Healthcare Context Research Articles

The Impact of Outpatient Parenteral Antimicrobial Therapy (OPAT) in Al Hada Armed Forces Hospital, Taif, Saudi Arabia

Background In the realm of healthcare quality, outpatient parenteral antimicrobial therapy (OPAT) has emerged as the gold standard for managing patients who have transitioned from inpatient care but still require extended intravenous antimicrobial treatment. The adoption of OPAT at Al Hada Armed Forces Hospital in Taif, Saudi Arabia, not only bolsters patient satisfaction but also serves as a catalyst for reduced hospitalization durations, lower rates of emergency department readmissions, and an overall reduction in healthcare expenditures. The main objective of this study was to evaluate the effectiveness of OPAT in a tertiary center facility in Saudi Arabia. Methods In this retrospective investigation, we conducted a thorough review of patient records spanning from November 2020 to October 2021. Our study encompassed all patients who had intravenous antibiotics and were participants in the hospital’s OPAT program during this specific timeframe. Our primary goal was to achieve a 20% reduction in the total number of hospital bed days related to long-term antibiotic therapy. Results The incorporation of OPAT has yielded a multifaceted transformation within the hospital. Over the span of one year, from November 2020 to October 2021, there was a notable decrease in the proportion of patients requiring intravenous antibiotics. This percentage initially dropped from 23% to 12% with the implementation of the OPAT quality improvement project, and later, it reached an even lower 8%. This positive transformation not only had a positive impact on patient care but also led to significant cost savings, exceeding 2 million riyals. These savings were primarily driven by the reduction in hospitalization duration and the more efficient allocation of resources. Moreover, this improvement contributed to the avoidance of 673 patient days of hospitalization, thereby creating additional resources for more critical cases. Conclusion OPAT has emerged as a pivotal component of Al Hada Armed Forces Hospital’s commitment to elevating healthcare quality. This abstract offers a concise insight into the quality-driven impact of OPAT within a specific healthcare context, underlining its capacity to optimize patient care, enhance healthcare efficiency, and elevate resource allocation. Ongoing research and continuous evaluation will play a critical role in refining and expanding the OPAT program while preserving its quality-oriented perspective.

Designing Behavior Change Support Systems Targeting Blood Donation Behavior

While blood is crucial for many surgeries and patient treatments worldwide, it cannot be produced artificially. Fulfilling the demand for blood products on average days is already a major challenge in countries like South Africa and Ghana. In these countries, less than 1 % of the population donates blood and most of the donations come from first-time donors who do not return. Sufficient new, first-time and even lapsed donors must be motivated to donate regularly. This study argues that blood donation behavior change support systems (BDBCSS) can be beneficially applied to support blood donor management in African countries. In this study, the design science research (DSR) approach is applied in order to derive generic design principles for BDBCSS and instantiate the design knowledge in prototypes for a blood donation app and a chatbot. The design principles were evaluated in a field study in South Africa. The results demonstrate the positive effects of BDBCSS on users’ intentional and developmental blood donation behavior. This study contributes to research and practice by proposing a new conceptualization of blood donation information systems support and a nascent design theory for BDBCSS that builds on behavioral theories as well as related work on blood donation information systems. Thus, the study provides valuable implications for designing preventive health BCSS by stating three design principles for a concrete application context in healthcare.

How are We Doing Today? Using Natural Speech Analysis to Assess Older Adults’ Subjective Well-Being

The research presents the development and test of a machine learning (ML) model to assess the subjective well-being of older adults based solely on natural speech. The use of such technologies can have a positive impact on healthcare delivery: the proposed ML model is patient-centric and securely uses user-generated data to provide sustainable value not only in the healthcare context but also to address the global challenge of demographic change, especially with respect to healthy aging. The developed model unobtrusively analyzes the vocal characteristics of older adults by utilizing natural language processing but without using speech recognition capabilities and adhering to the highest privacy standards. It is based on theories of subjective well-being, acoustic phonetics, and prosodic theories. The ML models were trained with voice data from volunteer participants and calibrated through the World Health Organization Quality of Life Questionnaire (WHOQOL), a widely accepted tool for assessing the subjective well-being of human beings. Using WHOQOL scores as a proxy, the developed model provides accurate numerical estimates of individuals’ subjective well-being.Different models were tested and compared. The regression model proves beneficial for detecting unexpected shifts in subjective well-being, whereas the support vector regression model performed best and achieved a mean absolute error of 10.90 with a standard deviation of 2.17. The results enhance the understanding of the subconscious information conveyed through natural speech. This offers multiple applications in healthcare and aging, as well as new ways to collect, analyze, and interpret self-reported user data. Practitioners can use these insights to develop a wealth of innovative products and services to help seniors maintain their independence longer, and physicians can gain much greater insight into changes in their patients’ subjective well-being.

Person-centred care intervention to promote self-efficacy in patients following a myocardial infarction (P2MIR): a protocol of a qualitative study for cultural adaptation within a Portuguese healthcare context

IntroductionCardiovascular diseases remain a leading cause of death worldwide. Recovery from myocardial infarction is challenging as the causes of symptoms span multiple aspects of health not just physical conditions. Evidence...

Thematic Analysis of Using Visual Methods to Understand Healthcare Teams

In healthcare, teams are essential in solving today’s toughest challenges. However, narrow disciplinary perspectives have limited our current understanding of how teams function in various healthcare contexts. Researchers often rely on traditional survey methods as their primary tool, which can prevent them from gathering comprehensive data. To overcome this limitation, sharing stories and narratives visually allows participants to create representations of their perceptions of team experiences and complex encounters using a variety of approaches. Despite the potential of this method, there is little empirical guidance on how to use it in health sciences research. To address this gap and provide guidance on using visual methods, particularly for analysing team function, we contacted researchers worldwide specializing in qualitative research methods. These researchers had published experience using visual methods. Over a year, three virtual, asynchronous brainstorming sessions were conducted with 16 researchers. The brainstorming sessions consisted of respondents receiving a survey with open-ended prompts to gather insight into the best practices for using visual methods. Researchers agreed that visual methods can gather implicit data, break down researcher-participant power dynamics, and improve a study’s accessibility to under-represented groups. It was highlighted, when interpreting drawings, co-analysis with the creator should be facilitated to mitigate biases and support interpretation. This use of visual methods can aid the creation of tacit and more nuanced descriptions of complex phenomena and improve team function through a deeper understanding and respect of each members’ needs/experiences/perspectives. Future studies should pilot visual methods with different healthcare teams to further investigate team dynamics and how findings can be used to optimize team function.

New educational approaches to the patient. A scoping review of systematic reviews.

New educational approaches are emerging to assist healthcare professionals in better personalizing patient's educational pathways. Specifically, "gamification" - the incorporation of game elements into non-game contexts - appears to be a novel and affordable approach. This scoping review aims to explore and map the literature that evaluates the efficacy of gamification in healthcare contexts. A scoping review of reviews was conducted in MEDLINE, CINAHL, and PsycINFO using the JBI Manual for Evidence Synthesis guidelines and the PRISMA ScR checklist. A total of four systematic reviews and four meta-analyses were included. It appears that gamification, when used in conjunction with other conventional educational tools, improves physical activity, facilitates better self-management of type 2 diabetes, improves cognitive functions, and improves the quality of life, particularly among specific groups like the elderly. Gamification is an innovative educational approach that could be useful in patient's educational pathways. However, it seems that gamification is effective only in particular subgroups, and therefore the generalization of the results should also be assessed with caution due to the high risk of bias in the included studies and the small sample sizes considered. More randomized controlled trials and meta-analysis studies should be conducted to better understand the role and efficacy of gamification in patient education.

Applying ordered network analysis to video-recorded physician–nurse interactions to examine communication patterns associated with shared understanding in inpatient oncology care settings

ObjectivesThe main aim of this study was to demonstrate how ordered network analysis of video-recorded interactions combined with verbal response mode (VRM) coding (eg, edification, disclosure, reflection and interpretation) can...

Psychometric validation of the Persian version of the ethical awareness scale for nurses working in Iranian intensive care units.

The purpose of this study was to translate and validate the ethical awareness scale for nurses working in Iranian intensive care units. A cross-sectional psychometric study. The study was conducted in Oct 2020 to Sep 2021, involving the participation of 200 ICU nurses. The process included translation of the original version of the ethical awareness scale into Persian, following the World Health Organization guideline, for use in Iran. The translated version was then evaluated for reliability, face validity, content validity ratio, content validity index, convergent validity and construct validity. The initial reliability of the scale was established. In qualitative face validity, a few items changed slightly and all items were retained in the quantitative face validity assessment. Based on Lawshe's values, three items were removed from the scale during CVR assessment. All items exhibited acceptable CVI scores. Convergent validity was established with an average variance extracted greater than 0.5. The fit indices, such as CFI = 0.94, GFI = 0.94, RMSEA = 0.01, AGFI = 0.97 and CMIN/DF = 2.99, supported the structural model of the scale. The fit indices for the structural model of the scale were all within acceptable ranges, suggesting that the model fit the data well. Its reliability was confirmed through the test-retest method, with Cronbach's alpha = 0.84 and McDonald's omega coefficient >0.8. The findings of this study indicate the Persian version of the ethical awareness scale for Iran (EAS-IR) is comparable in content to the original version, demonstrating its validity and reliability for assessing ethical awareness among Iranian nurses in ICUs. The scale can be a valuable resource for measuring ethical awareness in the Iranian healthcare context and may contribute to improving ethical practices and decision-making in ICU settings. In this project, no patient or public contribution was necessary, because it was not applied to our work.

Robotic Guardians: Navigating Hospital Isolation Zones for Disease Control

Abstract: In healthcare contexts where human access is limited, particularly in isolation and quarantine rooms, autonomous solutions become critical. This study presents a novel solution to addressing this problem: a line-following robot built for use in hospital isolation units. The robot's operating principle is led by a color recognition system, which responds dynamically to certain colors linked with directing cues. The system's ability to capture vital information by utilizing the ESP32 camera module increases its utility beyond navigation, extending to the collection of patient vitals displayed beside beds. By combining precise navigation with information gathering capabilities, this line-following robot offers a potential solution for tasks in restricted access healthcare environments.

Impact of technological innovations on healthcare delivery: A literature review of efficiency, patient care, and operational challenges

The rapid integration of technology in healthcare systems globally has ushered in transformative changes in patient care, operational efficiency, and data management. This literature review assesses the impact of emerging technologies such as blockchain, information technology, electronic medical records (EMRs), and artificial intelligence (AI) within healthcare settings. Drawing from a wide range of peer-reviewed articles and empirical studies, this paper synthesizes current research findings to understand the multifaceted effects of these technologies on healthcare delivery. The review highlights how these innovations enhance healthcare quality, streamline operations, and tackle prevalent challenges, particularly focusing on their implementation in Saudi Arabian healthcare contexts. Key findings indicate that while technological advancements offer significant improvements in patient care and system management, they also introduce challenges related to privacy, security, and the need for significant infrastructure investments. The review underscores the necessity for ongoing research to navigate technology adoption’s complexities and optimize healthcare practices effectively. This paper contributes to academic and practical discussions on leveraging technology to foster more efficient and responsive healthcare systems worldwide.\

Supporting contraceptive self-care and reproductive empowerment with a digital health game in Barbados: Development and Pre-implementation study for What’s My Method?

Effective contraceptive education is essential to reducing unwanted pregnancy, increasing uptake of modern contraceptive methods, and thoughtfully planning desired births. New WHO and family planning organization guidelines recommend situating contraceptive education and counseling within a broader context of self-care that emphasizes individual agency and reproductive empowerment. Digital health interventions, and games for health specifically, have been validated as effective and scalable tools for self-guided and interactive health education, especially among younger tech-savvy individuals. Barbados currently supplements provider-based contraceptive counseling with analog materials (pamphlets and posters) and informational videos that play on a screen in the waiting room. This study seeks to conduct a formative evaluation of the What’s My Method? (WMM) game intervention as a tool to support contraceptive counseling and increase reproductive empowerment among childbearing persons in Barbados. We test-deployed the WMM game in Bridgetown, Barbados, conducting focus groups and sample deployments with prototypes of the WMM game among three groups of stakeholders (youth contraception ambassadors: n=8; healthcare providers: n=7; and nursing students: n=27) to determine acceptability of the intervention, efficacy of the game as a learning tool, and willingness to adopt the tool in their healthcare context. Feedback on acceptability of the game was largely positive. Constructive feedback informed modifications and improvements to the game. Assessment of contraceptive knowledge gain was complicated by several factors and resulted in modifications of the questionnaire and methodology for measurement of efficacy. Results indicate that the WMM game is well-reviewed and accepted by the target audience of childbearing people and healthcare professionals who would be deploying it. The questionnaire did not perform as intended for our target audience. This pilot testing has informed the design and outcome selection for the upcoming RCT with the final version of the game.

General and healthcare-related HIV stigma among cisgender Brazilian women: the role of socioeconomic vulnerability

Background HIV-related stigma is associated with worse health outcomes and lower adherence to antiretroviral therapy. There is limited data on the stigma faced by Latin American cisgender women, although they are among the populations most affected by HIV. This study aims to provide insight into the Stigma Index Brazil, with the objective of estimating the prevalence of HIV-related stigma among cisgender women in Brazil and to investigate the role of low socioeconomic status in stigma experience. Methods This is a cross-sectional community-based study. A total of 30 people with HIV were trained to recruit participants from their peer networks; 1,768 people with HIV from all regions of Brazil participated in the study, of which 566 participants were cisgender women. We used the Stigma Index, an instrument that assesses global trends in HIV-related stigma from the perspective of people with HIV. Results Approximately 70% of participants reported some form of HIV-related stigma. The most prevalent forms were discriminatory comments or gossiping (51.26%) and verbal harassment (30.99%). More than 20% experienced any health care related HIV-stigma in the last 12 months, the most frequent being the avoidance of physical contact (10.02%). Women in social vulnerability faced more stigma compared to the group without social vulnerability, both in general contexts (75.79% vs 64.32%; χ2 = 8.67, p < 0.05) and in healthcare contexts (24.12% vs 16.02%; χ2 = 4.06, p < 0.05). Conclusion We found a high prevalence of stigma associated with HIV faced by Brazilian women from all regions of the country, both in everyday life and in healthcare contexts. Evidence-based interventions to reduce stigma in the general population, and specific mental health care aimed at women with HIV in Brazil, especially among those with greater socioeconomic vulnerability, are urgent.

Enhancing Cardiac Arrest Skills: Exploring Student Nurses’ Journey through Mental Simulation to Self-efficacy

Objective: This study explores mental simulation (MS) as a potential tool for enhancing skill acquisition and readiness among student nurses in life-saving procedures, particularly in high-stress, time-sensitive situations like cardiac arrest. It aims to investigate the impact of MS on learning life support skills and creating self-officious students in nursing education. Methods: The study combines a theoretical framework grounded in social constructionism with qualitative research methods. We utilize a qualitative reflexive thematic analysis approach. Eleven pre-registration student nurses participated in interview-based investigations after engaging in a 4-week MS program. Data collection utilized open-ended questions, allowing participants to express their experiences and perceptions regarding MS for life support skill acquisition. Results: The research identified six key themes and sub-themes: “Motivation to learn”, “emulating reality”, “emulating real-world intensity”, “emotional resonance”, “harmonizing reflective practice”, and “empowering confidence”. Participants reported using MS to address self-efficacy challenges, creating vivid simulated experiences, inducing real-world intensity, personalizing visualizations, fostering reflective practice, enhancing team understanding, and demystifying cardiac arrest skills, ultimately empowering confidence in employing their cardiac arrest skills. Conclusion: The findings underscore MS’s potential as a valuable training tool in nursing education. MS not only bridges knowledge gaps but also prepares student nurses for real-life scenarios, demystifying cardiac arrests and enhancing self-efficacy. The study advocates for the integration of MS alongside traditional training methods to enhance preparedness and confidence among student nurses in critical life support situations. Further research could explore the broader implications of MS across various healthcare contexts.

#1381 Economic evaluation of an integrated care program versus conventional care for chronic kidney disease patients in rural communities of Thailand

Abstract Background and Aims This study evaluates an integrated care program for chronic kidney disease (CKD), which has demonstrated effectiveness in delaying kidney function decline in the rural population of Thailand. Efficacy of the program was initially established through the ESCORT-1 study, a cluster-randomized controlled trial (doi: 10.1186/s12882-016-0414-4), and further demonstrated the effectiveness by the larger-scale prospective cohort study, ESCORT-2 (doi: 10.1111/nep.13849). The aim of this study is to assess the cost-effectiveness of incorporating this program into Thailand's public health benefit package, with the goal of establishing it as a model for similar rural areas in resource-limited settings. Method Following the Thailand's guideline for health technology assessment, a cost-utility analysis utilizing data from the ESCORT studies, local databases, and literatures. The integrated care program was tailored to primary healthcare system by using preexisting workforces. It involved a collaboration between Multi-Disciplinary Care Teams (MDCT) at district hospitals and Community Care Network (CCN) teams at Sub-District Health Centers (SDHC). The MDCT, comprising general practitioners, CKD nurse managers, pharmacists, a nutritionist, and a physical therapist, provided key patient education on diet, medication adherence, exercise, and avoiding certain medications and herbal remedies. The CCN teams, including community nurses and village health volunteers, conducted home visits for health monitoring and lifestyle guidance. Both MDCT and CCN personnel received training in CKD care based on the NKF-K/DOQI and KDIGO Clinical Practice Guidelines. A decision-analytic Markov model and Monte-Carlo simulation were applied to quantify and compare the lifetime costs and quality-adjusted life years (QALY) outcomes of the intervention and conventional-care from a societal perspective considering both direct and indirect costs. The analysis included extensive sensitivity analyses, incorporating a probabilistic model and scenario-analyses based on patient ages, CKD stages, and varying program efficacy. Additionally, a budget impact analysis from the payer's perspective assessed the financial impact and affordability over a five-year period. Results The integrated care program was found to dominate conventional care. The results indicated an incremental cost-effectiveness of (-)278,000 Thai Baht (∼7,267 EUR) per QALY for the base case analysis. Probabilistic analysis demonstrated consistent outcomes, with the integrated care program being cost-effective at almost 100% of the time during analysis at the 160,000 Thai Baht (∼4,182 EUR) willingness-to-pay threshold (Fig. 1). These results are driven by significant cost savings due to reduced time and overall costs in dialysis before death. The program is most cost-effective when provided early to patients, in terms of both age and CKD stages (Fig. 2). The budget impact analysis showed that introducing the intervention could save the payer 184 billion Thai Baht (4.76 billion EUR) over five years. (The exchange rate; 1 Thai Baht = 38.26 EUR) Conclusion The integrated care program for patients with stage 3-4 CKD is cost-effective and suitable for inclusion in Thailand's health benefit package, mainly due to its significant cost savings and enhanced health outcomes. The program's design, focusing on sustainability and feasibility by utilizing existing workforces, positions it as a viable model for similar economic and healthcare contexts, especially in resource-limited countries.

Towards a decolonial developmental science: Adolescent development in the Majority World taking center stage.

While aspiring to be a diverse and global science, developmental science continues to be dominated by EuroAmerican epistemologies, researchers, and communities in its published scholarship. Adolescents in communities across Africa, Asia, the Middle East, and Latin America comprise 85% of the world's adolescent population, and yet their experiences and perspectives are marginalized in our science. Adolescents in the Majority World live in highly diverse social, cultural, political, economic, educational and healthcare contexts that contribute to their development, and we have much to learn from their experiences. This article situates the marginalization of the global majority within coloniality embedded in developmental science. The article describes the impetus for this special issue Towards a decolonial developmental science and the process of putting it together, along with providing an overview of the 18 articles in this collection that push us towards decoloniality. The special issue serves as a call to transform developmental science to be decolonial by empowering adolescent development in Majority World communities to take center stage. Adolescent development research from Majority World communities has the potential to challenge the knowledge base generated from Minority World samples, contributing to a science that is comprehensive, inclusive, and can inform prevention and intervention efforts to support the well-being of adolescents globally.

Effectiveness of a home-based pulmonary rehabilitation maintenance programme: the Rehab2Life study protocol

Pulmonary rehabilitation (PR) is the bedrock of non-pharmacological treatment for people with COPD. Nonetheless, it is well described in the literature that unless the patient changes his behaviour, the benefits of PR programmes will decline in six to twelve months after finishing the programme. Therefore, maintenance programmes can address the problem of PR programmes’ effect loss over time.Community care units can provide multidisciplinary care in the current Portuguese primary health care context. These units have an interdisciplinary team that aims to develop competencies in COPD patients to self-manage the disease.This study aims to test the effectiveness of a 12-month home-based PR programme (Rehab2Life) compared to usual care through a single-blind randomised controlled trial with two parallel groups. The Rehab2Life programme includes two distinct phases. The first is an 8-week PR programme delivered to both groups, and the second is a PR maintenance programme delivered to the intervention group after the initial eight weeks. The control group receive the usual care and regular appointments. The primary outcome is functional capacity, and secondary outcomes are dyspnea, Health-Related Quality of Life (HRQoL), number of exacerbations, symptoms burden, anxiety and depression symptoms, and physical activity.We expect to observe that the home-based PR programme brings clinically relevant benefits to the participants at the end of the first eight weeks and that, at 12 months after the maintenance phase of the programme, benefits are less dissipated than in the control group. We expect to identify the characteristics of the patients who benefit the most from home-based programmes.The trial was registered on 7 April 2022 at ClinicalTrials.gov (NCT05315505).

Pandemic narratives in stories about hospice palliative care: The impact of Covid-19 upon ideals of timely, holistic care and quality of life

BackgroundHospice palliative care aims to provide timely interventions and holistic care that focusses on quality of life for people who are terminally ill. In the first two years of the Covid-19 pandemic the national political and healthcare contexts changed significantly. Throughout this time hospices had to repeatedly adjust their approach to supporting terminally ill people, many of whom were especially vulnerable to Covid-19. AimThe aim of this paper was to explore hospice patients, carers, staff and senior managers stories to identify how changing pandemic narratives affected their understanding of hospice palliative care as timely, holistic and supporting quality of life. MethodsNarrative analysis of in-depth interviews with patients, carers, staff and senior managers (n = 70) recruited from hospices across the West-Midlands, UK, in 2020–22. FindingsWe identified four ‘pandemic narratives’ (reaction; revision; resilience; (re)normalisation) in the participants' accounts of hospice palliative care support in the first two years of the pandemic. In each narrative we explore how Covid-19 and the associated pandemic guidance affected what quality of life was understood to be; how what was considered to be timely care could change during the palliative care journey; and, how different ideas of holistic care were emphasised as the hospice and wider healthcare context changed. ConclusionThis is the first-time stories about the first two-years of the Covid-19 pandemic from hospice patients, carers, staff and senior managers have been analysed together. We identified how the pandemic brought an existential challenge to ideas of what hospice palliative care is and could be. Our findings suggest that ‘living with covid’ will continue to affect hospice palliative care's ideals of timeliness of care, holistic support, and quality of life left.

Patient-related decisional regret: An evolutionary concept analysis.

Health-related decision-making is a complex process given the variability of treatment options, conflicting treatment plans, time constraints and variable outcomes. This complexity may result in patients experiencing decisional regret following decision-making. Nonetheless, literature on decisional regret in the healthcare context indicates inconsistent characterization and operationalization of this concept. To conceptually define the phenomenon of decisional regret and synthesize the state of science on patients' experiences with decisional regret. A concept analysis. Rodgers' evolutionary method guided the conceptualization of this review. An interdisciplinary literature search was conducted from 2003 until 2023 using five databases, PubMed, CINAHL, Embase, PsycINFO and Web of Science. The search informed how the concept manifested across health-related literature. We used PRISMA-ScR checklist to guide the reporting of this review. Based on the analysis of 25 included articles, a conceptual definition of decisional regret was proposed. Three defining attributes underscored the negative cognitive-emotional nature of this concept, post-decisional experience relating to the decision-making process, treatment option and/or treatment outcome and an immediate or delayed occurrence. Antecedents preceding decisional regret comprised initial psychological or emotional status, sociodemographic determinants, impaired decision-making process, role regret, conflicting treatment plans and adverse treatment outcomes. Consequences of this concept included positive and negative outcomes influencing quality of life, health expectations, patient-provider relationship and healthcare experience appraisal. A conceptual model was developed to summarize the concept's characteristics. The current knowledge on decisional regret is expected to evolve with further exploration of this concept, particularly for the temporal dimension of regret experience. This review identified research, clinical and policy gaps informing our nursing recommendations for the concept's evolution. This concept analysis examines existing literature and does not require patient-related data collection. The methodological approach does not necessitate collaboration with the public.

Estimating and Rewarding the Value of Healthcare Interventions Beyond the Healthcare Sector: A Conceptual Framework.

Evaluating healthcare interventions for their impacts beyond health outcomes may result in recognition of changes in human capital, income level, tax revenue, and government spending, which could affect economic growth and population health. In this paper, we document instances where current health technology assessment (HTA) practices fail to account for the impacts of healthcare interventions on broader society beyond the healthcare sector. We propose a novel conceptual framework, highlighting its three components (distributional cost-effectiveness analysis [DCEA], input-output model, and voting scheme) and their contributions to capturing the economic and societal ripple effects of healthcare interventions. This manuscript also outlines a case study in which the framework is applied to the reassessment of a previously evaluated digital health therapeutic for the treatment of opioid use disorder (OUD) compared with standard of care, demonstrating its practical application. The DCEA health value metric indicates that digital therapeutic is more equitable, favoring socioeconomically disadvantaged groups, while standard of care exacerbates health inequality by benefiting the already advantaged. Additionally, digital therapeutic shows potential for boosting productivity, raising income, and creating jobs, supporting its consideration by employer-sponsored health plans to optimize resource allocation for treating OUD. The conceptual framework provides insights for enhancing HTAs to incorporate the broader economic and societal impacts of healthcare interventions. By integrating DCEA, extended HTA analysis with input-output modeling, and a voting scheme, decision makers can make informed choices aligned with societal priorities, although further research and validation are necessary for practical implementation across diverse healthcare contexts.

Building Healthcare Brand: Role of service, image, and trust

Objective: Healthcare branding is a recent concept, and its theoretical modeling is still somewhat inadequate. This paper examines how perceived service quality affects healthcare brand performance, brand image, and behavioral intention. Methods: The present study uses survey responses from 678 patients who have taken treatment in multi-specialty medical institutes. Standard scales were used from the literature to measure the variables used. The conceptual model was validated using structural equation modeling using AMOS. SPSS was used to determine the validity and reliability of the questionnaire. Results: The theoretical model has a relatively high and significant coefficient path for each of the hypotheses. The R2 value for satisfaction was 0.70 or 70 percent. The R2 value for the trust was 0.78. For Brand performance, Brand image and behavioral intentions were 81, 82.5, and 74%, respectively. Overall, the scores suggest an acceptable level of measure score and predictive ability of the relevant constructs. The results disclose the dimensions of service quality in the circumstances of healthcare. The patients place relatively more importance on healthcare service quality than any other attributes of healthcare institutions. Service quality has a high beta value of 0.98 and p p-value of 0.000. Conclusion: The study makes an innovative theoretical contribution by establishing a relationship between experience-centric healthcare brand performance and brand image. Patient satisfaction and trust were demonstrated to mediate the relationship between perceived service quality, brand performance, brand image, and behavioral intention in a healthcare context. The study established the novel finding that trust and satisfaction play a significant role in service quality, brand performance, and brand image of healthcare institutions. This study also shows that brand performance has a positive and significant direct effect on brand performance. This shows the dependency of brand image on brand performance in the healthcare institution context.