Changing Health Care Environment Research Articles

North Carolina Academic Health Centers and Social Determinants of Health

Background Academic health centers (AHCs) have traditionally focused on 3 core missions: patient care, research, and education. The current changing health care environment requires AHCs to broaden their focus to improve the health of their communities. This study reports the opportunities and challenges for the 5 North Carolina AHCs addressing social determinants of health (SDOH). Methods We used a mixed methods design. We analyzed financial data from systemwide community benefits reports and the Form 990 Schedule H of the primary medical centers (when available) from the 5 AHCs, and we conducted 4 key informant (KI) interviews at each of the 5 AHCs for a total of 20 interviews. Results Overall, AHCs spend a very small percentage of their total spending on community improvement services and community benefit operations. By far, the largest amount spent on community benefit is for treating patients eligible for charity care. Food insecurity and access to health care were the most addressed SDOH. Housing was viewed as a crisis that needed to be addressed at statewide and national levels. Limitations Community benefits reports from North Carolina AHCs lack important details. Key informant interviews provide far more recent information on the quantity and breadth of initiatives than the latest community benefits reports that were all completed pre-pandemic. We only interviewed 4 stakeholders from each AHC in North Carolina. Conclusion A new strategic vision must incorporate social accountability into the AHCs’ core missions to remove barriers and institute and sustain change, but the AHCs face a steep challenge to incorporate social accountability at a core mission level.

Thresholds for the value judgement of health technologies in the United Arab Emirates: a consensus approach through voting sessions

BackgroundIn the evolving healthcare landscape of the United Arab Emirates (UAE), establishing cost-effectiveness thresholds (CETs) is pivotal to informing decision-makers about the value of health technologies.ObjectiveThis study aimed to establish...

COVID-19 and autoimmune rheumatic disease: behavioural changes adopted by patients amid the pandemic.

Amid concerns about severe COVID-19 in patients with autoimmune rheumatic disease (AIRD) during the outbreak, it is crucial to explore behavioural changes, whether healthy or unhealthy, arising from this patient population in response to the changing healthcare environment. To investigate COVID-19-driven behavioural changes in patients with AIRD. This observational study invited patients who attended the rheumatology clinic of the Korle Bu Teaching Hospital from 1 August 2020 to 1 July 2021, to respond to a survey questionnaire distributed on the patient's WhatsApp platform. Variables observed were changes in patient behaviour and decision-making related to medication, healthcare service utilisation and clinical advice. Results for 233 patients were analysed in the study, the majority (89.7%) of whom were women. The most significant behavioural changes were a reduction in hydroxychloroquine (HCQ) dosage, adoption of telemedicine for clinical consultation and keen adherence to protective/preventive health measures. Patients also expressed anxiety regarding the risk of contracting COVID-19 (52.5%), infecting their families (66.5%) and losing income (50.2%) due to the pandemic. Women and students were more likely to engage in self-isolation/shielding behaviour. Employed participants practised social distancing more, reduced HCQ dosage and had more fear of losing income. Having mixed connective tissue disease is associated with being anxious about the risk of COVID-19 infection. The COVID-19 pandemic has resulted in behaviour changes among patients with AIRD. Despite the perceived risk, most of these patients continue to adhere to their prescribed medication regimens, especially maintaining the dosage of traditional immunosuppressive agents.

Literature review on Curriculum Development

Background: Curriculum development in medical education is vital at all educational levels, from undergraduate to postgraduate and professional education focused on patient care. Understanding the systematic approach to curriculum development and evaluation is essential for maximizing the potential of medical education initiatives. Objective: The objective of this review was to explore and synthesize the existing literature on curriculum development in medical education, focusing on the processes and outcomes, and to provide recommendations for effective curriculum design and implementation. Methods: A comprehensive literature review was conducted using multiple electronic databases, including PubMed, MEDLINE, ERIC, Scopus, Web of Science, and Google Scholar. The search terms included "curriculum development," "medical education," "learning outcomes," "educational strategies," "assessment tools," "curriculum implementation," and "curriculum evaluation." Articles published in peer-reviewed journals were included based on relevance and methodological rigor. Data were synthesized using a narrative approach. Results: The review identified three types of curricula: explicit, implicit, and null. The explicit curriculum is structured and publicly available with clear learning objectives. The implicit curriculum is influenced by geographical, political, and socioeconomic contexts. The null curriculum refers to aspects not covered despite being planned. Key steps in curriculum development included needs assessment, content determination, goal and objective setting, selection of educational strategies, implementation, and evaluation. Educational strategies varied, including lecture-based learning, hands-on skill delivery, flipped classroom, and case-based learning. Continuous evaluation, both formative and summative, was essential for curriculum adaptation and improvement. Conclusion: A systematic approach to curriculum development in medical education ensures comprehensive and adaptive educational programs. This process addresses the diverse and evolving needs of learners and society, ultimately enhancing the quality of medical education. Effective curricula prepare healthcare professionals with the necessary knowledge, skills, and attitudes for high-quality patient care and adaptability to changing healthcare environments.

Telehealth Monitoring System for Chronic Disease Management

Telehealth Monitoring System for Chronic Disease Management

Designing Iranian hospital organizational charts: Global comparisons.

Hospitals should have effective and efficient organizational charts to face the changing healthcare environment. Thus, for this purpose, the present study seeks to compile an organizational chart for Iranian hospitals. The present study was conducted in two phase overview and qualitative (using focus group discussion). In the overview phase, the organizational charts of hospitals were analyzed in terms of complexity (i.e., degree of horizontal and vertical separations), and the initial hospital organizational chart was developed based on the results. Subsequently, experts were interviewed in a focus group discussion to finalize and validate the initial organizational chart. The final organizational chart was designed to contain features such as internal divisions, specialization, reduction of organizational hierarchies, expansion of supervision scope, and moderate-sized organizational pyramid. Using designed organizational chart would eliminate the redundant managerial levels since it reduces organizational hierarchies to two levels of management, expands the supervision scopes, fosters a moderate-sized organizational pyramid, and catalyzes communications.

AACP’s Strategic Commitment to Improving Pharmacy Education: Past, Present, and Future

Since its founding in 1900, the American Association of Colleges of Pharmacy (AACP) has been focused on quality pharmacy education. As the Association and its institutional and individual members now consider contemporary issues in education, such as competency-based education, it is important to continue their collective work in the context of AACP’s enduring mission: to advance pharmacy education, research, scholarship, practice, and service, in partnership with members and stakeholders, to improve health for all. While language, labels, and strategies evolve over time and across significant changes in social, economic, political, and health care environments, AACP’s commitment to quality in education has been and must continue to be unwavering. Constraints and challenges perceived in the short term should not deter deliberate and strategic quality improvement efforts over time and in the longer term. AACP’s 2021–2024 Strategic Plan, entitled Preparing Pharmacists and the Academy to Thrive in Challenging Times, acknowledges the need to prepare pharmacists for seemingly constant change in the health care environment.

Frailty in Aging HIV-Positive Individuals: An Evolving Healthcare Landscape.

The life expectancy of people living with HIV (PLWH) has greatly increased due to advancements in combination antiretroviral treatment (cART). However, this longer life has also increased the prevalence of age-related comorbidities, such as frailty, which now manifest sooner in this group. Frailty, a term coined by the insurance industry, has been broadened to include physical, cognitive, and emotional elements and has been recognized as a critical predictor of negative health outcomes. With the median age of PLWH now in the mid-50s, treating frailty is critical given its link to chronic diseases, cognitive decline, and even death. Frailty assessment tools, such as the Frailty Phenotype (FP) and the Frailty Index (FI), are used to identify vulnerable people. Understanding the pathophysiology of frailty in PLWH indicates the role of immunological mechanisms. Frailty screening and management in this group have progressed, with specialized clinics and programs concentrating on multidisciplinary care. Potential pharmacotherapeutic solutions, as well as novel e-health programs and sensors, are in the future of frailty treatment, but it is critical to ensure that frailty evaluation is not exploited to perpetuate ageist healthcare practices. This narrative review investigates the changing healthcare environment for older people living with HIV (OPLWH), notably in high-income countries. It emphasizes the significance of identifying and managing frailty as a crucial feature of OPLWH's holistic care and well-being.

Fear in Nursing: The Heroes Perspective

Nurses encounter unique and substantial challenges in professional practice. Nurses remain at the forefront of care but struggle with work-related fears and risk exposure. These challenges have significantly increased during unprecedented social unrest and the global pandemic making nurses less safe than in previous years. Nurses' fears and risks include patient harm, changing healthcare environments, and psychological and physical harm. This study reveals nurses' fears and highlights the significance of fear on the individual nurse and the profession. Healthcare leaders, administrators, educators, and practitioners must work on creating a culture of preparedness, support, and protection for healthcare workers in all areas.

Managing Healthcare Product Demand Effectively in The Post-Covid-19 Environment: Navigating Demand Variability and Forecasting Complexities

Managing the demand for healthcare products is a complex problem requiring in-depth knowledge of epidemiological trends, supply chain dynamics, and regulatory considerations. The intricate management of healthcare product demand in the post-COVID-19 era is thoroughly explored in this study. It is divided into nine sections exploring various facets of this critical field, emphasizing the persistent demand variations and difficulty in forecasting in the healthcare industry. It underscores the necessity for efficient demand management techniques in the changing healthcare environment. The significance of historical demand trends and provides examples of how studying historical data is essential for comprehending and forecasting the demand for healthcare products. Identifying seasonal fluctuations, forecasting disease outbreaks, and improving inventory management are emphasized. Investigating the difficulties in predicting the need for healthcare products, deals with problems caused by epidemiological ambiguity, supply chain breakdowns, patient demographics, regulatory adjustments, and technological advancements. The importance of data availability and quality in accurate demand forecasting is emphasized in this section. It encompasses scenario planning, resource allocation, technology adoption, supplier diversity, flexible manufacturing, collaborative and information sharing, data-driven decision-making, demand forecasting models, and strategic stockpiling. "Data Analytics and Predictive Modeling in Demand Forecasting," emphasize the function of these techniques in comprehending and forecasting demand trends. All covered are time series analysis, machine learning algorithms, epidemic predictive modeling, supply chain integration, scenario planning, optimization, risk assessment, in-the-moment monitoring, and feedback loops. "Supply Chain Resilience and Demand Response" explains why it's crucial to create robust supply chains and successfully adapt to demand changes. Supplier diversity, strategic stockpiling, agile production, real-time visibility, teamwork, data-driven decision-making, scenario planning, and regulatory flexibility are all covered

Changing Health Care Markets Have the Potential to Undermine Stroke Systems of Care

This Viewpoint discusses the importance of prioritizing quality of care for patients with stroke in a changing health care environment.

The economic influence of climate change on Bangladesh agriculture: application of a dynamic computable general equilibrium model

PurposeEvaluating the economic effects of climate change is a pivotal step for planning adaptation in developing countries. For Bangladesh, global warming has put it among the most vulnerable countries in the world to climate change, with increasing temperatures and sea-level rise. Hence, the purpose of this paper is to examine how climate change impacts the economy in Bangladesh in the case of climate scenarios.Design/methodology/approachUsing a dynamic computable general equilibrium (CGE) model and three climate change scenarios, this paper assesses the economy-wide implications of climate change on Bangladesh’s economy and agriculture. It is clear from the examination of the CGE model that the impacts of climate change on agricultural sectors were felt more sharply, reducing output by −3.25% and −3.70%, respectively, and increasing imports by 1.22% and 1.53% in 2030 and 2050, compared to the baseline.FindingsThe findings reveal that, relative to baseline, agricultural output will decline by a range of −3.1% to −3.6% under the high climate scenario (higher temperatures and lower yields). A decrease in agricultural output results in declines in agricultural labor and household income. Household income falls in all categories, although it drops the most in urban less educated households with a range of −3.1% to −3.4%. On the other hand, consumption of commodities will fall by −0.11% to −0.13%, according to the findings. Although climate change impacts had a relatively small effect on gross domestic product, reducing it by −0.059% and −0.098% in 2030 and 2050, respectively.Practical implicationsAs agricultural output, household consumption and income decline, it will impact the majority of the population’s health in Bangladesh by increasing malnutrition, hidden hunger, poverty, changing food environment, changing physical and mental health status and a changing health-care environment. Therefore, population health and food security will be a top socioeconomic and political concern for Bangladesh Government.Originality/valueThe examination of the dynamic CGE model is its originality. In conclusion, the evidence generated here can provide important information to policymakers and guide government policies that contribute to national development and the achievement of food security targets. It is also necessary to put more emphasis on climate change issues and address potential risks in the following years.

The Relationship Between Lifelong Learning Perceptions of Pediatric Nurses and Self-Confidence and Anxiety in Clinical Decision-Making Processes

ABSTRACT This study was conducted to evaluate the relationship between lifelong learning perceptions of pediatric nurses and self-confidence and anxiety in clinical decision-making processes. One of the most important ways to adapt to change in the developing and changing health care environment worldwide and in evidence based nursing care is lifelong learning. The most essential characteristics of a lifelong learner are reflection, questioning, enjoying learning, understanding the dynamic nature of knowledge and engaging in learning by actively seeking learning opportunities so that evidence-based nursing care can be achieved. Pediatric nurses were included in this descriptive, correlational and cross‐sectional study. The study was based on pediatric nursing in the pediatric clinics of a hospital in the capital of Turkiye between April and July 2021. It was determined that the mean scores of lifelong learning differed according to gender, education level, length of service in the profession and the unit in which each individual worked, and these differences were statistically significant. Pediatric nurses’ lifelong learning level explained the three subdimensions of self‐confidence in clinical decision-making. The results of the regression analysis indicate that lifelong learning levels of the pediatric nurses did not significantly predict their scores on the subdimensions of anxiety with clinical decision‐making scale. Positive effects on clinical decision-making in the nursing process can be achieved if the tendencies of pediatric nurses toward lifelong learning are sufficient. Assessing nurses’ lifelong learning perceptions is an essential step toward implementing evidence-based care for pediatric patients. Clinical decision-making skills can be supported by increasing nurses’ lifelong learning awareness.

Awareness of Digital Imaging/Telepathology Among Dental Post Graduate Students: A Survey

Background: The collection, storage and sharing of pathological data among oral pathologists to this day is done mostly by physical transfer of slides and reports. Telepathology is a form of communication between medical professionals that includes the transmission of pathology images or testing data. Aim: The aim of the study is to assess the knowledge, attitude and perception of digital pathology/telepathology among dental post graduate students. Materials and Methods: A cross-sectional study consisting of a self constructed survey was distributed through an online portal to dental post graduate students. The survey focused on the type of respondent, knowledge of microscopic digital photography, current usage, strengths and weaknesses and perceived future direction of digital imaging in the pathology laboratory. Results: A total of 102 responses were collected. The overall response rate was 100%. 56.9% of dental post graduate students are aware of the term “Digital Pathology” or “Telepathology”. 11.8% of dental post graduate students use digital pathology in their routine practice. 20.6 % of dental post graduate students send specimens once a year. 75.5% of dental post graduate students believe that “Digital Pathology/Telepathology” can be effective for research purposes. 62.7% of dental post graduate students believe that digital pathology imaging provides faster diagnosis. 75.5% of dental post graduate students believe that digital pathology imaging has high equipment cost. Comparison between the age of the respondents and their awareness of the term Digital Imaging/Telepathology and its scope in India stated that dental post graduate students of age group between 21-30 years were aware of the term and believed it has scope in India, but the results were insignificant (p>0.05). Conclusion: Improved knowledge and acceptance of digital pathology and telepathology throughout the dentistry community could facilitate the communication and cooperation necessary to realize the type of initiatives capable of advancing the importance of pathologists in the changing healthcare environment.

APA Board Discusses ‘Roadmap for the Future,’ M/UR Nomenclature

APA Board Discusses ‘Roadmap for the Future,’ M/UR Nomenclature

Making a move: Using simulation to identify latent safety threats before the care of injured patients in a new physical space.

In today's rapidly changing health care environment, hospitals are expanding into newly built spaces. Preserving patient safety by identifying latent safety threats (LSTs) in advance of opening a new physical space is key to continued excellent care. At our level 1 pediatric trauma center, the hospital undertook a 5-year project to build a critical care tower, including a new emergency department with five trauma bays. To allow for identification and mitigation of LSTs before opening, we performed simulation-based clinical systems testing. Eight simulation scenarios were developed, based on actual patient presentations, incorporating a variety of injury patterns. Scenarios included workflow and movement from the helipad and squad entrance as well as to radiology, the operating room, and the pediatric intensive care unit. A multiple resuscitation scenario was also designed to test the use of all five bays simultaneously. Multidisciplinary high-fidelity simulations were conducted in the new tower. Key trauma and emergency department stakeholders facilitated all sessions, using a structured framework for systems integration debriefing framework and failure mode and effect analysis to identify and prioritize LSTs, respectively. Eight sessions were conducted for 2 months. A total of 201 staff participated, including trauma surgeons, respiratory therapists, nurses, emergency physicians, x-ray technicians, pharmacists, emergency medical services, and operating room staff. In total, 118 LSTs (average of 14.8/session) were identified. Latent safety threats were categorized. An action plan for mitigation was developed after applying failure mode and effects analysis prioritization scores (based on severity, probability, and ease of detection). Systems-focused trauma simulations identified a large number of LSTs before the opening of a new critical care building. Identification of LSTs is feasible and facilitates mitigation before actual patient care begins, improving patient safety. Therapeutic/Care Management; Level IV.

A Focus Group Study of Retirement-Age Nurses: Balancing Tension and a Love of Nursing in a Changing Healthcare Environment.

The aims of this study were to explore the experience of retirement-age nurses and identify decision-making factors and innovations to enhance retention. A national shortage of nurses has created challenges to preserving quality patient care and level of nursing competency and managing turnover costs. A qualitative study using focus groups was conducted of nurses 55 years or older who were working or recently retired. Data were audiotaped and transcribed verbatim, with content analysis used to code in an iterative process until consensus was reached. The tension of balancing the love of patient care within a changing healthcare system was described. Patient acuity, competing roles, and the centrality of computers were stressors and integrally related. Flexibility in work schedules and new practice models were important to retirement decision making for work-life balance and retention. Passion for patient care dominated decisions to continue working. Innovations in practice models and scheduling offer opportunities to enhance the retention of experienced nurses.

From the Frontlines to the Future: Emergency Department Nurses' Advice During the COVID-19 Pandemic

Nurse educators are challenged to bridge the gap between academia and the health care environment to provide nursing students with the knowledge and skills to ensure their readiness to practice. With limited traditional clinical experiences, many new graduate nurses begin their careers in high-stress environments such as emergency departments. A convenience sample of 66 emergency department nurses completed two qualitative survey questions related to their experiences working with new graduate nurses during the coronavirus disease 2019 (COVID-19) pandemic. Respondents reported lack of clinical skills was the biggest weakness observed in new graduate nurses. Four themes were identified: protection and unpreparedness, thirst for knowledge, burnout, and support and self-care; these themes built the foundation for the overarching theme of resilience. Nurse faculty must be able to support students' transition into a rapidly changing health care environment. Student preparation should focus on skill building, communication, self-care strategies, and resilience. [J Nurs Educ. 2022;61(12):711-715.].

Increasing Exposure to Primary Care Nursing Through Curriculum Revision and an Innovative Nursing Minor.

The changing health care environment dictates a workforce competently trained to address chronic health care issues particularly in primary care settings. Curriculum analysis identified deficits in primary care education and the need to create academic opportunities that bridge the gap between primary health care needs and nursing preparation. An existing academic-clinical partnership was leveraged to create a primary care minor for BSN students designed to provide a comprehensive adjunct to the traditional baccalaureate nursing curriculum. A total of 19 credits and 150 clinical hours are necessary to complete the minor. Additionally, the BSN curriculum was revised to include primary care for all students. A total of 45 students and 26 preceptors have participated in the elective courses. Eight students have completed the minor with 11 additional students in the final course. A nursing curriculum with increased primary care exposure may improve workforce preparation and address health care needs.

Feasibility of Use of the Clinical Internship Evaluation Tool in Full-Time Clinical Education Experiences: A Multi-institutional Study

Introduction. The Clinical Internship Evaluation Tool (CIET) is a reliable and valid clinical education assessment tool but is used less frequently by physical therapist education programs than the Physical Therapist Clinical Performance Instrument (PT CPI). The purposes of this exploratory study were to: 1) explore CI and student perceptions for the CIET as an accurate and user-friendly measurement of physical therapist (PT) student clinical performance; and 2) to compare stakeholder perceptions of CIET as a clinical performance tool to PT CPI. Methods. Clinical instructors and PT students were recruited from 5 geographically diverse physical therapist education programs and completed both the PT CPI and CIET at the midterm and final evaluation during a full-time clinical education experience. A post-survey collected data related to participants' perceptions of tool feasibility and ease of use. The Wilcoxon sign rank test was used to determine whether significant differences existed in the participants’ perceptions related to the utility of the CIET versus PT CPI. Results. One hundred one participants (56 PT students; 45 CIs) completed the study. Most student and CI participants (91.1%) indicated that the CIET completion time was < 45 minutes. More students (66.1%) and CIs (73.3%) reported a PT CPI completion time of > 45 minutes. Students (71.4%) and CIs (68%) preferred the CIET to the CPI. There was a significant difference in perception of ease of use (Z-score = −5.42, P < .001), appropriate completion time (Z-score = −7.25, P < .001), and little redundancy of items (Z-score = −7.17, P < .001). Discussion and Conclusion. Students and CIs preferred the CIET which was perceived to be easy to use and completed in < 45 minutes while still retaining the ability to accurately measure student performance in clinic. Clinical education requires efficient, valid, and reliable assessment tools to match the dynamic needs of a changing health care environment.