Care System Research Articles

3.H. Scientific session: Advancing Health and Care System Transformation with the THCS Partnership

Abstract Health and care systems across Europe are facing similar challenges. These include demographic and epidemiological changes, such as growing ageing population and increasing incidence and prevalence of chronic diseases, in addition to diminishing of budgets. These challenges can be met by innovative, evidence-based solutions, the research and development of which can be supported by several ways. The European Partnership on Transforming Health and Care Systems (THCS) is a co-fund action within the Horizon Europe Programme which supports coordinated national and regional research and innovation programs, alongside capacity building, networking, dissemination, and other activities crucial for health and care systems’ transformation. The core of THCS’s activities lies in funding research and innovation projects through transnational calls, engaging numerous research and innovation funding organisations. In addition to the funding activities, THCS develops several means for supporting the transformation towards sustainable, efficient, resilient, inclusive, innovative, and people-centred health and care systems accessible to all. This workshop aims at discussing on the trends and needs for research, development and innovation and capacity building in the European health and care systems, on leveraging research outcomes for evidence-based strategies and translating research into practice, on transferring and implementing innovative health and care practices, on fostering ecosystems, and on facilitating knowledge exchange and sharing. In the workshop the different means of the THCS partnership to support the transformation of health and care systems are presented and their further development discussed. The workshop consists of five presentations followed by a general discussion. Key messages • Participants will learn about the different means of the THCS partnership to support the transformation of health and care systems. • Participants can contribute to the further development of the THCS activities by sharing their reflections, opinions, and viewpoints.

Facilitating the transfer and implementation of practices across health and care systems

Abstract The THCS partnership has developed the initial draft of a framework designed to facilitate the transfer and implementation of solutions across health and care systems. During the workshop, we will present this framework along with the preliminary results of its real-world testing in transfer and implementation activities. The goal of this presentation is to gather feedback on the framework and generate ideas for its further development. Choosing to transfer existing solutions rather than developing new ones can offer several advantages in terms of efficiency, reliability, and cost-effectiveness. Adopting existing solutions can save time and reduce development costs significantly. The THCS framework aims to support, promote, and accelerate the transfer and implementation of solutions across health and care systems. The THCS framework is primarily targeted at individuals involved in planning, coordinating, and executing development activities within health and care organizations. This framework includes: 1) Paradigmatic commitments that underpin its understanding of development activities, transferability, and implementation; 2) Principles for conducting the activities of transferring and adapting solutions developed elsewhere; 3) Guidelines for describing original solutions; and 4) Key development tasks that outline the necessary steps for transferring, adapting, and implementing solutions developed elsewhere.

How can health practitioners support children and young people in social care?

Abstract Health practitioners are responsible for safeguarding, delivering preventive and responsive care for children and young people in social care settings. However, drivers and determinants that place children in care settings lie outside of the doctor’s office. In fact, primary care health practitioners often deal with children and young people who face or are at risk of severe neglect, abuse or vulnerability outside the care system. Recent findings from the UK’s Millennium cohort study have repeatedly demonstrated that social disadvantage in the early years accounts for more than 2/3 of health inequalities in adolescence. Professor Saxena is a practising GP with 25 years of experience of inner-city primary care and global expert on primary care of children. She will present dilemmas posed in clinical settings for health practitioners and professionals working in a broad range of areas including public health, education settings and social care. What responsibility do health professionals have when they encounter children living in social care settings? What should they be especially alert to? How can they make a difference to reduce health inequality faced by young people growing up in the care system.

Inequities to the access to and use of telemedicine among cancer patients in Europe: A scoping review

Abstract Background Over the last few years, telemedicine services (TMs) have increasingly been used in European health and care systems. TMs include remote assistance with teleconsultation and telemonitoring. The expected benefits to individuals include easier access to information and personalized care. However, while the effectiveness and utility of TMs among cancer patients are well-established in Europe, several evidences highlighted the fact that TMs may widen existing inequities in health. Therefore, the aim of this study is to identify barriers and facilitators contributing to inequities to TMs among cancer patients in Europe. Methods Medline (via Ovid) and Scopus databases were searched in March 2023 for all publications providing evidence on factors influencing the access to and use of TMs services among cancer patients aged 18 and over in Europe published between January 2018 and March 2023. The PROGRESS-plus framework was used to stratify health opportunities, patients characteristics and outcomes. Results A total of 1683 peer reviewed publications were identified and after screening, 26 articles were retained in our scoping review. All included studies focused on TMs used by cancer patients through mobile or web-based applications. On one hand, socioeconomic status and language were the most cited influential factors as well as having an internet connection and a (mobile) device to the access to TMs. On the other hand, factors that influence the use of TMs are the level of education with digital skills and (e-)health literacy, social support, age and presence of comorbidities. Conclusions Identifying and addressing factors influencing access to and use of TMs among cancer patients will enable the development and tailoring of TMs that align more effectively with the needs and expectations of cancer patients. Integration of patient-centered care in TMs is necessary to enhance equity and allow a better implementation of TMs in European health and care systems. Key messages • The main factors influencing the access to and use of TMs are socioeconomic status and level of education respectively. • TMs must be developed and used to tackle inequities already present among cancer patients instead of widening the gap.

Implementation of polygenic risk scores in secondary prevention of (breast) cancer

Abstract Utilizing polygenic risk scores to inform secondary prevention of breast cancer via population screening programs is one of the pioneering applications of genomics in public health applications. Over the last decade, polygenic risk scores for breast cancer have been developed and validated in various European populations (AUC ± 0.63, OR per Z unit ± 1.6, depending on the population). In some countries, the polygenic risk score has been integrated with decision modeling tools, such as CanRisk in the Netherlands, and low-level implementation into health and care systems has started. Implementation strategies vary, but generally consider initial implementation into high-risk populations, such as breast cancer families, in specialized clinical setting, such as academic medical centres, or specialized cancer clinics, referring relatives of patients to population screening based on comprehensive risk modelling, including polygenic risk scores. This route may be followed by other disease fields as well. The presentations outlines the current evidence and considerations on breast cancer genetic risk modelling, clinical pilot studies and the outline of step-wise implementation of such models to benefit secondary prevention programs. We start from the perspective of a single hospital, to the needed steps to upscale to national populations, both in diversity of these populations, as the throughput of genetic testing and counselling, until the harmonization and recalibration of various European healthcare models. We draw from examples of the Genotyping on all patients (GOALL), building cancer health platforms (CanHeal) and Genome of Europe (GoE) consortia.

The health of older caregivers in Spain: a matter of age or a matter of care?

Abstract Introduction Informal care is crucial in Spain’s care system, with a rising number of caregivers aged 75 or older, yet studies on its health effects are lacking. This study aims to determine the differential impact of age and care-related variables on the health of older caregivers. Materials and methods This is a cross-sectional, national study with a sample of 3,870 informal caregivers from the Spanish 2020 Disability, Personal Autonomy and Dependency Survey. We performed a logistic regression where self-reported deterioration in caregiver health due to caregiving was the dependent variable and age (<75 vs. ≥ 75) was the independent variable. Caregivers’ sex, educational level (primary and lower or secondary and higher), income (<1,150 euros per month vs. ≥ 1,150), severe functional limitation of caregivers and care-receptors (yes or no), duration of care (< 8 years vs. ≥ 8 years), and daily hours of care were used as covariates. Results One in 6 caregivers was 75 or older (16,1%). Caregivers’ mean age was 58.4, and care-receptors’ 66.6 years. Women represented 63.0% of caregivers, and 42.8% of care-receptors. Up to 4.6% of caregivers had a severe limitation, and 43.7% of caregivers reported deterioration of their health due to caregiving. A greater perception of deterioration in caregiver health due to caregiving was associated with being 75 years or older (β = 0.34, p = 0.009). Covariates associated with caregivers’ health deterioration were being a woman (β = 0.77, p < 0.001), presence of severe limitation of care receptors (β = 0.58, p < 0.001), and increased daily hours of care (β = 0.01, p = 0.013). Caregivers’ severe limitation, level of education, income and years of care did not show a significant association with perception of health deterioration. Discussion Caregivers older than 75 years in Spain experience a key deterioration in their health associated with caregiving. This vulnerable population must be prioritized in health and social policies. Key messages • One out of 6 caregivers in Spain is aged 75 years or older. Caregiving impacts greatly in their health status. • Older caregivers is a vulnerable population that must be a priority for health and social services.

Strengthening ecosystems

Abstract The mission of THCS activities with respect to strengthening ecosystems is based on the understanding that the actual transformation of health and care systems is dependent on the ability of numerous actors to align their goals and actions so that they are complementary. At the same time, it is also true that the transformation takes place at national, regional and local levels, making activities and support at these levels essential for the success of THCS. Therefore, the focus lies on connecting and supporting the broad community and other stakeholders in developing ecosystem-wide approaches and creating awareness and urgency among ecosystem layers and components, thus serving as a platform for transformation. One strand of activities for strengthening ecosystems aims at identifying, analysing, describing and disseminating key learnings from successful transformative ecosystems (TE’s). TE’s are broad constellations of interacting organisations and people who are committed, and through aligned actions, able to reach joint, explicitly defined goals in long-term. Making not only the most successful TE’s but also the dynamics explaining their achievements visible, value is being added through three main routes. Firstly, the experiences are distributed widely on European arenas and platforms as well as through national, regional and local channels to inspire ecosystem building processes in earlier stages of maturity. Secondly, collaboration between identified forerunner ecosystems is supported to enable mutual peer-learning. Thirdly, the examples are used to give guidance and inspiration to consortia that are applying for or receiving THCS project funding. As strategic partners of the ecosystem strengthening activities, other work packages of the THCS programme as well as the THCS National Mirror Groups are of great importance.

"I Needed to be That Voice": A Multi-Party Study of the Healthcare and Social Service Experiences and Needs of Transgender and Gender-diverse Older Adults in Canada.

The social contexts of transgender and gender-diverse (TGD) older adults remain under-examined. In this qualitative study, which involved six virtual focus groups with a total of 21 participants inclusive of TGD adults ages 50+, service providers, and community advocates, we sought to examine the healthcare and social service experiences and needs of TGD older adults in Canada. Drawing theoretically on critical gerontology and intersectionality, and methodologically on interpretive description, we examined the perspectives of different participant groups to develop insight into TGD older adults' issues and priorities in the context of their engagements with systems of care. Our findings revealed the role of histories of marginalization, precarity, contemporary sources of intersectional oppression, and resistance in shaping the experiences of this population, while also highlighting community-driven ground-up activities to address evolving needs. Drawing on this conceptualization, we explored the implications of our research for ongoing inquiry, policy, and practice.

Rethinking Intergenerational Living as the Ideal Form of Senior Care: Life Course Research with Immigrant Families in Toronto

Canada’s care systems are ill-equipped to support its aging population, and this crisis intertwines with an acute shortage of affordable housing. Immigrants to Canada have a higher propensity to cohabitate multi-generationally, an arrangement that is sometimes romanticized as an ideal form of senior care. This article contributes to scholarship exploring intergenerational cohabitation as a practice of care, using life course research to consider how class and migration timing shape experiences of intergenerational living and senior care. Based on 19 in-depth interviews with immigrant seniors from Latin America and the Caribbean (n=10) and family caregivers (n=9) living in the Greater Toronto Area, this study uncovers two central findings. First, intergenerational living should not be viewed as an ideal form of senior care since (1a) some seniors resist intergenerational living, preferring independence and downtown residence nearer to culturally relevant communities and (1b) cohabitation does not always provide sufficient or better care. Second, access to smooth multigenerational cohabitation is inequitable, as housing arrangements are structured by class and migration timing, with middle-class families who have been in Canada longer facing fewer barriers to positive experiences of intergenerational living, compared to more recent migrants with lower incomes. This article challenges culturally essentializing assumptions about immigrant intergenerational cohabitation and argues that access to affordable housing is a senior care issue.

Services for perinatal patients with opioid use disorder: a comprehensive Baltimore City-wide 2023 assessment

BackgroundOverdose is a leading cause of maternal mortality; in response, maternal mortality review committees have recommended expanding substance use disorder (SUD) screening, improving collaboration between obstetric and SUD treatment providers, and reducing fragmentation in systems of care. We undertook an analysis of the perinatal SUD treatment landscape in Baltimore, Maryland in order to identify barriers to treatment engagement during pregnancy and the postpartum period and guide system improvement efforts.MethodsWe conducted a survey of seven birthing hospitals, 31 prenatal care practices, and 108 SUD treatment providers in Baltimore from April-June 2023. Organizations were asked to quantify care for perinatal patients with opioid use disorder (OUD) as well as about screening, service availability, referral practices, and support needed to improve care.Results61% of the 145 contacted organizations responded. Birthing hospitals reported caring for pregnant persons with OUD with greater frequency than prenatal care practices or SUD treatment programs. Most birthing hospitals and prenatal care practices reported screening for OUD at intake, but the minority reported using validated tools. Service availability varied by type of organization and type of service. In general, prenatal care practices offered the fewest number of SUD-related services. Most SUD treatment programs that offered buprenorphine or methadone to the general population also offered these medications to pregnant patients. Withdrawal management for comorbid alcohol/benzodiazepine use disorders during pregnancy was more limited. The majority of birthing hospitals and prenatal care practices reported offering neither direct naloxone distribution nor prescriptions. Few SUD treatment programs offered tailored services for perinatal patients or for parents of young children, and many programs do not permit children onsite. Respondents reported high levels of interest in education and consultative support on SUD treatment in pregnancy within obstetric settings and on pregnancy-related medical concerns within SUD programs.ConclusionsThis project provides a comprehensive picture of services available for treatment of perinatal OUD in a major US city. Results have served as a guide for ongoing citywide system improvement efforts by our project team and offer a model for other jurisdictions hoping to strengthen services for perinatal OUD and reduce maternal mortality.

Living less safely through the pandemic in England for people with serious mental and physical health conditions: qualitative interviews with service users and carers of Black African, Caribbean, and South-Asian descent.

COVID-19 Ethnic Inequalities in Mental health and Multimorbidities (COVEIMM) is a mixed methods study to explore whether COVID-19 exacerbated ethnic health inequalities in adults with serious mental and physical health conditions. We analysed data from electronic health records for England and conducted interviews in Birmingham and Solihull, Manchester, and South London. Sites were selected because they were pilot sites for the Patient and Carer Race Equality Framework being introduced by NHS England to tackle race inequalities in mental health. Prior to the pandemic people in England with severe mental illnesses (SMIs) faced an 11-17-year reduction in life expectancy, mostly due to preventable, long-term, physical health conditions. During the pandemic there was a marked increase in deaths of those living with an SMI. This qualitative interview study aimed to understand the reasons underlying ethnic inequalities in mortality and service use during the COVID-19 pandemic for adult service users and carers of Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds living with serious multiple long-term mental and physical health conditions. We took a participatory action research approach and qualitative interviews undertaken by experts-by-experience and university researchers Participants were purposively sampled by ethnicity, diagnoses, and comorbidities across three geographically distinct sites in England. Transcriptions were coded inductively and deductively and analysed thematically. Findings indicated multiple points along primary and secondary health pathways for mental and physical health that have the potential to exacerbate the unjust gap in mortality that exists for Black and Asian people with SMIs. Issues such as timely access to care (face-to-face and remote), being treated in a culturally appropriate manner with empathy, dignity and respect, and being able to use services without experiencing undue force, racism or other forms of intersectional discrimination were important themes arising from interviews. These poor experiences create systemic and enduring healthcare harms for racialised groups with SMIs that need to be addressed. Our findings suggest a need to address these, not only in mental health providers, but across the whole health and care system and a need to ensure more equitable healthcare partnerships with service users, carers, and communities from racialised backgrounds who are often excluded.

Tinjauan Atas Prosedur Pengajuan Hingga Pembayaran Klaim Asuransi Kendaraan Bermotor

The development of the number of vehicles is inseparable from the risk of uncertainty that lurks. Therefore, motor vehicle insurance is present as a place to transfer risk from unexpected things that happen to vehicles, or to parties included in the policy. The accounting information system exists because of the need to monitor business activities. In submitting an insurance claim, a procedure is needed regarding the claim submission flow to facilitate the company and monitor the company's performance. The purpose of this review is to determine the application of the system in the procedure for submitting to paying JP-Astor claims. This research was conducted by the author at PT. Asuransi Jasaraharja Putera Bogor Marketing Office located at Jl. Re. Martadinata Komp. Ruko Sentra Air Mancur No. 2h, Bogor Tengah, Bogor City. The results of the review indicate that PT Asuransi Jasaraharja Putera Bogor Marketing Office has been quite good at carrying out the procedure for submitting to paying JP-Astor claims. The claim submission and claim payment system at Jasaraharja Putera Bogor Marketing Office has helped the work of employees and insured parties, so that they know the extent of the claim process that has been submitted. Accounting Information System implemented through Care System helps companies in registering and remote authorization. Keywords: Submission, Payment, Claim, Motor Vehicle

A study of older women’s lives in India beyond four walls

This paper conducts a comparative and exploratory study on altruistic and pay-to-stay care systems, exploring the intersection of tradition and contemporary society. The research delves into the underlying mechanisms of both care systems, shedding light on the daily lives, challenges, and vulnerabilities of older women residing in care homes. Emphasising the state’s and market’s evolving role in the older care system, the study highlights the relatively recent market invasion. Employing an exploratory and descriptive research design, the sample comprises fifty-six women aged 60 and above in Lucknow city’s (Uttar Pradesh, India) care homes. Given the heterogeneity among women in care homes regarding social and moral values, the study utilises multi-stage random, stratified, and purposive sampling techniques as needed for the analysis. Data had been gathered from two care homes— one not charging residents and another a paid facility catering to lower-middle and middle-income groups. The researcher spent a year and a half working in these homes, conducting interviews with all respondents. The paper uncovers distinctions in care homes based not only on altruism and pay-to-stay but also on caste and class dynamics, contributing to social inequality and limiting social mobility. The stratification of the State and market results in varying quality of life for older women. While the market holds potential for innovation and improved service quality, economically dependent women often defer this choice to their family members. Socioeconomic status significantly influences the decision to lead a dignified life, with some women reluctantly relying on the state for survival after being abandoned by their families, leaving them hapless and hopeless.

Defects in Value Associated With Hospital-Acquired Conditions: How Improving Quality Could Save U.S. Healthcare $50 Billion.

Hospital-acquired conditions in the United States are considered avoidable complications but remain common statistics reflecting on health system performance and are a leading cause of patient fatality. Currently, over 3.7 million patients experience a hospital-acquired condition in the United States each year, which costs the U.S. healthcare delivery system an excess of $48 billion. Evidence-based clinical practice guidelines for common hospital-acquired conditions (e.g., infections, falls, pressure injuries) to reduce risk to the patient. In each of these instances, preventing the outcome with these guidelines costs less than treating the outcome, in addition to keeping the patient safe from harm. By applying the framework of defects in value to hospital-acquired conditions, we estimate that U.S. health systems could avert this $48 billion in spending on treating harmful hospital-acquired conditions; more so, these systems of care could recuperate over $35 billion after investing proportionally in a system that delivers greater quality by preventing hospital-acquired conditions over treating them. Currently, the Centers for Medicare and Medicaid Services only withholds reimbursements for hospital-acquired conditions and penalizes health systems with high rates of these outcomes. However, payers do not offer any reward-based incentives for hospital-acquired condition prevention. A series of policy and health system solutions, including tracking of hospital-acquired condition rates in electronic health records, identifying centers of excellence at reducing rates of harm with the use of clinical practice guidelines, and rewarding them monetarily for reduced rates could create equal-sided risk and opportunity to engage health systems in improved performance.

Effectiveness of mental-health interventions for children and adolescents placed in residential care by the welfare services: A systematic review

BackgroundChildren and adolescents in residential youth care are a vulnerable population with great needs of mental health. PurposeThe present study undertook a systematic review to seek available mental health interventions and investigate its effectiveness. MethodsFollowing PRISMA guidelines, a systematic search was performed for publications between 1992 and July 2023 in seven databases and relevant journals for residential care. Methodological quality was assessed using the Mixed Methods Appraisal Tool. After multi-stage screening, 14 eligible articles were retrieved for analysis and a narrative synthesis performed. ResultsThirteen interventions were identified, predominantly focusing on internalising difficulties, showing congruently positive results mostly on internalised-related outcomes. Most interventions were based on cognitive-behaviour therapy and outdoor-based therapies (surf-, animal assisted, and forest-therapy). Short-term interventions, delivered on a weekly basis in group format, were the most frequent delivery mode. Most studies managed to recruit a comparison group but follow-ups were generally absent. Poor reporting and lack of methodological rigor were common features of the reviewed studies. ConclusionsThis systematic review extends the state of the art regarding psychological interventions in residential youth care. Evidence-based interventions are still needed, and future research should focus on developing and rigorously testing more interventions within this care system.

Efficacy of internet-based cognitive behavioral and interpersonal treatment for depression in Arabic speaking countries: A randomized controlled trial

BackgroundPolitically and economically unstable contexts have been associated with increased prevalence rates of depression. Despite high demand, the availability of mental health experts and care systems is limited in Arabic-speaking countries. Internet-based interventions might provide an opportunity to treat patients independently of location. Therefore, we investigated the efficacy of internet-based cognitive behavioral treatment (iCBT) and interpersonal treatment (iIPT) for depression in Arabic-speaking countries. MethodsIn total, 743 Arabic-speaking adults with depression were randomly allocated to iCBT (n = 243), iIPT (n = 247), or waitlist (n = 253). Depressive, anxiety, and somatoform symptoms, perceived social support and quality of life (QoL) were assessed at pre-, and post-treatment and at three months follow-up. Multiple imputation was performed for missing data. Changes associated with treatment were analyzed using regression in the completer and intention-to-treat sample. ResultsParticipants in both treatment groups showed lower depressive and anxiety symptom severity, higher QoL, and perceived social support compared to the waitlist group (p < .001). Somatoform symptom severity was significantly lower in participants receiving iIPT compared to waitlist (p < .001). Differences between the two treatments in all outcomes were non-significant (p > .05). Three-month follow-up treatment effects regarding depressive symptoms were indicated. LimitationsThe sample mainly consists of educated, single, female adults. Three-month follow-up results rely on a small subsample and must be interpreted with caution. ConclusionsThis is the first randomized controlled trial to demonstrate the efficacy of iCBT and iIPT for depression in Arabic-speaking countries. It provides first indications that internet-based interventions might help specific individuals in this region.

The Networked Data Lab: lessons from four years of analytical collaboration on common problems in health on social care

ObjectiveThe Networked Data Lab (NDL) is a UK-wide network of analytical teams embedded in the health and care system. Each year, we support five local partners to acquire and link new health and social care datasets on a different topic. The NDL provides insights from this linked data to help UK policymakers improve health and care, leveraging public, patient, and stakeholder engagement to prioritise topics of shared local interest. Approach Now in its fourth year, the NDL has commissioned a Learning Study (LS) to evaluate progress towards its aims. This employs a theory-based approach to test and assess key assumptions about programme impact through a Theory of Change. For the study, semi-structured interviews with analysts and stakeholders at the five NDL sites were conducted to identify factors influencing the programme’s impact. ResultsDrawing on interim LS findings, we will describe the types of impact the programme has achieved, and some of the key barriers and enablers to analytical collaboration across geographic and organisational boundaries. Themes include senior sponsorship; stakeholder input into problem definition; information governance and tools and skills. Themes will be illustrated with case studies drawn from the different NDL topic areas, including children and young people’s mental health and unpaid carers. Conclusions and ImplicationsThe Networked Data Lab shows that data linkages can provide unique insights that local service planners can act on, but highlights a complex set of conditions that need to be met to enable impactful analytics using real-world health and care data.

Disabilities in children receiving care and support in Wales and risk factors associated with being placed in care: A population-based data linkage study

ObjectiveTo determine the prevalence of functional impairments in children with disabilities receiving care and support in Wales between 2016 and 2022, and to investigate risk factors associated with being placed in care amongst these children. MethodThis study used Children Receiving Care and Support (CRCS) Census records held in the Secure Anonymised Information Linkage Databank. We examined the proportion of children with specific impairments by their looked-after status, using bar charts and Upset plots. CRCS records were linked to demographic datasets to obtain information on area-level deprivation, and we conducted multivariable logistic regression analyses to model risk factors associated with being placed in care for children with disabilities. ResultsOf 38,165 children receiving care and support, 10,075 (26%) had a disability, and 3,360 (33%) of these children were placed in care. Older children were less likely to be placed in care than infants (e.g. for age group 1‒4: OR 0.37 (95% CI 0.24‒0.56)). Children of mixed ethnicity were more likely to be placed in care compared to White children (2.17 (1.65‒2.85)). Child mental health problems were associated with being placed in care (1.82 (1.60‒2.07)) as were parental mental health problems (1.44 (1.29‒1.60)), parental substance/alcohol misuse (3.16 (2.81‒3.56)), parental learning disability (2.92 (2.51‒3.38)), and domestic abuse (1.48 (1.31‒1.66)). ConclusionsThis new evidence may assist in the planning and provision of appropriate ongoing care and support for these children and their families to help prevent entry into the care system.

The Networked Data Lab: using linked data to understand intermediate care services in the United Kingdom

Intermediate care (IC) is short-term care aimed at maximising patients’ independence. Across the UK, scaling up IC is included in post-pandemic recovery plans. This could reduce pressures on acute services through timely discharge or preventing admissions. The issues IC seeks to address are common across high-income countries. The Networked Data Lab is a network of analytical teams embedded in the UK health and care system. Each year, we support five local partners with acquisition, linkage and analysis of health and social care datasets. Our 2023-24 project is focused on IC. Patients and the public (PP) played an integral role in throughout our project. We established a panel of individuals with lived experience of IC to assist with the research questions, interpretation, and communication of results. Our partners all consult PP in their areas to inform their analyses. Our partners’ analyses of linked patient-level data on IC will provide information about who is receiving IC, changes over time and outcomes for patients. We are also analysing national linked data for England on intermediate care following hospital discharge. Preliminary results include: The age and health needs of people receiving bed-based intermediate care has increased over time (Grampian, Scotland) Intermediate care following a hospital admission is more common for emergency admissions than elective admissions (Leeds, England) Large variation in intermediate care delivery between neighbouring boroughs (North West London, England) Full results are expected in April 2024. Our work highlights the importance of linking data to answer important health and care questions.

United States Veterans' Utilization of Spinal Cord Injuries and Disorders Annual Evaluation Services

ObjectiveTo evaluate Veterans’ engagement in spinal cord injury and disorder (SCI/D) specialty annual evaluations (AEs). DesignCross-sectional retrospective cohort study. SettingSCI/D System of Care, United States Department of Veterans Affairs (VA). ParticipantsVeterans with SCI/Ds (N=14,662). InterventionsNot applicable. Main Outcome MeasuresReceiving SCI/D AEs during the study period (fiscal years [FY] 2019 and 2020). ResultsA total of 14,662 Veterans with SCI/Ds were included in the sample; 32.8% (n=4811) received 2 AEs, 28.8% (n=4219) received 1 AE, and 38.4% (n=5632) received no AEs, with an average of 0.9 AEs per Veteran over the 2-year study timeframe (range, 0-2y). Black Veterans had an 8% higher number of AEs than White Veterans after adjusting for other variables (adjusted relative risk [RR], 1.08; 95% confidence interval [CI], 1.04-1.12). Veterans who lived ≥240 minutes away from a VA SCI/D System of Care Center had 45% fewer AEs than Veterans who lived within 30 minutes (adjusted RR, 0.55; 95% CI, 0.52-0.59). Veterans with more SCI/D specialty visits had 90% more AEs than those with fewer visits (adjusted RR, 1.90; 95% CI, 1.78-2.03), whereas Veterans with more outpatient visits in VA primary care had 28% fewer AEs (adjusted RR, 0.72; 95% CI, 0.69-0.76). Veterans with higher comorbidity scores had 9% more AEs than Veterans with lower scores (adjusted RR, 0.66; 95% CI, 0.61-0.70). ConclusionsMore than half (62%) of Veterans received ≥1 SCI/D AE during FY19-20. Veterans living closer to a VA SCI/D System of Care Center/Hub had more engagement in SCI/D AEs. Veterans with SCI/Ds who used VA primary care outside of the SCI/D System of Care had fewer AEs. There were no major racial, age-based, or sex disparities in SCI/D AE usage. Our findings suggest the need for targeted intervention efforts to promote AE use among Veterans.