Optimal Health Care Research Articles

Barriers to Providing Optimal Care in Idaho from the Perspective of Healthcare Providers: A Descriptive Analysis

Background/Objectives: Few studies have assessed barriers to providing care from the perspective of interprofessional healthcare providers. Despite Idaho’s predominantly rural geography, limited research exists assessing barriers to providing care within the state. This study sought to assess barriers to providing optimal healthcare using a sample of 400 healthcare providers at 22 clinic sites across the state. Methods: A barriers to providing optimal care 9-factor, 41-item survey was modified from an existing survey. Healthcare providers rated barrier items using an 11-point Likert scale. The survey was distributed to a convenience sample of healthcare providers in 22 different clinic sites in rural Idaho. Results: Four hundred interprofessional healthcare providers in Idaho across 13 professional disciplines completed surveys. Items in the Service Access (mean = 7.14), Patient Complexity (mean = 6.59), and Resource Limitations (mean = 6.18) factors were reported as the most commonly perceived barriers to providing optimal care. Conclusions: Few studies have assessed rural interprofessional providers’ perceived barriers to providing optimal, high-quality, care, specifically in the rural state of Idaho, where healthcare services are often not equitable compared to urban regions. The results suggest that commonly perceived barriers exist throughout the state, particularly Service Access, Patient Complexity, and Resource Limitations. Further research is needed to develop data-driven decisions to address these concerns.

Post-COVID Emergent Trends in Consumer Buying Behaviour for Pharma-OTC Sector

Good health is a fundamental human necessity, and access to quality healthcare is vital for a nation's development. Article 21 of the Indian Constitution guarantees the right to life and liberty, but providing optimal public healthcare, especially in rural areas, remains challenging for a rapidly growing population. In this context, self-medication and Over-The-Counter (OTC) products play a crucial role. OTC products, including medicines and personal care items like sanitisers, nutrient supplements, and pregnancy kits, can be purchased without prescriptions. The COVID-19 pandemic has been a global health crisis and an unprecedented socio-economic challenge, deeply impacting industries worldwide. However, the FMCG and pharmaceutical sectors have thrived due to the essential nature of their products. The pandemic has accelerated growth in the OTC segment, creating new opportunities for pharmaceutical companies. This research aims to explore emerging consumer behaviour trends in the pharma-OTC category post-COVID-19 and provide strategic recommendations for companies to capitalize on these trends.

Validity and Reliability Study of the Turkish Adaptation of the "Medical Office Survey on Patient Safety Culture".

The safety culture within health care organizations is essential for ensuring patient well-being and optimizing health care delivery. This study addresses the pressing need to establish a culture of patient safety within primary health care settings. The aim is to conduct a comprehensive validity and reliability study for the Turkish adaptation of the "Medical Office Survey on Patient Safety Culture" (MOSPSC) scale, designed to assess patient safety culture in primary care medical offices. The research model follows rigorous methodology, including a systematic translation and adaptation process aligned with World Health Organization guidelines. A diverse sample of 402 family physicians from primary health care centers across Turkey participated in the study. Descriptive results highlight participants' characteristics, work environments, and experiences in primary care. The scale's construct validity is evaluated using the Kaiser-Meyer-Olkin (KMO) and Bartlett tests, while its reliability is assessed through internal consistency analyses, including Cronbach α, split-half reliability, and item-total correlation. Results indicate strong internal consistency, with Cronbach α values ranging from 0.42 to 0.91 for scale dimensions and an overall value of 0.89. Construct validity assessment attests to the scale's appropriateness for assessing patient safety culture. Challenges in conducting factor analysis due to participant responses are discussed. The study contributes to the field by providing a validated and reliable tool specifically tailored for assessing patient safety culture in primary care medical offices. The Turkish adaptation of the MOSPSC scale offers health care professionals and organizations a valuable instrument for enhancing patient safety culture, identifying areas for improvement, and ultimately optimizing patient care within primary health care settings.

The Influence of Promotion and Service Quality on BPJS Patient Satisfaction at Clinic "X"

First-Level Health Facilities (Fasilitas Kesehatan Tingkat Pertama/FKTP) play a critical role in delivering healthcare services to participants of the National Health Insurance (BPJS) program in Indonesia. Every BPJS participant has the right to select an FKTP that collaborates with BPJS Health based on their preference. Therefore, FKTPs, including clinics partnering with BPJS Health, must actively promote their services and continuously enhance the quality of care to improve patient satisfaction and attract more BPJS participants. This study employs a quantitative, causal approach to examine the influence of promotion and service quality on BPJS patient satisfaction. Using a cross-sectional design and random sampling technique, data were collected through questionnaires from 63 BPJS patients at clinic "X." The data were analyzed using descriptive analysis and multiple linear regression, resulting in the regression equation Y = 1.245 + 0.077 X1 + 0.844 X2. The findings indicate that promotion and service quality significantly influence BPJS patient satisfaction, both individually and jointly, at clinic "X." These results highlight the importance of strategic promotion and continuous quality improvement by FKTPs to ensure optimal healthcare delivery and patient satisfaction among BPJS participants.

Implementation of a sexual health clinic in an oncology setting: patient and provider perspectives

BackgroundSexual dysfunction is prevalent among cancer survivors, significantly impacting patient and partner quality of life. Despite this, sexual health clinics (SHCs) remain rare in cancer centres across Canada. An innovative clinic was developed at Princess Margaret Cancer Centre in Toronto, Canada to address this significant gap in survivorship care. This study examines factors affecting the provision of sexual healthcare and the implementation of a sexual health clinic within a large urban centre.MethodsThe Quality Implementation Framework was used to explicate patient and provider experience and identify barriers and facilitators to integrating sexual healthcare into routine cancer care workflows. Healthcare providers and patients representing selected cancer types (prostate, cervical, ovarian, testicular, bladder, kidney, and head and neck cancer) participated in semi-structured interviews. Interviews were transcribed and analyzed using the Framework qualitative analysis protocol.ResultsThe analysis identified three organizing domains and ten themes that describe the unique aspects of the sexual healthcare experience and critical factors for sexual health implementation. Both patients and providers described a lack of sexual health support in the oncology setting and emphasized the need for comprehensive and personalized care. Limitations of current care provision included mutual silence between patients and providers due to discomfort in discussing sexual issues, insufficient provider confidence in delivering optimal sexual healthcare, and constraints related to space and time. Key Factors for implementing a sexual health clinic in oncology emphasized the importance of having a dedicated clinic, flexibility in service delivery, proactive patient engagement, and ongoing staff education.ConclusionsFindings highlight significant challenges in addressing sexual health in an oncology setting, underscoring the need for specialized sexual health clinics that are integrated with, but distinct from, routine oncology care. This study further emphasizes the need for incorporating sexual healthcare in survivorship programs as well as the necessity of conducting thorough implementation research, involving multiple stakeholders, prior to launching new programs.

Impact of Earthquakes During COVID-19 Lockdown on the Pediatric Injury Pattern in the Zagreb Urban Area.

Background/Objectives: Previous works on the epidemiology of pediatric trauma during the COVID-19 lockdown observed a decrease in pediatric surgical emergency consultations and fracture referrals. None of those works describes a unique situation in which there is the coexistence of another opposing factor, like an earthquake, that influences the number of injured children's referrals. Therefore, this study aimed to investigate the influence of earthquakes during the COVID-19 lockdown on pediatric injury pattern referrals at a tertiary care hospital in a urban setting. Methods: A retrospective single-center case-control study comprised a time interval at the time of the COVID-19 lockdown, starting with a day when the biggest earthquake happened and finishing at the end of the confinement period in Zagreb, Croatia (22 March-27 April 2020). The control group comprised the identical time interval in 2019. We identified all successive pediatric trauma patients referred to the Pediatric Emergency Department. Demographics and leading injury characteristics were analyzed. Results: We analyzed data from 1166 patients. In the case group, the median age was lower than in the control group but without gender differences. We detected a decrease in Pediatric Emergency Department referrals and a reduced proportion of pediatric trauma patients in the case group. Additionally, the proportion of shoulder/elbow injuries and head injuries was higher, and the proportion of foot/ankle injuries was lower in the case period than in the control period. Conclusions: Earthquakes during the COVID-19 lockdown changed the pattern of pediatric injuries. These data can be used to restructure health resources during similar conditions to provide optimal health care to children.

Time to consider health services dedicated for adults living with cerebral small vessel disease: Report of a ESO scientific seminar.

Cerebral small vessel disease (cSVD) is a highly prevalent disorder leading to physical, cognitive and functional decline. We report key barriers in the management of individuals with cSVD, the potential benefit of cSVD-dedicated health services, and evidence from existing models of care for adults with cSVD. We examined information from a scientific seminar developed between seven experts in cSVD during the eighth European Stroke Organisation Conference that discussed the optimal health care for adults with cSVD and what health services dedicated to cSVD should include. Barriers in cSVD care include unrecognised symptoms and modifiable risk factors, heterogeneity of clinical presentations, inefficient inter/intra-clinical services communication/organisation, and uncertainties regarding what assessments/treatments should be routinely done, when and by whom. However, existing health services and research studies suggest models of care in cSVD. Multi-step approaches can be used for identification and aetiological workup in individuals with cSVD, including basic and selected advanced evaluations, for example, monogenic cSVD testing. Although current guidelines for management of cSVD illlustrate limitations, there are recommendations on risk factors and lifestyle considerations, as well as pharmacological and non-pharmacological interventions for people with cSVD. Existing healthcare models do not provide optimal care for individuals with cSVD. Lack of awareness of heterogeneous clinical presentations and uncertainty in threshold of cSVD 'burden' for referral to specialist multidisciplinary services, are key challenges for health services to overcome. Creating cSVD-dedicated services may prevent underdiagnosing and achieve standardised holistic management to improve outcomes in people with cSVD. However, adequate prevention and early management should be offered at all levels of care.

Preventing disease progression in schizophrenia: What are we waiting for.

Despite research advances and progress in health care, schizophrenia remains a debilitating and costly disease. Onset occurs typically during youth and can lead to a relapsing and ultimately chronic course with persistent symptoms and functional impairment if not promptly and properly treated. Consequently, over time, schizophrenia causes substantial distress and disability for patients, their families and accrues to a collective burden to society. Recent research has revealed much about the pathophysiology that underlies the progressive nature of schizophrenia. Additionally, treatment strategies for disease management have been developed that have the potential to not just control psychotic symptoms but limit the cumulative morbidity of the illness. Given the evidence for their effectiveness and feasibility for their application, it is perplexing that this model of care has not yet become the standard of care and widely implemented to reduce the burden of illness on patients and society. This begs the question of whether the failure of implementation of a potentially disease-modifying strategy is due to the lack of evidence of efficacy (or belief in it) and readiness for implementation, or whether it's the lack of motivation and political will to support their utilization. To address this question, we reviewed and summarized the literature describing the natural history, pathophysiology and therapeutic strategies that can alleviate symptoms, prevent relapse, and potentially modify the course of schizophrenia. We conclude that, while we await further advances in mental health care from research, we must fully appreciate and take advantage of the effectiveness of existing treatments and overcome the attitudinal, policy, and infrastructural barriers to providing optimal mental health care capable of providing a disease-modifying treatment to patients with schizophrenia.

Awareness on oral health status of Indian women during pregnancy by gynaecologists

The awareness of gynecologists on oral health conditions during pregnancy is of interest. Gynecologists generally acknowledge the importance of oral health during pregnancy. However, there is a need for improved awareness regarding specific conditions, guidelines, and the importance of routine oral health assessment. Educational interventions and collaborative efforts between gynecologists and dental professionals are crucial to ensure optimal oral health care for pregnant women.

The Prevalence of Sickle Cell Disease in Colorado and Methodologies of the Colorado Sickle Cell Data Collection Program: Public Health Surveillance Study.

Sickle cell disease (SCD) is a genetic blood disorder that affects approximately 100,000 individuals in the United States, with the highest prevalence among Black or African American populations. While advances in care have improved survival, comprehensive state-level data on the prevalence of SCD remain limited, which hampers efforts to optimize health care services. To address this gap, the Colorado Sickle Cell Data Collection (CO-SCDC) program was established in 2021 as part of the Centers for Disease Control and Prevention's initiative to enhance surveillance and public health efforts for SCD. The objectives of this study were to describe the establishment of the CO-SCDC program and to provide updated estimates of the prevalence and birth prevalence of SCD in Colorado, including geographic dispersion. Additional objectives include evaluating the accuracy of case identification methods and leveraging surveillance activities to inform public health initiatives. Data were collected from Health Data Compass (a multi-institutional data warehouse) containing electronic health records from the University of Colorado Health and Children's Hospital Colorado for the years 2012-2020. Colorado newborn screening program data were included for confirmed SCD diagnoses from 2001 to 2020. Records were linked using the Colorado University Record Linkage tool and deidentified for analysis. Case definitions, adapted from the Centers for Disease Control and Prevention's Registry and Surveillance System for Hemoglobinopathies project, classified cases as possible, probable, or definite SCD. Clinical validation by hematologists was performed to ensure accuracy, and prevalence rates were calculated using 2020 US Census population estimates. In 2019, 435 individuals were identified as living with SCD in Colorado, an increase of 16%-40% over previous estimates, with the majority (n=349, 80.2%) identifying as Black or African American. The median age of individuals was 19 years. The prevalence of SCD was highest in urban counties, with concentrations in Arapahoe, Denver, and El Paso counties. Birth prevalence of SCD increased from 11.9 per 100,000 live births between 2010 and 2014 to 20.1 per 100,000 live births between 2015 and 2019 with 58.5% (n=38) of cases being hemoglobin (Hb) SS or HbSβ0 thalassemia subtypes. The study highlighted a 67% (n=26) increase in SCD births over the decade, correlating with the growth of the Black or African American population in the state. The CO-SCDC program successfully established the capacity to perform SCD surveillance and, in doing so, identified baseline prevalence estimates for SCD in Colorado. The findings highlight geographic dispersion across Colorado counties, highlighting the need for equitable access to specialty care, particularly for rural populations. The combination of automated data linkage and clinical validation improved case identification accuracy. Future efforts will expand surveillance to include claims data to better capture health care use and address potential underreporting. These results will guide public health interventions aimed at improving care for individuals with SCD in Colorado.

Serious games are more than just games.

Serious games (SG) or educational games are complete games designed for a specific purpose that fulfill both their classic function of entertainment and promote the learning of specific concepts or skills and optimize health care in general. In the pediatric setting, these games combine strategies to educate about health issues, promote healthy behaviors, provide therapy or medical treatment. SG have been shown to promote adherence to treatment in children with chronic diseases, reduce anxiety in those undergoing invasive medical procedures, and stimulate the development of cognitive, emotional, or psychomotor skills. However, it is important to emphasize that the success of SG in pediatrics depends to a large extent on game quality, their design based on clear objectives, and their accurate adaptation to the individual needs and preferences of patients.

The Role of Primary Care in Achieving Life's Essential 8: A Scientific Statement From the American Heart Association.

To reduce morbidity and mortality rates of cardiovascular disease, an urgent need exists to improve cardiovascular health among US adults. In 2022, the American Heart Association issued Life's Essential 8, which identifies and defines 8 health behaviors and factors that, when optimized through a combination of primary prevention, risk factor management, and effective treatments, can promote ideal cardiovascular health. Because of its central role in patient care across the life span, primary care is in a strategic position to promote Life's Essential 8 and improve cardiovascular health in the United States. High-quality primary care is person-centered, team-based, community-aligned, and designed to provide affordable optimized health care. The purpose of this scientific statement from the American Heart Association is to provide evidence-based guidance on how primary care, as a field and practice, can support patients in implementing Life's Essential 8. The scientific statement aims to describe the role and functions of primary care, provide evidence for how primary care can be leveraged to promote Life's Essential 8, examine the role of primary care in providing access to care and mitigating disparities in cardiovascular health, review challenges in primary care, and propose solutions to address challenges in achieving Life's Essential 8.

Simulation for Systems Integration: A Win-Win to Achieve Your Education, Quality, and Safety Goals.

Health care education is a cornerstone of clinical excellence, ensuring the highest level of readiness to achieve high-quality and safe care. Integrating simulation into health care systems can provide a modality to address educational, quality, and safety goals. Simulation is a methodology used to immerse individuals, teams, and medical systems into clinical scenarios or environments. Through facilitation and debriefing, the immersive experience can be used to provide vital education, develop optimal health care practices, and identify prospects for improvement. Simulation provides an opportunity to blend the needs of continuing multiprofessional education while addressing quality and safety goals, and ultimately, promoting a positive safety culture. Applied comprehensively, simulation for systems integration can both promote the transformation of the health care system into a learning organization, as well as translate to improved health care outcomes. [Pediatr Ann. 2024;53(11):e408-e413.].

Strategies To Overcome Language Barriers For Native Arabic Speakers In English-Dominant Medical Curricula—A Review

The globalization of medical education has led to a significant increase in the number of non-native Englishspeaking students pursuing medical studies in English-speaking countries. Among these students, Arabicspeaking learners face unique challenges due to linguistic differences. This literature review synthesizes existing research to identify the key challenges encountered by Arabic-speaking students in English medical education and explores strategies to address these challenges. This review revealed that to ensure the success of native Arabic speakers in English-based medical programs, a comprehensive approach is vital. By incorporating effective pedagogy, advancements in technology, and the potential of artificial intelligence (AI), educational outcomes can be significantly improved. Interactive learning approaches such as problem-based learning and virtual simulations, coupled with tailored language support and technological tools such as e-learning platforms, can revolutionize the educational experience for these students. AI has the potential to create adaptive learning environments that cater to individual student needs and tutors, create interactive resources, and provide immediate feedback. By integrating these strategies and technologies, educators can create a supportive, inclusive learning environment that promotes the success of native Arabic speakers in their medical studies and future careers and equips them with the skills required to deliver optimal healthcare in a global context.

Improving midwives' knowledge and attitudes in providing lactation education based on local wisdom of the Bugis ethnic in Indonesia

Background: The current rate of exclusive breastfeeding remains low due to several factors, including social and cultural changes, psychological factors, lack of education provided by healthcare workers, and the increasing promotion of formula milk as well as misinformation to the public. Therefore, it is necessary to have productive midwives who provide optimal healthcare services to improve the health status of infants. Currently, the healthcare services provided by midwives can also be carried out through independent practice. A midwife does not only provide obstetric services from a biological perspective but also addresses social, cultural, and spiritual needs. Purpose: To evaluate the impact of providing lactation education based on local wisdom in improving midwives' knowledge and attitudes in the Bugis ethnic in Indonesia. Method: A quasi-experiment method, specifically a pre-test and post-test with a control group design. The study population consists of midwives who have Independent Midwifery Practice in 15 districts of Makassar City. The sample obtained using purposive sampling. The sample size was 30 midwives, consisting of 15 midwives in the treatment group and 15 midwives in the control group. Results: The N-Gain Score test showed a value of 72.89% for the treatment group, while the control group scored 21.89%. The paired t-test showed an Asymp Sig (2-tailed) value of 0.000, which is less than the probability value of 0.05 for the treatment group. Conclusion: The use of printed and online pocketbooks for lactation education integrated with the cultural values of Sipakatau, Sipakalebbi, and Sipakainge in the exclusive breastfeeding program by independent midwives is more effective compared to counseling alone, which is less effective in the control group. Further testing concluded that there was a significant difference between the pre-test and post-test scores in the treatment group, indicating an increase in the midwives' knowledge.

A New Natural Language Processing-Inspired Methodology (Detection, Initial Characterization, and Semantic Characterization) to Investigate Temporal Shifts (Drifts) in Health Care Data: Quantitative Study.

Proper analysis and interpretation of health care data can significantly improve patient outcomes by enhancing services and revealing the impacts of new technologies and treatments. Understanding the substantial impact of temporal shifts in these data is crucial. For example, COVID-19 vaccination initially lowered the mean age of at-risk patients and later changed the characteristics of those who died. This highlights the importance of understanding these shifts for assessing factors that affect patient outcomes. This study aims to propose detection, initial characterization, and semantic characterization (DIS), a new methodology for analyzingchanges in health outcomes and variables over time while discovering contextual changes for outcomes in large volumes of data. The DIS methodology involves 3 steps: detection, initial characterization, and semantic characterization. Detection uses metrics such as Jensen-Shannon divergence to identify significant data drifts. Initial characterization offers a global analysis of changes in data distribution and predictive feature significance over time. Semantic characterization uses natural language processing-inspired techniques to understand the local context of these changes, helping identify factors driving changes in patient outcomes. By integrating the outcomes from these 3 steps, our results can identify specific factors (eg, interventions and modifications in health care practices) that drive changes in patient outcomes. DIS was applied to the Brazilian COVID-19 Registry and the Medical Information Mart for Intensive Care, version IV (MIMIC-IV) data sets. Our approach allowed us to (1) identify drifts effectively, especially using metrics such as the Jensen-Shannon divergence, and (2) uncover reasons for the decline in overall mortality in both the COVID-19 and MIMIC-IV data sets, as well as changes in the cooccurrence between different diseases and this particular outcome. Factors such as vaccination during the COVID-19 pandemic and reduced iatrogenic events and cancer-related deaths in MIMIC-IV were highlighted. The methodology also pinpointed shifts in patient demographics and disease patterns, providing insights into the evolving health care landscape during the study period. We developed a novel methodology combining machine learningand natural language processing techniques to detect, characterize, and understand temporal shifts in health care data. This understanding can enhance predictive algorithms, improve patient outcomes, and optimize health care resource allocation, ultimatelyimproving the effectiveness of machine learning predictive algorithms applied to health care data. Our methodology can be applied to a variety of scenarios beyond those discussed in this paper.

Managing no-shows in healthcare: insights from an urban Health District in Northern Italy

Abstract Background Non-attendance at healthcare appointments, known as no-show, poses significant challenges to healthcare systems, disrupting patient care continuity, exacerbating waiting times, and straining resources. Addressing this issue is crucial for optimizing health care delivery and containing costs. This study explores the phenomenon of patient no-shows and aims to identify factors associated in a densely populated healthcare district in Turin, Northern Italy. Methods Data were extracted from the healthcare management system covering outpatient care appointments in the health district in 2022 and 2023. The analysis included various patient and service-related variables. Missing information on key variables were managed with listwise deletion. Descriptive statistics provided an overview of missed appointment rates, while multivariate analysis explored various patient and service-related variables. Results A 5.1% (n = 6198) no-show rate was observed out of 120,405 records. The total cost incurred due to missed appointment fees amounted to €127,244. Several factors were associated with a significantly increased likelihood of no-show (p < 0.05), including initial visit (OR = 1.11), deferred priority (OR = 1.22), non-exempt status from healthcare co-payments (OR = 1.36), exemption based on income (OR = 1.82), age under 18 (OR = 2.46) and under 65 (OR = 2.32), male gender (OR = 1.17), residency outside the Piedmont Region (OR = 1.31) and outside Italy (OR = 2.46), and longer waiting time (OR = 1.01). Conclusions This study sheds light on the widespread issue of patient no-shows and its economic implications. It provides clear direction for implementing tailored interventions in healthcare settings. As a response to these findings, a telephone recall project was launched. Its efficacy will be evaluated in subsequent assessments to determine if it can effectively alleviate the burden of no-shows, thus enhancing healthcare efficiency and ensuring continuity of care for patients. Key messages • The no-show phenomenon has important implications both organizationally and economically. • The magnitude and major determinants of patient no-shows must be recognized to guide the deployment of tailored interventions in a real-world setting.

Wait, What? What's Going On?- Pregnancy Experiences of Deaf and Hard of Hearing Mothers Who Do Not Sign.

Deaf and hard of hearing (DHH) women experience higher rates of reproductive healthcare barriers and adverse birth outcomes compared to their hearing peers. This study explores the pregnancy experiences of DHH women who do not sign to better understand their barriers and facilitators to optimal perinatal health care. Qualitative study using thematic analysis. Semi-structured, individual remote, or in-person interviews in the United States. Twenty-two DHH English speakers (non-signers) who gave birth in the United States within the past 5 years. Semi-structured interviews explored how DHH women experienced pregnancy and birth, including access to perinatal information and resources, relationships with healthcare providers, communication access, and their involvement with the healthcare system throughout pregnancy. A thematic analysis was conducted. The barriers and facilitators related to a positive perinatal care experience among DHH women. Five key themes emerged. For barriers, healthcare communication breakdowns and loss of patient autonomy highlighted DHH women's struggle with perinatal health care. In contrast, DHH participants outlined the importance of accessible health communication practices and accommodations, use of patient advocacy or self-advocacy, and assistive technologies for DHH parents for more positive perinatal care experiences. Perinatal healthcare providers and staff should routinely inquire about ways to ensure an inclusive and accessible healthcare experience for their DHH patients and provide communication accommodations for optimal care. Additionally, healthcare providers should be more aware of the unique parenting needs and resources of their DHH patients.

Developing and piloting a set of quality-of-care indicators for Romanian public hospitals as part of a national programme to fund quality

BackgroundHealthcare systems aim to enhance the health status and well-being of the individuals and populations they serve. To achieve this, measuring and evaluating the quality and safety of services provided and the outcomes achieved is essential. Like other countries, Romania faces challenges regarding the quality of care provided in its public hospitals. To address this, the Romanian Ministry of Health initiated reforms in 2022, including implementing a pay-for-performance model based on quality indicators. This paper presents a descriptive analysis of processes, methods, results and lessons learned from developing and piloting a set of Quality of Care indicators for Romanian public hospitals.MethodsWorld Health Organization’s Athens Office on Quality of Care and Patient Safety assisted Romania in developing and piloting a set of quality-of-care indicators for public hospitals. The development phase included defining indicator domains, identifying potential indicators across these domains, and defining the final indicator set. The piloting phase involved selecting and recruiting piloting hospitals, developing data collection and validation methods and tools, training hospital staff, and collecting and analysing indicator data. Piloting ended with an evaluation workshop. Mixed, quantitative and qualitative methods were used, including literature reviews, stakeholder consultation workshops, survey instruments developed for this study, modified Delphi panels and consensus-building meetings. National stakeholders were actively involved throughout the process.ResultsFour priority domains were defined for quality-of-care indicators for Romanian public hospitals: patient safety, patient experience, healthcare workforce training and safety, and clinical effectiveness. 25 core indicators were selected across these domains. During the pilot, hospitals achieved an average completion rate of 90% for data submission, with all domains rated equally relevant during post-pilot evaluations. Lessons included the need for supportive legislation, improved internal auditing practices and enhanced staff training, refinement of indicator data collection methods and alignment of indicators with hospital-specific contexts.ConclusionsThis work presents a significant stride in improving Romanian public hospitals’ quality of care and patient safety. It underscores the importance of high-level commitment, stakeholder engagement, and robust data practices in driving successful quality improvement efforts. Emphasising the role of data-driven and patient-centric approaches in achieving optimal healthcare outcomes, lessons learned offer insights for the continuation of quality improvement work in Romania but also for healthcare systems elsewhere.

Gender and Sexuality Awareness in Medical Education and Practice: Mixed Methods Study.

The integration of gender and sexuality awareness in health care is increasingly recognized as vital for patient outcomes. Despite this, there is a notable lack of comprehensive data on the current state of physicians' training and perceptions in these areas, leading to a gap in targeted educational interventions and optimal health care delivery. The study's aim was to explore the experiences and perceptions of attending and resident physicians regarding the inclusion of gender and sexuality content in medical school curricula and professional practice in Israel. This cross-sectional survey targeted a diverse group of physicians across various specializations and experience levels. Distributed through Israeli Medical Associations and professional networks, it included sections on experiences with gender and sexuality content, perceptions of knowledge, the impact of medical school curricula on professional capabilities, and views on integrating gender medicine in medical education. Descriptive and correlational analyses, along with gender-based and medical status-based comparisons, were used, complemented, and enhanced by qualitative analysis of participants' replies. The survey, encompassing 189 respondents, revealed low-to-moderate exposure to gender and sexuality content in medical school curricula, with a similar perception of preparedness. A need for more comprehensive training was widely recognized. The majority valued training in these areas for enhancing professional capabilities, identifying 10 essential gender-related knowledge areas. The preference for integrating gender medicine throughout medical education was significant. Gender-based analysis indicated variations in exposure and perceptions. The study highlights a crucial need for the inclusion of gender and sexuality awareness in medical education and practice. It suggests the necessity for curriculum development, targeted training programs, policy advocacy, mentorship initiatives, and research to evaluate the effectiveness of these interventions. The findings serve as a foundation for future directions in medical education, aiming for a more inclusive, aware, and prepared medical workforce.