Care Pilot Research Articles

Music therapy Embedded in the Life Of Dementia Inpatient Care (MELODIC) to help manage distress: A mixed methods study protocol for co-designing a complex intervention

ABSTRACT Introduction Best practice guidelines state that psychosocial interventions should be the first line of treatment for people with dementia who are experiencing distress. However, little research explores psychosocial support for those experiencing the most complex symptoms of distress in inpatient mental health wards. Music therapy may reduce behaviours of distress and staff report it to be helpful, yet interventions are not common in the National Health Service (NHS) in the United Kingdom, and the type and method of delivery vary. Methods and design This study, funded by the National Institute for Health and Care Research, will co-develop and pilot a standardised protocol and guide, MELODIC (Music Therapy Embedded in the Life Of Dementia Inpatient Care), for music therapy in NHS inpatient mental health dementia wards. Two reviews, using realist and systematic methods, will be conducted to increase understanding of the current evidence base. Focus groups will then be facilitated to explore experiences of distress and the use of music on wards. MELODIC v1 will then be co-designed with experts by experience and stakeholders, and piloted on two NHS wards with differing experiences of music therapy. Mixed methods data collection will support protocol and theory refinement and establish the appropriateness of the methods to inform a future trial. Ethical approval has been received for all research activities. Discussion The protocol and findings will be disseminated in academic, clinical and public spaces. MELODIC can then be tested for feasibility and acceptability, with clinical and cost-effectiveness ultimately established in a definitive randomised controlled trial. Registration Realist review: CRD42023409635; systematic review: CRD42023429983.

Collaboration strategies for bridging health, behavioral health, and social services in California's Medi-Cal Whole Person Care Pilot Program.

To identify collaboration strategies used to integrate health, behavioral health, and social services for Medicaid members in California's Medi-Cal Whole Person Care Pilot program (WPC). WPC was a social care intervention implemented to identify and address eligible members' health, behavioral health, and social needs. Data included semi-structured key informant interviews conducted in 2018-2019 (n = 221) and 2021 (n = 167); pilot-level surveys; whole-network surveys of 507 organizations in all 25 pilots participating in WPC; and documents submitted by pilots to the state. Pilots served a total of 247,887 unique members between 2017 and 2021, the majority of whom were non-white (72%) and over half of whom experienced homelessness. Data were collected as part of the statewide evaluation of WPC. We analyzed qualitative data to examine strategies used by pilots to integrate care, network data to identify pilots that improved cross-sector collaboration (i.e., strengthened density or multiplexity of cross-sector ties) following WPC implementation, and comparative case analysis to identify strategies that differentiated pilots that improved collaboration from those that did not. Pilots used multiple strategies to facilitate the integration of care. Network analyses identified 10 pilots that significantly improved either density or multiplexity of cross-sector ties, and one pilot with high cross-sector collaboration prior to WPC. Compared to pilots that did not improve cross-sector collaboration, these pilots meaningfully engaged partners in program design and implementation, used braided funds, and leveraged WPC to support broader systems change. These pilots also reported fewer challenges in developing and managing contractual relationships and ensuring meaningful use of data-sharing infrastructure by frontline staff responsible for care coordination. Data sharing is necessary but not sufficient for systems alignment. Collaboration strategies focused on addressing financial barriers to integration and strengthening normative and interpersonal integration are also needed.

In the Context of Integrated Healthcare and Nursing Services, the Study Explores the Production Dilemmas and Optimization of End-of-life Care Services in the Context of Aging Population in Guangxi - based on a Survey of an End-of-life Care Pilot Project i

With the continuous deepening of China's aging population, the number of the elderly has been increasing, and the mortality rate has been rising year by year. At the end of life, people often face psychological fear and physical pain. End-of-life care plays an important role in improving the quality of life of the elderly at the end of life. End-of-life care is an extremely important link in integrated healthcare and nursing services, and it is also an effective measure promoted by the state to cope with aging population. It aims to provide end-of-life care for the elderly in China and ensure the last leg of their life journey. This study takes an end-of-life care pilot project in Guangxi as an example and conducts a field survey on the implementation of end-of-life care services in relevant nursing homes. It also conducts semi-structured interviews with 13 end-of-life care workers and analyzes the data using Nvivo software. The study aims to explore the production dilemmas of end-of-life care services in the context of integrated healthcare and nursing services and propose relevant optimization measures.

NHS Sussex ICB Urgent Dental Care and Stabilisation Pilot Part 1 - A new approach to addressing a critical patient priority

NHS Sussex ICB Urgent Dental Care and Stabilisation Pilot Part 1 - A new approach to addressing a critical patient priority

Role of mixed healthcare providers networks in strengthening primary care systems: a case study of a rural primary care site

IntroductionService delivery networks, also called healthcare providers networks (HCPNs) have been used to address health inequities and promote universal healthcare (UHC). This study described the effect of instituting a mixed...

Program Implementation Strategies Associated With Reduced Acute Care Utilization for Medicaid Beneficiaries in California's Whole Person Care Pilot Program.

Public health care policymakers and payers are increasingly investing in efforts to address patients' health-related social needs (HRSNs) as a strategy for improving health while controlling or reducing costs. However, evidence regarding the implementation and impact of HRSN interventions remains limited. California's Whole Person Care Pilot program (WPC) was a Medicaid Section 1115 waiver demonstration program focused on the provision of care coordination and other services to address eligible beneficiaries' HRSN. In this study, we examine pilot-level variation in impact on acute care utilization and identify factors associated with differential outcomes. The majority of pilots reduced emergency department (ED) visits for enrollees relative to matched controls; however, only four pilots reduced both ED visits and hospitalizations. Coincidence analysis results highlight the importance of cross-sector partnerships, field-based outreach and engagement, and adequate program investment in differentiating pilots that reduced acute care utilization from those that did not.

99 An Equity-Oriented Model of Team-Based Care: A Co-Designed Knowledge Mobilization and Model of Care Pilot Intervention in British Columbia, Canada

99 An Equity-Oriented Model of Team-Based Care: A Co-Designed Knowledge Mobilization and Model of Care Pilot Intervention in British Columbia, Canada

Effectiveness of a pediatric critical care pilot preceptor program: Improved confidence and competency outcomes among a cohort of professional nurses in Blantyre, Malawi

BackgroundAvailability of high-level pediatric training for nurses in Malawi is limited. To address this gap, a novel pediatric critical care nurse preceptor program was developed and implemented by pediatric nurse specialists. AimEvaluate the effectiveness of a pediatric critical care nurse preceptor program, via change in nurses' knowledge, skills, confidence, and precepting competence. DesignA 12-month pediatric critical care nurse preceptor program with assessments at baseline, end of intensive (3 months), and end of program (6 months). SettingBlantyre, Malawi. ParticipantsNurses with two or more years of pediatric nursing experience (N = 20) nominated by unit managers. MethodsQuantitative data were collected throughout program implementation. Assessments included: (1) multiple choice knowledge test, (2) Objective Structured Clinical Examinations in two areas (vital signs and airway, breathing, circulation, disability, exposure assessments; and blood gas and electrolyte analysis), (3) group simulations (cardiopulmonary resuscitation or respiratory distress), (4) Likert-scale clinical confidence survey, and (5) Likert-scale precepting competence survey. Data were analyzed using repeated measures ANOVA with pairwise comparisons. For Likert-scale surveys, median confidence scores were compared using a Friedman test with post hoc pairwise comparisons using Wilcoxon signed-rank tests. ResultsParticipants demonstrated significant improvement in clinical knowledge (p < .001), vital signs and airway, breathing, circulation, disability, exposure assessment (p = .001), blood gas and electrolyte analysis (p = .001), CPR (p < .001) and respiratory distress (p < .001) simulations, clinical confidence (p = .002), and precepting competence (p = .041). ConclusionThis pediatric critical care nurse preceptor program was effective in improving participants' confidence and competence (knowledge and skills) in pediatric critical care nursing and precepting. Results suggest the program's potential to address the shortage of highly trained pediatric critical care nurses in Malawi. This lays groundwork for refining and expanding preceptorship, ultimately improving pediatric critical care nursing education in resource-limited settings.

Cost Evaluation of the Ontario Virtual Urgent Care Pilot Program: Population-Based, Matched Cohort Study.

In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns. This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable). We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts. This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions.

Addressing healthy aging in China: Practices and prospects.

One important challenge for global development is aging. China is one of the world's countries with the highest elderly population and the most rapid aging; in 2022, the percentage of the population over 65 was 14.9%; by 2050, it is expected to rise to 26.1%. China's health security, elderly care, and healthcare services are facing serious challenges as a result of this aging trend. With 80% of provinces including medical and elderly care in national basic public health care programs, China has adopted a proactive national plan to combat population aging. Moreover, geriatric departments have been established at 69.3% of public general hospitals at secondary and higher tiers, 48% of provinces have devises preventive interventions for disability and dementia in the elderly, 48 percent of provinces are serving as test regions for medical care related to rehabilitation, and 49 cities are involved in long-term care insurance (LTCI) trials that encompass 170 million people. There are 4,259 medical and health care facilities that provide hospice care services, 152 hospice care pilot regions, and 87,000 pairs of contracts between medical and health care facilities and elderly care providers. These developments provide a strong basis, but there are still major obstacles to overcome. The Chinese Government is urged to adopt early preventive measures, offer more ongoing, practical, and cost-effective diagnostic and treatment services, allocate resources equitably, and use intelligent technologies to enhance elderly care. The ultimate goals are to lessen the financial burden, enhance the health of the elderly, and offer a vital global resource.

Effects of Rehabilitation after Knee Arthroplasty by Home Care Pilot Program

Effects of Rehabilitation after Knee Arthroplasty by Home Care Pilot Program

Data to Care Pilot Program in Chicago: Experience, Outcomes, and Direction for the Future.

Data to Care (D2C) involves sharing HIV surveillance data between health care facilities and health departments to improve continuity of care for people living with HIV (PLWH). The Chicago Department of Public Health (CDPH) initiated a D2C pilot program at the University of Chicago Medicine (UCM) from June 2016 to September 2019. To describe the proportion of patients reported by UCM as not in care who were able to be matched to CDPH enhanced HIV/AIDS Reporting System (eHARS) and to report the individual-level factors associated with matching and viral suppression. Retrospective program evaluation. UCM, an academic health care center that provides HIV care to adults via a Ryan White clinic on the south side of Chicago. Adult PLWH who had received care at UCM but did not have current documented HIV care visit(s). Proportion of matched patients; factors associated with matching and viral suppression. Overall, 72.4% (n = 813/1123) of patients reported by UCM were matched by CDPH to eHARS. Individuals aged 40 to 49 years (odds ratio [OR] = 1.99; 95% confidence interval [CI], 1.10-3.62), 50 to 59 years (OR = 2.47; 95% CI, 1.37-4.47), and 60 years or older (OR = 6.18; 95% CI, 3.18-12.32) were more likely to match in eHARS. People who lived outside of Chicago (OR = 0.09; 95% CI, 0.05-0.15) or with unknown zip codes (OR = 0.08; 95% CI, 0.05-0.12) were less likely to match. Men who have sex with men and persons older than 50 years were more likely to be virally suppressed. D2C is an evidence-based strategy for reengagement of PLWH; however, program implementation relies on successful data matching. We found that a large proportion of patients from UCM were not matched, particularly those who were younger or lived outside of Chicago. Additional research is needed to understand ways to improve data matching to facilitate reengagement in HIV care.

Analyzing the Shortcomings in Smart Healthcare for Remote Home Care-A Case Study of the Taiwan Market.

In Taiwan, remote healthcare initially focused on telemedicine, with systematic development starting in 2007 through the "Remote Care Pilot Program" and subsequent initiatives. Significant advancements came with the "Remote Health Care Services Development Plan" in 2010, which integratedArtificial intelligence and Information and communications technologies, enhancing smart healthcare in home care. This study investigated strategic gaps in smart healthcare applications for remote home care using a mixed-methods approach, particularly the Analytic Hierarchy Process (AHP). This study identified and ranked strategic gaps, including "legal regulations", "economic factors", "user behavior habits", "policy and culture", and "environment and technology". Findings, based on in-depth interviews with 6 experts and 16 AHP questionnaire samples, highlight "legal regulations" and "user behavior habits" as critical areas needing attention. Addressing these gaps can improve user acceptance and the effectiveness of smart healthcare applications, providing valuable insights for future research and practice in making remote home care more comprehensive and efficient.

5-year multicenter analysis of clinical trial participation and total cost of care for older adults with cancer.

11013 Background: Clinical trial access particularly for older adults aged 65 years and above with cancer is impacted by multilevel barriers, including cost concerns to payers in the usual models of cancer care delivery. Alternative models recently studied include the Centers for Medicare and Medicaid Innovation’s Oncology Care Model (OCM), a value-based care pilot to enhance quality &amp; reduce costs. Here, we investigated the association between clinical trial participation (CTP) and the total cost of care (TCOC) within this non-traditional model. Methods: We identified prospective longitudinal observational cohort of patients cared for in 11 states within 323 clinics in 14 multi-site community practices participating in OCM, in The US Oncology Network and extracted data (episode claims, medical records, episodes) from OCM performance periods (PP) 3-11 between 7/1/17 and 6/30/22. Propensity score matching by PP, age, gender, date of death, cancer type identified the analysis cohort of matched episodes, then stratified by trial participation (CTP vs usual care) to compare TCOC and drug expenditures. Results: Over 5 years, 121,717 unique patients (94% of whom were aged 65y+) received 282,604 episodes of cancer care in the community, most common cancers being breast, lung, multiple myeloma. Propensity score matching identified 13,260 matched episodes (6630 usual care, 6630 CTP). The actual expenditure differed by $2,341 per episode between CTP &amp; usual care (CTP $43,890 vs usual care $41,548; p &lt; 0.0001), while trial participation had significant savings against the OCM CTP benchmark ($4816 saved per CTP episode), compared to usual care vs its benchmark ($826 saved per usual care episode, p &lt; 0.0001). Drug costs per episode did not differ between the two groups (CTP $29,516 vs usual care $30,553; p 0.54). Further breakdown shows that drug spending on anticancer agents (CTP $28,008 vs usual care $29,139) and other drugs including supportive care meds (CTP $1,511 vs usual care $1,414) did not differ significantly. Conclusions: Clinical trial participation saw relative cost savings against the benchmark compared to usual care, owing largely to the higher benchmark prices for CTP episodes in OCM’s risk-adjusted price prediction model, rather than an absolute cost savings to payers. Drug expenditures remain the largest contributor to total cost of care in this alternative model. The contributors to both drug expenditures as well as the absence of absolute cost savings between the two cohorts represent key areas for further investigation. CMMI Disclaimer: The statements contained in this document are solely those of the authors and do not necessarily reflect the views or policies of CMS. The authors assume responsibility for the accuracy and completeness of the information contained in this document.

Impact of a Pilot Project for Integrated Care on Hospitalization Rate among Older Adults in South Korea.

Since 2019, the Korean government has implemented a pilot project for integrated care to encourage healthy aging of older adults. This study investigated the changes in hospitalization rates among older adults who participated in the integrated care pilot project. Administrative survey data collected from 13 local governments and the National Health Insurance Database were used in present study. The participants comprised 17,801 older adults who participated in the pilot project between August 01, 2019 and April 30, 2022 and 68,145 matched controls. A propensity score matching method was employed to select the control group, and this study employed difference-in-differences (DID) approach to examine variations in the hospitalization rate. The DID analysis revealed that the odds ratio for rates of hospitalization among older adults who participated in the pilot project was 0.88 (95% confidence interval [CI] 0.84, 0.91) in comparison to control group. In specifically, as compared to the control group, the odds ratio for hospitalization rates among the pilot project's discharged patients was 0.17 (95% CI 0.15, 0.20). Although not statistically significant, the odds ratio of older adults who utilized LTCI services was 0.93 (95% CI 0.83, 1.05), and the odds ratio of older adults who applied for LTCI but were rejected or were intensive social care was 1.09 (95% CI 0.95, 1.26) compared to the comparison group. The findings imply that the discharged patient group had greater medical demands than the other types, and it can be claimed that this is the group that may anticipate greater efficacy while using health services. In addition, the integrated care services provided by the pilot project have the effect of reducing unnecessary hospitalization such as social hospitalization. Participants in the integrated care pilot project showed a lower hospitalization rate than the older adults who did not participate in the project but had similar characteristics. In particular, the admission rate of discharged patients showed a sharp decline.

Risk and protective factors in risk assessment: Predicting inpatient aggression in adult males detained in a forensic mental health setting.

Structured clinical risk assessments represent a preferred means of assessing levels of aggression risk at different times and in different individuals. Increasing attention has been given to capturing protective factors, with sound risk assessment critical to high-secure forensic mental health care. The aim was to assess the predictive value of the HCR-20v3 for aggression risk and the long-term care pilot version of the SAPROF (the SAPROF-LC-pilot) in a high-secure forensic mental health inpatient population and to determine the incremental value of protective over risk factors.Participants were adult males detained in a high secure forensic mental health service, with a primary diagnosis of schizophrenia and/or personality disorder. The focus was on examining hospital based aggression (self- and other-directed) at two time points; up to 6 months (T1) and between 7 and 12 months (T2).The HCR-20V3 and SAPROF-LC-pilot demonstrated good predictive validity but with variability across subscales and aggression types/periods. Historical factors of the HCR-20V3 and External factors of the SAPROF-LC-pilot failed to predict, aside from a medium effect at T1 for verbal aggression and self-harm, for Historical factors. There was evidence for protective factors adding to prediction over risk factors alone, with the integration of protective and risk factors into a risk judgement particularly helpful in improving prediction accuracy.Protective factors contributed to risk estimates and particularly if integrated with risk factors. Combining risk and protective factors has clear predictive advantages, ensuring that protective factors are not supplementary but important to the aggression assessment process.

Perinatal Palliative Care Pilot Study: An Innovative Theory-based Telehealth Intervention

Perinatal Palliative Care Pilot Study: An Innovative Theory-based Telehealth Intervention

Medical management and surgery versus medical management alone for symptomatic cerebral cavernous malformation (CARE): a feasibility study and randomised, open, pragmatic, pilot phase trial

The highest priority uncertainty for people with symptomatic cerebral cavernous malformation is whether to have medical management and surgery or medical management alone. We conducted a pilot phase randomised controlled trial to assess the feasibility of addressing this uncertainty in a definitive trial. The CARE pilot trial was a prospective, randomised, open-label, assessor-blinded, parallel-group trial at neuroscience centres in the UK and Ireland. We aimed to recruit 60 people of any age, sex, and ethnicity who had mental capacity, were resident in the UK or Ireland, and had a symptomatic cerebral cavernous malformation. Computerised, web-based randomisation assigned participants (1:1) to medical management and surgery (neurosurgical resection or stereotactic radiosurgery) or medical management alone, stratified by the neurosurgeon's and participant's consensus about the intended type of surgery before randomisation. Assignment was open to investigators, participants, and carers, but not clinical outcome event adjudicators. Feasibility outcomes included site engagement, recruitment, choice of surgical management, retention, adherence, data quality, clinical outcome event rate, and protocol implementation. The primary clinical outcome was symptomatic intracranial haemorrhage or new persistent or progressive non-haemorrhagic focal neurological deficit due to cerebral cavernous malformation or surgery during at least 6 months of follow-up. We analysed data from all randomly assigned participants according to assigned management. This trial is registered with ISRCTN (ISRCTN41647111) and has been completed. Between Sept 27, 2021, and April 28, 2023, 28 (70%) of 40 sites took part, at which investigators screened 511 patients, of whom 322 (63%) were eligible, 202 were approached for recruitment, and 96 had collective uncertainty with their neurosurgeon about whether to have surgery for a symptomatic cerebral cavernous malformation. 72 (22%) of 322 eligible patients were randomly assigned (mean recruitment rate 0·2 [SD 0·25] participants per site per month) at a median of 287 (IQR 67-591) days since the most recent symptomatic presentation. Participants' median age was 50·6 (IQR 38·6-59·2) years, 68 (94%) of 72 participants were adults, 41 (57%) were female, 66 (92%) were White, 56 (78%) had a previous intracranial haemorrhage, and 28 (39%) had a previous epileptic seizure. The intended type of surgery before randomisation was neurosurgical resection for 19 (26%) of 72, stereotactic radiosurgery for 44 (61%), and no preference for nine (13%). Baseline clinical and imaging data were complete for all participants. 36 participants were randomly assigned to medical management and surgery (12 to neurosurgical resection and 24 to stereotactic radiosurgery) and 36 to medical management alone. Three (4%) of 72 participants withdrew, one was lost to follow-up, and one declined face-to-face follow-up, leaving 67 (93%) retained at 6-months' clinical follow-up. 61 (91%) of 67 participants with follow-up adhered to the assigned management strategy. The primary clinical outcome occurred in two (6%) of 33 participants randomly assigned to medical management and surgery (8·0%, 95% CI 2·0-32·1 per year) and in two (6%) of 34 participants randomly assigned to medical management alone (7·5%, 1·9-30·1 per year). Investigators reported no deaths, no serious adverse events, one protocol violation, and 61 protocol deviations. This pilot phase trial exceeded its recruitment target, but a definitive trial will require extensive international engagement. National Institute for Health and Care Research.

The comparison of spatial patterns and factors associated with healthcare provider knowledge in palliative care in various regions of China

As an integral part of the overall life cycle, it is crucial to ensure equity and accessibility to palliative care services at the end of life. The knowledge of healthcare providers has a significant beneficial impact on the quality of palliative care services. This study aimed to compare the nationwide geographic distribution of healthcare providers’ knowledge of palliative care at the provincial level in China and identify the possible factors associated with its geographic disparities. A descriptive cross-sectional study was conducted in all provinces (n = 29) that implemented palliative care pilot programs in China. Data were collected online using a structured questionnaire. The possible factors associated with healthcare providers’ knowledge including economy, demographics, and health, were explored by using exploratory regression and ordinary least squares. In addition, spatial autocorrelation was also examined with Moran’s I, LISA, and Geographically Weighted Regression. A total of 18,272 participants from 903 health institutions in 87 palliative care pilot cities were included across 29 out of 31 provinces in China. The average knowledge score (mean ± standard deviation [SD]) was 8.61 ± 2.85. A positive spatial correlation was observed in healthcare providers’ palliative care knowledge level in China. The high level of knowledge was significantly associated with fewer hospitals per 10,000 population (β = −0.384, 95% CI: −0.601 to −0.168, p = 0.001), more primary healthcare institutions per 10,000 population (β = 0.220, 95% CI: 0.032–0.407, p = 0.024), and more community health center visits (β = 0.259, 95% CI: 0.054–0.465, p = 0.016), with higher coefficients being observed in the northwest and northeast regions. This study suggested that the knowledge level of palliative care among healthcare providers nationwide was relatively low, indicating the existence of a disparity between the supply and demand of palliative care services. There may be regional disparities in palliative care services based on the substantial geographical variation in healthcare provider knowledge, emphasizing the necessity of tailored interventions targeting areas with the greatest need.

Spatial-temporal characteristics analysis and ecological environment quality evaluation of forest health care bases in Yunnan, Guizhou and Sichuan provinces

As the forest health care in China is still in the early stage of development, the construction standards of forest health care base are not unified yet, resulting in large differences in the evaluation criterion for the ecological environment of forest health care bases. So, it is urgent to develop a new forest health care ecological environment quality assessment method. Yunnan, Guizhou and Sichuan provinces of China were selected as the study area, the previous 6 batches of 165 national forest health care pilot construction bases were selected as the main data source. This study explored the spatial and temporal distribution characteristics of forest health care bases in the study area using standard deviation ellipses, kernel density estimation method and cold and hot spot analysis. Furthermore, this study evaluated the ecological environment quality of the forest health care bases with a new ecological environment quality evaluation index model, which assembled Fraction Vegetation Coverage (FVC), Wetness (WET), Evapotranspiration (ET), Land Surface Temperature (LST) and Normalized Difference Bare Soil Index (NDBSI). The results are as follows: (1) the forest health bases in the study area are mainly located by the east of the Hu Line with a northeast-southwest distribution direction characteristics, and gradually expanded into a shape of “high in the east and low in the west, multi-point development”. (2) the area with ecological environment quality in excellent, good and medium grade accounts for about 87.73 % in the study area, indicating that most of the study area is suitable for the construction of forest health care base. These results can provide a practical guidance for the further rational layout and balanced development of forest health care bases in the study area.