Current Health System Research Articles

The impact of living with multiple long-term conditions (multimorbidity) on everyday life – a qualitative evidence synthesis

BackgroundMultiple long-term conditions (MLTCs), living with two or more long-term conditions (LTCs), often termed multimorbidity, has a high and increasing prevalence globally with earlier age of onset in people living in deprived communities. A holistic understanding of the patient’s perspective of the work associated with living with MLTCs is needed. This study aimed to synthesise qualitative evidence describing the experiences of people living with MLTCs (multimorbidity) and to develop a greater understanding of the effect on people’s lives and ways in which living with MLTCs is 'burdensome' for people.MethodsThree concepts (multimorbidity, burden and lived experience) were used to develop search terms. A broad qualitative filter was applied. MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (EBSCO), CINAHL (EBSCO) and the Cochrane Library were searched from January 2000-January 2023. We included studies where at least 50% of study participants were living with three or more LTCs and the lived experience of MLTCs was expressed from the patient perspective. Screening and quality assessment (CASP checklist) was undertaken by two independent researchers. Data was synthesised using an inductive approach. PPI (Patient and Public Involvement) input was included throughout.ResultsOf 30,803 references identified, 46 met the inclusion criteria. 31 studies (67%) did not mention ethnicity or race of participants and socioeconomic factors were inconsistently described. Only two studies involved low- and middle-income countries (LMICs). Eight themes of work were generated: learning and adapting; accumulation and complexity; symptoms; emotions; investigation and monitoring; health service and administration; medication; and finance. The quality of studies was generally high. 41 papers had no PPI involvement reported and none had PPI contributor co-authors.ConclusionsThe impact of living with MLTCs was experienced as a multifaceted and complex workload involving multiple types of work, many of which are reciprocally linked. Much of this work, and the associated impact on people, may not be apparent to healthcare staff, and current health systems and policies are poorly equipped to meet the needs of this growing population. There was a paucity of data from LMICs and insufficient information on how patient characteristics might influence experiences. Future research should involve patients as partners and focus on these evidence gaps.

AI-driven health data analytics for early detection of infectious diseases: A conceptual exploration of U.S. public health strategies

This review paper explores the role of AI-driven health data analytics in enhancing the early detection and response to infectious diseases within U.S. public health strategies. It begins by outlining the importance of timely detection in controlling outbreaks and discusses current public health systems and their limitations, including passive surveillance and data fragmentation. The paper highlights innovative AI technologies such as machine learning, natural language processing, and predictive modeling, which can significantly improve disease monitoring and forecasting. By analyzing vast datasets in real time, these technologies facilitate quicker identification of emerging health threats and enable tailored public health responses. Furthermore, the review presents recommendations for integrating AI innovations into existing public health strategies, emphasizing improved data interoperability, investment in infrastructure, stakeholder collaboration, community engagement, and real-world pilot programs. Ultimately, the findings underscore the potential of AI-driven health data analytics to transform infectious disease management, thereby safeguarding public health.

A Personalized, Transdiagnostic Smartphone App (Mello) Targeting Repetitive Negative Thinking for Depression and Anxiety: Qualitative Analysis of Young People's Experience.

The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving most young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative just-in-time adaptive interventions, which provide support based on real-time data. This study explores young people's experiences with Mello, a just-in-time adaptive intervention that focuses on the transdiagnostic mechanism of repetitive negative thinking (RNT), a significant factor contributing to youth depression and anxiety. Semistructured qualitative interviews were conducted with 15 participants aged 16 to 25 years, all of whom had previously participated in a pilot randomized controlled trial of Mello. Of the 15 participants, 9 (60%) identified as women, 4 (27%) as men (including 1 transgender man), and 2 (13%) as nonbinary. Interviews focused on participants' experiences with the Mello app, factors influencing engagement, perceived benefits and limitations, and suggestions for future improvements. Thematic analysis was used to analyze the data. The analysis identified three superordinate themes: Mello as a tool for intentional reflection; doing therapy your own way; and barriers to engagement during low mood, anxiety, and RNT. Theme 1 explored young people's experiences of how the app facilitated active management of negative thoughts and supported the development of reflective habits, contrasting with their typical strategies of avoidance or resistance. Theme 2 highlighted the value of the app's self-guided nature, with a particular focus on its flexibility and accessibility, particularly when compared to traditional face-to-face therapy. Finally, theme 3 addressed barriers to engagement, particularly during emotionally difficult times, with participants reporting feeling "stuck" in their negative thoughts. To mitigate these challenges, participants suggested incorporating gamification elements, such as progress-tracking visuals, to enhance motivation and increase engagement with the app. Our findings underscored the value of Mello in promoting intentional engagement and reflection with RNT, consistent with prior research that emphasizes the effectiveness of tailored interventions. Although some users valued the self-guided nature of the application, others encountered difficulties with motivation. Future research should explore strategies to enhance engagement for young people with low mood and motivation, such as co-design methodologies, advanced personalization features, and gamification techniques.

Addressing tobacco screening and treatment among racially and ethnically minoritized parents in pediatric clinics: barriers and facilitators.

Household secondhand smoke (SHS) exposure remains a significant health issue for racially and ethnically minoritized children in the United States. Delivering parental tobacco treatment during pediatric primary care visits can reduce children's SHS exposure. This study examined current tobacco screening practices and health system stakeholder perceptions of facilitators and barriers to addressing tobacco use during pediatric visits among racially and ethnically minoritized parents. We conducted 25 semi-structured interviews with clinicians, staff, and health system leaders from 5 pediatric primary care clinics in Minneapolis-St. Paul, Minnesota. The study was informed by the Health Equity Implementation Framework. Interviews were analyzed using both directed content and thematic analysis. Participants identified multilevel facilitators and barriers to addressing parental tobacco use in minoritized families. Within the clinical encounter, barriers included linguistic and cultural barriers, health system navigational challenges, medical mistrust, low levels of clinician and staff knowledge, skills, and confidence, time constraints, and lack of alignment with external metrics. Facilitators centered on leveraging interpreters' cultural knowledge and the presence of culturally-congruent clinicians and staff to reduce medical mistrust and stigma, developing linguistically and culturally relevant resources, and integrating prompts and resources into the electronic health record. Participants described how lessons from previous system change mechanisms would facilitate this work. Addressing health system, training and resources, and linguistic and cultural barriers among clinicians and staff is essential to strengthen their capacity to address household SHS exposure among racially and ethnically minoritized populations as a component of pediatric preventive care. Clinicians and health system staff perceive unique barriers to identifying and addressing parental tobacco use among racially and ethnically minoritized parents during pediatric primary care visits. Solutions to expand tobacco treatment access to minoritized parents in pediatric settings must attend to clinician training needs on tobacco treatment, embedding clinical encounter resources and reminders that match the linguistic and cultural needs and preferences of their patient populations, and increasing access to high quality interpreting services and culturally-congruent staff.

Approaches, enablers and barriers to govern the private sector in health in low- and middle-income countries: a scoping review

IntroductionThe private sector plays a substantial role in delivering and financing healthcare in low- and middle-income countries (LMICs). Supporting governments to govern the private sector effectively, and so improve outcomes...

The centrality of nursing in realizing high quality palliative care: Exploring Canada’s framework on palliative care priorities

BackgroundFollowing an earlier mixed-method survey in which we asked stakeholders to report on their perceptions of the progress made in relation to Canada’s Framework on Palliative Care and Action Plan, the purpose of this study was to conduct an in-depth qualitative exploration of the factors influencing that progress, or lack thereof.MethodsThis was a qualitative interview study conducted in Canada. Inclusion criteria included experience with palliative care in Canada in a professional or volunteer capacity. Interviews were conducted by telephone using an interview guide that asked specific questions in relation to the Framework on palliative care priorities (e.g., education, caregiver support, and equitable access). Data was analyzed using qualitative descriptive methods.ResultsThirty-five diverse stakeholders with extensive experience in palliative care were interviewed. In relation to palliative education, participants indicated that although there were excellent palliative care resources available across the country there was further need for embedding palliative care in undergraduate education and for mentored opportunities to engage in care across diverse contexts. The identification, development, and strategic positioning of champions was an important strategy for improving palliative care knowledge and capacity. The development of standard competencies was viewed as an important step forward; although, there was a need to include more members of the care-team and to create pathways for life-long learning. In relation to support for family caregivers, even as participants cited numerous community-based resources offered by not-for-profit organizations, they described significant barriers including a shortage of in-home support, lack of understanding of what caregivers do, and policy-based contractual and privacy issues. In relation to palliative care access, participants described a nurse-centered, consult-based, multi-site and multi-provider model of care that was facilitated by technology. Barriers to this model were systemic healthcare issues of siloed, fragmented, and for-profit care.ConclusionParticipants in this study had clear insights into the factors that would support or impede progress to the development of palliative care in Canada. Some of those factors were achievable within current health and educational systems. Other factors were going to require longer term and more comprehensive solutions.

Dental team barriers and enablers for the dental management of adults with severe obesity: a qualitative analysis

BackgroundBroad challenges regarding the dental management of people with severe obesity experienced by general dentists have been minimally explored. The perspectives of the dental team regarding these multifaceted issues are currently unknown and they potentially impede the delivery of optimal dental care to this population and contribute to poor oral and general health.AimsOur qualitative study aimed to identify and explore barriers and enablers in the dental management of adults with severe obesity among dental professionals and support staff in Australia.MethodsFocus groups and semi-structured interviews (n = 34 participants) were conducted with dental professionals (n = 23) and support staff (n = 11). Recordings were transcribed verbatim and synthesised using thematic, inductive analysis.ResultsMultiple barriers to adequate provision of dental care for people living with severe obesity in both general and specialist dental settings were identified. Key themes emerged related to the clinical challenges reported by participants in providing dental management for people living with severe obesity, appropriateness of existing bariatric dental service provision and safety of care. Enablers to access were identified, including increased availability of bariatric dental chairs, environmental modifications, education of both patients and the entire dental team and for guideline development.ConclusionThe current study explored multiple barriers to optimal dental management of people living with severe obesity in both general and specialist dental settings. Enablers should be used to inform future practice. The optimisation of existing bariatric dental service provision requires urgent review with solutions guided by systemic change. Study findings suggest a review of current health systems, economics, access barriers, policies and procedures and education and training beyond the individual level are needed. Future directions to improve the dental management of people living with severe obesity are proposed.

Reviewing and assessing emerging trends and needs for research, development and innovation (RDI) and capacity building in a short, medium and long-term perspective

Abstract An important aim of the Partnership is to identify current and future health services and systems priorities and to identify capacity building and training needs to support RDI activities in health and care systems in the Partnership countries and the EU as a whole. This is being done by means of periodical reviews, among others building on scientific research literature, strategic and policy documents and consultations of stakeholders. At the conference workshop, results of the mapping are presented, with a special focus on priority areas that can contribute to health systems transformation towards sustainable and people-centred health and care systems accessible to all. The session will allow participants provide reflections on and refinements to potential common priorities across national RDI agendas. This will provide direction for future research calls, based on an inventory of priorities that are considered by both policy audiences, research and wider stakeholder communities that should be addressed at EU and national levels.

Creating "a Safe Place to Go": Yarning With Health Workers About Stroke Recovery Care for Aboriginal Stroke Survivors-A Qualitative Study.

Stroke affects Aboriginal people at disproportionate rates compared to other populations in Australia. Aboriginal peoples are less likely to receive a timely stroke diagnosis, or timely culturally responsive treatment, as there are very few stroke resources and recovery plans that have been developed by Aboriginal peoples for Aboriginal peoples. Understanding how to develop and implement culturally responsive stroke care requires research approaches that are informed by and with Aboriginal people. A qualitative Indigenous research methodology including "yarning" was undertaken to understand the experiences of both Aboriginal and non-Aboriginal health workers from nine health services providing stroke rehabilitation and recovery support to Aboriginal people living within the participating communities. Data were analyzed using an inductive approach driven by an Indigenous research approach. Yarns revealed three themes: (i) the role of culturally safe health environments to support stroke survivors, their family, and health workers; and how (ii) complicated, under-resourced systems impede the capacity to support stroke survivors; and (iii) collaborative and adaptive practices prevent people "falling through the cracks." This study highlights the need to scrutinize the cultural safety of health care, current health systems, workforce, and culture and how these influence the capacity of health workers to provide care that is responsive to the individual needs of Aboriginal stroke survivors and their families. These learnings will inform the co-design of a culturally responsive stroke recovery care strategy to improve the recovery experience and health and well-being of Aboriginal people and their families living with stroke.

From the periphery to inclusion within the health system: promoting community health worker empowerment as a way forward

BackgroundCommunity health worker programmes have the potential to contribute critically towards universal health coverage. However, CHWs globally have often continued to operate on the periphery of the health care system, viewed as a non-essential cadre. This results in a workforce that often remains disempowered and under-supported. This paper presents evidence from a study conducted in a rural part of South Africa, to better understand issues of CHW prioritisation, integration, and empowerment.MethodsWe applied an analytical lens based on empowerment theory and conducted a secondary analysis of qualitative data emerging from a sub-study of a cRCT evaluating the effectiveness of supportive supervision for CHWs within a large-scale national CHW programme. The cRCT was conducted between 2017 and 2022, and 39 CHWs were included in the study.ResultsWe organised our findings across the four domains of structural empowerment; information, resources, support, and opportunity, and mapped these domains against the domains of psychological empowerment. Our findings show how CHWs are still working in the periphery of the healthcare system. Without sufficient prioritisation, high level-support from national and district governments, and sufficient investments in programmatic domains—such as training, equipment, and supportive supervision—it is likely that the CHW cadre will continue to be seen as informal health care workers.ConclusionsCHW empowerment could be a lever to potentially transform the current health system towards universal coverage; however, this process can only happen with sufficient high-level prioritization and investment.

We Need a Combination of Approaches to Evaluate Health System Resilience Comment on "Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic".

Health system resilience has become a desirable health system attribute in the current permacrisis environment. The article by Saulnier and colleagues reviews the literature on health system resilience and refines the concept, pinpointing dimensions of resilience governance that have not reached consensus, or that are missing from the literature. In this commentary we complement the findings by discussing different conceptual frameworks for understanding resilience and introducing resilience testing, a method to assess health system resilience using a hypothetical shock scenario. Resilience testing is a mixed-methods approach that combines a review of existing data with a structured workshop, where health system experts collaboratively assess the resilience of their health system. The new method is proposed as a tool for policy-making, as the results can identify attributes of the current health system that may hinder or boost a resilient response to the next crisis.

Bridging the gaps in pediatric complex healthcare: the case for home nursing care among children with medical complexity

BackgroundChildren with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC).MethodsThis mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews.ResultsOverall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families.ConclusionsFindings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers’ insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.

Periprocedural Management and Multidisciplinary Care Pathways for Patients With Cardiac Implantable Electronic Devices: A Scientific Statement From the American Heart Association.

The rapid technological advancements in cardiac implantable electronic devices such as pacemakers, implantable cardioverter defibrillators, and loop recorders, coupled with a rise in the number of patients with these devices, necessitate an updated clinical framework for periprocedural management. The introduction of leadless pacemakers, subcutaneous and extravascular defibrillators, and novel device communication protocols underscores the imperative for clinical updates. This scientific statement provides an inclusive framework for the periprocedural management of patients with these devices, encompassing the planning phase, procedure, and subsequent care coordinated with the primary device managing clinic. Expert contributions from anesthesiologists, cardiac electrophysiologists, and cardiac nurses are consolidated to appraise current evidence, offer patient and health system management strategies, and highlight key areas for future research. The statement, pertinent to a wide range of health care professionals, underscores the importance of quality care pathways for patient safety, optimal device function, and minimization of hemodynamic disturbances or arrhythmias during procedures. Our primary objective is to deliver quality care to the expanding patient cohort with cardiac implanted electronic devices, offering direction in the era of evolving technologies and laying a foundation for sustained education and practice enhancement.

Healthcare Organizations' Readiness for Potential System Transformation to Value-Based Care

Aim: This study aimed to determine the readiness of healthcare organizations for a potential systemic shift to value-based healthcare. Meanwhile, it also sought to understand healthcare professionals' awareness and attitudes toward value-based healthcare, their views on the need for system change, and on what is needed to achieve system change. Methods: The basic qualitative analysis design was used in the study. Interviews using a semi-structured questionnaire were conducted with 14 clinical and non-clinical health professionals. The data obtained were evaluated by content analysis and MAXQDA 2024 program was used in the analysis. Results: It’s stated that there are deficiencies and failures in the current health system (n=14) and that value-based system can be realized in the long term, provided that some changes are made (n=9). Care delivery and human resources aspects of the current health system are the most problematic and these are the priority areas that will ensure the harmonization of organizations with the value-based system through regulation. Evaluations in terms of care delivery process, financial strength, clinical and operational informatics, and provider network comprehensiveness were particularly positive about technology and informatics (n=27). The areas with the most negative evaluations were provider network comprehensiveness (n=23) and financial strength (n=26). Conclusion: Healthcare professionals' demands on the system are aligned with the promises of value-based healthcare. Many processes, especially in private and city hospitals, are running parallel to value-based healthcare, even if they are not labeled as “value-based”. Private hospitals are better prepared than public hospitals for the potential transition to value. If implemented with the necessary changes, value-based healthcare can be a suitable reform for the Turkish health system and an ideal method to meet the needs.

Recent Progress in Poly (Lactic-co-Glycolic Acid)-Based Biodegradable Drug Delivery Carriers for Pain Management

Pain, a prevalent clinical symptom, significantly demands attention in the current public health system due to its profound impact on patients’ quality of life, daily activities, and economic circumstances. Despite being a pervasive issue, many forms of pain remain ineffectively addressed, hence posing an enormous burden on patients. Pharmaceutical treatments, the first-line approach for various forms of pain, continue to face considerable challenges due to their limited efficacy, lack of long-lasting effects, and adverse side effects. In recent years, the rapid advancements in science and technology, especially the incorporation of micro and nano technologies across various domains, have accelerated the development of novel therapeutics. This review underscores the merits and drawbacks of different pharmacological strategies for pain management. It focuses on the research progress and applications of poly (lactic-co-glycolic acid)(PLGA) as drug delivery carriers, elucidating their potential therapeutic influence over pain management. The review concludes with a thorough summary of current research outcomes and limitations, a discussion of potential clinical transformations, and projections for future pain management research and effective care strategies.

Enabling Personal Health Trajectory systems by means of a blockchain federation

Many proposals have arisen to integrate a patient’s health information produced by different heterogeneous sources. Ones trying to physically integrate this information and others making interoperable the data that remain stored in current health systems. Interoperable approaches have become the preferred solutions because of data security and privacy constraints, and blockchain technology is currently being used for integrating distributed health data. However, despite many approaches for performing such integration, there are unresolved issues around them such as the definition of who should keep this data structure alive and who should manage access to it. This makes difficult for health institutions to keep the global vision of patient’s always up to date. This paper offers a new patient-centered solution to achieve a global view of patient health that we call Personal Health Trajectory (PHT), which makes use of the blockchains’ federation concept. We provide a reference implementation architecture of PHT that has been validated over a case study on 50 sociosanitary institutions with 1156 patients. We have obtained a delay of 2.87s in write operations and 0.16s in reading ones—regarding the separate interaction with each health institution, which is not significant with respect to the benefits obtained.

Global health, planetary health, One Health: conceptual and ethical challenges and concerns

The Covid-19 pandemic has dramatically shown the level of interconnectedness of the human population, the direct relation between human health and the ecosystem, as well as the enormous ethical challenges required for a global response. Relatedly, society has been directly confronted by issues of ‘Global health,’ both in terms of awareness of health conditions and health systems resiliency all around the world, as well as in terms of governance of the worldwide response and its implications at national and local levels. While Global health is often used as a cosmetic label for neocolonial approaches, it is really an interdisciplinary approach consisting of the interaction between globalization and the determinants of health. Thus, it involves the ecosystem and its transformation and implies a systemic ‘One Health’ decolonized approach in the definition of its strategies. The Covid-19 pandemic has highlighted the inequities and the limits of the current hegemonic Global health system governance; calling for ethics to provide a renewed, comprehensive, inclusive, and decolonized conceptualization of Global health.

Pharmacy practice and First Peoples health equity: a scoping review protocol.

The objective of this review is to examine and describe global pharmacy practice strategies and interventions designed to achieve health equity for First Peoples. Access to medicines and quality use of medicines is critical to achieving health equity for First Peoples. Pharmacists are uniquely placed to lead the charge in transforming current health systems, reducing health disparities, and bolstering the movement toward health equity. Global studies describing pharmacy practice strategies and interventions designed to achieve health equity for First Peoples will be considered for inclusion in the review. Studies relating to all areas of pharmacy practice, including community and clinical pharmacy, social, administrative, pharmaceutical sciences, practice, teaching, research, advocacy, or service relevant to the review's objective will also be considered for inclusion. The types of studies to be included are qualitative, quantitative, and mixed methods systematic reviews, scoping reviews, literature reviews, and gray literature. This review will be conducted in accordance with JBI methodology for scoping reviews. Embase, MEDLINE, Scopus, CINAHL, and gray literature sources will be searched from 1998 to the present. Titles, abstracts, and full texts will be screened against the inclusion criteria. Strategies and interventions identified in the included reviews will be mapped to a published framework, outlining actionable strategies for pharmacy practice inclusion in sustainable efforts to achieve health equity. Qualitative content analysis and descriptive statistics will be utilized with data presented in tables, accompanied by a narrative. Open Science Framework osf.io/qa64b.

"The Space Is as Much Yours as It Is Mine": Insights From Health System Leaders About Inclusive Leadership.

The long-standing systemic inequities highlighted during the COVID-19 pandemic and current events of social injustice have underscored the importance for health system leaders to develop or strengthen their competencies related to equity, diversity and inclusion. Inclusive leadership values different perspectives across organizational hierarchies. It reduces psychological distress and improves the performance of individuals and teams in health settings. Through semi-structured interviews, we explored the inclusive leadership experiences of five health system leaders. This study offers initial insights by unpacking inclusive leadership as a competency, identifying barriers and enablers and providing advice for current and future health system leaders.

2024 Watch List: Top 10 Technologies and Issues Related to Caring for Children and Youth With Medical Complexity

What Is the 2024 Watch List?&#x0D; &#x0D; The Watch List annual Horizon Scan report presents emerging technologies and issues that have the potential to shape the future of health care in Canada.&#x0D; CADTH’s 2024 Watch List focuses on care for children and youth with medical complexity. This top 10 has been divided in 2 parts — the top 5 technologies and top 5 issues related to children and youth with medical complexity that have the potential to make a significant and meaningful impact in transforming health systems in Canada over the next 5 years. These technologies and issues could shape the future of health care for not only children and youth with medical complexity, but also for others with chronic health conditions.&#x0D; &#x0D; Why Is This an Issue?&#x0D; &#x0D; Children and youth (people aged 24 years and younger) with medical complexity are a diverse group with a range of needs (e.g., single or multiple conditions, rare diseases). Although there is no single definition, common characteristics include significant functional limitations often causing the child or youth to be reliant on technology; high health care utilization, often requiring specialized care and services from different providers in multiple settings; and high health care service needs, such as care provision in the home and care coordination, which can have significant social and financial impacts on caregivers and the family.&#x0D; Children and youth with medical complexity account for less than 1% of all children and youth in Canada, but they account for 37% of hospital stays and 17% of emergency department visits. Due in part to the high number of health care interactions, this group experiences the effects of challenges within the health care system more acutely than their less medically complex peers.&#x0D; &#x0D; What Is the Potential Impact?&#x0D; &#x0D; The Watch List highlights areas for innovation, systems change, and investment.&#x0D; Advances in medical care have resulted in more children living with conditions that previously would not have been survivable in infancy and childhood. Now there are more children and youth with medical complexity, and they are living longer. Our current health systems were not designed to meet the complex needs of this group of people and their caregivers, including that many of them face challenges in accessing needed care. This year’s Watch List spotlights new and emerging technologies and key issues that could have a major impact on how patient care is provided to children and youth with medical complexity.&#x0D; &#x0D; What Else Do We Need to Know?&#x0D; &#x0D; In the 2024 Watch List, we identify and describe the top 5 new and emerging technologies that could shape the future of health care for children and youth with medical complexity in Canada, including new models of care and technologies and systems to improve communication. We also explore some considerations for health care decision-makers about the potential impact of these technologies on care pathways, health care human resources, health care infrastructure, and health equity.&#x0D; The 2024 Watch List also identifies the top 5 issues that limit health systems from providing optimal quality of care for children and youth with medical complexity. Key issues such as the need for increased interoperability between health systems and the need for strategies to improve sustainability warrant more attention and will influence the wider adoption, diffusion, and implementation of new and emerging technologies for children and youth with medical complexity.&#x0D; Monitoring ongoing developments and evidence related to the top technologies and issues highlighted in the 2024 Watch List can help guide health system planning in Canada and improve access to high-quality care.&#x0D;