Health Care Priorities Research Articles

FORMATIVE EVALUATION TRIAL OF THE “MY HEALTH PRIORITIES” PROGRAM IN SOUTHERN OLDER AFRICAN AMERICANS: THE BHIP STUDY

Abstract Older African Americans (AA) with multiple chronic conditions (MCCs) living in the Deep South are less likely to have access to early palliative care (PC) despite experiencing higher symptom burden and healthcare use, and poorer communication around goals of care. This disparity in PC use may partly be due to a lack of culturally-responsive care practices that effectively activate AAs with MCCs to identify their own values and priorities for end-of-life care. We conducted a formative evaluation of the web-based, self-directed “My Health Priorities” Identification Program to determine cultural acceptability and feasibility of use among AAs with MCCs in a primary care setting. We are now recruiting 20 AA patient with MCC and caregiver dyads from UAB Kirklin Primary Care Clinic. Recruited dyads will complete the “My Health Priorities” program and participate in semi-structured acceptability interviews. Patients and caregivers will also complete pre- and post-test measures of perception of care, treatment burden, shared decision-making, and communication exchange. Preliminary findings from six dyads suggest that the current program lacks spirituality-specific content. Dyads also expressed that the exemplar character included in the program was not relatable or representative. Overall, participants stated that the program was useful in helping them to think about and articulate their healthcare values and priorities. The findings from the research will directly inform a small-scale pilot grant that will assess the acceptability, feasibility, and potential efficacy of a values solicitation and operationalization intervention for AAs with MCCs and caregivers.

THE IMPACT OF THE COVID-19 PANDEMIC ON FAMILY CARE PARTNERS OF PERSONS WITH DEMENTIA IN ASSISTED LIVING FACILITIES

Abstract Background The Covid-19 pandemic affected persons living with dementia and their family care-partners. Family care-partners are diverse, including spouses, children, and friends. Care-partners may live with the care recipient, or apart from them. Covid-19 policies and priorities isolated care-partners living at home, while banning others from supporting their loved ones in assisted living facilities (ALF). Purpose: The purpose of this study was to examine the impact the covid-19 pandemic had on family care-partners of persons living with dementia. Methods This study used an online survey of 133 family care-partners (89 living in ALF, 44 living in the community). Results Among family care-partners, 34.8% of those who lived in an ALF reported a severe change in routine compared to 38.6% of those living in the community. 78.7% of ALF care-partners reported that they were unable to visit their loved one in a care facility, compared to 31% of care-partners living in the community. 67.4% of ALF care-partners were separated from the person with dementia that they cared for, compared to 22.7% of care-partners living in the community. 70.5% of CPs in the community reported they had to spend a lot more time taking care of a family member with dementia compared to 13.5% of ALF CPs. Conclusion Unique differences exist in how the pandemic impacted the lives of family care-partners of community-based or ALF-based persons living with dementia. Understanding these differences can help tailor policies and healthcare priorities to best support family care-partners living in community or ALF settings.

Factors Associated With Levels of Public Engagement in Protective Behaviors During the Early COVID-19 Pandemic: Causal-Comparative Study Based on the Health Belief Model.

While the challenges of COVID-19 are still unfolding, the enhancement of protective behavior remains a top priority in global health care. However, current behavior-promoting strategies may be inefficient without first identifying the individuals with lower engagement in protective behavior and the associating factors. This study aimed to identify individuals with and potential contributing factors to low engagement in protective behavior during the COVID-19 pandemic. This is a causal-comparative study. A theory-based web-based survey was used to investigate individuals' protective behavior and potential associating factors. During June 2020, the distribution of the survey was targeted to 3 areas: Taiwan, Japan, and North America. Based on the theory of the health belief model (HBM), the survey collected participants' various perceptions toward COVID-19 and a collection of protective behaviors. In addition to the descriptive analysis, cluster analysis, ANOVA, and Fisher exact and chi-square tests were used. A total of 384 responses were analyzed. More than half of the respondents lived in Taiwan, followed by Japan, then North America. The respondents were grouped into 3 clusters according to their engagement level in all protective behaviors. These 3 clusters were significantly different from each other in terms of the participants' sex, residency, perceived barriers, self-efficacy, and cues of action. This study used an HBM-based questionnaire to assess protective behaviors against COVID-19 and the associated factors across multiple countries. The findings indicate significant differences in various HBM concepts among individuals with varying levels of behavioral engagement.

Priority healthcare needs amongst people experiencing homelessness in Dublin, Ireland: A qualitative evaluation of community expert experiences and opinions

In light of evidence that housing-related disparities in mortality are worsening over time, this study aimed to explore the perspectives of experts working in homeless health and addiction services on priority healthcare needs amongst people experiencing homelessness in Dublin, Ireland, a city facing problematic increases in homelessness. As part of a larger qualitative study, a series of semi-structured interviews were carried out with 19 community experts followed by inductive thematic framework analysis to identify emergent themes and sub-themes relating to priority healthcare needs. At the societal level, community experts identified a need to promote a culture that values health equity. At the policy level, accelerating action in addressing health inequalities was recommended with an emphasis on strategic planning, Housing First, social support options, interagency collaboration, improved data linkage and sharing, and auditing. At the health services level, removing barriers to access will require the provision of more and safer mental health, addiction, women-centred, and general practice services; resolved care pathways in relation to crisis points and multi-morbidity; expanded trauma-informed education and training and hospital-led Inclusion Health programmes; and outreach programmes and peer support for chronic disease management. The voices of people experiencing homelessness, including representatives from specific homeless groups such as migrants, youth, and the elderly, must be thoroughly embedded into health and social service design and delivery to facilitate impactful change.

Public and private healthcare administration priorities in new electronic age

The work defines the such priorities of healthcare administration as creation of free-tax medical town-campuses and reduction of costs for accessibility of medical services, increase in service speed and improvement in the quality, constant process of improving the qualification, wide-regional network management, combination of public and private insurance, essential increase in healthcare costs of GDP, striving for the highest standards of technical level, ensuring the non-profitability of medical organizations, combining various stages of medical services, electronic transparency and direct communication of financial reporting with some needful maintaining of commercial secrets and bank accounts, usage of wide outsourcing practices.

QALYs and rare diseases: exploring the responsiveness of SF-6D, EQ-5D-5L and AQoL-8D following genomic testing for childhood and adult-onset rare genetic conditions in Australia

BackgroundGenomic testing transforms the diagnosis and management of rare conditions. However, uncertainty exists on how to best measure genomic outcomes for informing healthcare priorities. Using the HTA-preferred method should be the starting point to improve the evidence-base. This study explores the responsiveness of SF-6D, EQ-5D-5L and AQoL-8D following genomic testing across childhood and adult-onset genetic conditions.MethodSelf-reported patient-reported outcomes (PRO) were obtained from: primary caregivers of children with suspected neurodevelopmental disorders (NDs) or genetic kidney diseases (GKDs) (carers’ own PRO), adults with suspected GKDs using SF-12v2; adults with suspected complex neurological disorders (CNDs) using EQ-5D-5L; and adults with dilated cardiomyopathy (DCM) using AQol-8D. Responsiveness was assessed using the standardised response mean effect-size based on diagnostic (having a confirmed genomic diagnosis), personal (usefulness of genomic information to individuals or families), and clinical (clinical usefulness of genomic information) utility anchors.ResultsIn total, 254 people completed PRO measures before genomic testing and after receiving results. For diagnostic utility, a nearly moderate positive effect size was identified by the AQoL-8D in adult DCM patients. Declines in physical health domains masked any improvements in mental or psychosocial domains in parents of children affected by NDs and adult CNDs and DCM patients with confirmed diagnosis. However, the magnitude of the changes was small and we did not find statistically significant evidence of these changes. No other responsiveness evidence related to diagnostic, clinical, and personal utility of genomic testing was identified.ConclusionGeneric PRO measures may lack responsiveness to the diagnostic, clinical and personal outcomes of genomics, but further research is needed to establish their measurement properties and relevant evaluative space in the context of rare conditions. Expected declines in the physical health of people experiencing rare conditions may further challenge the conventional application of quality of life assessments.

Naturally Occurring Isorhamnetin Glycosides as Potential Agents Against Influenza Viruses: Antiviral and Molecular Docking Studies.

Influenza remains one of the most widespread infections, causing an annual illness in adults and children. Therefore, the search for new antiviral drugs is one of the priorities of practical health care. Eight isorhamnetin glycosides were purified from Persicaria species, characterized by nuclear magnetic resonance spectroscopy and mass spectrometry and then evaluated as potential agents against influenza virus. A comprehensive in vitro and in vivo assessment of the compounds revealed that compound 5 displayed the most potent inhibitory activity with an EC50 value of 1.2-1.3 μM, better than standard drugs (isorhamnetin 28.0-56.0 μM and oseltamivir 1.3-9.1 μM). Molecular docking results also revealed that compound 5 has the lowest binding energy (-10.7 kcal/mol) among the tested compounds and isorhamnetin (-8.1 kcal/mol). The ability of the isorhamnetin glycosides to suppress the reproduction of the influenza virus was studied on a model of a cell culture and chicken embryos. The ability of active compounds to influence the structure of the virion, as well as the activity of hemagglutinin and neuraminidase, has been demonstrated. Compound 1, 5, and 6 demonstrated the most effective inhibition of virus replication for all tested viruses. Molecular dynamics simulation techniques were run for 100 ns for compound 5 with two protein receptors Hem (1RUY) and Neu (3BEQ). These results revealed that the Hem-complex system acquired a relatively more stable conformation and even better descriptors than the other Neu-complex studied systems, suggesting that it can be an effective inhibiting drug toward hemagglutinin than neuraminidase inhibition. Based on the reported results, compound 5 can be a good candidate to be evaluated for effectiveness in preclinical testing.

Evaluating the General Population of Saudi Arabia for Their Knowledge, Attitudes, and Practices Towards Dementia.

Introduction Dementia, a prevalent neurological condition, has a significant global impact on individuals and communities. Despite affecting approximately 50 million people worldwide, with an expected tripling by 2050, there are currently no widely available disease-modifying treatments. Recent efforts have concentrated on strategies involving legislation, regulations, and population-wide initiatives to address dementia risk, diagnosis, and care. Methods This cross-sectional survey engaged 6123 participants in Saudi Arabia, utilizing a multistage sampling design across provinces and cities. The study aimed to investigate the knowledge, attitudes, and practices of the Saudi Arabian general population regarding dementia. Results Participants displayed diverse opinions on dementia knowledge, with females exhibiting higher rates of knowledge, attitudes, and practices than males. Notably, 97.2% of females were aware of dementia compared to 78% of males. The perception of dementia as a healthcare priority was significantly higher in females (84.1%) than in males (59.6%). Older females (≥65) were identified as the age group most associated with dementia (92.50%) compared to males (71.10%). Conclusion While participants demonstrated excellent knowledge of hearing about dementia, understanding symptoms, and identifying modifiable factors, their knowledge regarding prevention and curability was found to be inadequate. A significant gender association was observed, with females exhibiting higher knowledge, attitudes, and practices than males.

Abstract C129: Impact of COVID-19 on colorectal cancer screening disparities: Results from a large commercially insured population in the United States

Abstract Background: Although colorectal cancer (CRC) screening reduces both CRC incidence and CRC-related mortality, it is underutilized, especially among those with lower socioeconomic status (SES) and in racial and ethnic minoritized populations who have been disproportionately impacted by COVID-19. The shift in healthcare priorities to contain and mitigate COVID-19 over the last few years reduced clinical capacity for non-urgent care, including CRC screening. This study aimed to assess the impact of COVID-19 on disparities in CRC screening. Methods: Blue Cross Blue Shield (BCBS) insures approximately one third of Americans. We leveraged BCBS Axis data to examine temporal patterns in CRC screening among individuals aged 45-75 years during 2017-2021, focusing on three periods: 1) first wave of COVID-19 outbreak (Mar-Apr 2020); 2) second wave of COVID-19 outbreak (i.e., the Delta variant, Jan-Feb 2021); and 3) the most recent 2-month interval for which data are available (Nov-Dec 2021). Both invasive and non-invasive CRC screening procedures were identified, and beneficiaries who received screening one year before were excluded. Screening rates within each 2-month interval were calculated. Neighborhood SES was assessed by Social Deprivation Index at the zip code level and categorized into quintiles. Results: The study cohort included 27,628,570 individuals. Throughout the 5-year period, except for the 1st wave of COVID-19 outbreak, screening rates were higher in areas with higher SES. Prior to the pandemic (Jan 2017–Feb 2020), the average bimonthly screening rate in areas with the highest SES was 2.1%, compared to 1.7% in areas with the lowest SES (p <0.001). During the 1st wave of COVID-19 outbreak, screening rate decreased to approximately 0.8% across all SES quintiles. During the 2nd wave of COVID-19 outbreak, screening rates were 1.7% and 1.3% in the highest and lowest SES areas, respectively. For the last 2-month interval in our study period (Nov-Dec 2021), screening rates increased to 2.4% and 1.8% in areas with the highest and lowest SES, respectively. Among 9,565,516 beneficiaries with known race and ethnicity, 8.0%, 11.0%, 3.3% and 0.4% were non-Hispanic Black, Hispanic/Latino, Asian, and Native Americans/Pacific Islanders, respectively. Across all racial and ethnic groups, the average bimonthly screening rate was 1.9% prior to the pandemic, 0.7% in Mar-Apr 2020, 1.5% in Jan-Feb 2021, and 2.1% in Nov-Dec 2021. Conclusion: After the onset of COVID-19, CRC screening rate decreased broadly and reached a similar level in all SES groups in early 2020, but it then recovered at a different pace for individuals with different SES, maintaining and even exacerbating inequities that existed prior to the pandemic. Screening patterns were comparable across different racial and ethnic groups who were privately insured through BCBS. Findings from this very large study may help inform interventions to address social and structural determinants of health and reduce the disproportionate burden of CRC in individuals residing in socially deprived areas. Citation Format: Arfan Siddique, Rong Wang, Jacquelyne Gaddy, Cary Gross, Xiaomei Ma. Impact of COVID-19 on colorectal cancer screening disparities: Results from a large commercially insured population in the United States [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C129.

Current Trends in Care for Infants Diagnosed with Neonatal Abstinence Syndrome in Canada: A Discussion Paper

Introduction: Neonatal abstinence syndrome (NAS) is a growing epidemic across the globe. Infants diagnosed often require resource-intensive nursing care and are at risk for future complex health conditions. A shift in approaches to care for this population has been identified as a priority health care need across Canada. Objectives: This discussion paper aims to highlight the current shift in care for the NAS population, focusing on the Finnegan Neonatal Abstinence Scoring Tool (FNAST) and the Eat, Sleep, Console (ESC) model of care. Methods: A comprehensive search strategy was developed to explore the current trend in care for infants diagnosed with NAS: the transition from the FNAST to the ESC model of care. Four scholarly databases (CINAHL, PubMed, Cochrane, and Google Scholar) were searched. Relevant articles were critically analyzed for their implications on infant and family health, family experience, health system outcomes, and nursing practice. Discussion: In our review of the literature, the FNAST was the most used tool when caring for infants diagnosed with NAS. Although this tool has guided care for infants for decades, it presents some limitations, including subjectivity, invasive and lengthy assessments, and lack of collaboration. Many facilities across Canada are shifting to the ESC model of care as an alternative model. It has potential to address challenges of the care guided by the FNAST, with the ESC model emphasizing non-pharmacological care, a focus on the birth-parent–infant dyad, and dedication to a function-based assessment. Conclusion: Further efforts are needed to support the real-world implementation of evidence-based models of care for this population.

Trainees' Perspectives on Components of Sickle Cell Specific Education

Background Sickle cell disease (SCD) is at the intersection of social, racial, and healthcare equity in the US. It is a socially and medically complex disease associated with increased morbidity and mortality when compared to age, race, and sex matched persons without SCD. Despite a historically high prevalence, it has not been a priority in healthcare, which contributes to healthcare inequities in this population. Patients and clinicians consistently identify lack of clinician knowledge about SCD as a barrier to quality care. Providers describe discomfort managing patients and have a poor understanding of its complications. The number of physicians trained and available to treat adults with SCD is insufficient to meet population needs. With most hematology/oncology trained physicians choosing careers in oncology, the pool of practitioners with expertise in SCD is shrinking. This underscores the time-sensitive need for building an effective, sustainable, and patient-centered sickle cell educational curriculum early in training. At present, there is no widely used resource for SCD-specific education, and little research has been published describing physician education for this complex disease. This qualitative study is the first part of a two-part study which aims to serve as a needs assessment to understand the SCD specific educational demands of trainees and set the stage for survey development for wider distribution. Methods Residents applying for hematology/oncology fellowship and current fellows were recruited to participate in focus groups to explore trainees' preferences and attitudes for education on the management of patients with SCD. Trainees were recruited via email from seven academic institutions in the US from regions with a high prevalence of SCD. A focus group guide was developed inquiring about trainee perspectives on facilitators and barriers to obtaining sickle cell specific education. Using an inductive and iterative thematic analysis coding approach, all focus group transcripts were coded by an academic hematologist specializing in SCD (LV) and an academic psychiatrist specializing in SCD (EP). Codes were categorized and themes and subthemes developed. Results Four focus groups were conducted with a total of 15 participants (2 PGY 3 residents, and 13 hematology/oncology fellows PGY 4-6). Three themes were identified (Table): 1. Discomfort caring for patients with SCD. Trainees experienced feelings of fear, frustration, and powerlessness when caring for patients with SCD. 2. Challenges managing SCD. Trainees described the complexity of SCD management, limited treatment options and evidence-based practice, and navigating bias in healthcare as contributing to the challenge of treating patients with SCD. 3. Desire for SCD specific education during fellowship.Trainees noted ideal components of education should include exposure to patients longitudinally and in multiple settings, access to SCD expertise in the form of experts and expert guidelines, and SCD specific didactic content. Conclusions This study examined the experience of trainees with regards to SCD education and clinical care. Participants described how a lack of SCD specific education reinforced a cycle of discomfort and difficulty caring for patients with SCD (Figure). Lack of exposure to patients and access to experts impedes developing a sense of mastery in treating SCD. SCD education was underemphasized even at institutions with a high prevalence of SCD and a SCD program. Evidenced-based guidelines based on low evidence hinders self-directed learning. Overall, SCD specific education is under-emphasized in fellowship. Trainees who felt the most comfortable had a SCD specific curriculum integrated throughout the fellowship experience. A SCD specific curriculum in the form of case-based didactics and a SCD rotation, where feasible, should be built into hematology/oncology fellowship training to increase trainees' knowledge, comfort and therefore desire in caring for patients with SCD. This qualitative research study is the first of its kind and serves to set the stage for survey development to capture a larger needs assessment of the SCD specific educational demands of hematology/oncology fellows. Optimizing the care of persons with SCD requires a competent and confident workforce. This study provides key insights into the development of infrastructure to support such training.

Evaluating Trainees' Experiences with Intravenous Iron Use

Background: Iron deficiency (ID) and iron deficiency anemia (IDA) cause significant morbidity. Despite being a disease of high prevalence, affecting people with heart failure, chronic kidney disease, heavy menstrual bleeding, irritable bowel disease, hereditary hemorrhagic telangiectasia (HHT), and bariatric surgery, it has low healthcare priority. The World Health Organization (WHO) estimates 37% of people who are pregnant, and 30% of women 15-49 years of age worldwide are anemic. Fibroids, which are the leading cause of abnormal uterine bleeding, disproportionately impact people of color. ID and IDA cause fatigue, impaired cognitive function, and poor mental health, eroding quality of life and personal productivity. In addition, IDA has been associated with an increase in all-cause mortality is associated with an increased risk of arterial and venous thrombosis. Under-treatment of IDA results in avoidable hospitalizations, emergency room visits, blood transfusions, decreased HRQoL, and loss of personal productivity. Despite the significant impact ID and IDA can have on morbidity, mortality, and quality of life, intravenous iron remains underutilized. No study has been performed to date to assess provider practices, knowledge, and perceptions of intravenous iron use. This qualitative study aims to understand trainees' experiences with intravenous iron use in patients with ID and IDA. Methods: We conducted an inductive reflective thematic analysis of semi-structured qualitative interviews from five focus groups to understand trainees' experiences with and barriers to prescribing intravenous iron in patients with ID and IDA. Internal medicine residents from academic institutions across the country were recruited via snowball sampling. Chief residents from six internal medicine programs were contacted to disseminate sign up links to their residents; programs were chosen for geographic diversity. Results: Twenty-eight internal medicine residents responded and nineteen residents across five institutions participated (PGY levels 1-3). Thematic analysis of trainees' experiences of caring for patients with conditions characterized by iron deficiency resulted in three main themes: education, systemic factors, and practice pattern. Participants identified a wide range of conditions for which they consider administration of oral or intravenous iron. However, they generally expressed uncertainty as to whether evidence-based guidelines exist to guide their decision-making with the exception of intravenous iron administration in heart failure patients. In addition, systemic factors, such as setting, support staff, hospital formularies, order sets, and insurance status often impacted their decision to use intravenous iron. Conclusions: There is a wide variation among residents' practice patterns in regard to their comfort with prescribing intravenous iron. The ease or hesitancy with which they do so is greatly influenced by educational and systemic factors. By gaining a deeper understanding of the experiences of trainees we can lay the foundation to develop evidence-based guidelines and educational initiatives for conditions characterized by ID and IDA. Additionally, by identifying both institutional facilitators and barriers, we can cultivate system-based initiatives to improve access to intravenous iron. To assess this need on a larger scale, our next step involves developing a survey that will be widely distributed via national societies. While cost, insurance status, and need for specialty referral were identified as barriers for intravenous iron use, there was no explicit discussion of how these barriers may contribute to healthcare inequity for underserved populations.

A Machine Learning-Based Preclinical Osteoporosis Screening Tool (POST): Model Development and Validation Study.

Identifying persons with a high risk of developing osteoporosis and preventing the occurrence of the first fracture is a health care priority. Most existing osteoporosis screening tools have high sensitivity but relatively low specificity. We aimed to develop an easily accessible and high-performance preclinical risk screening tool for osteoporosis using a machine learning-based method among the Hong Kong Chinese population. Participants aged 45 years or older were enrolled from 6 clinics in the 3 major districts of Hong Kong. The potential risk factors for osteoporosis were collected through a validated, self-administered questionnaire and then filtered using a machine learning-based method. Bone mineral density was measured with dual-energy x-ray absorptiometry at the clinics; osteoporosis was defined as a t score of -2.5 or lower. We constructed machine learning models, including gradient boosting machines, support vector machines, and naive Bayes, as well as the commonly used logistic regression models, for the prediction of osteoporosis. The best-performing model was chosen as the final tool, named the Preclinical Osteoporosis Screening Tool (POST). Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) and other metrics. Among the 800 participants enrolled in this study, the prevalence of osteoporosis was 10.6% (n=85). The machine learning-based Boruta algorithm identified 15 significantly important predictors from the 113 potential risk factors. Seven variables were further selected based on their accessibility and convenience for daily self-assessment and health care practice, including age, gender, education level, decreased body height, BMI, number of teeth lost, and the intake of vitamin D supplements, to construct the POST. The AUC of the POST was 0.86 and the sensitivity, specificity, and accuracy were all 0.83. The positive predictive value, negative predictive value, and F1-score were 0.41, 0.98, and 0.56, respectively. The machine learning-based POST was conveniently accessible and exhibited accurate discriminative capabilities for the prediction of osteoporosis; it might be useful to guide population-based preclinical screening of osteoporosis and clinical decision-making.

Experiences and Priorities in Youth and Family Mental Health: Protocol for an Arts-Based Priority-Setting Focus Group Study.

During the COVID-19 pandemic, eHealth services enabled providers to reach families despite widespread social distancing restrictions. However, their rapid adoption often occurred without community partners' involvement and without an understanding of how they prioritize aspects of their mental health and associated service provision, both of which promote family and community-centered health care delivery. Establishing priorities in health care is essential for developing meaningful and reliable health services. As such, there is an urgent need to understand how eHealth service users, especially families who may have historically faced oppression and systemic barriers to service access, can best benefit from them. Arts-based approaches can elicit an understanding of priorities by providing an engaging and expressive means of moving beyond readily expressible discursive language and stimulating meaningful dialogue reflective of participants' lived experiences. The purpose of this research is to determine the priorities and preferences of youth; parents or caregivers; newcomers and immigrants; and Indigenous community members regarding the use of eHealth in supporting their mental health using an innovative arts-based priority-setting method. This study uses a mixed-methods approach combining qualitative, quantitative, and arts-based research. It follows a survey used to identify key knowledge partners who are interested in improving eHealth services for mental health support in Manitoba, Canada. Knowledge partners interested in group-based priority setting will be contacted to participate. We will facilitate approximately two focus groups across each subgroup of youth, parents or caregivers, newcomers or immigrants, and Indigenous community members using an integrative, quantitatively anchored arts-based method termed the "Circle of Importance" to understand participants' mental health priorities and how eHealth or technology may support their mental well-being. The Circle of Importance involves placing small objects, whose meaning is determined by participants, on a visual board with concentric circles that correspond to a 5-point Likert scale of importance. Following each focus group, we will evaluate participants' and focus group facilitators' experiences of the Circle of Importance using a survey and follow-up structured in-person interviews to garner how we can improve the arts-based approach used in the focus groups. The PRIME (Partnering for Research Innovation in Mental Health through eHealth Excellence) theme received institutional ethics approval on August 23, 2023. Data collection is projected for August 2023, with follow-up focus groups occurring in early 2024 as required. Data analysis will occur immediately following data collection. Findings will directly inform a multiyear applied research agenda for PRIME aimed at improving mental health services through engaging key knowledge partners. The results may inform how arts-based methods in a priority setting can reflect aspects of experience beyond the capacities of qualitative or quantitative methods alone, and whether this approach aligns well with a positive experience of research participation. PRR1-10.2196/50208.

Prosthetics and orthotics for persons with movement disabilities in India in the postpandemic milieu.

The SARS-CoV-2 disease had a severe impact on global socioeconomic growth, and its harmful effects continue with virus mutation. Over the past 3 years, the pandemic has caused isolation, mental trauma, stress, financial losses, and various health complications in individuals. Recent reports have stressed the sufferings of the physically abled population. However, we should not neglect the challenges faced by the disabled population, which were more severe in many ways due to their dependency on others at various levels. The strategies implemented to contain the virus have further aggravated their sufferings and made it even worse because health care priorities were skewed toward public-centered care. As a result, it is difficult to determine the extent of care the disabled population received during the pandemic. Moreover, a single-centered study reports that amputations in India increased by 54.1% compared with those during the prepandemic era. This indicates the need for special attention to the physically disabled community, especially persons with movement disabilities. These individuals are partially dependent and have the potential to make significant contributions to the gross domestic product if included in the human resources pool. The Indian government had launched various initiatives to improve their living status. But delays in policy implementation, reduction in budget allocation, and the ongoing pandemic have derailed the efforts. For these reasons, this article emphasizes several challenges in movement disability care. In addition, it makes recommendations for improving the quality of life of persons with movement disabilities. These include collaboration, creating start-up businesses, applying state-of-the-art logistics, establishing a technological ecosystem, raising public awareness, accessing high-quality care, and using contemporary medical devices.

Abstract 16845: Heart Failure Hospitalist Service Line Have Decrease All Cause Readmission, Length of Stay and Cost at 3 UPMC Hospitals in Central Pennsylvania in 2022

Introduction: Heart Failure (HF) is an important health care issue given its high prevalence, mortality, and cost of care. Despite numerous evidence-based strategies in the literature aiming at reducing HF readmissions, patients with HF remain at high risk for subsequent hospitalization with 20 to 25% readmitted within 30 days. Methods: Patients with both primary diagnosis HF at UPMC Harrisburg/West Shore/Community General totaled to 1574 in 2022. Hospitalist, Cardiologist, teaching service N= 547 (36%); CHF hospitalist Team N=1027 (64%). Heart failure order set usage, length of stay, all-cause 30-day readmission rates, readmission with HF, cost per case were assessed between these two groups for 2022. Results: All-cause 30-day HF readmission rates at UPMC (Harrisburg, West Shore, Community General Hospitals) for all other providers (Hospitalist, Cardiologist, teaching service) is 32%. HF Hospitalist team at 3 UPMC hospitals had lower 30 day all cause readmission rates: 8.46%. All other providers length of stay was 7.7 days while length of stay while on HF hospitalist service was 6.3 days. Potential cost savings to UPMC hospitals greater than $2.3 million dollars since start of HF Hospitalist service line. Conclusions: HF patients rarely have a consistent provider when readmitted. To address this health care priority at a system level, UPMC Central Pennsylvania’s strategy of creating a HF hospitalist service line has shown to be a unique method to not only develop trusting relationships with our patients but also attain impressive results. The HF Hospitalist service line was created to support an environment of patient-centered care by providing continuity of care for HF admissions and HF patients admitted for non-HF medical issues. At this community-based healthcare system, HF Hospitalist outcomes include decreased 30 day all-cause readmission to an impressive 8.2%, and reduced 30 day HF readmissions 4.12%. This was done while reducing healthcare costs during the 5yrs of the HF Hospitalist service line now at 3 hospitals at UPMC.

The golden rule for prioritisation of treatment for substance use and mental health care – a qualitative study

For many years there has been broad political agreement on prioritising substance use treatment and mental health care in the specialist health service. Between 2014 and 2021, the 'golden rule' applied, meaning that there should be higher relative growth in mental health care and interdisciplinary specialised substance use treatment compared to somatic healthcare services. This study aimed to investigate the understanding among Norwegian health leaders and bureaucrats of the golden rule's role in the prioritisation of resources to the field of substance use and psychiatry in the specialist health service. The study is based on a one-year ethnographic study of priority-setting in Norwegian health trusts and bureaucracy. Documents, observations of meetings and twelve qualitative in-depth interviews were analysed using a qualitative discourse method. The golden rule contributed to an increased investment in substance use treatment and mental health care in the health trusts, according to health leaders. However, the golden rule was only one of many competing and at times conflicting guidelines they had to take into account. Many factors impeded higher growth in substance use treatment and mental health care compared to somatic health care. Several participants argued that it was impossible to follow the golden rule. The inability to achieve the goal was explained by demographic trends, funding arrangements and lack of follow-up of the rule. Healthcare priorities are set in institutions that have to consider numerous political interests and social mandates. The study's findings illustrate the complexity of practical implementation of political priorities.

Development and implementation of multicomponent homecare interventions for multimorbid and frail older people based on Information and Communication Technologies: The MULTIPLAT_AGE project

The prevention and treatment of frailty condition among multimorbid older adults, in community and hospital settings, is becoming a healthcare priority. Growing evidence suggests that a multidimensional approach could help not only in the early identification of older patients’ needs but also in designing personalized preventive interventions. However, in clinical practice, the effectiveness of such interventions is limited by a lack of continuity of care and poor compliance of patients. The widespread diffusion of the information and communication technology (ICT) could offer an excellent way to implement and monitor multidimensional and personalized interventions for multimorbid older adults.In this scenario, the MULTIPLAT_AGE, is a network project involving five research centers with the main objective to supply multidimensional interventions targeted to cognitive, motor, pharmacological, and functional domains including ICT-based: i) transitional care model from the hospital to a protected home area; ii) automatic home-care system to improve activities of daily living; iii) program to improve appropriate drug prescription in nursing-home residents; iv) tele-rehabilitation program to reduce the risk of falls and v) cognitive stimulation delivered by remote in older adults with neurological disorders. Each project is linked to the others by employing a shared online platform, in a perspective of technological-supplied multicomponent interventions according to the concept of “aging in place” as the best solution for the treatment and healthcare of older people. Here we describe the general framework of the MULTIPLAT_AGE, and we examine every single project, pointing out innovative aspects, and discussing the expected results.

How should we prioritise global surgery? A capabilities approach argument for the place of surgery within every health system

In the rapidly evolving landscape of global health issues and policy, surgery has historically been sidelined due to concerns about high cost, complexity and other concerns including quantitatively less surgical...

Bulgarian bioethicists on patients’ responsibility as a basis for prioritisation in healthcare

Abstract Background Patients’ responsibility as a criterion for setting priorities in healthcare has been widely discussed in the academic literature recently while the empirical knowledge is still limited. Methods We investigated perceptions of bioethicists within the Bulgarian Association of Bioethics and Clinical ethics (BABCE) on the relevance of patient's responsibility for priority setting in Bulgarian healthcare context through focus group interview. Discussions were recorded and transcribed verbatim. Conceptually driven thematic analysis was used. Results The findings suggest that members of BABCE supported the concept of patients’ responsibility but were reluctant to the application of the life style contract as a basis for prioritization in health care. The life style contract was seen as not corresponding to Bulgarian cultural particularities. The existing similar mechanisms in the field of social assistance in our country had proved to be ineffective. The main precondition for introduction of patients’ responsibility was the building of supportive environment on the side of the society and the government. The concept of prospective responsibility was seen as more acceptable than the retrospective responsibility. The participants distinguished other dimensions of personal responsibility such as intentional damages of healthcare facilities, misuse of resources, violence towards health professionals that were considered as deleterious to the healthcare system as the life style induced diseases. Conclusions The acceptance of patients’ responsibility as a criterion for prioritization in health care in Bulgaria needs to be studied further among wider professional community and the general public. A field study in the real national conditions would contribute to the development of specific tools to deal with resource allocation issues in our context. Key messages • Prioritisation in healthcare is inevitable and patients’ responsibility could be an acceptable criterion under certain conditions. • National particularities should be studied to find the most appropriate tools to deal with resource allocation issues.