Goal Of Health Care Research Articles

Identifying Levers for Change in Healthcare Coordination Between the Emergency Youth Shelter and Health Systems in Toronto, Canada Through Stakeholder Engagement: A Qualitative Study

Background: Healthcare coordination involves supporting youth experiencing homelessness (YEH) with accessing appropriate healthcare; synchronizing delivery of their healthcare across multiple systems; sharing healthcare and discharge plans with youth and providers who fall under their ‘circle of care;’ and coordinating post-care follow-up as necessary. Challenges with coordinating healthcare within and between the emergency youth shelter (EYS) and health systems include poor accountability for healthcare coordination across systems; information-sharing and privacy policies inhibiting communication between sectoral staff; inconsistencies in system-based and organizational norms, operations, and funding; and each system’s historically fragmented structure. Methods: We used a system thinking framework to identify levers for change in healthcare coordination within and between the EYS and health systems in Toronto, Canada. Six stakeholders who work at various levels of each system participated in online breakout room discussions as part of a two-hour forum facilitated by our research team. A series of four questions were asked to identify levers for change in system parts and system patterns in healthcare coordination within and between the EYS and health systems. Breakout room discussions were recorded, transcribed, and co-analyzed by the research team using reflexive thematic analysis for each question. Results: Organizational and system-wide goals discussed to strengthen healthcare coordination include clarifying accountability in staff roles, revisiting discharge policies to improve continuity of care, prioritizing funding for programs evaluated to be effective, establishing more opportunities for system cross over, enhancing accessibility for YEH, integrating social medicine into healthcare approaches, and streamlining health communication across both systems. When asked about what is realistically possible, stakeholders were optimistic about enhancing information-sharing through digital health platforms, adapting organizational policies to consider the holistic needs of YEH, and dispersing funds more intentionally to support coordination initiatives. Furthermore, poor staff-youth relations, harmful discharge policies and the Toronto housing crisis were noted as patterns impeding meaningful change in coordinating healthcare. Finally, stakeholders identified systems integration and alignment of well-defined healthcare coordination processes across systems to harmonize efforts in achieving healthcare coordination goals. Conclusions: Stakeholder forum participants discussed promising levers for change that are recommended to strengthen parts of the EYS and health systems along with patterns that influence healthcare coordination between them.

A Comparison of Molecular Techniques for Improving the Methodology in the Laboratory of Pharmacogenetics.

One of the most critical goals in healthcare is safe and effective drug therapy, which is directly related to an individual's response to treatment. Precision medicine can improve drug safety in many scenarios, including polypharmacy, and it requires the development of new genetic characterization methods. In this report, we use real-time PCR, microarray techniques, and mass spectrometry (MALDI-TOF), which allows us to compare them and identify the potential benefits of technological improvements, leading to better quality medical care. These comparative studies, as part of our pharmacogenetic Five-Step Precision Medicine (5SPM) approach, reveal the superiority of mass spectrometry over the other methods analyzed and highlight the importance of updating the laboratory's pharmacogenetic methodology to identify new variants with clinical impact.

Expanding the primary care workforce by integrating genetic counselors in multidisciplinary care teams.

Collectively, rare diseases are common, affecting approximately 8% of the population in Canada and the USA. Therefore, the majority of primary care (PC) clinicians will care for patients who are affected or at risk for a genetic disease. Considering the increasing ways in which genetics is being implemented into all areas of healthcare, one way to address these needs and expand the capacity of the PC workforce is through the integration of genetic counselors (GCs) into PC multidisciplinary teams. GCs are Masters-educated allied health professionals with specialized training in molecular genetics, communication, and short-term psychotherapeutic counseling. The current models of GCs in PC mimic other multidisciplinary models. Complex tasks related to genetics, such as pre- and post-test counseling, genetic test selection, and results interpretation, are conducted by GCs, which, in turn, allows physicians, nurse practitioners, and other PC providers to work at the top of their scope of practice. Quality genetics services provided by GCs improve clinical outcomes for patients and their families; the simultaneous provision of genetic education and psychological support by a GC is associated with an increase in patient knowledge, perceived personal control, decrease in distress, and can lead to positive health behavior changes, all of which are aligned with the goals of primary healthcare. With their extensive training in clinical care, medical communication, and psychotherapeutic counseling, integrating GCs into PC care teams will improve the care patients receive and allow PC clinicians to ensure their patients are at the forefront of the personalized medicine revolution.

P10.06.A AGENT-BASED MODELING FOR PATIENT-CENTERED CLINICAL DECISION SUPPORT IN NEURO-ONCOLOGY

Abstract BACKGROUND Complex clinical decision-making in neuro-oncology is a multifaceted process involving numerous specialties influenced by various objective factors and patient preferences. Modeling these multidisciplinary neuro-oncology discussions presents significant challenges, particularly given the multimodal nature of the data. Recent advancements in large language models (LLMs) have enabled the development of LLM “agents”. These agents pave the way for multi-agent systems capable of simulating interacting components, thus capturing the nuances of interdisciplinary clinical discussions. MATERIAL AND METHODS Utilizing GPT-4, we developed conversational agents with an agent-based modeling (ABM) approach; each agent was assigned a specific specialty. We simulated their interactions in various clinical decision-making scenarios. Lastly, we simulated 30 patient-agents and included them in the ABM system. We applied this ABM approach to a dataset of 16 clinical vignettes extracted from the UCSF Clinical Data Warehouse of primary adult glioma patients who underwent tumor board (TB) reviews. The TB decision was used as ground truth for quantitative evaluation. Seven independent clinicians evaluated the final decisions. RESULTS Our quantitative assessment showed that, when blinded to whether ABM or TB generated responses, evaluators preferred ABM recommendations 47.8% of the time, followed by TB recommendations (38%). The highest recommendation concordance was between TB and ABM (50.6%). The ABM was deemed clinically accurate in 76.8% of cases and provided clinically appropriate reasoning in 73.2%. Our qualitative assessment showed that including the patient agent significantly influenced the course of discussions, notably when the patient agents participated in the system by stating their healthcare goals. The most recommended individual treatment was standard-of-care chemotherapy, followed by targeted therapies, clinical trials, immunotherapy, and palliative care. The least frequently recommended management options were radiation, surgery, consultation with other specialties, and devices. CONCLUSION This study underscores the potential of ABM in neuro-oncology, particularly in simulating complex, real-world scenarios. ABM not only empowers patients but also offers clinicians a novel tool for understanding and navigating the multifaceted landscape of patient preferences and treatment options. It provides a platform for clinicians to visualize the potential impacts of various decisions, enhancing their ability to provide personalized, effective care. We envision future work where ABM systems are patient-centric, enabling patients to explore the potential impacts of their individual characteristics on clinical management options.

Identifying influential individuals and predicting future demand of chronic kidney disease patients

ABSTRACTTo ensure high service quality, managers need to personalize treatment options and meet their customer demands. Our research is motivated by the need to better anticipate and prepare for that. We develop a generalizable framework that is the first to address two healthcare risk management goals: (1) identifying high risk and stable‐demand customers and (2) predicting the medium‐term demand for services of stable‐demand customers. We also design a model‐agnostic method for variable evaluation. It can rank predictors based on their global impact, and highlight their effect on a model's local accuracy. In this research, we leverage a large electronic medical records' data set, which comprised of 48,344 chronic kidney disease patients treated across geographically diverse Veterans Affairs regions. Our framework indicates that although only 1.3% of the examined individuals are high‐risk patients, it can correctly identify 35% of them and highlight an additional 8.9% as having important demand implications. Identifying high‐risk individuals can be used in (1) monitoring prioritization, (2) patients' motivation, and (3) patients' stabilization. Furthermore, our model accurately predicts the monthly need for care of stable‐demand individuals up to 3 years into the future and outperforms popular statistical and data mining models. This information is especially critical for hospital management in identifying future hiring needs.

Application of Kolcaba’s Comfort Theory in healthcare promoting adults’ comfort: a scoping review

BackgroundComfort is a primary goal of healthcare. Theory-informed interventions and measurement are essential for comfort enhancement.ObjectivesTo categorise and synthesise the international literature on the application of Kolcaba’s Comfort Theory in...

Transformative personalized oxalate biomarker analysis through a wrist-worn microneedle device integrated with duplex nanozyme toolbox

The interstitial fluid (ISF) is valuable for disease diagnosis due to its unique biomarkers. Microneedles (MNs) offer a painless method for ISF sampling, facilitating primary diagnostics. This study introduces a minimally invasive, biocompatible MN patch made from a swellable hydrogel of polyvinyl alcohol (PVA) and polyvinyl pyrrolidone (PVP), which effectively extracts ISF. The hydrogel selectively permits small molecules like oxalate, a kidney disease biomarker, while blocking large biomolecules. The MN patch is integrated with a multilayer sensor via microfluidic channels, featuring cotton fiber, agarose, and Mn3[Fe(CN)6]2, alongside Fe3[Fe(CN)6]3 (AGH-CP/MnFeCN/FeFeCN). These nanozymes exhibit oxidase-like activity, reacting with 3,3′,5,5′-tetramethylbenzidine (TMB) to indicate oxalate levels through a color change from green (no oxalate) to light or dark blue, based on concentration. The designed sensor demonstrates high performance with a detection limit of 0.897 μM and an RSD of 1.22 %, enabling accurate quantification via smartphone image analysis as readout platforms for more accessibility and user-friendliness which helps to reach personalized healthcare goals. This integration facilitates real-time, remote, precise disease detection, biochemical analysis and forsooth miniaturization, leading to the development of portable, flexible, and wearable sensors. The MN patch and integrated sensor show excellent stability, selectivity, sensitivity, reliability, and long-term durability. This minimally invasive sensing system, designed for wristband integration, opens new avenues for precision point-of-care monitoring, enhancing personal healthcare.

Unveiling sex-disparities and the impact of gender-affirming hormone therapy on periodontal health

IntroductionAs personalized medicine advances, the need to explore periodontal health across different sexes and gender identities becomes crucial. This narrative review addresses the gap in understanding how biological sex and gender-affirming hormone therapy (GAHT) influence periodontitis risk.ResultsResearch has uncovered significant sex-based immunological disparities driven by X and Y chromosome gene expression and sex-hormones, which may influence susceptibility to periodontitis. Additionally, preliminary findings suggest that GAHT, particularly testosterone therapy in transgender men, could exacerbate pro-inflammatory cytokine production and alter immune cell responses, which may exacerbate inflammatory pathways crucial in the progression of periodontitis. Conversely, the effects of estrogen therapy in transgender women, although less extensively studied, suggest modifications in B cell functionality. These observations highlight the complex role of GAHT in modulating immune responses that are central to the development and exacerbation of periodontal disease.DiscussionThe review highlights a complex interaction between sex hormones, gene expression patterns, immune responses, and periodontitis risk. While cisgender males show increased susceptibility to periodontitis that could be linked to specific immune pathways, GAHT appears to modify these pathways in transgender individuals, potentially altering their risk and disease progression patterns.ConclusionThere is a critical need for more focused research on the direct impacts of GAHT on periodontal health. Understanding the nuances of immune modulation by GAHT will aid in crafting personalized periodontal care for transgender individuals, aligning with the broader goals of inclusive and effective healthcare.

Isolation, characterization and antimicrobial activity study of Thymus vulgaris

Herbal medicines are important for ensuring sustainable development goals (SDGs) in healthcare, particularly in developing countries with high rates of antimicrobial resistance (AMR) and little access to medical facilities. Thymus vulgaris is a widely used herbal medicinal plant known for its secondary metabolites and antimicrobial properties. The present study involved a comprehensive examination of the isolation, characterization, and antibacterial activity of Thymus vulgaris obtained from Ethiopia. The aerial part of the plant Thymus vulgaris was successively extracted with hexane, chloroform, and methanol based on differences in polarity. Phytochemical screening tests conducted against hexane, chloroform and MeOH crude extracts indicated the presence of some secondary metabolites. Based on the thin-layer chromatography tests, the chloroform extract was subjected to column chromatography, yielding Tv-2 compounds, namely 5-isopropyl-2-methylphenol. The structures of the compounds were elucidated via spectroscopic methods (UV–Vis, FT-IR and NMR). We investigated the antibacterial properties of hexane crude extract, chloroform crude extract, MeOH crude extract, and isolated fractions derived from T. vulgaris against various bacterial strains. This study contributes to a better understanding of the bioactive components present in Thymus vulgaris crude extracts and their potential role in tackling microbial infections.

Value-based healthcare: is it the way forward?

It is undeniable that the NHS, our universal healthcare system, is struggling to meet the needs and expectations of a population that is very different from its inception in 1948. Costs are rising inexorably and, yet, patient experience of their healthcare is often not what we would want it to be. Inequities still exist, both in terms of access to care and clinical outcome. As we spend more and more, surprisingly little is known about the extent to which we are meeting the healthcare goals and outcomes that really matter to patients. Equally, clinical teams are stretched and facing burnout as we emerge slowly from the pandemic. Meanwhile, value-based healthcare has gathered momentum worldwide as a lens through which to examine these problems. But does it provide helpful solutions? This article examines the strengths and limitations of value-based healthcare and its application in the UK context.

Evaluating the implementation of the Pediatric Acute Care Education (PACE) program in northwestern Tanzania: a mixed-methods study guided by normalization process theory

BackgroundIn low- and middle-income countries (LMICs), such as Tanzania, the competency of healthcare providers critically influences the quality of pediatric care. To address this issue, we introduced Pediatric Acute Care Education (PACE), an adaptive learning program to enhance provider competency in Tanzania’s guidelines for managing seriously ill children. Adaptive learning is a promising alternative to current in-service education, yet optimal implementation strategies in LMIC settings are unknown.Objectives(1) To evaluate the initial PACE implementation in Mwanza, Tanzania, using the construct of normalization process theory (NPT); (2) To provide insights into its feasibility, acceptability, and scalability potential.MethodsMixed-methods study involving healthcare providers at three facilities. Quantitative data was collected using the Normalization MeAsure Development (NoMAD) questionnaire, while qualitative data was gathered through in-depth interviews (IDIs) and focus groups discussions (FGDs).ResultsEighty-two healthcare providers completed the NoMAD survey. Additionally, 24 senior providers participated in IDIs, and 79 junior providers participated in FGDs. Coherence and cognitive participation were high, demonstrating that PACE is well understood and resonates with existing healthcare goals. Providers expressed a willingness to integrate PACE into their practices, distinguishing it from existing educational methods. However, challenges related to resources and infrastructure, particularly those affecting collective action, were noted. Early indicators point toward the potential for long-term sustainability of the PACE, but assessment of reflexive monitoring was limited due to the study’s focus on PACE’s initial implementation.ConclusionThis study offers vital insights into the feasibility and acceptability of implementing PACE in a Tanzanian context. While PACE aligns well with healthcare objectives, addressing resource and infrastructure challenges as well as conducting a longer-term study to assess reflexive monitoring is crucial for its successful implementation. Furthermore, the study underscores the value of the NPT as a framework for guiding implementation processes, with broader implications for implementation science and pediatric acute care in LMICs.

Effect of long-term care insurance on medical expenditure and health status: National cohort study

BackgroundLong-term care insurance (LTCI) was implemented in China to solve the elderly care problems caused by the aging population. It is crucial to evaluate the effectiveness of LTCI implementation from the perspective of value-based healthcare.ObjectiveThis study aimed to investigate the impact of LTCI on medical care expenditure and health status in China.MethodsWe used staggered difference-in-differences (DID) analysis to analyze the effect of LTCI policy on medical expenditure and health status based on China Health and Retirement Longitudinal Study data from 2011 to 2018.ResultsOur findings confirmed the positive contribution of LTCI policies to medical expenditures and health status. We found that the implementation of LTCI significantly reduced inpatient and outpatient expenditure, scores of self-report of health, and CESD scores by 26.3%, 12.3%, 0.103, and 0.538, respectively. It also decreased ADL scores, but the decrease was not significant. The impact of LTCI on reducing inpatient expenditure was greater for individuals aged between 65 and 80 and those residing in urban areas and eastern cities. In terms of outpatient costs, the effect of LTCI was more pronounced among median and high-income people and people living in central and eastern cities. The impact of LTCI on self-report of health is stronger for rural populations, individuals under 80, and those in central and eastern cities. For ADL scores, LTCI affected those aged 65–80 the most. About the CESD scores, LTCI had a greater impact on rural populations, people aged 45–65, median income groups, and those in eastern cities.ConclusionsOur study underscored LTCI’s effectiveness in curbing medical expenditures and enhancing health status, offering valuable insights for future LTCI development in China and beyond. Accelerating the development of LTCI is conducive to improving the quality of life of the disabled elderly, enhancing the well-being of people’s livelihoods, and realizing the goal of value-based healthcare.

Post Hoc Bias in Treatment Decisions

A goal of health care is to reduce symptoms and improve health status, whereas continuing dubious treatments can contribute to complacency, discourage the search for alternatives, and lead to shortfalls in care. To test a potential bias in intuitive reasoning following a marginal improvement in symptoms after a dubious treatment (post hoc bias). Surveys eliciting treatment recommendations for hypothetical patients were sent to community members throughout North America recruited via an online survey platform in the early winter months of 2023 and 2024 and presented to health care professionals (pharmacists who were approached in person using a secret shopper technique) in the summer months of 2023. Respondents received randomized versions of surveys that differed according to whether vague symptoms improved or remained unchanged after a dubious treatment. The primary outcome was a recommendation to continue treatment. In total, 1497 community members (mean [SD] age, 38.1 [12.5] years; 663 female [55.3%]) and 100 health care professionals were contacted. The first scenario described a patient with a sore throat who took unprescribed antibiotics; respondents were more likely to continue antibiotics after initial treatment if there was a marginal improvement in symptoms vs when symptoms remained unchanged (67 of 150 respondents [45%] vs 25 of respondents [17%]; odds ratio [OR], 3.98 [95% CI, 2.33-6.78]; P < .001). Another scenario described a patient with wrist pain who wore a copper bracelet; respondents were more likely to continue wearing the copper bracelet after initial care was followed by a marginal improvement in symptoms vs when symptoms remained unchanged (78 of 100 respondents [78%] vs 25 of 99 respondents [25%]; OR, 16.19 [95% CI, 5.32-19.52]; P < .001). A third scenario described a patient with fatigue who took unprescribed vitamin B12; respondents were more likely to continue taking vitamin B12 when initial treatment was followed by a marginal improvement in symptoms vs when symptoms remained unchanged (80 of 100 respondents [80%] vs 33 of 100 respondents [33%]; OR, 7.91 [95% CI, 4.18-14.97]; P < .001). Four further scenarios involving dubious treatments found similar results, including when tested on health care professionals. In this study of clinical scenarios, a marginal improvement in symptoms led patients to continue a dubious and sometimes costly treatment, suggesting that clinicians should caution patients against post hoc bias.

Opportunities to Advance Equity Through Implementation Strategy Design.

Implementation strategies are potential tools for advancing equity goals in healthcare. Implementation scientists have increased attention to the integration of equity considerations into implementation research, but limited concrete guidance is available for developing implementation strategies to improve equity. In parallel to an active hybrid effectiveness-implementation trial in two large health systems, our research team explored potential inequities in implementation across four non-study clinics, developed equity focused audit and feedback procedures, examined the feasibility of our approach, and identified design insights that could be tested in future work to inform equitable program scale-up. Based on our experiences deploying these strategies in pilot format, our research team identified key complexities meriting further examination in future work. These considerations are vital given the dearth of guidance on delivering feedback to clinicians in efforts to improve equity. Key takeaways include the importance of understanding local data culture, engaging constituents in co-design for the full feedback cycle, leveraging feedback for shared discourse, and centering multi-level strategies as part of robust implementation approaches. Prioritizing health equity in implementation science requires that research teams probe, interrogate, and innovate - and in doing so, grapple with central conceptual and pragmatic considerations that arise in the design of implementation strategies. Our work emphasizes the value of bidirectional and continuous learning.

Patients with dementia or frailty undergoing major limb amputation have poor outcomes

ObjectiveMajor lower limb amputation is a disfiguring operation associated with impaired mobility and high near-term mortality. Informed decision-making regarding amputation requires outcomes data. Despite the co-occurrence of both chronic limb-threatening ischemia (CLTI) and Alzheimer’s disease and related dementias (ADRD), there is sparse data on the outcomes of major limb amputation in this population and the impact of frailty. We sought to determine mortality, complications, readmissions, revisions, intensive interventions (eg, cardiopulmonary resuscitation), and other outcomes after amputation for CLTI in patients living with ADRD looking at the modifying effects of frailty. MethodsWe examined Medicare fee-for-service claims data from January 1, 2016, to December 31, 2020. Patients with CLTI undergoing amputation at or proximal to the ankle were included. Along with demographic information, dementia status, and comorbid conditions, we measured frailty using a claims-based frailty index. We dichotomized dementia and frailty (pre-frail/robust = “non-frail” vs moderate/severe frailty = “frail”) to create four groups: non-frail/non-ADRD, frail/non-ADRD, non-frail/ADRD, and frail/ADRD. We used linear and logistic regression via generalized estimating equations in addition to performing selected outcomes analyses with death as a competing risk to understand the association between dementia status, frailty status, and 1-year mortality as our primary outcome in addition to the postoperative outcomes outlined above. ResultsAmong 46,930 patients undergoing major limb amputation, 11,465 (24.4%) had ADRD and 24,790 (52.8%) had frailty. Overall, 55.9% of amputations were below-knee. Selected outcomes among frail/ADRD patients undergoing amputation (n = 10,153) were: 55.3% 1-year mortality 29.6% readmissions at 30 days, and 32.3% amputation revision/reoperation within 1 year. Of all four groups, those in the frail/ADRD had the worst outcomes only for 1-year mortality. ConclusionsFirst, patients with ADRD or moderate/severe frailty suffer an array of very poor outcomes after major limb amputation for CLTI, including high mortality, readmissions, revision, and risks of discharge to higher levels of care. Second, there is a complex relationship between outcome severity and ADRD/frailty status. Specifically, frailty is more often than ADRD associated with the poorest results for any given outcome. These data provide important outcomes data to help align decision-making with health care values and goals.

Overcoming Obstacles: a Systematic Review of Challenges Faced by Women in Healthcare Management and Innovative Interventions

Abstract Background: Despite the underrepresentation of women in healthcare leadership, there is limited evidence on impactful organisational strategies, practices, and policies to advance women's careers. This study aimed to explore such strategies across various sectors, providing insights into measurably advancing women in leadership roles in healthcare. Methods: A systematic review was conducted using Medline via OVID; Medline in-process and other non-indexed citations via OVID; PsycINFO, and SCOPUS from January 2000 to March 2021. The methods were outlined in a published protocol registered a priori on PROSPERO (CRD42020162115). Eligible studies reported on organizational interventions for advancing women in leadership with at least one measurable outcome. Two reviewers independently assessed the studies. Identified interventions were categorized, and a meta-synthesis was completed following the 'ENhancing Transparency in REporting the synthesis of Qualitative research' (ENTREQ) statement. Findings: The search identified 952 potentially relevant records, supplemented by an additional 76 records from other sources. After eliminating duplicates and conducting an initial review of titles and abstracts, 834 records were excluded, leaving 142 records for a thorough screening of full texts. Among these, 75 articles were further excluded for various reasons: 12 were not on the main topic, 10 involved medical students, 46 were personal commentaries or opinion papers, and 7 were not empirical. This process resulted in the selection of 48 articles that met eligibility criteria and underwent detailed analysis. Interpretation: This review establishes an evidence base on organizational interventions for advancing women in leadership across diverse settings, offering valuable lessons for healthcare. It transcends individual focus to target organizational change, capturing measurable outcomes across intervention categories. The findings directly inform a national initiative with international links, aiming to enable women to achieve their career goals in healthcare, and shifts the focus from barriers to solutions.

Leveraging an Electronic Health Record Patient Portal to Help Patients Formulate Their Health Care Goals: Mixed Methods Evaluation of Pilot Interventions.

Persons with multiple chronic conditions face complex medical regimens and clinicians may not focus on what matters most to these patients who vary widely in their health priorities. Patient Priorities Care is a facilitator-led process designed to identify patients' priorities and align decision-making and care, but the need for a facilitator has limited its widespread adoption. The aims of this study are to design and test mechanisms for patients to complete a self-directed process for identifying priorities and providing their priorities to clinicians. The study involved patients of at least 65 years of age at 2 family medicine practices with 5 physicians each. We first tested 2 versions of an interactive website and asked patients to bring their results to their visit. We then tested an Epic previsit questionnaire derived from the website's questions and included standard previsit materials. We completed postintervention phone interviews and an online survey with participating patients and collected informal feedback and conducted a focus group with participating physicians. In the test of the first website version, 17.3% (35/202) of invited patients went to the website, 11.4% (23/202) completed all of the questions, 2.5% (5/202) brought results to their visits, and the median session time was 43.0 (IQR 28.0) minutes. Patients expressed confusion about bringing results to the visit. After clarifying that issue in the second version, 15.1% (32/212) of patients went to the website, 14.6% (31/212) completed the questions, 1.9% (4/212) brought results to the visit, and the median session time was 35.0 (IQR 35.0) minutes. In the test of the Epic questionnaire, 26.4% (198/750) of patients completed the questionnaire before at least 1 visit, and the median completion time was 14.0 (IQR 23.0) minutes. The 8 main questions were answered 62.9% (129/205) to 95.6% (196/205) of the time. Patients who completed questionnaires were younger than those who did not (72.3 vs 76.1 years) and were more likely to complete at least 1 of their other assigned questionnaires (99.5%, 197/198) than those who did not (10.3%, 57/552). A total of 140 of 198 (70.7%) patients responded to a survey, and 86 remembered completing the questionnaire; 78 (90.7%) did not remember having difficulty answering the questions and 57 (68.7%) agreed or somewhat agreed that it helped them and their clinicians to understand their priorities. Doctors noted that the sickest patients did not complete the questionnaire and that the discussion provided a good segue into end-of-life care. Embedding questionnaires assaying patient priorities into patient portals holds promise for expanding access to priorities-concordant care.

The Lived Experiences of Racial Microaggressions for Black Individuals While Seeking Orthopedic-Related Care: A Qualitative Study.

Race-based health disparities for racially and ethnically diverse people with orthopedic-related conditions are well documented and their experiences when seeking care deserve more attention. The purpose of this study was to understand the lived experiences of racial microaggressions occurring when racially and ethnically diverse people seek health care services for orthopedic-related conditions. We used transcendental phenomenology to understand their lived experiences of racial microaggressions while receiving orthopedic-related health care services. All participants self-identified as Black, none as Hispanic. Nineteen final codes were organized into five patterns and then into five themes-two background and three figural themes. Background themes: discrimination can occur across a lifetime, and poor treatment of poor people fuels health inequity. Figural themes: racial discrimination can come at any time and in various forms; resistance is necessary in the face of racial discrimination; and despite discriminatory encounters, health care goals are achievable. Participants shared their lived experiences of racial microaggressions while seeking care for their orthopedic-related conditions (figural) through a lens shaped by their other past experiences with varied discrimination (background). Black individuals have a longstanding relationship with racial discrimination that has a negative impact on many aspects of their lives, including their health. The results highlight ways to promote equity by capitalizing on Black individuls' goals to actively pursue health.

Healthcare for All: A Comparative Analysis of Medicaid in the United State of America and Ayushman Bharat in India

This paper presents a comparative analysis of two prominent healthcare initiatives: Medicaid in the United States and Ayushman Bharat in India. Both programs aim to improve healthcare accessibility and affordability for vulnerable populations within their respective countries. Medicaid, established in 1965, provides comprehensive health coverage primarily to low-income individuals and families through federal and state cooperation. In contrast, Ayushman Bharat, launched in 2018, seeks to address healthcare disparities by offering health insurance coverage to over 500 million people, focusing on the economically disadvantaged. This comparative study examines the structures, objectives, implementation challenges, and outcomes of Medicaid and Ayushman Bharat, analyzing their effectiveness in achieving universal health-care goals. Key factors explored include funding mechanisms, coverage criteria, administrative efficiency, healthcare delivery models, and socio-economic impact. By highlighting successes, challenges, and lessons learned from these programs, this research aims to contribute valuable insights into the global discourse on healthcare policy and the pursuit of equitable health outcomes.

Birth cohort and social change decreased quality of life among older adults: A cross‐temporal meta‐analysis, 1999–2017

AbstractQuality of life (QoL) has become an essential goal of contemporary healthcare and protective psychological resources. Individual life expectancy has increased with improved social progress, healthcare, nutrition and advanced health‐related technologies. However, research often overlooks the significant impact of social change and generational effects on the QoL of the ageing population. As people age, optimising opportunities for health, participation and safety to improve QoL has become crucial for society, policymakers and researchers. This study utilised a cross‐temporal meta‐analysis to investigate changes in the QoL among older adults from 1999 to 2017. Fifty two studies (N = 34,844) that used the Brief Health Status Survey Scale (SF‐36) were analysed. Direct and lagged correlation analyses were performed to examine the relationship between changes in the QoL of older adults and the macro social environment. The findings showed that QoL decreased by 7.94 points (d = −0.50) over the past 18 years. Economic status, social connectedness, and general threats were significant predictors of declining QoL among older adults. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement.