Operation Of Health Care System Research Articles

A network-based simulation framework for robustness assessment of accessibility in healthcare systems with the consideration of cascade failures

The accessibility of healthcare system is vulnerable to various types of hazards, where the failure of one system component may lead to a diffusion of the pressure and result in cascading failures. This study proposes a network-based simulation framework for robustness assessment of access to healthcare through integrating cascading failure mechanism. Weighted complex networks are constructed to model the accessible patient transfer under both general and elderly healthcare scenarios. The cascade failure mechanism is incorporated into the constructed networks, and several attack strategies (including random, initial degree (ID), initial betweenness (IB), recalculated degree (RD), and recalculated betweenness (RB) attack) are adopted to simulate the process of system robustness assessment. Results indicate that the proposed framework enables to discover the vulnerable nodes in the constructed healthcare accessibility networks, where the robustness metric combining network efficiency and relative size of the largest component acts as a benchmark; all the intentional attack strategies outperform the random attack strategy, which indicates the effectiveness of the detection of vulnerable healthcare facilities by the developed model; and the metrics of node degree and betweenness centrality make progress on identifying the vulnerable healthcare facility nodes, which should be taken heed of to optimize the management and operation of healthcare systems.

Brief Communications Data Hygiene: Important Step in Decision Making with Implications for Health IT Professionals

Medical and health data that have been entered into an electronic data system in real-time cannot be assumed to be accurate and of high quality without verification. The adoption of the electronic health record (EHR) by many countries to the support care and treatment of patients illustrates the importance of high quality data that can be shared for efficient patient care and the operation of healthcare systems. This brief communication provides a high-level overview of an EHR system and practices related to high data quality and data hygiene that could contribute to the analysis and interpretation of EHR data for use in patient care and healthcare system administration.

Clinical Considerations in Chronic Pain Management during the Era of COVID-19 Pandemic

<p>新冠肺炎疫情自2019年末以來，自中國武漢地區迅速蔓延至世界各地，對各國的公衛和醫療量能造成巨大威脅。醫療資源的整合和重新分配成為公共衛生的一大課題，所以許多慢性疾病的處置，在疫情之下有著不同的面貌。保持社交距離和減少不必要的外出，在疫情期間是許多國家廣泛採取的防疫措施，也因此，病人因非急迫性醫療至醫院就診的意願大幅下降。慢性疼痛為一普遍的健康問題，在處理上往往需要長期的使用藥物及非藥物的治療方式，且必須定期地監控各項治療所帶來的療效和潛在副作用。疫情席捲各國的當下，就面對慢性疼痛病人的第一線醫護人員而言，是一個全新的挑戰。本篇旨在藉由文獻回顧，協助醫師和健康相關從業人員能在疫情期間，讓慢性疼痛病人持續地得到適切且有效的治療和追蹤。</p> <p> </p><p>Chronic pain is a major public health concern which not only results in impaired quality of life on the individual level but also poses a tremendous burden on the healthcare system and economy on a national scale. As the COVID-19 pandemic has greatly impacted the world since 2019, the operation of healthcare systems has changed to accommodate non-pharmacologic interventions against the COVID-19 outbreak. As a result, chronic conditions have been managed differently since the medical resources are less accessible. Chronic pain requires continuous and concerted medical attention to carefully assess the possible adverse events associated with pharmacologic interventions and to adjust the regimen accordingly. The indication for procedural interventions should also be evaluated since the pain is often fluctuating. In this article, we aim to review updated evidence-based practices of pharmacologic and non-pharmacologic interventions with a focus on clinical considerations for chronic pain management. A feasible framework is proposed for telemedicine and interdisciplinary teamwork to help facilitate continuous care during this trying time.</p> <p> </p>

Discussing climate change and other forms of global environmental change during the clinical encounter: Exploring US physicians’ perspectives

Physicians could arguably play a role in efforts to mitigate and adapt to the health effects of global environmental change. This paper presents an initial qualitative exploration of United States physicians’ perspectives with regard to whether, why and how physicians might discuss the health effects of global environmental change, climate change in particular, with their patients and what would need to change in healthcare systems to facilitate this. Interviews were conducted with eighteen physicians working across the US and representing different medical specialties. Data were analyzed using conventional content analysis. We found that most physicians felt such conversations should become part of clinical encounters, primarily to help patients protect their health. However, it was also highlighted that physicians might have objections, referring to the risk of creating feelings of fear or powerlessness and of undermining the physician-patient relationship. This study highlighted that such conversations therefore need to be relevant and actionable, for which timing and communication style are essential. Major barriers for such conversations include a lack of knowledge, conversation skills and guidance, lack of time, and physicians’ perspectives on their role in realizing good quality care. Building on these explorative findings, our tentative conclusion is that discussing the health effects of global environmental change during clinical encounters can become part of physicians’ roles, but that this requires competence development and fundamental changes in the operation of healthcare systems. Future (quantitative) studies are necessary to further understand how such discussions could take place and be facilitated in different settings.

Prolonged Effects of the COVID-19 Pandemic on Sleep Medicine Services-Longitudinal Data from the Swedish Sleep Apnea Registry.

The worldwide COVID-19 pandemic has affected the operation of health care systems. The direct impact of obstructive sleep apnea (OSA) on COVID-19 infection outcome remains to be elucidated. However, the coincidence of common risk factors for OSA and severe COVID-19 suggests that patients with OSA receiving positive airway pressure therapy may have an advantage relative to those untreated when confronted with a COVID-19 infection. The ongoing COVID-19 pandemic has led to a substantial reduction of sleep medicine services, and the long-term consequences may be considerable. New strategies for the management of sleep disorders are needed to overcome the current underdiagnosis and delay of treatment.

How artificial intelligence may help the Covid-19 pandemic: Pitfalls and lessons for the future.

SummaryThe clinical severity, rapid transmission and human losses due to coronavirus disease 2019 (Covid‐19) have led the World Health Organization to declare it a pandemic. Traditional epidemiological tools are being significantly complemented by recent innovations especially using artificial intelligence (AI) and machine learning. AI‐based model systems could improve pattern recognition of disease spread in populations and predictions of outbreaks in different geographical locations. A variable and a minimal amount of data are available for the signs and symptoms of Covid‐19, allowing a composite of maximum likelihood algorithms to be employed to enhance the accuracy of disease diagnosis and to identify potential drugs. AI‐based forecasting and predictions are expected to complement traditional approaches by helping public health officials to select better response and preparedness measures against Covid‐19 cases. AI‐based approaches have helped address the key issues but a significant impact on the global healthcare industry is yet to be achieved. The capability of AI to address the challenges may make it a key player in the operation of healthcare systems in future. Here, we present an overview of the prospective applications of the AI model systems in healthcare settings during the ongoing Covid‐19 pandemic.

The Business of Emergency Medicine: A Nonclinical Curriculum Proposal for Emergency Medicine Residency Programs

Over the course of their postgraduate medical education, physicians are expected not only to acquire an extensive knowledge of clinical medicine and sound procedural skills, but also to develop competence in their other professional roles as communicator, collaborator, mediator, manager, teacher, and patient advocate. Although the need for physicians to develop stronger service delivery skills is well recognized, residency programs may underemphasize formal training in nonclinical proficiencies. As a result, graduates can begin their professional careers with an incomplete understanding of the operation of health care systems and how to utilize system resources in the manner best suited to their patients' needs. This article proposes the content, educational strategy, and needs assessment for an academic program entitled The Business of Emergency Medicine (BOEM). Developed as an adjunct to the (predominantly) clinical content of traditional emergency medicine (EM) training programs, BOEM is designed to enhance the existing academic curricula with additional learning opportunities by which EM residents can acquire a fundamental understanding of the nonclinical skills of their specialty.

Unequal treatment: report of the institute of medicine on racial and ethnic disparities in healthcare

When the Institute of Medicine (IOM) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care issued its report in March 2002 [1], it created a stir not unlike the one that greeted the announcement of two other influential, and somewhat controversial reports, the report on patient safety and that on the quality chasm. The press, by and large, reported the bottom line on the racial and ethnic disparity study: that the quality of care received by racial and ethnic minorities in this country is generally lower than that provided to the majority population. Does this mean that the IOM report says that doctors and nurses in America are racist? The answer is “no,” and the press generally reported this accurately. The study explicitly says that there is no evidence that any significant proportion of healthcare professionals in the United States harbors overtly prejudicial attitudes. However, the study does say that our society still reflects attitudes and behaviors that can fairly be called discriminatory, which should come as no surprise to anyone. It also says that doctors and other clinicians are human and are influenced by the environment in which they live and practice, and that among the multiple complex factors that influence their decisions, bias and stereotypical behavior may play a role. But its most important contribution, in my view, is its attempt to understand and lay out how racial and ethnic disparities come about and what we, as professionals, should be doing about it. This is what I would like to focus on today. The committee gave considerable thought to a name for the study and selected Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The implications of the title were carefully weighed. “Unequal Treatment” stands in contrast to “equal treatment under the law,” as defined in the 14th amendment to the Constitution of the United States. The word “confronting” clearly points to a portion of its charge that the committee took equally seriously: to recommend interventions that can be undertaken to try eliminate such racial and ethnic disparities. The study on racial and ethnic disparities was commissioned by the Congress, and had as its specific charge:

Hospital Bed Scarcity: An Analysis of the Effects of Inter-Regional Differences

Economic analysis is becoming a powerful tool for the efficient administration of public programmes. Techniques of public expenditure evaluation have already been widely applied to problems of water resource development, defence and transport. Econometric investigations are being used in studies of urban areas and transport services. This article is an example of the use of economic analysis in studying the operation of health care systems. Since its inception in 1948, the National Health Service (N.H.S.) has tried to achieve not only a more just distribution of medical services but also a more efficient use of the nation's health care resources. Although the early years of the service saw the latter aim overshadowed by the attempt to curtail spending and reduce costs, the Ministry of Health has more recently shown a renewed interest in improving the service's efficiency.2 A previous article reviewed this growing interest and discussed the contribution that economic analysis could make in providing a conceptual framework for choosing among competing potential uses of health care resources.3 In the present study we examine the effects of area differences in the scarcity of hospital beds on the way in which these beds are used. We show the surprising result that the number of cases treated per 1,000 population is more responsive to bed scarcity than is the average duration of stay per case. We then discuss the responsiveness to bed scarcity of patients in different age-sex groups and diagnostic categories. These findings are not only interesting in themselves to anyone concerned with the operation of the N.H.S., but also suggest some policy consequences. In addition, they illustrate the way in which analysis of this kind can improve understanding and uncover previously unrecognized problems. DATA