Allocation Of Care Resources Research Articles

Endometriosis and Cannabis Consumption During the COVID-19 Pandemic: An International Cross-Sectional Survey.

Introduction: Endometriosis affects 1 in 10 women worldwide, with most experiencing difficulties achieving adequate symptom control. These difficulties have been compounded by the onset of the COVID-19 pandemic due to worldwide shifts in health care resource allocation. As cannabis is a relatively common form of self-management in endometriosis, this study aims to explore the impact of the COVID-19 pandemic on cannabis consumption in those with endometriosis. Methods: An anonymous, cross-sectional online international survey was developed and promoted by endometriosis advocacy/support organizations worldwide. Respondents needed to have a diagnosis of endometriosis and be aged between 18 and 55. Results: A total of 1634 responses were received from 46 different countries. The average age of respondents was 30, with a mean diagnosis age of 25. Eight hundred forty-six respondents (51%) reported consuming cannabis in the past 3 months, with 55% of these reporting use for symptom management only. One in five respondents (20%) reported having consumed cannabis previously, the most common reason for discontinuation (65%) was access difficulties during COVID. Those who had legal access were more likely to consume cannabis than those without (p<0.0001) and were more likely to disclose usage to health care professionals (p<0.0001). The most common reasons for consuming cannabis during COVID was increased stress/anxiety (59%) and lack of access to normal medical care (48%). Pre-pandemic, cannabis was mostly consumed at least once a day (61%) and in inhaled forms (51.6%). Consumption increased for most people (57%) during the pandemic. During the pandemic just under a quarter (23%) of respondents changed their mode of consumption, with a reduction in inhaled forms (39.5%) and an increase in consumption of edibles (40%) or oil (25.2%). Conclusions: Cannabis consumption, especially for symptom relief, was relatively common among those with endometriosis, with some people starting their consumption of cannabis due to health care restrictions that occurred due to the COVID-19 pandemic. Difficulties accessing cannabis and unpleasant/unwanted side effects were the most common reasons for lack of current cannabis consumption in those who had previously consumed it. Cannabis consumption may form an important part of endometriosis management especially when access to routine medical care is restricted.

A proteomic survival predictor for COVID-19 patients in intensive care.

Global healthcare systems are challenged by the COVID-19 pandemic. There is a need to optimize allocation of treatment and resources in intensive care, as clinically established risk assessments such as SOFA and APACHE II scores show only limited performance for predicting the survival of severely ill COVID-19 patients. Additional tools are also needed to monitor treatment, including experimental therapies in clinical trials. Comprehensively capturing human physiology, we speculated that proteomics in combination with new data-driven analysis strategies could produce a new generation of prognostic discriminators. We studied two independent cohorts of patients with severe COVID-19 who required intensive care and invasive mechanical ventilation. SOFA score, Charlson comorbidity index, and APACHE II score showed limited performance in predicting the COVID-19 outcome. Instead, the quantification of 321 plasma protein groups at 349 timepoints in 50 critically ill patients receiving invasive mechanical ventilation revealed 14 proteins that showed trajectories different between survivors and non-survivors. A predictor trained on proteomic measurements obtained at the first time point at maximum treatment level (i.e. WHO grade 7), which was weeks before the outcome, achieved accurate classification of survivors (AUROC 0.81). We tested the established predictor on an independent validation cohort (AUROC 1.0). The majority of proteins with high relevance in the prediction model belong to the coagulation system and complement cascade. Our study demonstrates that plasma proteomics can give rise to prognostic predictors substantially outperforming current prognostic markers in intensive care.

Palliative care in Japanese long-term care facilities.

Internationally, the demand for the provision of high-quality palliative care is increasing exponentially. Japan is a rapidly ageing society and it is therefore important to understand the current context to develop practice and inform future resource allocation in long-term care facilities (LTCFs). To describe the broad context of palliative care services, practice, education and policies in LTCFs in Japan. A process of expert elicitation and documentary review undertaken. The WHO palliative care model for public health was used as an analytical framework. Several deficits were identified regarding palliative care in Japanese LTCFs: a lack of palliative care strategy and standardised training for staff, and limited information on the use of palliative care medicines, quality improvement tools and frameworks. Such deficits need to be addressed to inform current nursing practice, future training needs for staff, quality care initiatives and decision making for advance care planning and resource allocation to respond to the ever-increasing demand for palliative care in these settings.

Problematic of Intensive Care Units in Venezuela

Critical care corresponds to the contemporary stage and includes automated multi-parameter monitoring for the management of patients with multi-organ impairment, complementary tests, devices for basic and advanced bedside support, and a multidisciplinary clinical team. Insufficient financing and inefficiencies in the allocation and use of available resources for health care represent important challenges in moving towards equity and financial protection. In fact, the average public spending on health (GPS) in the Region of the Americas is around 4% of the gross domestic product (GDP), a very low level compared to the 8% that the countries of the Americas allocate on average. The sixth edition of the Venezuela National Hospital Survey (ENH), collects information from 40 hospitals in the 24 states of the country. In the National Survey of Hospitals 2018, it can be seen in the Operative / Non-existent services line that 20% of the units are inoperative in Intensive Care Units for adults, 70% have intermittent failures and only 9% are 100% functional. . In relation to Pediatric Intensive Care, it is observed that 4% are inoperative and 95% have intermittent failures and the Emergency areas 5% are inoperative and 95% have intermittent failures. During 2019, both adult and pediatric Intensive Care Units maintained a pattern of operation between 10 and 20% of closed units, between 65 and 70% of open units and between 10 and 15% with intermittent operation.

Geographic Variation in Inpatient Care Utilization, Outcomes and Costs for Dementia Patients Aged 65 Years or Older - China, 2017-2019.

Dementia leads public health issues worldwide. China has the largest population of adults living with dementia in the world, imposing increasing burdens on the public health and healthcare systems. Despite improved access to health services, inadequate and uneven dementia management remains common. The report documents the provincial-level geographic patterns in healthcare utilization, outcomes, and costs for patients hospitalized for dementia in China. Regional patterns demonstrate gaps in equity and efficiency of dementia care and management for dementia patients. Public health policy and practices should consider geographic disparities in disease burden and healthcare provision to promote equitable allocation of resources for dementia care throughout China.

The CCEDRRN COVID-19 Mortality Score to predict death among nonpalliative patients with COVID-19 presenting to emergency departments: a derivation and validation study.

Background:Predicting mortality from COVID-19 using information available when patients present to the emergency department can inform goals-of-care decisions and assist with ethical allocation of critical care resources. The study objective was to develop and validate a clinical score to predict emergency department and in-hospital mortality among consecutive nonpalliative patients with COVID-19; in this study, we define palliative patients as those who do not want resuscitative measures, such as intubation, intensive care unit care or cardiopulmonary resuscitation.Methods:This derivation and validation study used observational cohort data recruited from 46 hospitals in 8 Canadian provinces participating in the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). We included adult (age ≥ 18 yr) nonpalliative patients with confirmed COVID-19 who presented to the emergency department of a participating site between Mar. 1, 2020, and Jan. 31, 2021. We randomly assigned hospitals to derivation or validation, and prespecified clinical variables as candidate predictors. We used logistic regression to develop the score in a derivation cohort and examined its performance in predicting emergency department and in-hospital mortality in a validation cohort.Results:Of 8761 eligible patients, 618 (7.0%) died. The CCEDRRN COVID-19 Mortality Score included age, sex, type of residence, arrival mode, chest pain, severe liver disease, respiratory rate and level of respiratory support. The area under the curve was 0.92 (95% confidence interval [CI] 0.90–0.93) in derivation and 0.92 (95% CI 0.90–0.93) in validation. The score had excellent calibration. These results suggest that scores of 6 or less would categorize patients as being at low risk for in-hospital death, with a negative predictive value of 99.9%. Patients in the low-risk group had an in-hospital mortality rate of 0.1%. Patients with a score of 15 or higher had an observed mortality rate of 81.0%.Interpretation:The CCEDRRN COVID-19 Mortality Score is a simple score that can be used for level-of-care discussions with patients and in situations of critical care resource constraints to accurately predict death using variables available on emergency department arrival. The score was derived and validated mostly in unvaccinated patients, and before variants of concern were circulating widely and newer treatment regimens implemented in Canada. Study registration:ClinicalTrials.gov, no. NCT04702945

Research on the Construction Strategies of Community-Based Targeted Elderly Care Service—Based on the Investigation of Elderly Care Services in Y City

Improving the precision of supply and demand of elderly care services is an important countermeasure to deal with the mismatch contradiction between supply and demand of elderly care services in China. Based on the investigation of the mismatch situation between supply and demand of elderly care services in Y City, from the perspective of social work, and according to the analysis framework of identifying-allocating-integrating, it is a practical path to improve the precision of supply and demand of elderly care services by constructing a community-based targeted elderly care service mode under the hub role of social work stations located in towns and streets. It is found that, there are three basic elements for the construction of the community-based targeted elderly care service mode: the life circles of the elderly in the community are the basis for the targeted identification of elderly care needs; the sense of belonging to the community organization where the elderly live is the basis of targeted allocation of elderly care resources; social work stations located in towns and streets with dual attributes of “state and society” are the basis for targeted integration of supply and demand process of elderly care.

Incidence and prevalence of major epilepsy-associated brain lesions.

Epilepsy surgery is an effective treatment option for drug-resistant focal epilepsy patients with associated structural brain lesions. However, little epidemiological data are available regarding the number of patients with these lesions. We reviewed data regarding (1) the prevalence and incidence of epilepsy; (2) the proportion of epilepsy patients with focal epilepsy, drug-resistant epilepsy, and drug-resistant focal epilepsies; and (3) the number of epilepsy presurgical evaluations and surgical resections. We also assessed the relative proportion of brain lesions using post-surgical histopathological findings from 541 surgical patients from the Cleveland Clinic and 9,523 patients from a European multi-center cohort. Data were combined to generate surgical candidate incidence and prevalence estimates and the first lesion-specific estimates for hippocampal sclerosis (HS), low-grade epilepsy-associated brain tumors (LEAT), malformations of cortical development (MCD), glial scars, vascular malformations, and encephalitis. The most frequently diagnosed brain lesions were HS (incidence=2.32±0.26 in 100,000, prevalence=19.40±2.16 in 100,000) for adults and MCD (incidence=1.15±0.34 in 100,000, prevalence=6.52±1.89 in 100,000) for children. Our estimates can guide patient advocacy groups, clinicians, researchers, policymakers in education, development of health care strategy, resource allocation, and reimbursement schedules.

The ED-PLANN Score: A Simple Risk Stratification Tool for Out-of-Hospital Cardiac Arrests Derived from Emergency Departments in Korea.

Early risk stratification of out-of-hospital cardiac arrest (OHCA) patients with insufficient information in emergency departments (ED) is difficult but critical in improving intensive care resource allocation. This study aimed to develop a simple risk stratification score using initial information in the ED. Adult patients who had OHCA with medical etiology from 2016 to 2020 were enrolled from the Korean Cardiac Arrest Research Consortium (KoCARC) database. To develop a scoring system, a backward logistic regression analysis was conducted. The developed scoring system was validated in both external dataset and internal bootstrap resampling. A total of 8240 patients were analyzed, including 4712 in the development cohort and 3528 in the external validation cohort. An ED-PLANN score (range 0–5) was developed incorporating 1 point for each: P for serum pH ≤ 7.1, L for serum lactate ≥ 10 mmol/L, A for age ≥ 70 years old, N for non-shockable rhythm, and N for no-prehospital return of spontaneous circulation. The area under the receiver operating characteristics curve (AUROC) for favorable neurological outcome was 0.93 (95% CI, 0.92–0.94) in the development cohort, 0.94 (95% CI, 0.92–0.95) in the validation cohort. Hosmer–Lemeshow goodness-of-fit tests also indicated good agreement. The ED-PLANN score is a practical and easily applicable clinical scoring system for predicting favorable neurological outcomes of OHCA patients.

Assessing equity of the spatial distribution of primary health care facilities in Fuzhou City, China: A comprehensive method.

It is well known that equity assessment of the spatial distribution of primary health care facilities (PHCFs) is significant to optimize the allocation of health care resources and enhance the ability to react to public health emergencies, yet there is much discussion about the poor effectiveness of assessment for many cities due to the limitations of the insufficient ability of traditional data to reflect residents' demands, etc. In many cities where PHCFs are inequity distributed, this is urgently needed for the government. Using Fuzhou City, China as a case study, we propose a comprehensive method for assessing the equity that consisting of two frameworks based on the Geographic Information System. The first framework is assessing resident demand based on daily demand and potential demand, and the second is assessing PHCFs supply based on road impedance. This method combines an index system based on multi-source data and a spatial matching analysis between resident demand and PHCFs supply based on the supply-demand disparity index. The demand degree for the PHCFs and the supply degree of accessing the PHCFs of different residential areas differ to great extents. The equity of the spatial distribution of PHCFs shows well overall, but there is still a lack of equity in local areas. The number of the residential areas with the lowest equity, insufficient supply and oversupply accounted for 10.31% and 39.00% respectively; the former is mainly gathered in a concentrated form at the edge and in a scattered form inside, and the latter is distributed in the interior mostly in a concentrated manner. The key findings highlight several aspects of improving the layout of PHCFs such as strengthen an in-depth analysis on residents' demand. This study contributes to a more accurate equity assessment, and further improves the layout of health care facilities.

Evaluation of Health Resource Allocation Efficiency Based on Data Envelopment Analysis 2014–2018 in Two Dimensions of Time-Region

Since the new health care reform, China’s health care system has become increasingly mature and perfect, and the health awareness and needs of residents have also increased, which has raised higher requirements for the scientific understanding of the current status of health care resource allocation and making it achieve the goal of efficient operation. This paper evaluates the allocation of health resources in China from 2014 to 2018 in two dimensions: time and space by reviewing the China Health and Health Statistical Yearbook from 2014 to 2020, collecting data on the number of medical institutions, number of beds, per capita medical budget expenditure, number of consultations, and bed utilization rate during the study time interval, and analyzing them using data envelopment analysis. The results show that there are regional differences in the supply level of medical and health resources in China. Although the supply level is mainly on the rise, there are differences in the supply level of medical and health resources among provinces. The polarization phenomenon exists between eastern, central, and western regions, the urban and rural areas, the urban hospitals, and grassroots-level health care organizations.

Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study

Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered.

Identification of patients at risk of new onset heart failure: Utilizing a large statewide health information exchange to train and validate a risk prediction model.

New-onset heart failure (HF) is associated with poor prognosis and high healthcare utilization. Early identification of patients at increased risk incident-HF may allow for focused allocation of preventative care resources. Health information exchange (HIE) data span the entire spectrum of clinical care, but there are no HIE-based clinical decision support tools for diagnosis of incident-HF. We applied machine-learning methods to model the one-year risk of incident-HF from the Maine statewide-HIE. We included subjects aged ≥ 40 years without prior HF ICD9/10 codes during a three-year period from 2015 to 2018, and incident-HF defined as assignment of two outpatient or one inpatient code in a year. A tree-boosting algorithm was used to model the probability of incident-HF in year two from data collected in year one, and then validated in year three. 5,668 of 521,347 patients (1.09%) developed incident-HF in the validation cohort. In the validation cohort, the model c-statistic was 0.824 and at a clinically predetermined risk threshold, 10% of patients identified by the model developed incident-HF and 29% of all incident-HF cases in the state of Maine were identified. Utilizing machine learning modeling techniques on passively collected clinical HIE data, we developed and validated an incident-HF prediction tool that performs on par with other models that require proactively collected clinical data. Our algorithm could be integrated into other HIEs to leverage the EMR resources to provide individuals, systems, and payors with a risk stratification tool to allow for targeted resource allocation to reduce incident-HF disease burden on individuals and health care systems.

The QALY is ableist: on the unethical implications of health states worse than dead

IntroductionA long-standing criticism of the QALY has been that it would discriminate against people in poor health: extending the lives of individuals with underlying health conditions gains fewer QALYs than extending the lives of ‘more healthy’ individuals. Proponents of the QALY counter that this only reflects the general public’s preferences and constitutes an efficient allocation of resources. A pivotal issue that has thus far been overlooked is that there can also be negative QALYs.Methods and resultsNegative QALYs are assigned to the times spent in any health state that is considered to be worse than dead. In a health economic evaluation, extending the lives of people who live in such states reduces the overall population health; it counts as a loss. The problem with this assessment is that the QALY is not based on the perspectives of individual patients—who usually consider their lives to be well worth living—but it reflects the preferences of the general public. While it may be generally legitimate to use those preferences to inform decisions about the allocation of health care resources, when it comes to states worse than dead, the implications are deeply problematic. In this paper, I discuss the (un)ethical aspects of states worse than dead and demonstrate how their use in economic evaluation leads to a systematic underestimation of the value of life-extending treatments.ConclusionStates worse than dead should thus no longer be used, and a non-negative value should be placed on all human lives.

Using NEWS2 to triage newly admitted patients with COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has spread globally and caused a major worldwide health crisis. Patients who are affected more seriously by COVID-19 usually deteriorate rapidly and need further intensive care. We aimed to assess the performance of the National Early Warning Score 2 (NEWS2) as a risk stratification tool to discriminate newly admitted patients with COVID-19 at risk of serious events. We conducted a retrospective single-centre case-control study on 200 unselected patients consecutively admitted in March 2020 in a public general hospital in Wuhan, China. The following serious events were considered: mortality, unplanned intensive care unit (ICU) admission, and non-invasive ventilation treatment. Receiver operating characteristic (ROC) analysis and logistic regression analysis were used to quantify the association between outcomes and NEWS2. There were 12 patients (6.0%) who had serious events, where 7 patients (3.5%) experienced unplanned ICU admissions. The area under the ROC curve (AUROC) and cut-off of NEWS2 for the composite outcome were 0.83 and 3, respectively. For patients with NEWS2 ≥ 4, the odds of being at risk for serious events was 16.4 (AUROC=0.74), while for patients with NEWS2 ≥ 7, the odds of being at risk for serious events was 18.2 (AUROC=0.71). NEWS2 has an appropriate ability to triage newly admitted patients with COVID-19 into three levels of risk: low risk (NEWS2=0-3), medium risk (NEWS2=4-6), and high risk (NEWS2 ≥ 7). Using NEWS2 may help nurses in early identification of at-risk COVID-19 patients and clinical nursing decision-making. Using NEWS2 to triage new patients with COVID-19 may help nurses provide more appropriate level of care and medical resources allocation for patients safety.

The effects of smoking, regular drinking, and unhealthy weight on health care utilization in China

BackgroundPreventive risk factors such as smoking, drinking, and unhealthy weight have contributed to the accelerated rise in noncommunicable chronic diseases, which are dominant drivers of health care utilization and spending in China. However, few studies have been conducted using a large longitudinal dataset to explore the impact of such preventive risk factors on health care utilization. Therefore, this study aimed to ascertain the effects of smoking, regular drinking, and unhealthy weight on health care utilization in China.MethodsThis research was a longitudinal study using data from five waves of the China Family Panel Studies (CFPS) conducted between 2010 and 2018, and the final sample consisted of 63,260 observations (12,652 participants) across all five waves of data collection. Health care utilization was measured from two perspectives: outpatient utilization and inpatient utilization. Smoking status was categorized as never smoker, former smoker, or current smoker. Unhealthy weight was classified based on the participants’ body mass index. A fixed effects logistic regression model was used for the analysis.ResultsThe results of fixed effects logistic regression showed that current and former smokers were approximately 1.9 times and 2.0 times more likely to use outpatient care than those who never smoked, respectively (odds ratio (OR) = 1.88, p < 0.05; OR = 2.03, p < 0.05). Obese people were approximately 1.3 times more likely to use outpatient care than healthy weight people (OR = 1.26, p < 0.05). Moreover, the results show that compared to those who never smoked, for current and former smokers, the odds of being hospitalized increased by 42.2 and 198.2%, respectively (OR = 1.42; p < 0.1, OR = 2.98; p < 0.05). Compared to healthy weight people, overweight and obese people were also more likely to be hospitalized (OR = 1.11; p < 0.1, OR = 1.18; p < 0.1, respectively).ConclusionAmong Chinese adults, current and former smokers were more likely to use outpatient and inpatient care than those who had never smoked. Moreover, compared to healthy weight people, obese people were more likely to use outpatient and inpatient care, and overweight people were more likely to use inpatient care. These results may have important implications that support the government in making health care resource allocation decisions.

Clinical features and predictors of mortality among hospitalized patients with COVID-19 in Niger

IntroductionCOVID-19 has spread across the African continent, including Niger. Yet very little is known about the phenotype of people who tested positive for COVID-19. In this humanitarian crises region, we aimed at characterizing variation in clinical features among hospitalized patients with COVID-19-like syndrome and to determine predictors associated with COVID-19 mortality among those with confirmed COVID-19.MethodsThe study was a retrospective nationwide cohort of hospitalized patients isolated for COVID-19 infection, using the health data of the National Health Information System from 19 March 2020 (onset of the pandemic) to 17 November 2020. All hospitalized patients with COVID-19-like syndrome at admission were included. A Cox-proportional regression model was built to identify predictors of in-hospital death among patients with confirmed COVID-19.ResultsSixty-five percent (472/729) of patients hospitalized with COVID-19 like syndrome tested positive for SARS-CoV-2 among which, 70 (15%) died. Among the patients with confirmed COVID-19 infection, age was significantly associated with increased odds of reporting cough (adjusted odds ratio [aOR] 1.02; 95% confidence interval [CI] 1.01–1.03) and fever/chills (aOR 1.02; 95% CI 1.02–1.04). Comorbidity was associated with increased odds of presenting with cough (aOR 1.59; 95% CI 1.03–2.45) and shortness of breath (aOR 2.03; 95% CI 1.27–3.26) at admission. In addition, comorbidity (adjusted hazards ratio [aHR] 2.04; 95% CI 2.38–6.35), shortness of breath at baseline (aHR 2.04; 95% CI 2.38–6.35) and being 60 years or older (aHR 5.34; 95% CI 3.25–8.75) increased the risk of COVID-19 mortality two to five folds.ConclusionComorbidity, shortness of breath on admission, and being aged 60 years or older are associated with a higher risk of death among patients hospitalized with COVID-19 in a humanitarian crisis setting. While robust prospective data are needed to guide evidence, our data might aid intensive care resource allocation in Niger.

Influence of Admission Time on Health Care Quality and Utilization in Patients with Stroke: Analysis for a Possible July Effect and Weekend Effect.

(1) Purpose: Undesirable health care outcomes could conceivably increase as a result of the entry of new, less experienced health care personnel into patient care during the month of July (the July effect) or as a result of the less balanced allocation of health care resources on weekends (the weekend effect). Whether these two effects were present in Taiwan’s National Health Insurance (NHI) system was investigated. (2) Methods: The current study data were acquired from the NHI Research Database. The research sample comprised ≥18-year-old patients diagnosed as having a stroke for the first time from 1 January 2006 to 30 September 2012. The mortality rate within 30 days after hospitalization and readmission rate within 14 days after hospital discharge were used as health care quality indicators, whereas health care utilization indicators were the total length and cost of initial hospitalization. (3) Results: The results revealed no sample-wide July effect with regard to the four indicators among patients with stroke. However, an unexpected July effect was present among in-patients in regional and public hospitals, in which the total lengths and costs of initial hospitalization for non-July admissions were higher than those for July admissions. Furthermore, the total hospitalization length for weekend admissions was 1.06–1.07 times higher than that for non-weekend admissions; the total hospitalization length for weekend admissions was also higher than that for weekday admissions during non-July months. Thus, weekend admission did not affect the health care quality of patients with stroke but extended their total hospitalization length. (4) Conclusions: Consistent with the NHI’s general effectiveness in ensuring fair, universally accessible, and high-quality health care services in Taiwan, the health care quality of patients examined in this study did not vary significantly overall between July and non-July months. However, a longer hospitalization length was observed for weekend admissions, possibly due to limitations in personnel and resource allocations during weekends. These results highlight the health care efficiency of hospitals during weekends as an area for further improvement.

Long-term assessment of efficacy with a novel Thoracic Survivorship Program for patients with lung cancer

ObjectiveWe developed a novel, nurse practitioner–run Thoracic Survivorship Program to aid in long-term follow-up. Patients with non–small cell lung cancer who were disease-free at least 1 year after resection could be referred to the Thoracic Survivorship Program by their surgeon. Our objectives were to summarize follow-up compliance and assess long-term outcomes between Thoracic Survivorship Program enrollment and non–Thoracic Survivorship Program. MethodsPatients who underwent R0 resection for stages I to IIIA between 2006 and 2016 were stratified by enrollment in Thoracic Survivorship Program versus surgeon only follow-up (non–Thoracic Survivorship Program). Follow-up included 6-month chest computed tomography scans for 2 years and then annually. Lack of follow-up compliance was defined by 2 or more consecutive delayed annual computed tomography scans/visits ± 90 days. Relationships between Thoracic Survivorship Program and second primary non--small cell lung cancers, extrathoracic cancers, and survival were quantified using multivariable Cox proportional hazards regression with time-varying covariate reflecting timing of enrollment. ResultsA total of 1162 of 3940 patients (29.5%) were enrolled in the Thoracic Survivorship Program. The median time to enrollment was 2.3 years; 3279 of 3940 (83%) had complete computed tomography scan data, and 60 of 3279 (1.8%) had 2 or more delayed scans; 323 of 9082 (3.6%) non–Thoracic Survivorship Program visits were noncompliant versus 132 of 4823 (2.7%) of Thoracic Survivorship Program visits (P = .009); 136 of 1146 Thoracic Survivorship Program patients developed second primary non–small cell lung cancer, and 69 of 1123 developed extrathoracic cancer, whereas 322 of 2794 of non–Thoracic Survivorship Program patients developed second primary non–small cell lung cancer and 225 of 2817 patients developed extrathoracic cancer. In multivariable analyses, Thoracic Survivorship Program enrollment was associated with improved disease-free survival (hazard ratio, 0.57; 95% confidence interval, 0.48-0.67; P < .001). ConclusionsOur novel nurse practitioner–run Thoracic Survivorship Program is associated with high patient compliance and outcomes not different from those seen with physician-based follow-up. These results have important implications for health care resource allocation and costs.

Association between local spatial accessibility of dental care services and dental care quality

BackgroundThe aim of our study was to evaluate the allocation of dental resources and explore access to dental care in Taiwan. In addition, we tried to understand the spatiotemporal characteristics of dental care quality and analyze the relationship between dental care quality and areas with deficiencies in dental resources.MethodsThe study used a two-step floating catchment area to calculate the dental resources accessibility and explore the spatiotemporal distributions of dental care quality. The association between dental care quality and spatial accessibility was analyzed using a spatial error model.ResultsMost areas with deficient dental resources and lower dental care quality were remote townships, agricultural towns, or aging towns with spatial clustering. The quality of children's preventive dental care had increased over time. Most highly urbanized areas had higher dental care quality. The quality of some dental care types such as children's preventive care and full-mouth calculous removal was associated with higher accessibility.ConclusionsUnderstanding the spatiotemporal distribution of both dental care accessibility and quality can assist in allocation of dental care resources. Adequate dental resources may elevate dental care quality. Suggestions include policies to balance dental resources and routinely monitor improvement in areas with deficient dental care.