED is not performed although it was indicated in the contract; the most important reasons are the need for additional investigations, the administrative obstacles and the non-eligibility of the embryos. Between 2017 and 2021, few ED were performed in these centers (n = 2, 38 and 6).Eight out of 16 centers previously offered ED but ceased. In two centers, patients who want to donate their supernumerary embryos are referred for treatment to a center where ED is performed, but none of these centers transfer embryos to a center performing ED.The main reasons for discontinuing ED were the additional investigations required and the unprofitable investment in time and personnel.Five out of 16 centers never offered ED. At one center, patients who still indicate ED for their supernumerary embryos are referred to a center performing ED. The reduction of the administrative burden and avoiding additional testing are the most indicated measures that could facilitate the introduction of an ED program. ConclusionsEmbryo donation, although legally allowed, is currently hardly performed in Belgium. The reasons for this are mainly associated to additional mandatory post-hoc testing and the extra administrative burden which is not financially covered. Poor transparency and communication between Belgian centers may be an additional factor explaining the country’s low embryo donation rate.

Administrative Burdens and Child Medicaid and CHIP Enrollments

Administrative Burdens and Child Medicaid and CHIP Enrollments

Exploring the feasibility and acceptance of an optimised physiotherapy approach for lateral elbow tendinopathy: a qualitative investigation within the OPTimisE trial

ObjectivesTo explore the acceptability of an optimised physiotherapy (OPTimisE) intervention for people with lateral elbow tendinopathy (LET) and feasibility of comparing it to usual care in a randomised controlled trial.DesignSemistructured...

Development and acceptability of PETS-Now, an electronic point-of-care tool to monitor treatment burden in patients with multiple chronic conditions: a multi-method study

BackgroundThe aim of this study was to develop a web-based tool for patients with multiple chronic conditions (MCC) to communicate concerns about treatment burden to their healthcare providers.MethodsPatients and providers from primary-care clinics participated. We conducted focus groups to identify content for a prototype clinical tool to screen for treatment burden by reviewing domains and items from a previously validated measure, the Patient Experience with Treatment and Self-management (PETS). Following review of the prototype, a quasi-experimental pilot study determined acceptability of using the tool in clinical practice. The study protocol was modified to accommodate limitations due to the Covid-19 pandemic.ResultsFifteen patients with MCC and 18 providers participated in focus groups to review existing PETS content. The pilot tool (named PETS-Now) consisted of eight domains (Living Healthy, Health Costs, Monitoring Health, Medicine, Personal Relationships, Getting Healthcare, Health Information, and Medical Equipment) with each domain represented by a checklist of potential concerns. Administrative burden was minimized by limiting patients to selection of one domain. To test acceptability, 17 primary-care providers first saw 92 patients under standard care (control) conditions followed by another 90 patients using the PETS-Now tool (intervention). Each treatment burden domain was selected at least once by patients in the intervention. No significant differences were observed in overall care quality between patients in the control and intervention conditions with mean care quality rated high in both groups (9.3 and 9.2, respectively, out of 10). There were no differences in provider impressions of patient encounters under the two conditions with providers reporting that patient concerns were addressed in 95% of the visits in both conditions. Most intervention group patients (94%) found that the PETS-Now was easy to use and helped focus the conversation with the provider on their biggest concern (98%). Most providers (81%) felt they had learned something new about the patient from the PETS-Now.ConclusionThe PETS-Now holds promise for quickly screening and monitoring treatment burden in people with MCC and may provide information for care planning. While acceptable to patients and clinicians, integration of information into the electronic medical record should be prioritized.

Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage

Private Medicare Advantage (MA) plans recently surpassed traditional Medicare (TM) in enrollment. However, MA plans are facing scrutiny for burdensome prior authorization and potential rationing of care, including home health. MA beneficiaries are less likely to receive home health, but recent evidence on differences in service intensity and outcomes among home health patients is lacking. To examine differences in home health service intensity and patient outcomes between MA and TM. This cross-sectional study was conducted from January 2019 to December 2022 in 102 home health locations in 19 states and included 178 195 TM and 107 102 MA patients 65 years or older with 2 or fewer 60-day home health episodes. It included a secondary analysis of standardized assessment and visit data. Inverse probability of treatment weighting regression compared service intensity and patient outcomes between MA and TM episodes, accounting for differences in demographic characteristics, medical complexity, functional and cognitive impairments, social environment, caregiver support, and local community factors. Models included office location, year, and reimbursement policy fixed effects. Data were analyzed between September 2023 and July 2024. TM vs MA plan. Home health length of stay and number of visits from nursing, physical, occupational, and speech therapy, social work, and home health aides. Patient outcomes included improvement in self-care and mobility function, discharge to the community, and transfer to an inpatient facility during home health. Of 285 297 total patients, 180 283 (63.2%) were female; 586 (0.2%) were American Indian/Alaska Native, 8957 (3.1%) Asian, 28 694 (10.1%) Black, 7406 (2.6%) Hispanic, 1959 (0.7%) Native Hawaiian/Pacific Islander, 237 017 (83.1%) non-Hispanic White, and 678 (0.2%) multiracial individuals. MA patients had shorter home health length of stay by 1.62 days (95% CI, -1.82 to 1.42) and received fewer visits from all disciplines except social work. There were no differences in inpatient transfers. MA patients had 3% and 4% lower adjusted odds of improving in mobility and self-care, respectively (mobility odds ratio [OR], 0.97; 95% CI, 0.94-0.99; self-care OR, 0.96; 95% CI, 0.92-0.99). MA patients were 5% more likely to discharge to the community compared with TM (OR, 1.05; 95% CI, 1.01-1.08). The results of this cross-sectional study suggest that MA patients receive shorter and less intensive home health care vs TM patients with similar needs. Differences may be due to the administrative burden and cost-limiting incentives of MA plans. MA patients experienced slightly worse functional outcomes but were more likely to discharge to the community, which may have negative implications for MA patients, including reduced functional independence or increased caregiver burden.

Electronic Case Reporting Development, Implementation, and Expansion in the United States.

The COVID-19 pandemic highlighted the need for a nationwide health information technology solution that could improve upon manual case reporting and decrease the clinical and administrative burden on the US health care system. We describe the development, implementation, and nationwide expansion of electronic case reporting (eCR), including its effect on public health surveillance and pandemic readiness. Multidisciplinary teams developed and implemented a standards-based, shared, scalable, and interoperable eCR infrastructure during 2014-2020. From January 27, 2020, to January 7, 2023, the team conducted a nationwide scale-up effort and determined the number of eCR-capable electronic health record (EHR) products, the number of reportable conditions available within the infrastructure, and technical connections of health care organizations (HCOs) and jurisdictional public health agencies (PHAs) to the eCR infrastructure. The team also conducted data quality studies to determine whether HCOs were discontinuing manual case reporting and early results of eCR timeliness. During the study period, the number of eCR-capable EHR products developed or in development increased 11-fold (from 3 to 33), the number of reportable conditions available increased 28-fold (from 6 to 173), the number of HCOs connected to the eCR infrastructure increased 143-fold (from 153 to 22 000), and the number of jurisdictional PHAs connected to the eCR infrastructure increased 2.75-fold (from 24 to 66). Data quality reviews with PHAs resulted in select HCOs discontinuing manual case reporting and using eCR-exclusive case reporting in 13 PHA jurisdictions. The timeliness of eCR was <1 minute. The growth of eCR can revolutionize public health case surveillance by producing data that are more timely and complete than manual case reporting while reducing reporting burden.

Access to social rights under tension: The growing role of third‐party actors in dealing with the administrative burden and its implications

AbstractThe digital transformation in the public sector is a converging trend in many social protection systems. In France, it is being combined with the gradual closure of many government offices, particularly those responsible for managing social security benefits. This article focuses on one of the consequences of these developments. They lead to an increase in requests for support and help from individuals experiencing administrative burdens. They make their requests to a range of very different local actors, who do not always have the skills or the responsibility to respond to them. Based on a study carried out in social centres in France, this article presents the role of third parties in reducing the administrative burden. More specifically, it investigates the types of costs associated with the administrative burden to which social centres have to respond, and who meets them. The article analyses the tensions posed by this growing role, which range from professional and organisational to political.

Leadership Practices of Head Teachers: Primary School Teachers’ Perspective in Public Schools of Punjab

Effective leadership of head teachers shapes teacher attitudes and school organizational outcomes. This quantitative descriptive research aimed to find out the head teachers’ leadership practices perceived by the primary school teachers. There were selected 150 participants through a random sampling technique from public schools. A five-point Likert scale questionnaire was self-developed keeping in view the previous literature and experts’ perspectives. The questionnaire was focused on supportiveness, maintaining standards, communication capabilities, and instructional leadership. Data was analyzed through the SPSS 20 version. According to the findings of the study, teachers’ perceived positive regarding coordinating policy, classroom helpfulness, resource provision, relationship building, and confident interaction. There were 70-80% of the respondents who agreed about head teachers’ strengths for monitoring performance, motivation, decision making, shaping direction, and enabling autonomy. Low disagreement levels indicated teachers perceive head teachers as demonstrating competence across diverse leadership competencies. Highest rated areas and lowest regarding managing stress showed public sector heads capably transform restrictive bureaucracies through prioritizing secure environments, and communications, and upholding high instructional expectations enabling performance. Statistically, teachers had decidedly positive perspectives on headteacher leadership practices. Practical recommendations include sustaining areas with already high agreement, improving emotional support, increasing staff participation, enacting distributed leadership, enhancing recognition, and ensuring adequate time for core instructional leadership oversight by assessing administrative burdens on public school heads.

Navigating a climate of administrative burden: the perspectives of young adult undocumented immigrants in applying for COVID-19 disaster relief assistance for immigrants in California.

Undocumented immigrants experienced high levels of economic insecurity during the COVID-19 pandemic while being excluded from government-based relief and unemployment benefits. In April 2020, California became the first state to offer financial aid to undocumented immigrants through the innovative Disaster Relief Assistance for Immigrants (DRAI) program in collaboration with several community-based organizations (CBOs). However, the process of applying for aid was marked by many implementation challenges, such as intake and language access; however, little data exists on the direct experiences of the undocumented community. This qualitative study examines the experiences of undocumented Asian and Latinx young adults living in California in applying for DRAI through framework of administrative burden. Themes distilled from participant experiences highlight how administrative burden via learning, psychological, and compliance costs shape the ways in which undocumented immigrants navigate policies and programs, such as DRAI. These experiences highlight the need for policymakers to address structural and programmatic administrative burdens in policy development; failure to do so result in detrimental impacts that outweigh financial benefits or cause communities to forgo needed resources.

A153 IMPLEMENTATION OF THE CHAMPLAIN REGION GASTROINTESTINAL ENDOSCOPY CENTRAL INTAKE (GICI) PROGRAM

Abstract Background The Champlain region of Ontario is implementing a regional central intake triage program for screening colonoscopy services (FIT+, screening and surveillance indications). The aim of this program is to improve the delivery of regional endoscopy services, so that access to resource-intensive endoscopy procedures can be equitable, timely and evidence-based. We characterized the first phase of implementation of the Champlain Regional GI Central Intake (GICI). Aims The primary objective of this study is to identify program strengths and opportunities for quality improvement. Methods Prospective data was collected from August 1, 2022 to August 31, 2023. Descriptive statistics were analyzed. Discrete data were presented in terms of counts, percentages and means where appropriate. Results 1942 CIP referrals were received during the period of study. 1478(76.1%) referrals were submitted by fax, and 571(29.4%) were for positive FITs. 703(36.2%) referrals were declined, with 374(19.3%) not meeting Cancer Care Ontario (CCO) referral indications, 84(4.3%) being duplicates and 56(2.9%) being symptomatic. Prior to a policy change in March 2023, 23(1.2%) referrals were declined due to incomplete referral forms. 581(29.9%) referrals indicated a preferred physician or hospital site. On average, triage decisions were made within 11.4 hours of receipt of referrals for positive FIT, and 6.8 days for other indications. The average time from FIT positivity to referral receipt at CIP was 20.0 days. In the first quarter of 2023, 75th percentile wait times for colonoscopy were 35 days for FIT positivity, 150 days for symptoms, and 346 days for other screening indications. Conclusions GICI and the use of CCO evidence-based guidance reduces the need for colonoscopy in nearly 20% of referrals. It also decreases physician administrative burdens by eliminating duplicate referrals. Referrals should not be declined due to incomplete forms. Measures to improve timely access to colonoscopy for symptomatic patients should be explored. Most referred patients do not have a preferred physician or hospital site. Further primary care support and engagement is needed to encourage the use of the GICI as well as immediate referral for FIT+ colonoscopy. Funding Agencies None

Reducing WIC Administrative Burdens to Promote Health Equity

This Viewpoint discusses barriers to Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation for low-income and racial and ethnic minoritized families and outlines strategies that health care professionals and health systems can use to help families overcome these barriers.

Revisiting Value-Added Tax Structures: Strategies For Mitigating Regressivity In Basic Commodities Consumption

This study explores the advantages and disadvantages of implementing a value-added tax on tax-exempt essential goods in Indonesia. The research employs historical, comparative, empirical, and normative legal methods to analyze the tax policy's legal and socio-economic context and assess its impacts and challenges. The analysis shows that applying VAT to necessities with exemptions can increase transparency, reduce tax avoidance, and ensure a fair distribution of the tax burden among businesses and consumers. However, this policy may impose additional administrative burdens and financial pressures on companies, particularly small and medium enterprises. It is crucial to balance promoting tax compliance and alleviating excessive administrative requirements. This research provides extensive insights into the dynamics of VAT policy on essential goods in Indonesia. It presents new perspectives on the distribution of economic burden and provides recommendations based on thorough legal analysis.