Services Research Projects Research Articles

Challenges and Lessons from an Acute Telehealth Homeopathy Service During the Pandemic: A Case Series Exploring How Changing Demographics, Efficiency and Outcomes, Point to New Options for Epidemic Readiness.

Background: In 2020, HOHM Foundation launched Homeopathy Help Now (HHN), a network of professional homeopathy telehealth practitioners, administrative volunteers, and independent researchers to work collaboratively in order to respond to the urgent need of care for the ever-growing number of COVID-19 cases in the United States. Methods: in this pragmatic case series study, cases of positively testing or probable COVID-19 (n = 3495) are analyzed using conventional quantitative analysis. The sample includes clinical data collected from clients who attended the clinic between 23 March 2020 and 31 December 2023. Results: The youngest client at the clinic was less than one year old, and the eldest was 92. Many of the participants at this clinical facility were adults (58.1%), with fewer (41.9%) aged 0-17. Many were female (61.7%), while fewer were male (32.4). Most clients found their symptoms improved at final contact (83.6%), and the majority of individual remedy responses improved symptoms (73.7%) over the course of their care. Discussion: Health Services and Public Health research projects are warranted to investigate the ways in which such a necessary stop-gap clinical service as HHN could become implemented in early- and later-phase response to pandemics. HHN's collaborative, horizontally integrated team structure was essential for the creation of the novel approach needed to address the serious symptoms of COVID-19. Moreover, HHN's organizational model draws on a mutual aid structure, whereby dynamic, flexible systems are created that empower a community to meet emerging needs, especially when more formal structures are strained, failing or simply unavailable. Further research is urgently needed into the implementation and benefits of innovative, flexible healthcare structures, such as the one used in this study, that can meet the unpredictable and fluctuating public health needs in our changing world.

Health services research in acute pain medicine : Where do we come from in Germany?

Up to the early 2000s the need for optimization in the treatment of acute pain in hospitals was highlighted. Only afew successes were achieved in the optimization process. As the acute pain care in Germany remained persistently unsatisfactory, the first health services research projects in pain medicine were initiated. These were intended to achieve improvements in patient care. To illustrate the beginnings of health services research in the field of pain medicine in Germany the research projects "Pain-free hospital" and "Action alliance pain-free City of Münster" as well as the certification initiative Certkom are described. An analysis of the current state of pain care for patients and interdisciplinary pain management, the derivation of optimization measures, their implementation and subsequent evaluation were carried out in all the projects presented in the sense of acomplex intervention. All the projects could achieve improvements in patient care through asystematic survey of the current situation, targeted planning and the introduction of optimization measures. Corresponding evaluations could demonstrate these results. The systematic approach in the projects with the collation of scientific data in real-life care has achieved optimization in acute pain management. The foundations were laid for further healthcare research in pain treatment in Germany; however, the projects also revealed limitations in the inclusion of vulnerable patient groups.

Navigating the challenges of imposter participants in online qualitative research: lessons learned from a paediatric health services study

BackgroundThe growth in online qualitative research and data collection provides several advantages for health service researchers and participants, including convenience and extended geographic reach. However, these online processes can also present unexpected challenges, including instances of participant fraud or scam behaviour. This study describes an incident of participant fraud identified during online focus group discussions and interviews for a PhD health services research project on paediatric neurodevelopmental care.MethodsWe aimed to recruit carers of Australian children with neurodevelopmental disorders. Potential participants were recruited via a publicly available social media advert on Facebook offering $50 AUD compensation. Those who expressed interest via email (n = 254) were sent a pre-interview Qualtrics survey to complete. We identified imposters at an early stage via inconsistencies in their self-reported geographical location and that captured by the survey as well as recognition of suspicious actions before, during and after focus group discussions and interviews.ResultsInterest in participation was unexpectedly high. We determined that all potential participants were likely imposters, posing as multiple individuals and using different IP addresses across Nigeria, Australia, and the United States. In doing so, we were able to characterise several “red flags” for identifying imposter participants, particularly those posing as multiple individuals. These comprise a combination of factors including large volumes and strange timings of email responses, unlikely demographic characteristics, short or vague interviews, a preference for nonvisual participation, fixation on monetary compensation, and inconsistencies in reported geographical location. Additionally, we propose several strategies to combat this issue such as providing proof of location or eligibility during recruitment and data collection, examining email and consent form patterns, and comparing demographic data with regional statistics.ConclusionsThe emergent risk of imposter participants is an important consideration for those seeking to conduct health services research using qualitative approaches in online environments. Methodological design choices intended to improve equity and access for the target population may have an unintended consequence of improving access for fraudulent actors unless appropriate risk mitigation strategies are also employed. Lessons learned from this experience are likely to be valuable for novice health service researchers involved in online focus group discussions and interviews.

Supply of Medical Aids in home Mechanical Ventilation: needs-Based and Safe? - The Views of Stakeholders Related to the Care Process on the Current Status and Perspectives

The supply of medical aids is essential for patients with home mechanical ventilation. However, it is largely unclear to what extent this supply is needs-based and safe. As part of a health services research project, 20 expert interviews were conducted with a heterogeneous group of stakeholders related to ventilation-specific medical aids supply. The interviews were analysed using qualitative content analysis. The interviewees pointed to challenges and problems regarding structural, procedural and personal aspects at all levels of medical aids supply. In particular, deficits in task performance, coordination and cooperation between the stakeholders and authorities involved became apparent. Such might result in avoidable safety risks and hinder needs-oriented supply of medical aids. Further development in ventilation-associated medical aids supply is needed, with focus on evidence-based practices, a comprehensive, cross-sectoral and cross-professional design as well as systematic evaluation.

Hidradenitis Suppurativa Is Associated with Severe Sexual Impairment

Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit, often affecting and deforming intimate regions. HS is associated with severe pain, pruritus, and constant, purulent, malodorous discharge expected to impair sexual health of patients. Methods: We performed a cross-sectional, multicentric study involving 199 German patients from the health services research project “Epidemiology and Care in Acne inversa (EpiCAi).” The sexual health, HS severity, and quality of life of the studied group were evaluated using a specially designed questionnaire. Results: Regardless of gender, HS has an enormous impact on patients’ sexual health. The patients scored, on average, 28.8 ± 5.3 points on the Relation and Sexuality Scale (RSS). Multiple linear regression revealed that females and patients with Hurley III stage had higher sexual dysfunction (p = 0.012). Sexual dysfunction is associated with pain (β = 0.25), the number of active lesions, the affected areas (β = 0.14), and psychosocial aspects, including low quality of life (β = 0.404), stigmatization (β = 0.411), depression (β = 0.413), and anxiety (β = 0.300). Patients already see a substantial decrease in sexual frequency in the early stages of HS, while functional impairment and fear increase with the severity of the disease. Conclusion: Sexual health and management of its dysfunctions should be part of a holistic approach to HS patients.

Digital Twins and Software Services: Leveraging Product Data for Improved Product Development

As the digital transformation continues to evolve, manufacturing companies must adapt by broadening their service offerings to include digital solutions. This expansion addresses current challenges and positions these companies favorably in emerging collaborative production ecosystems, future proofing their business models. This work extends the work done in the research project Product Lifecycle Enrichment as a Service (PLCEaaS) research project that involved partners from academia and industry. It showcases the prototypical implementation of specialized services to enrich a product portfolio. Building on pre-existing use cases and a digital twin based on the concept of the Asset Administration Shell, our primary focus lies in services tailored for enhancing product sizing and facilitating data-driven innovation for product enhancements. Based on this prototypical implementation, the project contents are presented holistically: The conceptual design of the services, the systematic modeling of the digital twin, the application of analytical methods to evaluate the product data, and a possible deployment for users of the services. The services’ fundamental functioning and the relevant components’ interaction are shown. The paper concludes with a critical review of the research project and addresses open issues in an outlook.

Use of administrative claims data in observational studies of antirheumatic medication effects on pregnancy outcomes: a scoping review protocol.

The primary objective of this review is to examine which disease-modifying antirheumatic drugs (DMARDs) and biologics used to treat pregnant individuals with rheumatic conditions have been reported in observational studies using population-based health administrative data. The secondary objective is to describe which adverse pregnancy outcomes (both maternal and neonatal) have been reported, their definitions, and corresponding diagnostic and/or procedural codes. Pregnant individuals are typically excluded from drug trials due to unknown potential risks to both the pregnant person and fetus, leaving most antirheumatic drugs understudied for use in pregnancy. Despite these substantial knowledge gaps, most pregnant individuals continue to be maintained on antirheumatic medications due to the benefits generally outweighing the risks. In contrast to previous systematic reviews of findings from randomized trials, our scoping review aims to leverage this real-world data to generate real-world evidence of antirheumatic drug safety during pregnancy. Articles must report on observational studies using population-based health administrative data from pregnant individuals with rheumatic conditions (rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, and psoriatic arthritis) receiving antirheumatic drug therapy (DMARDs and biologics). Randomized trials, reviews, case studies, opinion pieces, and abstracts will be excluded. Electronic databases (MEDLINE [Ovid], Embase [Ovid], CINAHL [EBSCOhost]) and gray literature (OpenGrey, Health Services Research Projects in Progress, World Health Organization Library, and Google Scholar) will be searched for relevant evidence. Search terms will combine 4 concepts: rheumatic diseases, drug therapy, pregnancy, and health care administrative data. Identified articles will be independently screened, selected, and extracted by 2 researchers. Data will be analyzed descriptively and presented in tables. Open Science Framework https://osf.io/5e6tp.

SDG commentary: collaboration services for sustainable development goal (SDG) partnerships

PurposeThe purpose of this commentary is to complete the synthesis of the United Nations 17 Sustainable Development Goals (SDGs) into Seven Commentaries on Service Research Themes developed by ServCollab and the Journal of Services Marketing. As an approach to achieving SDG #17, ServCollab’s collaborative logic and design perspective for collaboration services for sustainable development partnerships are presented.Design/methodology/approachCollaboration is ServCollab’s Service Research Theme #7, which reframes the UN SDG meta goal #17 of Partnerships. In prior ServCollab research, four possible human interactions were identified: conflict, competition, cooperation and collaboration. Only the shared purpose of collaboration enables elevating the human experience.FindingsThe authors found no published service research that studied SDG #17, which means there are huge opportunities for service research on the role of collaboration in service systems. The alignment between the UN SDGs and ServCollab’s goals is explored. A research agenda for service research and SDG goals was proposed for collaborative communications, collaborative technologies and collaborative projects.Practical implicationsPractical ideas are offered for serving humanity through collaboration. Collaborations are the only practical solutions to humanity’s myriad sustainable development problems.Social implicationsWhen the United Nations developed its first 16 SDGs, they knew that accomplishing these goals required complex collaborations. That is why SDG #17 is Partnerships. ServCollab’s serving humanity logic applies collaboration to all social settings (large or small) where working together can sustain and regenerate the service ecosystem of Planet Earth.Originality/valueThis commentary describes a unique approach to building collaborative capacity for conducting service research projects for sustaining and regenerating the service ecosystem of Planet Earth.

Outcome quality in colorectal cancer—the EDIUM health services research project

Outcome quality in colorectal cancer—the EDIUM health services research project

Reform of hospital financing: revenue-independent flat rates for acute inpatient obstetrics facilities

Patient safety is the tenth national health target so-called strategic objectives in Germany. Although the topic has been on the health policy agenda for more than 20 years, the need for action remains high. In inpatient care, communication, both between professional groups and with patients, has a great impact on the reduction of so-called preventable adverse events. In a health services research project funded by the Innovation Fund of the G-BA (‚TeamBaby‘ grant number 01VSF18023), the effects of communication training on satisfaction, perceived communication skills and the reduction of preventable adverse events in obstetrics were examined. Even time-limited training sessions resulted in positive effects. Safe obstetric care, in addition to the physical health of mother and child, enhances satisfaction and strengthens family bonding for the entire family. It also increases satisfaction among professional teams. The regular implementation of communication training within working hours is therefore recommended to increase patient safety.

P197: Delirium in nursing homes (DeliA) - an interdisciplinary health services research project

Background:Delirium is a potential emergency with serious consequences. Little attention has been paid to residents of nursing homes, although they are at extreme risk for developing delirium. Health Care Professionals (HCPs) such as nurses and general practitioners are assumed to know little about delirium in nursing homes.Objectives:The German project DeliA (delirium in nursing homes) comprises three sub- studies and two reviews. The sub-studies have the following objectives: (1) to determine the prevalence of delirium and its sub-types in German nursing homes; (2) to describe and assess the quality of delirium care practices (prevention, diagnosis, therapy) of HCPs in nursing homes; and (3) to develop a Technology Enhanced Learning (TEL) to increase the delirium- specific knowledge of HCPs in nursing homes. The reviews aim to (a) summarize the prevalence of delirium reported in international studies and (b) to find out how, why and under what context education for HCPs in nursing homes works.Methods:A systematic review of the reported prevalence of delirium in nursing homes will be conducted (a). The prevalence study (1) will assess delirium and its proposed associated factors in at least 50 nursing homes using validated measurements. Medication schedules of participating residents will be analyzed to determine potential for delirium. To describe current practice, process-oriented semi-structured guided interviews will be conducted with 30 representatives of the (nursing home) medical service and the nursing service of nursing homes (2). As a theoretical basis for the TEL, a realist review will be conducted to understand the active ingredients of educational interventions and to develop an initial program theory (b). The curriculum for the proposed TEL will be developed based on a synthesis of existing curricula and evaluated by Delphi experts for relevance, comprehensiveness, and content. A final feasibility study will assess the potential increase in knowledge about delirium among HCPs (n = 50) in nursing homes (3).Expected Results:It is expected that the project and the dissemination of its findings will raise awareness among HCPs and the public about delirium in nursing homes. The developed TEL and its underlying program theory will be further tested.

History of Health Services Research Project: Interview with Kerr White.

The interview conducted in 1998 with Kerr L. White (1917-2014) is presented, translated into Spanish. White, an economist, epidemiologist, statistician, general physician, and health advocate, was highly critical of the separation between research, clinical practice, epidemiology, public health, and health policies. He was one of the pioneers in healthcare services research. His primary concern was society's responsibility to allocate healthcare resources in the most appropriate way to improve the health of populations. White's work critically addresses the absence of a population perspective in epidemiology applied to healthcare services and systems, and the lack of evaluation of the social and economic impact of practices. He also highlights the dehumanization of care processes. Despite being undercited in health literature, we reintroduce his figure with the aim of disseminating the relevance of his thoughts and contributions.

Uncovering gender bias in health services: the case of kidney transplantation

Abstract Gender-based inequalities of access to health care are major public health issues. Studies performed in several countries and in some French regions showed that women had less access to kidney transplantation waiting list (KTWL) than men. Through a quantitative study based on REIN registry data, we analysed gender-based disparities in the access to KTWL in France. All incident patients who initiated dialysis from 2017 to 2019 and aged between 18 and 85 years old were included. Cox proportional hazard models, adjusted on age, comorbidities and neighbourhood deprivation level using European Deprivation Index (EDI), at national level and in all French regions, were performed. Among 29 395 patients who started dialysis in 2017-2019, 35% were women. 40% of women and 34% of men lived in most deprived areas. Men were more comorbid than women at dialysis start. At the national level, women had less access to the KTWL compared to men one and three years after dialysis start. Analyses were stratified by age (<60 and ≥ 60 years old). Only women aged more than 60 had less access to the KTWL one year (adjHR: 0.76 [0.71 - 0.82]) and three years (adjHR: 0.75 [0.71 - 0.81]) after dialysis start. At regional level, the same trends were found in Nouvelle Aquitaine and Pays de Loire one year after dialysis start and two more regions (Bourgogne-Franche-Comté and Île-de-France) 3 years after dialysis start. Gender-based disparities in KTWL persist even after controlling for EDI and comorbidities, especially among women over 60. These results are issued from a health service research project on gender-based disparities of access to KTWL in France. A qualitative study is ongoing to better understand the reasons of these disparities. Patients’ perspectives on Kidney transplantation and nephrologists’ practices are studied using Semi-structured interviews in three French regions.

National Institutes of Health funding among vascular surgeons is rare

BackgroundThe National Institutes of Health (NIH) is an essential source of funding for vascular surgeons conducting research. NIH funding is frequently used to benchmark institutional and individual research productivity, help determine eligibility for academic promotion, and as a measure of scientific quality. We sought to appraise the current scope of NIH funding to vascular surgeons by appraising the characteristics of NIH-funded investigators and projects. In addition, we also sought to determine whether funded grants addressed recent Society for Vascular Surgery (SVS) research priorities. MethodsIn April 2022, we queried the NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database for active projects. We only included projects that had a vascular surgeon as a principal investigator. Grant characteristics were extracted from the NIH Research Portfolio Online Reporting Tools Expenditures and Results database. Principal investigator demographics and academic background information were identified by searching institution profiles. ResultsThere were 55 active NIH awards given to 41 vascular surgeons. Only 1% (41/4037) of all vascular surgeons in the United States receive NIH funding. Funded vascular surgeons are an average of 16.3 years out of training; 37% (n = 15) are women. The majority of awards (58%; n = 32) were R01 grants. Among the active NIH-funded projects, 75% (n = 41) are basic or translational research projects, and 25% (n = 14) are clinical or health services research projects. Abdominal aortic aneurysm and peripheral arterial disease are the most commonly funded disease areas and together accounted for 54% (n = 30) of projects. Three SVS research priorities are not addressed by any of the current NIH-funded projects. ConclusionsNIH funding of vascular surgeons is rare and predominantly consists of basic or translational science projects focused on abdominal aortic aneurysm and peripheral arterial disease research. Women are well-represented among funded vascular surgeons. Although the majority of SVS research priorities receive NIH funding, three SVS research priorities are yet to be addressed by NIH-funded projects. Future efforts should focus on increasing the number of vascular surgeons receiving NIH grants and ensuring all SVS research priorities receive NIH funding.

The development of a regional network for health care research in Hamburg, Germany

Abstract Background At the University Medical Center Hamburg-Eppendorf (UKE), health care research has been established as one of five research priorities recommended by the Research Council with the founding of the Center for Health Care Research (CHCR) in 2006. The CHCR was involved in numerous research projects with the focus on strengthening regional networking. Despite the numerous initiatives, there is still potential for improvement with regard to a systematic and sustainable exchange in the region of Hamburg, Germany. Methods These requirements led to the initiation of the ‘Hamburg Network Health Services Research (HAM-NET)'. The mission of HAM-NET is to build an open forum for all relevant institutions, to concentrate their interests and needs in health services research and to promote and conduct innovative, efficient, needs-based and patient-centred health services research projects in the metropolitan area of Hamburg. Three main tasks were appointed: 1) linking health care research to relevant regional institutions, 2) promoting research activities and new fields of research and 3) using methodological expertise to promote young scientists. Results By today 40 institutions from all sectors of health care joined HAM-NET. The regularly general meetings offer exchange and advice. Internal communication is promoted by mailing lists and newsletters. Also, HAM-NET presents itself with a website, logo and by organizing recurring events and participating in international and national congresses and networks. Within two funding phases a total of four overarching research projects were developed and implemented. Furthermore, a person with lived experience committee was established. Conclusions For the further development of health care research as one the core disciplines of public health a regional network with an efficient infrastructure is needed. HAM-NET promotes this with the implementation of an innovative, efficient and patient-oriented network. Key messages • Regional networks help to integrate multiple public health initiatives and community stakeholders. • Public health networks can be established on multidisciplinary cooperations in different out- and inpatient sector levels.

Commentary – The ServCollab Perspective on Elevating Human Experience

PurposeThis commentary describes ServCollab’s perspective on Elevating Human Experience and urges researchers to join in collaborating on research to reduce suffering and improve human well-being.Design/methodology/approachThis commentary is based on ServCollab’s pioneering approach to building a serving humanity logic and growing service research capacity to work on the hardest service systems problems humanity faces.FindingsServCollab’s ongoing efforts to Elevate the Human Experience are described. First, ServCollab seeks to develop a serving humanity logic. Second, ServCollab seeks to coalesce divergent perspectives on service. Third, ServCollab seeks to build a serving humanity movement capable of addressing complex service systems problems.Practical implicationsPractical ideas are offered for serving humanity through collaboration.Social implicationsBecause human life depends on service systems, this ServCollab commentary has broad application to all human experience.Originality/valueThis commentary offers a unique approach to building collaborative service research projects capable of addressing service inclusion, service language and climate change.

Publicly Available, Interactive Web-Based Tools to Support Advance Care Planning: Systematic Review.

BackgroundThere is an increasing number of interactive web-based advance care planning (ACP) support tools, which are web-based aids in any format encouraging reflection, communication, and processing of publicly available information, most of which cannot be found in the peer-reviewed literature.ObjectiveThis study aims to conduct a systematic review of web-based ACP support tools to describe the characteristics, readability, and quality of content and investigate whether and how they are evaluated.MethodsWe systematically searched the web-based gray literature databases OpenGrey, ClinicalTrials.gov, ProQuest, British Library, Grey Literature in the Netherlands, and Health Services Research Projects in Progress, as well as Google and app stores, and consulted experts using the following eligibility criteria: web-based, designed for the general population, accessible to everyone, interactive (encouraging reflection, communication, and processing of information), and in English or Dutch. The quality of content was evaluated using the Quality Evaluation Scoring Tool (score 0-28—a higher score indicates better quality). To synthesize the characteristics of the ACP tools, readability and quality of content, and whether and how they were evaluated, we used 4 data extraction tables.ResultsA total of 30 tools met the eligibility criteria, including 15 (50%) websites, 10 (33%) web-based portals, 3 (10%) apps, and 2 (7%) with a combination of formats. Of the 30 tools, 24 (80%) mentioned a clear aim, including 7 (23%) that supported reflection or communication, 8 (27%) that supported people in making decisions, 7 (23%) that provided support to document decisions, and 2 (7%) that aimed to achieve all these aims. Of the 30 tools, 7 (23%) provided information on the development, all of which were developed in collaboration with health care professionals, and 3 (10%) with end users. Quality scores ranged between 11 and 28, with most of the lower-scoring tools not referring to information sources.ConclusionsA variety of ACP support tools are available on the web, varying in the quality of content. In the future, users should be involved in the development process of ACP support tools, and the content should be substantiated by scientific evidence.Trial RegistrationPROSPERO CRD42020184112; https://tinyurl.com/mruf8b43

Building a Trainee-led Research Community to Propel Academic Productivity in Health Services Research

Academic productivity is an increasingly important asset for trainees pursuing academic careers. Medical schools and graduate medical education programs offer structured research programs, but providing longitudinal and individualized health services research education remains challenging. Whereas in basic science research, members at multiple training levels support each other within a dedicated community (the laboratory), health services research projects frequently occur within individual faculty-trainee relationships. An optimal match of expertise, availability, and interest may be elusive for an individual mentor-mentee pair. We aimed to share our experience building Surgeons Writing about Trauma (SWAT), a trainee-led research community that propels academic productivity by facilitating peer collaboration and opportunities to transition into independent researchers. We highlight challenges of health services research for trainees, present how structured mentorship and a peer community can address this challenge, and detail SWAT's operational structure to guide replication at peer institutions.

Integrative medicine for mental health (INTEGRAL) - An ongoing health service research project comparing psychiatric routine care and integrative psychiatry

Integrative medicine for mental health (INTEGRAL) - An ongoing health service research project comparing psychiatric routine care and integrative psychiatry

The EU needs a demand-driven innovation policy for climate services

Climate services have climbed high on the agenda of EU research policy, yet few contributions have reflected on the actual usability of climate services from the perspectives of the intended users, let alone the implications for future EU research and innovation policy. This commentary reflects on four key lessons learnt from engagement in climate services research projects and discusses implications for future EU research policy: i) all end-users have pre-established decision-making processes and tools for their purposes, hence all new information needs to be adapted ii) one size fits none – and tailoring takes time iii) building trust between different actors, processes and confidence in new information is key in the tailoring process – and resource-demanding iv) purveyors and intermediaries can facilitate tailoring processes but need to finance their activities until end-users demonstrate willingness to pay and/or the climate service is readily implemented. The main argument is that more attention needs to be paid to the demand-side of climate services to help viable climate services make it through the innovation “valley of death” – that is, the twilight zone between technical invention and (commercially) successful innovation. EU Research and Innovation (R&I) funding streams and policies for establishing truly transdisciplinary learning loops driven by (actual) user needs can function as vehicles through the valley of death.