Mentoring in healthcare is becoming an increasingly relevant topic, especially in the context of continuous professional development and changes in the healthcare system. The article examines the role of mentoring in the field of medicine as an important tool aimed at improving the professional training and support of new medical professionals in the face of rapid changes in the technological and organizational aspects of healthcare. The study is based on quantitative and qualitative analysis methods, including surveys and in-depth interviews conducted among medical professionals in Moscow and the Moscow Region. The results showed that mentoring significantly affects professional satisfaction, contributing to the harmonization of work processes and emotional support for employees. The author recommends that medical institutions develop and structure mentoring programs, taking into account the revealed survey results, which will not only improve the quality of medical care, but also improve the general condition of healthcare workers, thereby contributing to the effective adaptation and professional growth of new specialists. It is noted that further research in this area will be equally important to understand the long-term effects of mentoring and its impact on the entire healthcare system.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Although preventable harm in custodial settings has been widely documented, progress towards implementing the reforms that are often identified in reviews and inquiries into the quality of care afforded has been slow. It has even been suggested that government departments routinely engage in the practice of ignorance-making — the intentional use of strategies to deny the ongoing experience of harm, to deflect attention away from the statutory body, and/or to minimise responsibility. One means of countering such practice is open disclosure; a process that involves acknowledging and apologising for harm, and engaging directly with affected individuals and families. In this article we examine the occurrence of preventable harm in custodial settings, employing a case study from Australia’s Northern Territory to contrast criminal justice responses with the more transparent approaches that have been adopted in healthcare. We put forward recommendations to improve harm recognition, embed meaningful apology, and strengthen systemic accountability in custodial settings in Australia.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Effective communication is crucial in perioperative healthcare settings. However, language barriers hinder this communication. In the United States, 8% of individuals over age 5 have a non-English language preference (NELP). Lack of language concordance between patients and healthcare clinicians has been linked to poorer healthcare metrics and outcomes. Despite these challenges, limited research has focused specifically on language barriers in perioperative settings, and few studies have captured experiential data from both caregivers and clinicians. This study aimed to explore whether language discordance between clinicians and caregivers is associated with lower perceived quality of care by either caregivers or clinicians. We also explored whether the interpreting modality impacts perceptions of care by either caregivers or clinicians. This study employed a mixed-methods approach, composed of 9-item 5-point Likert scale questionnaires and explanatory sequential semi-structured interviews of caregivers and clinicians in a large academic medical center. We analyzed caregiver quantitative data using a Mann-Whitney U test. Interview transcripts from caregivers and clinicians underwent thematic analysis. The caregiver and clinician participant response rates were 60% and 69%, respectively. Analysis of caregiver surveys revealed no significant differences between NELP and ELP caregiver responses. Clinician survey analysis revealed significant discrepancies between awareness of interpretation services and true availability of these services in perioperative areas. Major themes identified in caregiver interviews included informational quality, trust, perceived understanding, and overall satisfaction. Major themes identified in clinician interviews included communication barriers, system improvement suggestions, and communication facilitators. This study underscores the importance of preoperative patient/caregiver education to ensure adequate comprehension and understanding in the perioperative setting, particularly within NELP populations. Additionally, the results suggest that in-person interpretation services may improve patient and clinician satisfaction.

The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee for Diabetes, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Introduction The DEW (Diabetes Education and Wellness) Clinic is an interprofessional, student-led initiative that provides diabetes care through both in-person and telehealth formats. This model offers a unique platform to explore the effectiveness of interdisciplinary collaboration while enhancing student learning and addressing patient care needs in a community-based setting. Methods This article synthesizes findings from three mixed-methods studies conducted between 2022 and 2024. Study 1 evaluated the effectiveness of hybrid (telehealth and in-person) care delivery in diabetes management. Study 2 assessed patient satisfaction, perceived care quality, and outcomes. Study 3 explored student and faculty experiences in the clinic through surveys and focus groups. Participants included adult patients with diabetes, student providers from medicine, pharmacy, etc., and interprofessional faculty mentors. Results The hybrid care model was found to improve access and continuity of care for patients with diabetes, with telehealth appointments providing flexibility and convenience. Patients reported high satisfaction, particularly noting the personalized education and supportive interprofessional approach. Students described enhanced confidence, communication skills, and understanding of interprofessional roles. Faculty mentors valued the opportunity to guide learners in real-time collaborative care. Across all studies, the interprofessional model was viewed as effective in promoting both high-quality patient care and meaningful educational experiences. Conclusion The DEW Clinic exemplifies a scalable, interprofessional approach to chronic disease management that benefits both learners and patients. Integrating telehealth with in-person services enhances accessibility and patient engagement while offering a dynamic educational environment for health professions students. These findings support the continued development and replication of similar interprofessional models in community-based chronic care settings.

High-volume thyroid surgeons (HVTS) provide quality care with fewer adverse outcomes, yet access to these surgeons can be challenging. This study aimed to assess factors associated with receiving care from a HVTS for thyroid cancer. This retrospective cohort study analyzed adults with thyroid cancer who underwent thyroidectomy in a statewide multi-payor claims registry (2015-2022). Surgeons were classified as high- (>25/year) or low-volume (≤25/year; LVTS). Logistic regression evaluated demographics; distance between home, surgical facility, and closest endocrinologist; and zip code-level census data in association with surgery by a HVTS. Overall, 357 surgeons performed thyroidectomies on 3,839 patients with thyroid cancer: 17 (4.8%) were HVTS and 340 (95.2%) were LVTS. Most thyroidectomies were performed by LVTS (53.9%, n=2,068). Patients treated by HVTS travelled an average of 4.8 miles farther to their treating surgeons (33.7±44.4 miles versus 28.9±44.3 miles to LVTS, p<0.001). Factors significantly (p<0.05) associated with an increased likelihood of treatment by a HVTS included: having Medicare Advantage through a preferred provider organization and living further from their treating surgeon. Patients who were significantly (p<0.05) less likely to have surgery by a HVTS were: male, had Medicare insurance without an Advantage plan, lived in a zip code with low educational attainment, and lived further from an endocrinologist. This study identified several factors independently associated with decreased odds of having thyroidectomy by a HVTS for thyroid cancer treatment in the state of Michigan. These results underscore the continued existence of inequities in access within our healthcare system.

Antimicrobial resistance (AMR) is a major public health issue that, combined with healthcare-associated infections (HAIs) threaten the quality and safety of hospital care. Monitoring AMR and HAIs is one of the cornerstones of preventing these phenomena with the use of indicators. Various monitoring networks and indicators exist for this type of surveillance, yet the landscape is cluttered with a confusing array of them, making it unclear why so many are used or how they were chosen. We provide a comprehensive overview of the diversity indicators employed in monitoring AMR and HAI from local to international networks. One challenge is the variation in case definitions between networks, which complicates direct comparisons. Standardized infection rates help adjust for confounding factors such as demographics (age, sex) and other infection-related risks, but obtaining such detailed data remains complex. Benchmarking hospital indicators involves comparing performance metrics with those of peer institutions, offering valuable insights to improve care quality, patient safety, and overall healthcare efficiency. However, to drive meaningful improvements, comprehensive feedback must be shared to guide targeted corrective actions.The emergence of health data warehouses (HDWs) and artificial intelligence (AI) provides new opportunities to refine and develop indicators, better addressing the challenges of contemporary healthcare monitoring.

Sexual and reproductive health and rights (SRHR) remain critically underfunded and underresearched in humanitarian settings. Existing global research agendas are outdated, lack an implementation focus and often exclude perspectives from frontline practitioners. This exercise aims to identify and rank actionable research priorities globally and by region. We conducted a cross-sectional global, multiphase prioritisation exercise with information from frontline practitioners. The process included a scoping review and 11 regional consultations (informed by 91 SRHR experts), resulting in a long list of 101 SRHR research needs. Using these, we systematically listed and refined the SRHR research questions. A budget-weighted research prioritisation (BWRP) method was used for a global, multilingual survey to score 73 SRHR implementation questions across nine SRHR topical domains and three crosscutting domains. Domains were weighted equally, and regional priorities were identified. A total of 271 experts contributed to the prioritisation ranking. Themes prioritised within the domains included the delivery of community-based care, self-care strategies, the integration of mental health into SRHR services and the improvement of adolescent access to contraception. A strong consensus emerged on the need to research topics such as human papilloma virus (HPV) vaccination, emergency obstetric and newborn care, and resilient SRHR service delivery amid climate shock. Substantial regional variation underscores the need for locally contextualised agendas, e.g., Europe and Central Asia prioritised quality of care and noncommunicable disease integration, whereas Latin America and the Caribbean emphasised gender-transformative approaches and community leadership. This stakeholder-informed research agenda responds to calls for context-specific SRHR research in humanitarian settings. The importance of tailoring research to local realities, including health system capacity, legal constraints and cultural norms, was a recurrent theme across all regions. The BWRP method enables clear prioritisation while reducing respondent burden, offering a practical model for future exercises. As global funding for SRHR contracts, aligning research with frontline needs is critical to ensuring effective, equitable service delivery.

Abstract Background More evidence is needed for understanding how evidence-based psychological interventions work, especially when implemented by briefly trained non-professionals in low- and middle-income settings. The nine-session caregiver support intervention (CSI) is such an evidence-based intervention, aiming to improve parental wellbeing and parenting skills. Specifically, this study aims to assess if and how a set of quality of care indicators explain intervention outcomes amongst participants from refugee settlements in Jordan. Methods We conducted a three-path mediational model, wherein levels of facilitators’ competency (using the ENhancing Assessment of Common Therapeutic factors tool [ENACT]), facilitators’ fidelity of implementing CSI, caregivers’ attendance, and caregivers’ adoption of the key intervention skills and strategies (i.e. mechanisms of action) are predictive of intervention outcomes. Outcome measures include the Warwick-Edinburgh Mental Wellbeing Scale to assess caregiver wellbeing, Kessler Psychological Distress measure to assess caregivers’ psychological distress symptoms, Brief Parenting Questionnaire to assess warm and responsive parenting and harsh parenting and Kid(dy)-KINDL for Parents to assess children’s psychosocial wellbeing. Results The study, amongst caregivers ( n = 588) and facilitators ( n = 51), demonstrates that baseline to endline intervention improvements in parenting, caregiver wellbeing, and caregiver-reported child wellbeing are all (fully or partly) mediated by a pathway of higher levels of facilitator competencies leading to higher levels of participants’ attendance. Higher attendance in turn leads to higher levels of adoption of key intervention strategies by participants. Higher adoption in turn leads to the bespoke positive outcomes (indirect effects: 0.50 [SE = 0.14]; 0.90 [SE = 0.26]; 0.92 [SE = 0.29], respectively). This pathway does not play out for caregiver distress as an outcome (−0.20 [SE = 0.13]). Conclusion Both common factors (foundational therapeutic competencies among the service providers) and specific factors (active ingredients of the intervention) are relevant in predicting outcomes following CSI—albeit through different pathways. This study provides support for using competency assessments, attendance tracking, and monitoring participant’s skill adoption as a framework for the evaluation and improvement of quality of care.

Chemo Chair Conversations: A Qualitative Study of How Life and Death Influence Oncology Nurses' Well-being and Professional Care.

Adults with congenital heart disease and heart failure (HF) face lifelong, complex challenges. Despite improved survival, current care models often overlook their emotional, social, and long-term planning needs. Existing health-related quality of life (HRQoL) tools frequently miss key domains relevant to adult congenital heart disease (ACHD) patients, such as psychological fatigue, family dependence, and unmet support needs. Standard metrics like NYHA class and LVEF offer limited insight into their lived psychosocial burden. To explore the lived experiences of ACHD patients with HF (ACHD-HF) and identify domains to inform development of patient-centred HRQoL tools and improvements in shared decision-making and care delivery. Three focus groups (n = 22) and cognitive interviews (n = 12) were conducted with ACHD-HF patients at a UK specialist centre. Data were analysed using template analysis, guided by predefined domains (physical, psychological, social, and long-term planning) and emergent themes. Five themes reflected unmet psychosocial and care needs: (1) mental exhaustion and cognitive fatigue, (2) feeling misunderstood and emotionally invisible, (3) the burden of lifelong family dependence, (4) challenges with relationships, intimacy, and identity, and (5) uncertainty around end-of-life planning. Participants voiced the need for more meaningful communication, integrated psychological support, and structured opportunities to engage in care decisions. Patient narratives provide critical insight into care quality. Incorporating underrepresented psychosocial domains into HRQoL assessment and service planning can promote more responsive, equitable, and emotionally informed ACHD-HF care.

The need for curricular innovation, especially in university education, is incorporated into the agenda of universities for undergraduate health courses, whether through the models adopted in educational institutions, referenced by their curricula, or through traditional practices that still prevail in the 21st century as a form of teaching, to the detriment of innovative practices. With high retention and dropout rates in university courses, the contemporary scenario calls for the development of strategies to reorganize curricula that meet the new demands of student training, implementing new projects, programs, and/or tools that stimulate new teaching and learning processes. Therefore, the objective of this study was to analyze the evidence of the effectiveness of projects, programs, and/or strategies for curricular innovation in undergraduate health courses through a systematic review and meta-analysis. The systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and were carried out in two stages: (a) search and selection and (b) analysis and evaluation. Eight databases were used: Cochrane Library; Education Resource Information Center (ERIC); Embase; Latin American and Caribbean Health Sciences Literature (LILACS); PubMed-Medline; SCOPUS; Scientific Electronic Library Online (SciELO); and Web of Science. The review included qualitative research, cohort studies, cross-sectional and quasi-experimental analytical studies that addressed evidence of the effectiveness of projects, programs, and/or strategies for curricular innovation in undergraduate health courses. The quality of the selected studies was assessed based on the Joanna Briggs Institute evaluation criteria. The meta-analysis was based on data on student satisfaction prevalence, self-efficacy, and academic performance. Publication bias was investigated by visual inspection of funnel plots and Egger's test. Ninety-nine studies were included in the systematic review and 23 in the meta-analysis, covering publications from 1995 to 2024 in 19 countries, with a time span of almost three decades of studies on curricular innovations and evaluations in the health field, which provided an overview of the advances in this area. The interventions were classified into seven thematic areas: clinical simulation, interprofessional training, diversity and equity, assessment and feedback, educational leadership, humanistic education, and digital teaching. The studies analyzed highlighted that curricular innovations promote the improvement of critical skills, such as critical thinking, clinical reasoning, and interprofessional teamwork, in addition to increasing student satisfaction and engagement. Advances were also observed in the development of humanistic skills, cultural sensitivity, and adaptation to digital technologies and online education. These interventions positively impacted health education, strengthening technical competencies and clinical skills, while transforming institutional culture by valuing collaborative teaching practices. Students exposed to early practical experiences reported greater motivation, confidence, and satisfaction with the course, reflecting more robust preparation for professional challenges. In addition, the results of the meta-analysis showed a weighted prevalence of 82% (76%-88%) for student satisfaction, 67% (49%-86%) for self-efficacy, and 70% (64%-75%) for academic performance after the implementation of curricular interventions. Furthermore, it was observed that most studies showed significant positive effects on outcomes after the adoption of these interventions. The findings suggest that curricular interventions have the potential to positively impact the training of health professionals. Thus, we conclude that curricular innovation strategies in health courses are promising, based on improvements in self-efficacy, academic performance, and student satisfaction, promoting indicators of teaching quality in the contexts in which they were carried out. We recommend the development of longitudinal and multicenter studies that investigate the effects of these innovations on professional practice and the quality of health care, considering different cultural and institutional contexts.

Prior evidence indicate that differences in treatment settings between patients with colorectal cancer (CRC) from high-poverty areas (HPA, ≥ 20% residents living under poverty level) and low-poverty areas (LPA) might have contributed to disparities in their health outcomes. We sought to determine whether certain hospitals predominantly provided surgical care for patients with CRC from HPAs and examine associated patient outcomes. We identified patients undergoing surgery for nonmetastatic CRC diagnosed during 1/1/2009-12/31/2019 from SEER-Medicare. We defined poverty-area-serving (PAS) hospitals as hospitals with ≥ 50% patients from HPAs. We compared in-hospital adverse events, 30day readmission, and long-term mortality between patients from HPAs and LPAs treated at PAS and non-PAS hospitals using logistic and Cox regression. Our cohort included 81,992 patients with CRC (median age = 78 years, 53.8% female, 15.9% in HPAs) treated by 991 hospitals. The 180 (18.2%) PAS hospitals treated 64.2% of patients from HPAs versus 2.6% from LPAs. Compared with patients from LPAs treated at non-PAS hospitals, patients from HPAs treated at PAS hospitals had more frequent in-hospital adverse events (OR[95%CI] = 1.17[1.07-1.29]), 30-day readmission (OR[95%CI] = 1.33[1.20-1.47]), worse all-cause (HR[95%CI] = 1.16[1.10-1.22]), and cancer-specific mortality (HR[95%CI] = 1.23[1.15-1.32]). A group of PAS hospitals treated a significant proportion of patients with CRC from HPAs and few from LPAs and was associated with worse short- and long-term patient outcomes. These findings highlight the presence and negative impact of healthcare segregation by area-level poverty and systemic inequities faced by individuals from HPAs. Multilevel resources are needed to address quality of care and other healthcare-associated needs for individuals from disadvantaged areas.

Nosocomial infections remain a major challenge in improving the quality of health services, particularly in pediatric wards where patients are more vulnerable. This study aims to explore nurses' experiences in providing nursing care for pediatric patients with nosocomial infections in the Pediatric Ward of Soe Regional General Hospital, Timor Tengah Selatan (TTS), East Nusa Tenggara. A qualitative research approach with a case study design was employed. The main informants consisted of staff nurses, while triangulation informants included physicians, the ward head nurse, and parents of hospitalized children. Data were collected through in-depth interviews, non-participant observations, and document reviews. Data analysis followed Miles and Huberman’s interactive model, including data reduction, data display, and conclusion drawing. The study identified four major themes: (1) nurses’ experiences in caring for children with nosocomial infections; (2) challenges in implementing infection prevention and control (IPC) measures; (3) nurses’ strategies to minimize infection risks; and (4) family involvement in the care process. The findings highlight the need to strengthen nurse competencies, ensure adequate IPC facilities, and promote family engagement to improve pediatric nursing care quality.

It is unknown if virtual nursing (VN) enhances care quality or improves the workload of bedside nurses in hospitals. To describe what services VNs provide to patients and nurses in hospitals; to evaluate whether the presence of VNs improves nurse workload and patient care quality; and to examine bedside nurses' experiences with VNs. This cross-sectional study using mixed methods included results from the 2024 Nurses4All survey conducted between December 2023 and March 2024. Eligible respondents were hospital-employed registered nurses in 10 states. Experience providing VN-assisted bedside care. Bedside nurses reported the services provided by VNs and answered questions about VNs' impact on workload and quality of care. Nurses also answered the open-text response, "Please share any positive or negative experiences you have had working with virtual nurses." The registered nurse sample included 880 respondents with a mean (SD) age of 44.2 (12.3) years and 13.3 (11.3) years of experience (92 Asian [10.5%], 87 Black [9.9%], 514 White [58.4%]; 84 [9.5%] with Hispanic ethnicity). The top uses of VNs reported by nurses were patient observation (434 nurses [53%]), admission and discharge activities (381 nurses [45%]), and patient education (306 nurses [37%]). The majority of nurses (483 nurses [57%]) reported that VNs did not reduce their workload, and among these, 81 nurses (10%) said VNs increased their workload. Of the 366 nurses (43%) who said VNs reduced their workloads, only 70 (8%) reported that workloads were reduced "by a lot." Slightly over half of nurses (452 [53%]) said VNs improved quality of care, but only 96 (11%) reported that quality was improved "by a lot." VNs had no impact on care quality according to 391 nurses (47%), with 34 (4%) stating that VNs reduced care quality. Nurses described the strengths of VNs for monitoring and documentation, and limitations related to staffing, patient distrust, and workflow inefficiencies. In this cross-sectional study, there were mixed findings on VNs, suggesting such models should be introduced cautiously.

The aim of this study was to evaluate the safety of unruptured intracranial aneurysm (UIA) treatment by assessing postprocedural ischemic lesions using MRI diffusion-weighted imaging (DWI) and correlating these findings with clinical outcomes. This investigator-initiated, single-center study prospectively enrolled consecutive patients undergoing UIA treatment at Helsinki University Hospital between December 2022 and August 2024. Postprocedural brain MRI was performed within 3 days, and clinical outcomes (modified Rankin Scale [mRS] score, neurological symptoms, and return to work) were assessed at 3 months. The authors compared the incidence of DWI lesions between treatment modalities and assessed the association between DWI lesions and outcome metrics. A total of 169 consecutive UIA patients were included, of whom 120 (71%) were treated endovascularly and 49 (29%) surgically. At 3 months, 98% of patients had an mRS score of 0 or 1, 6% had a worsening of their mRS score, and 4% had new neurological symptoms. The incidence of a new DWI lesion was 63%, with no difference between the groups (endovascular 63% vs surgical 63%, p = 0.993). Endovascular patients more often had ≥ 6 DWI lesions (14% vs 0%, p = 0.012), while surgical patients more frequently had lesions ≥ 10 mm (20% vs 8%, p = 0.016). The majority (85%, 91/107) of DWI lesions were asymptomatic, but the presence of a lesion was associated with an increased risk of new neurological symptoms (15% vs 2%, p = 0.006 [59% of symptoms being transient]). There was no association between the presence of any DWI lesion and mRS score (mRS score 0 or 1: 96% with lesions vs 100% without, p = 0.298) or mRS score worsening (7% with lesions vs 5% without, p = 0.747). However, lesions ≥ 10 mm were associated with poorer mRS outcomes (mRS score 0 or 1 16/19 [84%] vs 149/150 [99%], p = 0.005) and an increased risk of mRS score worsening (4/19 [21%] vs 1/150 [1%], p = 0.016). Overall, 97% of patients who were working before treatment returned to work within 3 months. New DWI lesions are frequent after UIA treatment, despite excellent clinical and mRS outcomes. The mRS score alone might not fully capture the neurological impact of treatment-related ischemia. DWI assessment can provide valuable additional information when evaluating the quality of modern neurovascular care. Clinical trial registration no.: NCT06147102 (ClinicalTrials.gov).

Digital health strategies are increasingly being adopted in Africa, but their consistency with best practice planning is poorly documented. 54 countries were screened; 48 had a plan in the Global Digital Health Monitor, and 11 recent plans met the inclusion criteria. Using the “Ready, Extract, Analyze, Distill” methodology and a customized grid merging the Walt-Gilson policy triangle with WHO/ITU standards, we compared four dimensions: context, content, priority actions, and emerging technologies. Only one strategy reported complete socio-economic and health data; more than half of the strategies did not provide the challenges facing health systems; and there were recurring gaps in the pillars relating to workforce, legal frameworks, financing, and interoperability. Most visions cited universal health coverage (8/11) and quality of care (7/11), but objectives followed three distinct approaches to achieving them. Of 148 planned digital health interventions, 45% target providers, and just 7% clients; linkages between interventions and stated health system challenges are often weak. None of the plans explicitly provides for the integration of emerging technologies or locally adapted innovations. These findings have highlighted weaknesses in contextualization, challenge-based planning, and innovation in strategies, set priorities for the next review of these plans, and aim to increase the expected outcome.

Background:Patient portal (PP) usage enhances patient engagement, quality of care, and clinical outcomes. However, effective utilization requires digital literacy and internet access, resulting in disparities, particularly among older, non-White, uninsured, or publicly insured patients. While prior studies have examined PP use in specific orthopaedic subspecialties, comprehensive analyses are limited. The aim of this study was to identify social determinants of health of interest (SDOH) associated with PP utilization across orthopaedic subspecialties and to assess its association with outcomes.Methods:A retrospective cohort study of adult patients who underwent orthopaedic procedures was conducted between January 2021 and December 2022. The study included 33,143 encounters involving 28,028 patients. PP utilization was defined as activating and using the PP at least once. SDOH assessed included age, sex, race, ethnicity, language, domestic partnership status, employment status, insurance, and urbanicity. Clinical outcomes included hospital length of stay, 30-day return to the emergency department (ED), 30-day readmission, and discharge disposition. Univariable and multivariable models evaluated associations between SDOH and PP use, while mixed-effects models assessed the association between PP utilization and outcomes.Results:PP utilization varied across subspecialties, with the highest rates in sports medicine (93.9%) and hip preservation (92.6%) and the lowest in trauma (71.7%). Lower odds of PP use were observed among patients older than 65 years, male, non-White, non-English speaking, single, unemployed, uninsured or publicly insured, and those living in rural areas. A decrease of 1 SDOH was associated with a 2.21-fold increase in PP use (odds ratio [OR]): 2.21; 95% confidence interval [CI]: 2.14-2.29; p < 0.001). Nonusers had higher odds of 30-day ED return (OR: 1.73; 95% CI: 1.51-1.99), 30-day readmission (OR: 2.49; 95% CI: 2.12-2.93), nonhome discharge (OR: 4.63, 95% CI: 3.76-5.70), and experienced longer hospital stays (Rate Ratio: 1.61; 95% CI: 1.52-1.70).Conclusions:PP utilization in orthopaedic surgery is associated with social determinants of health and varies by subspecialty. PP nonusage is associated with worse clinical outcomes, highlighting the need for targeted interventions to improve PP adoption among at-risk populations and reduce disparities in orthopaedic care.Level of Evidence:Level III. See Instructions for Authors for a complete description of levels of evidence.