Organization Of Health Care Services Research Articles

P177 The prevalence and incidence of psoriasis and psoriatic arthritis in England from 2009-2019: an observational study using primary care data

Abstract Background/Aims Psoriasis (PsO) and psoriatic arthritis (PsA) greatly impact quality of life and result in substantial personal and societal costs. Complete and up-to-date data on the prevalence and incidence of these conditions and whether these change over time and vary by age is important for healthcare service planning so that specialist care and funding can be appropriately allocated. Objective to determine the prevalence and incidence of PsO and PsA in males and females from 2009-2019 across all age groups in England. Methods We used Clinical Practice Research Datalink AURUM, a primary care electronic health record database, including 20% of the English population. The codes used to identify patients with PsO and PsA were selected by rheumatologists and dermatologists and cross-checked with published code lists from other studies. All included patients must have data for at least 1 year before their diagnosis. The annual incidence and point prevalence were calculated from 2009-2019 and stratified by age/sex. The study period ended in 2019 to avoid COVID-19 pandemic affecting results. Results The prevalence of PsO and PsA in males and females has increased annually, peaking in 2019 (PsO males 2.41% [95% confidence interval (CI) 2.40, 2.42]; PsO females 2.60% [95% CI 2.59-2.61]; PsA males 0.20% [95% CI 0.20-0.20]; PsA females 0.21% [95% CI 0.21- 0.22]), as illustrated in Table 1. In 2019, the prevalence of PsO and PsA was highest in the over 65 years age group; PsO 4.25% [95% CI 4.22-4.28] and PsA 0.38% [95% CI 0.37-0.38]. The annual incidence (per 100,000 person years) of PsO has gradually decreased in males (from 168 [164-171] in 2009 to 148 [145-151] in 2019) but in females it has been stable with a slight annual decrease (from 180 [177-184] in 2009 to 173 [170-176]) in 2019. The annual incidence for PsA has increased in both males and females; 13 (12-14) in 2009 and 15 (14-16) in 2019 for males and 12 (11-13) in 2009 and 18 (17-19) in 2019 for females. Conclusion The increasing prevalence of PsO and PsA highlights the importance of organising healthcare services to meet this need, particularly in the elderly population. Disclosure A. Vivekanantham: None. E. Burn: None. M. Pineda Moncusi: None. S. Khalid: None. D. Prieto Alhambra: Consultancies; DP-A’s research group has received consultancy or speaker fees from Astellas, Amgen, AstraZeneca, and UCB Biopharma. Grants/research support; DP-A’s research group has received research grants from the European Medicines Agency; the Innovative Medicines Initiative; and Amgen, Chiesi, and UCB Biopharma. L.C. Coates: Grants/research support; LCC has received grants/research support from AbbVie, Amgen, Celgene, Eli Lilly, Novartis and Pfizer; worked as a paid consultant for AbbVie, Amgen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene.

Healthcare for people with intellectual and developmental disabilities in Italy

AbstractThe Italian healthcare system is public and freely available to the population. With a few exceptions, there are no distinctions between the healthcare services and practices (e.g., primary care) designed for the general population and those for individuals with intellectual and developmental disabilities (IDD). Prevalence data on adults with IDD are lacking and most disability policies and resources are designed for people with disabilities broadly defined, without specification based on disability type or severity level. Recent legislation provides specific supports for individuals with severe disabilities or autism spectrum disorder. This paper describes the legislation and health policies developed for people with disabilities, the organization of the Italian healthcare system, and the organization of disability support services and healthcare services. Strengths (e.g., availability of many financial resources, adoption of biopsychosocial approach to disability, presence of innovative projects to address the healthcare needs of people with IDD) and weaknesses (e.g., lack of distinction among disability types, territorial differences, lack of disability training of healthcare providers) of the current healthcare practices are reported and discussed.

Something in the water: opening the public health law policy window for fluoridation?

Alongside the more widely debated provisions relating to the organisation and delivery of healthcare services in the National Health Service in England, the Health and Care Act 2022 contains measures relating to public health. This article offers a critical examination of one of these, that relating to fluoridation of water supplies. The nature of this intervention as a response to problems of poor oral health is considered, and the changes made by the 2022 Act are explained. It is argued that there are clear reasons for altering the statutory framework, but that it is less immediately apparent why this development is taking place at this point in time. In order to answer this question, John Kingdon’s concept of a ‘policy window’ is deployed as a framework for understanding agenda-setting in this context. Additionally, this can facilitate analysis of the future likelihood of use of the powers conferred by the 2022 Act in this controversial area of public health.

The resilience of the regional ecosystems: Healthcare-service organizations, public agents and communities in the times of COVID-19

The aim of this study is to compare regional ecosystems' resilience in terms of their ability to contain the spread of Covid-19. This is carried out through institutional measures as well as through spontaneous community behaviour in order to preserve public health and the institutional actions to strengthen the health-care system in dealing with the pandemic. The discussion is framed through the institutional approach. We develop a twostep method. In the first step, regions have been clustered by considering the kind of response to Covid-19, in terms of formal and informal rules. In the second step a random effect panel regression analysis was performed in order to define the effect of the single response variable to Covid-19 on the resilience index over time. Implications for policy makers are then discussed. The first is that coping with a regional emergency requires taking into account regional specificities. Strictly imitative models risk being inconsistent with the characteristics of the area, resulting in outputs that are not homogeneous. The second involves social capital, which is crucial to the application of the norms. In regions with high social capital there is a sense of solidarity that presents itself in informal rules aimed at reinforcing the formal rules. However, there is no sense of conformity for the sake of conformance to the standard.

Nurses' Perception on the Implementation of Nursing Care Documentation Using Electronic Medical Record: A Literature Review

Background: The global use of Electronic Medical Records in healthcare service organizations such as hospitals is currently undertaken as a measure to enhance efficiency and safety in healthcare provision. Despite considerable attention being given to this aspect, the benefits of this technology are often not fully realized.
 Objectives: This research aims to examine the concept of electronic medical records about nurses' perceptions of nursing care documentation, particularly in healthcare services.
 Methods: The design of this research utilizes a literature review approach by collecting several articles from selected databases, including ScienceDirect and PubMed, with articles published from 2016 to 2023. An article search was conducted by using the keywords "(Electronic medical record) OR (EMR) OR (e-Health Record) AND (perception) OR (Perceived)". The search for articles was limited by inclusion and exclusion criteria. Inclusion criteria for this study encompassed articles investigating electronic medical records, Electronic Health Record (EHR), or Electronic Medical Record (EMR) with a design of a Crossectional Study, while exclusion criteria included non-health service-related articles, abstracts, and books only, as well as letters to the editor.
 Results: EMR provides significant benefits in clinical practice and healthcare services. The majority of respondents view EMR as a highly advantageous technology in terms of patient data access, workflow efficiency, and the improvement of service quality.
 Conclusion: This research can be used as a foundation for further development and improvement in the implementation of EMR to enhance the quality of service and patient safety in clinical practice.

Factors Affecting Intention to Use Blockchain Technology in Health Records in Saudi Arabia: A Case Study of the Eastern Province

The study aims to measure the impact of the combined independent factors (technical skill level of users, technical infrastructure, ease of use, security privacy, perceived benefit, and perceived risks) on the trend to use blockchain technology through the study of the attitude towards the use of blockchain technology. This study relies on the quantitative descriptive approach using a questionnaire. The sample population consisted of workers in the health sector in the eastern region of the Kingdom of Saudi Arabia, where the responsive sample amounted to n = 256. Results showed that there is a strong positive correlation at the significance level (α≤0.05) for the combined independent factors on the attitude towards the use of blockchain technology. The results of the model path quality efficiency test indicators also mostly showed ideal values. Thus, we conclude through these indicators that there is a positive impact of the combined independent factors (technical skill level of users, technical infrastructure, ease of use, security privacy, perceived benefit, perceived risks) on the orientation to use blockchain technology at the significance level (α≤0.05). The study recommends the need to continuously develop the technical infrastructure to keep pace with recent and rapid changes in information technology, such as health record systems, based on blockchain technology, which allows easy data sharing between healthcare service organizations and beneficiaries while maintaining the privacy and security of data in providing the best services.

Transdisciplinary is the new multidisciplinary: why and how can healthcare workers and managers make the shift?

Introduction: Demand for healthcare services is increasing due to the ageing population and events such as the COVID-19 pandemic. Healthcare workers and managers can respond by shifting from multidisciplinary to transdisciplinary teams, where multiple services are integrated and designed around the healthcare needs of individuals and patient groups. 
 Background: Transdisciplinary teams provide the formal structures for healthcare professionals to blur professional boundaries, share and acquire new skills and knowledge, support each other, and provide high quality patient care. Instead of organising healthcare services in silos of professional groupings, transdisciplinary teams place the patient at the centre of care. Reorganising teams around the patient can reduce duplication of healthcare services, the number of healthcare professionals delivering services, and occasions of service. Healthcare professionals gain skills, time, and the ability to support each other, which are qualities of a flexible and capable workforce.
 Aims: In this submission, we show healthcare workers and managers how co-designed transdisciplinary teams can be translated into clinical practice. We aim to explain why and how to shift from multidisciplinary to transdisciplinary teams by 1) providing clinical evidence demonstrating how transdisciplinary teams can improve person-centred care and the healthcare workforce; and 2) sharing practical learnings when planning a transdisciplinary team.
 Methods/engagement: At the Mater Hospital Brisbane, assessment processes were reorganised around patients experiencing stroke symptoms. A transdisciplinary assessment was co-designed by allied health professionals, nurses, and managers where tasks and questions were integrated from occupational therapy, physiotherapy, speech pathology, social work, and nursing. A clinical mixed methods study evaluated the transdisciplinary assessment compared to usual multidisciplinary assessment. Patients and staff were also consulted during the clinical study via surveys and fortnightly meetings.
 Results/impact: All occupational therapists and physiotherapists completed transdisciplinary competency training, which improved staff availability and flexibility to comprehensively assess patients. Use of a transdisciplinary assessment resulted in a time saving of approximately 53 minutes per assessment, which indicated improved workforce productivity and capacity. The time saved could be reallocated to increasing rehabilitation time, or to an extra occasion of service to the same or other patients. Additionally, staff reported that the transdisciplinary assessment “saves time and helps staff manage clinical workloads by reallocating resources across teams” and resulted in an “agile workforce”. 
 Learnings/next steps: To co-design and shift from a multidisciplinary to transdisciplinary team, stakeholder consultation was imperative to ensure comprehensive planning and barrier identification. Addressing barriers when shifting to a transdisciplinary team involved behaviour change from staff. For example, a lack of confidence in the skills of another professional, or a lack of willingness to share skills could impede transdisciplinary efforts. To negotiate these barriers, it was essential to establish clear competency training requirements and educate staff on the purpose of transdisciplinary teams for improving patient care and workforce capacity. To translate transdisciplinary teams into other healthcare settings internationally, we propose the practice guidelines: 1) key stakeholders should be consulted to co-design the transdisciplinary team, identify and address implementation barriers; 2) competency training is required; and 3) staff education on transdisciplinary teams is required.

COMMUNITY COLLABORATOR AND OLDER ADULT EXPERIENCES WITH INTERVENTIONS DELIVERED BY OLDER ADULTS

Abstract This symposium will include researchers, collaborators from healthcare and social service organizations, and older adults serving as volunteer coaches or peer educators; speakers will describe their experiences conducting two randomized controlled trials involving behavioral interventions for older adults delivered by older adults. The first trial is a NIMH-funded three-site RCT for community-dwelling older adults with symptoms of depression, in which participants receive behavioral activation delivered by a masters-level clinician or a streamlined version (“Do More, Feel Better”) delivered by an older adult volunteer. This trial involves close collaboration with senior centers and an Area Agency on Aging (AAA). The second trial is a PCORI-funded RCT to reduce health disparities for Black/African-American and Hispanic/Latino older adults after medical hospitalization, in which participants receive the evidence-based Care Transitions Intervention (CTI), CTI plus a peer educator intervention, or usual care. This trial involves close collaboration with three regional hospital systems and an AAA. First, research investigators will describe the background, rationale, and methodology of each trial. Second, two representatives from the collaborating organizations (one from each trial) will present about their experiences collaborating on these trials – benefits of collaborating, challenges and strategies for overcoming challenges, and recommendations for other researchers engaged in similar community-based research. Third, two representatives from the older adult volunteers and peer educators (one from each trial) will present about their experiences collaborating on these trials – benefits of collaborating, challenges and strategies for overcoming challenges, and recommendations for other researchers engaged in similar community-based research.

National Health Policy 2017 - Review in the context of Nursing Services and Practice

The Union Cabinet approved the new National Health Policy On March 15, 2017 with an aim to inform, clarify, strengthen and prioritize the role of the Government role in shaping health systems in all its dimensions, investment in health, organization and financing of healthcare services, prevention of diseases and promotion of good health through cross sectoral action, access to technologies, developing human resources, encouraging medical pluralism, building the knowledge base required for better health, financial protection strategies and regulation and progressive assurance for health. The target is to achieve “Health for All”, which is the basic objective of NHP 2017. National Health Policy impacting Nursing Profession at educational and service levels in view of overall well - being aspects of society.

CONTINUOUS EDUCATION OF NURSES AND PHYSIOTHERAPISTS AS A PREREQUISITE FOR ENHANCING COMPETENCIES IN PLANNING AND ORGANIZATION

Background: Nurses and physiotherapists play a pivotal role in providing high-quality healthcare and patient rehabilitation, underscoring the importance of possessing a high level of expertise in planning and organizing their activities. The healthcare sector continually evolves and refines itself due to technological advancements, making it imperative for professionals to remain open to continuous learning and adapt to new information and techniques. Consequently, the maintenance and development of essential competencies through continuous education play a crucial role. Aim: To examine the significance of continuous education for nurses and physiotherapists in the context of enhancing their competencies in healthcare service planning and organization. Results and Discussion: The findings demonstrate that continuous education is essential for maintaining relevance and improving skills in the dynamic environment of contemporary professions. However, it is frequently accompanied by challenges such as financial constraints, time limitations, motivational issues, and technological adaptation barriers. Regarding the methods of continuous education available to nurses and physiotherapists, these encompass formal education, professional workshops, seminars, practical training, online education, and mentorship. A combination of these methods can contribute to the development and enhancement of healthcare professionals and competencies in their practice. Furthermore, attention is directed toward key competencies in healthcare service planning and organization, encompassing time management, teamwork, communication skills, decision-making, and problem-solving. Conclusion: It can be inferred that continuous education not only contributes to improved practice and patient care but also ensures that healthcare professionals stay aligned with changes within the healthcare system and the latest techniques and technologies.

Healthy Finland survey as the latest uptake for 50 years of population health monitoring in Finland

Abstract In Finland, population-based health examination surveys (HESs) have been conducted in regularly since early 1960's to obtain information on population health and health determinants. These surveys have covered adult population living in the mainland Finland. Surveys have always been conducted by specially trained personnel using international standardized protocols such as WHO MONICA protocol or EHES protocol. The latest HES, Healthy Finland, is ongoing and will run until June 2023. The Finnish Institute for Health and Welfare (THL) had the responsibility of the coordination of the preparation phase as well as conducting the survey. Survey planning was started already in early 2021 with a multidisciplinary group including representatives from different stakeholders. Survey sample includes 66.000 randomly selected adults aged 18+ years living in Finland. In the 1st phase, they receive a questionnaire to be filled in. Questionnaire covers topics such as quality of life, health, use of health care services, lifestyles, background information, work ability and functional capacity, wellbeing, accidents, and sexual and reproductive health. In the 2nd phase, 10.000 of those selected to the survey were invited to health examination including for example anthropometric measurements, blood pressure, spirometry test, collection of biological samples and sub-studies. This from these national HESs has been widely used for policy making, planning and evaluation of the prevention programmes, as epidemiological background for clinical treatment guidelines of several diseases, and for research. Information obtained from the Healthy Finland survey will be used for the evaluation of wellbeing service counties which are responsible for the organization of social and health care services in Finland. Survey will generate new information about health inequalities by providing information not only by age and sex but also by education and other socio-economic indicators.

Roadmap for implementation of genomics in healthcare: towards equity in access to genomics

Abstract Issue Implementing genomic medicine in healthcare can bring us closer to making personalised medicine a reality, with notable socioeconomic benefits. Description of the problem The 1+Million Genomes Initiative is promoting a reflection in European countries regarding their national strategies for genomic medicine, and how these contribute to research and improve clinical practice. Implementation of genomic medicine is complex and requires investment and adjustments in the organisation and practices of healthcare services, including technical infrastructure for genomic data generation and management, a trained healthcare workforce, and appropriate ethical and legal frameworks. Methods To promote the implementation of genomic medicine in healthcare systems, and improve its societal impact, the Beyond 1+MG (B1MG) project organised three country exchange visits for capacity building, developed and validated in real world settings a comprehensive Maturity Level Model (B1MG MLM) for genomic medicine, and organized workshops on health economics models for genomics. Results The products resulting from these activities provide policy recommendations for adoption of genomic medicine, an innovative MLM Toolkit for health systems to self-assess their current maturity status regarding genomic medicine implementation, and plan the path for improvement, as well as several brief papers highlighting main challenges and key indicators for health economic evaluation of genomic tests. Overall, this set of B1MG products provide a Playbook to support the development of national or regional roadmaps for the implementation of genomic medicine in healthcare systems. Lessons Country healthcare systems have specific practices, barriers and constraints, so the actions needed for progress in genomic medicine implementation towards optimization are specific to the context of each healthcare system. Key messages • The B1MG Roadmap will support the definition of strategies for adoption of genomics in healthcare systems, towards equity in the access to genomic medicine for all European citizens. • Country healthcare systems actions needed for progress in genomic medicine implementation towards optimization are specific to the context of each healthcare system.

Enacting multisectoral service chains and packages in the health and social care regions in Finland

Abstract Several studies have concluded that about 10% of the users of the health care and social services use most services and produce about 80% of the costs of care. However, this client group and their needs for services, which are often complex and multisectoral, are poorly characterized. The new Act on Organizing Health and Social Care Services in Finland obliges the health and social care regions to identify the client groups who need integrated services and to define the multisectoral service chains and packages for these clients. The assumption is that an individual client's personal service path can be planned and enacted by utilizing the pre-defined service chains and packages. This study aimed at studying the definition, development and enactment of the service chains and packages. The study was based on a survey which was carried out in the 22 health and social care regions in spring 2023 for analyzing 1) to which client groups the service chains and packages are defined, 2) what needs there are in the background of defining service chains and packages, 3) what kind of goals are defined for the service chains and packages, 4) what the current developmental state of the service chains and packages is and how they manage to cross the sectoral and disciplinary boundaries, and 5) what successes and challenges there are in defining, developing and enacting the service chains and packages. The survey was the first part of a study which focuses on the development and enactment of service chains and packages in the health and social care regions. The survey results showed that most of the development activities were in the definition phase. The survey gives perspective and background knowledge to the second part of the study which focuses on one specific client group, the children with neuropsychiatric symptoms, and on the definition and enactment of their service chains and packages within three regions.

A case study on variations in network structure and cross-sector alignment in two local systems serving pregnant and parenting women in recovery.

To describe network structure and alignment across organizations in healthcare, public health, and social services sectors that serve pregnant and parenting women with substance use disorder (SUD) in an urban and a rural community. Two community networks, one urban and one rural with each including a residential substance use treatment program, in Kentucky during 2021. Social network analysis measured system collaboration and cross-sector alignment between healthcare, public health, and social services organizations, applying the Framework for Aligning Sectors. To understand the alignment and structure of each network, we measured network density overall and between sectors, network centralization, and each organization's degree centrality and effective size. Computer-assisted telephone interviews were conducted to document alignment around shared purpose, data, financing, and governance. On average, overall and cross-sector network densities in both communities were similar. However, alignment was highest for data sharing and financing in the urban community and for shared purpose and governance in the rural community. Cross-sector partnerships involving healthcare organizations were more prevalent in the rural county (44% vs. 38% for healthcare/public health, 44% vs. 29% for healthcare/social services), but more prevalent for those involving public health/social services organizations in the urban county (42% vs. 24%). A single healthcare organization had the highest degree centrality (Mdn [IQR] = 26 [26-9.5]) and effective size (Mdn [IQR] = 15.9 [20.6-8.7]) within the rural county. Social services organizations held more central positions in the urban county (degree centrality Mdn [IQR] = 13 [14.8-9.5]; effective size Mdn [IQR] = 10.4 [11.4-7.9]). Cross-sector alignment may strengthen local capacity for comprehensive SUD care for pregnant and parenting women. Healthcare organizations are key players in cross-sector partnerships in the rural community, where one healthcare facility holds the central brokerage role. In contrast, public health agencies are key to cross-sector collaboration with social services in the urban community.

Spanish‐speaking 988 staff remove language barriers to care

Prioritizing efforts to remove language barriers in a behavioral health emergency, a national health care services organization announced this month its operation of the largest Spanish‐language 988 call center for text and chat response. The move is helping to reduce the stigma that pushes the Hispanic community away from seeking care, officials stated.

Engaging Stakeholder Advisors Around Health-Related Social Needs Research, Policy, and Practice Priorities.

As health care systems invest significant resources to address social needs associated with poor health such as food, financial, and housing insecurity, many eligible patients are still not obtaining the resources they need. The recently initiated PURPLE Project (Promoting Understanding in Social Needs Research Projects by Listening and Engaging) engages stakeholder advisors to help address 2 challenges: (1) many patients do not accept offered assistance, and (2) of patients who accept assistance, less than half have their needs addressed. This article presents the team's engagement with local advisors, garnering real-life insights from patients with social needs, staff and leadership in public health, health care, and community service organizations. The team shares these organizations' priorities and recommendations and how these can be applied to these major challenges. This article can assist others in the social care arena who seeks to involve local partners as advisors to improve practices and policies in addressing social needs.

Predictors of Nursing Staff Turnover Intentions - Evidence from Primary Care Organizations in Taiwan

Abstract The direct contact between nursing staff and patients during the COVID-19 epidemic increased their turnover tendency due to severe cases, mortality, disease uncertainty, and increased care giving stress during the outbreak, which had a significant impact not only on nursing staff but also on patients and hospitals. It is important for hospital administrators to examine the factors related to nursing staff and turnover tendency. In this study, we investigated the effects of personality traits, job satisfaction, organizational commitment, and turnover tendency by examining the correlation theory among frontline health care workers. The main findings showed that (1) personality traits had a significant positive relationship with organizational commitment; (2) job satisfaction had a significant positive relationship with organizational commitment; and (3) organizational commitment had a significant positive relationship with turnover tendency. The results of the study contribute to relevant literature and have guiding implications for the management of human resources in healthcare service organizations. Keywords: Personality Traits, Organizational Commitment, Turnover Intention, Job Satisfaction.

Impact of Regional Network on the Management of STEMI Patients in North Cairo

Abstract Background Worldwide, coronary artery disease (CAD) is the single most frequent cause of death. Over seven million people every year die from CAD. The management of patients with STElevation myocardial infarction (STEMI) is influenced by health care service organizations. Regional STEMI networks for acute myocardial infarction facilitate primary percutaneous coronary intervention (PPCI) and its efficacy in reducing mortality and improving its outcomes. Aim of the Work The aim of the present study was to examine the impact of regional STEMI network on patients' management and on hospital outcomes in north Cairo governorate, Egypt. Methods The present study is a Prospective observational multicenter study that was conducted on 352 patients with STEMI and symptom onset within 48 hours who presented to north Cairo hospitals. The patients were divided into 2 groups, group I in the first six months before establishment of a network between the north Cairo hospitals and group II in the second six months when the network between those hospitals was activated. Comparison was done between the two groups as regards patients' demographics, logistics of presentation and in hospital outcomes. Results The number of patients upon implementation of STEMI network increased from 140 to 212 (51.4%) to the same hospitals with the same facilities and in equal periods of time (6 months). It was found that the mean time of chest pain to first medical contact (FMC) between the two groups before and after establishment of STEMI network did not change, it was 4 hours in both groups (P = 0.36) while the mean door to balloon time improved from 54.3 to 44.1 minutes (P = 0.01). In our study thrombolytic therapy use declined from 36.4% before STEMI network set up to only 7.5% (P > 0.001), Ejection fraction (EF) improved from 51.3% to 55.4% (P > 0.001), mitral regurge (MR) also improved upon establishment of STEMI network from 53.6% to 78.8 with (P > 0.001), the mean CCU stay in group II was 2 days versus 3 days before implementation of STEMI network (P > 0.001), the mean door in door out from the spokes was 40 minutes. In-hospital mortality improved upon establishment of STEMI network from 6.4% to 2.8% (P = 0.10). Conclusion The establishment of the STEMI network in Egypt is feasible and can lead to improvement of patients' outcomes. Thrombolytic therapy was no longer the main reperfusion therapy and primary PCI was offered to most patients after establishment of STEMI network.

Post-COVID-19 Pandemic Era and Sustainable Healthcare: Organization and Delivery of Health Economics Research (Principles and Clinical Practice)

Health services research aims to improve population health by studying the organization, delivery, and financing of healthcare services. While the field has made progress in defining its boundaries and core research topics, our literature survey revealed a lack of attention given to the management, cost, and policy aspects of healthcare systems (SCs). Moreover, the readiness of the system to handle supply policy and device deficiencies, especially during the pandemic, was rarely mentioned. Unplanned urban growth, characterized by reduced open spaces, deteriorating infrastructure, and changes in biological morphology, has led to an uneven distribution of urban amenities, facilities, and healthcare services. This research proposes two reliable models for site selection in a major hospital in Hong Kong, considering uncertainty levels, infeasibility tolerance, and reliability. We examine two categories of uncertainty—symmetric and bounded—and provide a solution with a nominal objective function value of 121.37. By considering 23 uncertain parameters with specific tolerance levels, we extend the processing time of uncertain tasks to ensure feasibility. However, the objective function value decreases due to violations of intermediate due-dates and decreased overall production. A comparative analysis is presented to evaluate the solution and address scheduling challenges under uncertainty using a specified probability distribution function. The study concludes by introducing justice and health problems, outlining four typical strategies, and emphasizing the importance of the effective management of systems, components, and procedures for the production, distribution, and administration of medications and healthcare supplies. This research contributes to fairness in health systems and population health at local, national, and global levels, addressing health inequity and promoting public dialogues on the subject.

Nurses' professional discretion in the purchaser-provider split in home care in Norway.

To explore how nurses' professional discretion is operationalized in home care services that follow a purchaser-provider organization in Norway. A qualitative descriptive study. Semi-structured interviews with open-ended questions were used, and data were collected from in-depth interviews with 15 registered nurses working in home care in four Norwegian local authority areas between April and November 2020. Braun and Clark's six-step analysis was used to analyse the empirical data. The analysis yielded two main themes, namely 'The purchaser's instructions: facilitating and constraining care' and 'Professional discretion meets the purchaser-provider organisation of healthcare,' with five associated codes. Nurses are dependent on an organizational framework due to the complexity of health care services and the number of tasks involved. At the same time, they perform considerable compensatory work and need the ability to be flexible to enable this work and to perform actions related to the unforeseen needs of individual patients or those involving professional discretion. The purchaser-provider model both facilitates and constrains nursing practice and professional responsibility in home nursing. Home nursing services need to be well organized because of their complexity and the wide variety of tasks they involve. In this context, the element of constraint is associated with the need for flexibility and professional discretion. Despite a strict framework, the nurses perform additional and compensatory tasks. Reforms inspired by 'New Public Management,' such as the purchaser-provider split, limit the workload for nurses; however, there is still a need to exercise discretion. The findings of this study may help home care managers and health policy-makers understand the interaction between management logic and health care logic, leading to a more appropriate organization of health care services where the nurses, as actors, gain more trust. This study highlights home care nurses' opportunities to exercise discretion in an organizational framework that strives towards standardization. The nurses' ability to exercise discretion is important for individual and holistic patient care. At the same time, an organizational framework is needed because nurses cannot attend to all the needs the patients may have, as this will overload both home health services and the nurses.