Regional Information System Research Articles

The importance of healthcare monitoring systems

Abstract Issue Healthcare evaluation is an important tool of governance in the health sector that reinforces its key components: evidence-based care, effectiveness, programme standards, performance monitoring, quality improvement, risk and incident management and patient-centered care. One of the evaluation systems used by the Veneto Region (north italian region of about 4.8 million inhabitants) consists of the National Outcomes Programme (PNE) developed by the Italian National Agency for Regional Healthcare Services (AGENAS) on behalf of the Health Ministry. Description The PNE is an instrument used to measure, analyze, evaluate and monitor clinical and welfare assistance performances of Italian healthcare facilities. The Veneto Region, in particular, utilizes a regional epidemiologic service to periodically monitor 21 performance indicators based on “treemap” methodology. These indicators are used to assess processes, outcomes and volumes. The data used to monitor these practices derive from the hospital discharge documentation (SDO) and tax registry information system. The aim of this monitoring system is to track any critical situation that is not in alignment with national guidelines and to improve the efficacy, efficiency, appropriateness and safety within the healthcare system. Results In the Veneto region, over the course of nearly 10 years, this method of management has led to the development of various training courses that guide clinicians to correctly document and code different diagnosis and treatments. The treemap process of analysis has also made possible various clinical audits that have provided significant policy changes regarding risk and overall health management. Lessons Having a constant view of healthcare performance has proven to be helpful not only to identify some common gaps in care given from different facilities on a national level, but also guides different regions to develop specific strategies that lead to quality improvement. Key messages • Data on healthcare quality can be used as comparative information and for quality improvement. • Continuous monitoring of specific performance indicators can help identify difficulties in healthcare facilities and create strategies for long term solutions.

Оценка стоимости проектирования локальной вычислительной сети предприятия водного транспорта

The main stages of designing a local area network at a water transport enterprise are considered. The goals and objectives of each stage are outlined, the most significant stage in the design is highlighted – a pre-design survey, within which a thorough collection of information from the customer (industry enterprise) should be carried out and the parameters and conditions for the functioning of the future network should be determined. It is important to take into account the need for employees to work in industry information systems and the specifics of working with them, as well as to provide appropriate reliable equipment for the correct and uninterrupted operation of the enterprise. An example of a room plan for water transport enterprises is given, it is noted which physical characteristics must be taken into account when developing the plan. A general list of equipment for the future local area network is defined, active and passive equipment are noted. The main advantages and disadvantages of communication lines are considered. Examples of a physical circuit and a logical circuit for connecting computers to a network in an enterprise are given. The federal and regional information systems used at water transport enterprises for the implementation of state functions are listed. Enterprises can use a large number of such systems simultaneously, as well as real-time access from several workplaces to one system. The cost of designing the local network of a water transport enterprise was estimated, it was determined that the largest part falls on material costs.

The regional features of digitalization in public administration: experience of the Orel region

Relevance. Russian regions are characterized by varying degrees of readiness for the introduction of digital technologies into the management system, this process often takes place formally and does not imply a significant change in the format of interaction between the population and business, on the one hand, and regional executive authorities, on the other. The study of the specifics of digitalization of public administration will allow to identify "bottlenecks" for improving measures to support digital transformation at the level of the subject of the Russian Federation, to identify and replicate successful experience.The purpose of the article is predetermined by its topic and is to determine the regional features of the digitalization of public administration in the Orel region.Objectives. To achieve this goal, the theoretical, methodological, organizational and regulatory foundations of digitalization of public administration are considered, a comparative analysis of key indicators of digitalization in this area is carried out, the opportunities and threats of digitalization are determined, taking into account the specifics of the socio-economic development of the region under study.Methodology. The materials for the study were official statistics presented on the official websites of the Federal State Statistics Service of Russia, compiled by constituent entities of the Russian Federation in the “Information Society” section. The main research methods are statistical analysis of data series, comparative analysis, SWOT analysis.Results. Based on the results of the study, it was revealed that the basic conditions for the digital transformation of management in the Oryol region have been formed: relevant regional strategies and programs have been developed and are being implemented, benchmarks for their implementation have been established, the system of authorities is functioning and the infrastructure necessary for successful digitalization is being developed. At the same time, there is no list of specific measures necessary for the integration of state regional information systems into federal super services, measures for personnel and financial support for digitalization processes, increasing the level of digital literacy of the population, and intensifying outreach work among the population. Solving these problems will improve the efficiency of the digital transformation of public administration in the Orel region.Conclusions. Regional specifics determine the effectiveness of the digital transformation of public administration in the constituent entities of the Russian Federation, and therefore regional programs should not only repeat federal initiatives, but also adapt them taking into account the territorial characteristics of socio-economic development.

Pulp calcification identification on cone beam computed tomography: an artificial intelligence pilot study

BackgroundThis study aims to verify the effectiveness of a deep neural network (DNN) in automatically identifying pulp calcification on cone beam computed tomography (CBCT) images.MethodsThis study retrospectively analysed 150 CBCT images. Pulp calcification was identified and manually annotated by three endodontists with 10 years of experience. A DNN model based on the U-Net architecture was constructed to identify pulp calcification, and ten rounds of fourfold cross-validation were conducted. The model performance was evaluated using sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve (AUC).ResultsThe model achieved a sensitivity of 75.91 ± 2.84% in automatically identifying pulp calcification, with a specificity of 68.88 ± 2.35%, an accuracy of 72.78 ± 2.13%, and an AUC of 73.68 ± 3.09%. According to the ranking for diagnostic tests, the proposed method achieved a “good” grade for sensitivity, accuracy, and AUC and a “fair” grade for specificity.ConclusionsThe results indicate that the proposed method shows promise for identifying pulp calcification on CBCT images. Future research aims to expand the dataset and refine the model, thereby enhancing its clinical applicability. The integration of artificial intelligence into diagnostic and treatment systems is anticipated to increase the efficiency of diagnosing pulp calcification and assist dentists in assessing the difficulty of root canal treatment cases preoperatively.Clinical registrationRegistration was performed on the Chinese Clinical Trial Registry (https://www.chictr.org.cn/) (Registration number: ChiCTR2300077078, 27/10/2023) and National Medical Research Registry Information System (https://www.medicalresearch.org.cn/, 30/10/2023) (Number: MR-44–23-039664).

Internship Information System at PT Biro Klasifikasi Indonesia Samarinda Branch

The rapid development of information technology has led almost all companies and certain sectors to desire that all processes in their offices become fast and practical, including the internship application and registration process. PT Biro Klasifikasi Indonesia, Samarinda Branch, is a company that utilizes information technology; however, there are still aspects of information technology use that are not yet effective and efficient. One such aspect is the student internship registration, which is still done by registering directly at the company. This process is quite time-consuming and has many weaknesses. These weaknesses include long processing times and inadequate accuracy, such as incomplete or lost documents upon receipt, which can disadvantage applicants. As a result, this registration system poses difficulties for prospective interns outside the area. Therefore, the purpose of designing and developing a web-based internship information system at PT Biro Klasifikasi Indonesia Samarinda Branch is to simplify the internship registration process and assist the admin in verifying registration status, managing certificate data, and making it easier for applicants to fill out the registration form, view registration results, and check registration status through the website. The system development method used in this research is the waterfall model. To implement this internship registration information system, supporting components must function properly. These components use the Laravel framework and MySQL database. The results of this research, based on black box testing and respondent questionnaires, indicate that all features of this web-based internship information system can be used effectively and function as intended, thereby helping users manage internship registration.

Epidemiology and SARIMA model of deaths in a tertiary comprehensive hospital in Hangzhou from 2015 to 2022

BackgroundBy analysing the deaths of inpatients in a tertiary hospital in Hangzhou, this study aimed to understand the epidemiological distribution characteristics and the composition of the causes of death. Additionally, this study aimed to predict the changing trend in the number of deaths, providing valuable insights for hospitals to formulate relevant strategies and measures aimed at reducing mortality rates.MethodsIn this study, data on inpatient mortality at a tertiary hospital in Hangzhou from 2015 to 2022 were obtained via the population information registration system of the Chinese Center for Disease Control and Prevention. The death data of inpatients were described and analysed through a retrospective study. Excel 2016 was utilized for data sorting, and SPSS 22.0 software was employed for data analysis. The statistical inference of single factor differences was conducted via χ2 tests. The SARIMA model was established via the forecast, aTSA, and tseries software packages (version 4.3.0) to forecast future changes in the number of deaths.ResultsA total of 1938 inpatients died at the tertiary hospital in Hangzhou, with the greatest number of deaths occurring in 2022 (262, 13.52%). The sex ratio was 2.22:1, and there were significant differences between sexes in terms of age, marital status, educational level, and place of residence (P < 0.05). The percentage of males in the groups aged of 20 to 29 and 30 to 39 years was significantly greater than that of females (χ2 = 46.905, P < 0.001). More females than males died in the widowed group, and divorced and married males experienced a greater number of deaths than divorced and married females did (χ2 = 61.130, P < 0.001). The proportions of male students with a junior college and senior high school education were significantly greater than that of female students (χ2 = 12.310, P < 0.05). The primary causes of mortality within the hospital setting included circulatory system diseases, injury, poisoning, tumours, and respiratory system diseases. These leading factors accounted for 86.12% of all recorded deaths. Finally, the SARIMA (2, 1, 1) (1, 1, 1)12 model was determined to be the optimal model, with an AIC of 380.23, a BIC of 392.79, and an AICc of 381.81. The MAPE was 14.99%, indicating a satisfactory overall fit of this model. The relative error between the predicted and actual number of deaths in 2022 was 8.02%. Therefore, the SARIMA (2, 1, 1) (1, 1, 1)12 model demonstrates good predictive performance.ConclusionsHospitals should enhance the management of sudden cardiac death, acute myocardial infarction, severe craniocerebral injury, lung cancer, and lung infection to reduce the mortality rate. The SARIMA model can be employed for predicting the number of deaths.

The Japanese Catheter Ablation Registry (J-AB): Annual report in 2022.

The Japanese Catheter Ablation (J-AB) registry, started in August 2017, is a voluntary, nationwide, multicenter, prospective, observational registry, performed by the Japanese Heart Rhythm Society (JHRS) in collaboration with the National Cerebral and Cardiovascular Center. From January 2022, the data registration system was changed from Research Electronic Data Capture (REDCap) system to Fountayn system. The purpose of this registry was to collect the details of target arrhythmias, the ablation procedures, including the type of target arrhythmias, outcomes, and acute complications in the real-world settings. During the year of 2022, we have collected a total of 90,042 procedures (mean age of 66.7 years and 65.9% male) from 614 participant hospitals. Detailed data were shown in Figures and Tables.

The Association of Dietary Diversity with Hyperuricemia among Community Inhabitants in Shanghai, China: A Prospective Research.

Hyperuricemia, a major worldwide burden on public hygiene, is closely connected with dietary habits. However, few studies have evaluated the association of dietary diversity with hyperuricemia. To preliminarily reveal the status of a diversified diet in preventing hyperuricemia based on a neighborhood-based, massive-scale cohort in China, a total of 43,493 participants aged 20-74 years old, with no history of hyperuricemia at baseline, were enrolled in the research from April 2016 to December 2019. The Dietary Diversity Score (DDS) was utilized to evaluate the dietary variety and split the participants into the low-, medium-, and high-DDS groups. Information on participants was connected to regional health information systems that acquired data on hyperuricemia instances up to 28 February 2023. Hazard ratios (HRs) and 95% confidence intervals (CIs) were computed by Cox proportional hazards models. Restricted cubic splines (RCS) were implemented to analyze dose-response correlation. A total of 1460 individuals with newly diagnosed hyperuricemia were observed over a median follow-up period of 5.59 years. Compared to the low-DDS group, HRs for the medium- and high-DDS groups were 0.87 (95% CI 0.76-0.99) and 0.80 (95% CI 0.70-0.91) in the fully adjusted model, respectively. The risk of hyperuricemia incidence was reduced by 5% for each 1 unit of DDS increase. A linear correlation of DDS with hyperuricemia emerged and further revealed that the intake of 8-10 broad categories of food could decrease the incidence of hyperuricemia. Our results validate the dietary principle of "food diversification" recommended in guidelines. Conclusions should be applied with caution considering the paucity of related evidence in additional nations.

Chest X-Ray Comparison Between Drug-Resistant and Drug-Sensitive Pulmonary Tuberculosis in Children.

Chest X-ray (CXR) remains one of the tools used in diagnosing tuberculosis (TB). However, few studies about such tools exist, specifically in children in Indonesia. We aim to investigate and compare the CXR findings of children with pulmonary drug-resistant TB (DR-TB) and drug-sensitive TB (DS-TB) that could help in the evaluation and management of TB cases in children. Retrospective analysis with cross-sectional approach was conducted in children (<18 years old) diagnosed with pulmonary DR-TB and DS-TB from January 2018 to December 2021. Documented data were collected from the Paediatric Respirology Registry and Tuberculosis Information System at Dr. Hasan Sadikin General Hospital Bandung. Characteristics of children, CXR findings, and TB severity were assessed and compared using the chi-square and Fisher's exact tests with significance levels set at p value <0.05. Sixty-nine children (DR-TB 31 children vs. DS-TB 38 children) were assessed. Of the 31 children with DR-TB, 65% were classified as multidrug-resistant TB (MDR-TB), followed by rifampicin-resistant TB (RR-TB), pre-extensively drug-resistant TB (pre-XDR-TB), and extensively drug-resistant TB (XDR-TB). The most common CXR findings in DR-TB are consolidation (68%), fibrosis (42%), and cavity (29%), whereas in DS-TB, it is pleura effusion (37%). Severe TB accounts for 50% of DR-TB (p = 0.008). Consolidation, fibrosis, cavities, and findings of severe TB are most common in DR-TB. Pleural effusion is the most common in DS-TB. These findings have the potential to be considered in further examination of children with pulmonary DR-TB and DS-TB; hence, more extensive studies are needed to confirm these results.

The development of math skills from grades 1 to 12: Novel findings using person-oriented approach.

The development of math skills is widely studied, but there is a lack of longitudinal studies investigating person-oriented developmental patterns of math skills. The present study aims to describe profiles of students with various calculation and word-problem solving skills from Grades 1 to 9, as well as the developmental trajectories of these profiles, how profiles are related to students' further educational pathways, and whether having a specific skill profile in Grade 9 is related to the results of math and language exams at the end of Grade 12. The sample included 1,023 Estonian students who completed calculation and word-problem solving tests in Grades 1, 3, 6, and 9 (ages 6-16 years old). Educational pathway information and results of the math and language exam in Grade 12 were retrieved from the Estonian Education Information System's registry. Socioeconomic status was determined via parental education level. Overall, results indicated that math skills were positively interrelated between the school years. However, person-oriented approach demonstrated that less than half of students tended to stay in a similar profile from Grades 1 to 9. This suggests that, in terms of math skills, most students have diverse developmental trajectories from elementary school through the end of middle school. Profiles were also related to further educational pathways and high school exam results. This study complements previous variable-oriented research to provide unique and valuable information regarding the development of math skills. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Framework to Support the Standardized Management of Real-World Data.

Relying on our experience on the development of data registration and management systems for clinical and biological data coming from patients with hematological malignancies, as well as on the design of strategies for data collection and analysis to support multi-center, clinical association studies, we designed a framework for the standardized collection and transformation of clinically relevant real-world data into evidence, to meet the challenges of gathering biomedical data collected during daily clinical practice in order to promote basic and clinical research.

Effect of indoor residual spraying on sandfly abundance and incidence of visceral leishmaniasis in India, 2016–22: an interrupted time-series analysis and modelling study

Efforts to eliminate visceral leishmaniasis in India mainly consist of early detection and treatment of cases and indoor residual spraying with insecticides to kill the phlebotomine sandfly Phlebotomus argentipes that transmits the causative Leishmania protozoa. In this modelling study, we aimed to estimate the effect of indoor residual spraying (IRS) on vector abundance and transmission of visceral leishmaniasis in India. In this time-series analysis and modelling study, we assessed the effect of IRS on vector abundance by using indoor vector-abundance data (from 2016 to 2022) and IRS quality-assurance data (from 2017-20) from 50 villages in eight endemic blocks in India where IRS was implemented programmatically. To assess a potential dose-response relation between insecticide concentrations and changes in sandfly abundance, we examined the correlation between site-level insecticide concentrations and the site-level data for monthly sandfly abundances. We used mathematical modelling to link vector data to visceral leishmaniasis case numbers from the national Kala-Azar Management Information System registry (2013-21), and to predict the effect of IRS on numbers of averted cases and deaths. IRS was estimated to reduce indoor sandfly abundance by 27% (95% CI 20-34). Concentrations of insecticides on walls were significantly-but weakly-associated with the degree of reduction in vector abundance, with a reduction of -0·0023 (95% CI -0·0040 to -0·0007) sandflies per mg/m2 insecticide (p=0·0057). Reported case numbers of visceral leishmaniasis were well explained by trends in vector abundance. Village-wide IRS in response to a newly detected case of visceral leishmaniasis was predicted to reduce disease incidence by 6-40% depending on the presumed reduction in vector abundance modelled. Indoor residual spraying has substantially reduced sandfly abundance in India, which has contributed to reductions in visceral leishmaniasis and related deaths. To prevent the re-emergence of visceral leishmaniasis as a public health problem, surveillance of transmission and sandfly abundance is warranted. Bill & Melinda Gates Foundation. For the Hindi translation of the abstract see Supplementary Materials section.

Rancang Bangun Aplikasi Penerimaan Siswa Baru di SMA Gerardus Mayella Kalembu Weri

Gerardus Mayella Kalembu Weri High School is a school that operates in the field of educational institutions which currently still has problems with the process of admitting new students requiring quite a long time in filling out paper forms and student data still using the main book as a medium for storing student data. Then the committee will input or copy student data on the computer, which is a problem regarding new student registration which is still manual, which of course keeps the committee busy in terms of new student registration. And the data could be lost because it is still in the form of sheets of paper. System This can be more efficient in terms of costs, energy and time, so that it is effective in achieving goals. In accessing the current system, we sometimes experience obstacles in implementing information, such as accepting new students. For this reason, a special information system is needed to overcome this problem, namely an online registration information system. This system was developed using web engineering methods. The method is used to create a web-based application system using engineering science, management principles and a systematic approach so that high quality web systems and applications can be obtained.

The role of microbiological monitoring in the prevention and control of antibiotic resistance

The article deals with the problem of antibiotic resistance of opportunistic microorganisms. The aim of the study is to determine the predominant microflora of a medical organization and to develop protocols for empirical antibacterial therapy in infectious and inflammatory processes. The main groups of infectious agents in the departments for the treatment of patients with new coronavirus infection of the Oryol region «Botkin City Hospital» for 2020–2022 are analyzed. Isolation, identification and determination of antibiotic sensitivity were carried out using standard methods. The results of the study made it possible to identify priority microorganisms and assess their antibiotic resistance. The growth of resistance to carbapenems of microorganisms isolated from patients in 2020–2021 was revealed. The effect obtained from the correction of antibiotic therapy has been shown, which has significantly reduced the resistance of isolated strains to carbapenems. To ensure effective epidemiological surveillance of clinically significant microorganisms and curb the growth of antimicrobial resistance in medical organizations of the Orel region, it is important to consider the possibility of maintaining a regional medical information system in order to monitor the prevalence of potential pathogens of infectious diseases, including those related to the provision of medical care resistant to antimicrobial drugs.

The Influence of Organizational Culture on the Implementation of Regional Financial Management Information Systems (Empirical Study in Regency Government of Humbang Hasundutan)

This study aims to analyze the influence of organizational culture (the ability to adapt, mission, involvement, and consistency) partially and simultaneously on the implementation of regional financial management information systems in the Regency Government of Humbang Hasundutan. This type of research is associative explanatory research using a quantitative approach. The population used in this study was all regional apparatus organizations in the Regency Government of Humbang Hasundutan. At the same time, the sample of this research consisted of 100 respondents, including regional apparatus organizations leaders, financial administration officials, financial treasurers, and staff. The data collection technique used in this study is a questionnaire method. The data analysis technique used is validity and reliability analysis using Smart PLS software. The results in this study indicate that partially, the ability to adapt, missions, and involvement have a positive and significant influence on the implementation of regional financial management information systems, and consistency has no effect on the implementation of regional financial management information systems in the Regency Government of Humbang Hasundutan. In addition, simultaneous test results also show that the ability to adapt, mission, and involvement has a positive and significant influence on the implementation of regional financial management information systems, and consistency does not affect the implementation of regional financial management information systems in the Regency Government of Humbang Hasundutan. Keywords: organizational culture, adaptability, mission, involvement, consistency, financial information system, regional financial management information system implementation.

PENGARUH PENERAPAN STANDAR AKUNTANSI PEMERINTAHAN, IMPLEMENTASI SISTEM INFORMASI MANAJEMEN DAERAH, DAN KOMPETENSI SUMBER DAYA MANUSIA TERHADAP KUALITAS LAPORAN KEUANGAN PEMERINTAH DAERAH (STUDI KASUS DI KOTA MADIUN)

Abstract- This research aims to examine the effect of implementing government accounting standards, implementing regional management information systems and human resource competence on the quality of regional government financial reports. This type of research is quantitative. The data collection technique in this research uses questionnaires directly to respondents. The respondents in this study were employees of the Madiun City Regional Revenue Agency. Data analysis was carried out using multiple linear regression analysis with the SPSS (Statistical Product and Service Solution) version 25 for Windows program. The results of the hypothesis research show that the Implementation of Government Accounting Standards variable is 0.022, the Regional Management Information System Implementation variable is 0.004, the Human Resources Competency variable is 0.031 and the Adjusted R Square shows a value of 0.626 or 62.6%. The results of this research show that the implementation of government accounting standards has a positive influence on the quality of regional government financial reports, the implementation of regional management information systems has a positive influence on the quality of regional government financial reports, and human resource competence has a positive influence on the quality of regional government financial reports.

The two-year epidemiological investigation of the COVID-19 pandemic in the nomadic population of Fars province, Southern Iran: An ecological study (February 20, 2020, to February 19, 2022)

BackgroundThe COVID-19 pandemic has highlighted the vulnerability of traveling populations, yet little is known about the health status of nomadic communities. This ecological study aimed to investigate the health status of the nomadic population in Fars Province, Iran, during the first two years of the COVID-19 pandemic. MethodsNomadic Information Registration System (NIRS) data were used to compare COVID-19 diagnostic tests, confirmed cases, referrals, hospital admissions, deaths, and vaccination coverage between the nomadic and general populations. Non-parametric chi-square test was used for data analysis. ResultsIn Fars Province, COVID-19 diagnostic tests were performed on 2.73 % of the nomadic population and 40 % of the general population. The test positivity rate was 23.91 % for the nomadic population and 29.3 % for the general population. The case fatality ratio (CFR) for COVID-19 was 9.24 % for the nomadic population and 1.29 % for the general population. Additionally, only 41.83 % and 24.35 % of the nomadic population had received the first and second doses of a COVID-19 vaccine, respectively, which were lower than the general population's rates of 65.65 % and 59.71 %. ConclusionThe nomadic population in Fars Province received suboptimal COVID-19 care compared to the general population.

Maternal Risk Factors Associated with Congenital Abnormalities in Infants Born in Yazd from 2018 to 2021

Background: Maternal factors like age, existing medical conditions, and exposure to medications/substances during pregnancy are crucial in the development of congenital anomalies. This study aims to investigate maternal risk factors associated with congenital anomalies in newborns in Yazd from 2018 to 2021. Methods: This particular research entails a cross-sectional descriptive analysis where the data concerning all live births and their respective mothers from the years 2018 to 2021 in the hospitals situated in Yazd were culled from the database of the National Mother and Newborn Health Registration System affiliated with Shahid Sadoughi University of Medical Sciences. Results: Over four years, approximately 122,098 mothers' information was recorded in the mother's information registration system. The outcomes about social factors indicated that 1.3% of mothers with limited educational background and 0.62% of educated mothers had newborns with abnormal conditions. The heightened occurrence of newborns with congenital anomalies among mothers with lower educational attainment in comparison to their educated counterparts was deemed statistically significant (P &lt; 0.001). Moreover, mothers under the age of 19 exhibited a 1.2% frequency of abnormalities, a rate significantly surpassing that of other age brackets. Conclusion: The discernment that very young mothers and those with limited education exhibit a higher frequency of abnormalities underscores the necessity for enhanced medical attention and awareness within these specific demographic segments. Nevertheless, further comprehensive inquiries regarding risk factors among mothers and high-risk cohorts are imperative.

Effect of Service Quality and System Quality on Online Registration Aplication on User Satisfaction with Usage Frequency as An Intervening Variable

Purpose — This research aims to investigate the impact of system quality and service quality on user satisfaction, specifically examining the mediating role of usage frequency in an online registration information system for hospital queues. Design/methodology/approach — This research used an analytic observational design with a cross-sectional approach. Data were collected from 96 patients attending a Private Hospital in Malang City from May to July 2022. The data were analyzed using multiple linear regression and path analysis, including the Sobel test and causal step. Findings — The results of this research indicate that neither service quality (t-test statistic = -1.458, t-stat &lt; 1.96) nor system quality (t-test statistic = -0.448, t-stat &lt; 1.96) directly affected user satisfaction through usage frequency. This suggests that usage frequency does not mediate the relationship between service quality, system quality, and user satisfaction. Practical implications — This research highlight the importance of service quality and system quality in online registration application services. Improving these aspects could enhance user satisfaction, even though usage frequency may not directly mediate this relationship. Originality/value — This research contributes to the understanding of factors influencing user satisfaction in online registration systems for healthcare services. The findings suggest that service providers should focus on improving system quality and service quality to enhance user satisfaction, independent of usage frequency.

P2Y12 Inhibitors Refill Gap Predicts Death in Medicare Beneficiaries on Chronic Dialysis

Oral P2Y12 inhibitors (P2Y12-I) are commonly used antiplatelet drugs in patients with end-stage kidney disease (ESKD) on chronic dialysis. Although gaps in prescription refills are quite common in patients with ESKD, it remains unclear whether P2Y12-I prescription refill patterns are associated with adverse clinical outcomes. We used the United States Renal Data System (USRDS) registry for patients with ESKD to capture new P2Y12-I prescriptions from 2011 to 2015. The primary exposure was prescription refill patterns and the primary outcome was all-cause death. Among the 31,243 patients with new P2Y12-I prescription, median age was 64 years; 54% were male; and 39% were Caucasian, 37% African American, and 18% Hispanic. We observed 3 P2Y12-I refill patterns as follows: continuous users (45.1%), noncontinuous users (3.6%), and users with≥30 days refill gap (51.4%). Prescription refill pattern with≥30 days refill gap (vs. continuous use) was associated with all-cause death (adjusted hazard ratio [HR]: 1.18; 95% confidence interval [CI]: 1.13-1.23). Age and race were the most important risk factors associated with prescription refill pattern. African Americans (vs. Caucasians) were more likely to demonstrate≥30 days refill gap, (adjusted odds ratio [OR]: 1.43; 95% CI: 1.36-1.51). In addition, younger patients (vs. older) were more likely to demonstrate≥30 day refill gap (adjusted OR/decade: 0.9; 95% CI: 0.89-0.92). Nonadherence to P2Y12-I prescriptions is quite common, and disproportionately affects minorities. Younger individuals with ESKD are independently associated with a higher risk of death. The odds of having a refill gap are decreasing for older patients who are more compliant than younger patients. Future studies should investigate whether phenotyping subgroups of patients with ESKD based on prescription refill patterns can help in improving adverse clinical outcomes.