Introduction Based on the principles of DRG, this study aimed to analyze the current status and existing problems in the clinical use of high-value medical consumables for certain specialized diseases in orthopedics and cardiovascular medicine, and propose application standards and targeted management strategies.Methods DRGs involving the use of high-value medical consumables in orthopedic total hip replacement and cardiovascular percutaneous coronary drug-eluting stent implantation were selected. Data from all patients within these groups were extracted, and the total hospitalization costs and high-value medical consumable costs were calculated for each patient. The cost structure of consumables was analyzed in relation to DRGs payment standards, and the related differences were evaluated.Results Within the same DRGs, the average proportion of high-value medical consumable costs in orthopedics and cardiovascular medicine were 43.12% and 62.02%, respectively. Compared to the DRG payment standards, a high percentage of cases in orthopedics and cardiovascular medicine exceeded the total cost, that rates of 81.56% and 77.41%, respectively, and were the main drivers of total hospitalization costs.Conclusion DRG can be used to evaluate the use of high-value medical consumables, which would lay the foundation for establishing reasonable standards for the proportion of consumable costs in specialized diseases.
Pain and symptoms related to illness are among the main reasons for seeking healthcare services, primarily communicated with language. However, linguistic expressions often pose significant challenges in diagnosing and treating illnesses effectively for healthcare professionals. Despite the importance of this issue, there is a notable lack of studies examining the impact of linguistic expressions in pain communication and illness diagnoses. We address this gap by examining the importance of linguistic expressions of pain and symptoms in the diagnostic and treatment process according to healthcare professionals' perceptions. Data were collected through in-depth interviews with 23 healthcare professionals. A descriptive phenomenological approach was employed to explore the significance of linguistic expressions in the diagnostic and treatment process. Five key themes emerged from the data: (i) language barriers to symptom expression and understanding, (ii) expressing pain in culturally sensitive language, (iii) emotional and psychological support for patients, (iv) the patient's use of medical jargon, and (v) gendered aspects of pain and illness and their communication. Our findings suggest the potential value of employing psycholinguists, particularly in multilingual and multicultural settings, to bridge communication gaps. This area of inquiry holds promise for improving healthcare outcomes in diverse and multilingual communities.
Background: Healthcare professionals play a central role in organ and tissue donation, particularly in intensive care settings, where donor identification and family communication are critical. Aim: To translate, culturally adapt, and evaluate the psychometric properties of the Italian version of the Donor Action Hospital Attitude Survey among intensive care professionals. Methods: A multicentre cross-sectional validation study was conducted in intensive care units in Italy. The survey was administered to nurses and physicians. Content validity was assessed using the Content Validity Index. Structural validity was examined through exploratory factor analysis, and reliability was evaluated via internal consistency and test-retest analyses. Construct-related validity was assessed through hypothesis testing. Results: A total of 553 professionals participated. Items showed satisfactory content validity (I-CVI >= 0.80; S-CVI = 0.96). Exploratory factor analysis supported a three-factor structure (i.e., attitudes, confidence, and training). Internal consistency and temporal stability were acceptable. Professional experience and age were associated with more favorable attitudes and greater knowledge. Involvement, operationalized as experiential exposure and perceived appropriateness of communication timing, was associated with confidence and related domains, supporting construct-related validity. Conclusions: The Italian version of the survey demonstrates adequate validity and reliability for assessing professional domains related to organ and tissue donation.
While leadership quality is a key factor for retention in healthcare, it remains unclear whether formal leadership qualifications are associated with leadership quality in practice. This study examined the association between leadership qualifications and leadership quality, while jointly considering employees' and leaders' working conditions in Switzerland. This cross-sectional secondary analysis included 1,942 employees and 118 leaders from 22 healthcare organizations. Leadership quality and psychosocial job demands and resources were assessed using COPSOQ and EWCS scales. Linear mixed-effects models were estimated to examine associations. Leadership qualifications were not associated with perceived leadership quality. In contrast, several employee-reported job demands and resources were associated with leadership quality. Higher quantitative (B = -0.41) and emotional demands (B=-0.12), insecurity of the working environment (B=-0.27), and unfair behaviour (B = -0.07) were associated with lower leadership quality, whereas social support (B = 0.56) and rewards (B = 0.16) were positively associated (all p < .001). Leaders' own job demands were not associated with perceived leadership quality. The findings suggest that leadership quality in healthcare is shaped more by employees' working conditions than by formal leadership qualifications. Improving leadership quality therefore requires addressing organizational and psychosocial work environments alongside individual leadership development.
Medical errors remain a significant threat to patient safety, and organizational silence may influence nurses' willingness to report errors or raise safety concerns. This study aimed to examine how nurses' organizational silence behaviors, along with their sociodemographic and work-related characteristics, are associated with their attitudes toward medical errors. A cross-sectional descriptive and correlational study was conducted in a public hospital in T & uuml;rkiye between February and June 2023. The sample comprised 208 nurses. Data were collected using a sociodemographic questionnaire, the Organizational Silence Behavior Scale, and the Scale of Attitudes Toward Medical Errors. Descriptive statistics and multiple linear regression analysis were used. Overall, nurses reported a generally low level of organizational silence, and among the different types of silence, acquiescent silence was the most pronounced. Their attitudes toward medical errors were broadly positive. The regression analysis showed that silence due to fear, gender, and shift type were significant predictors of attitudes toward medical errors. These findings highlight the importance of fostering psychologically safe environments, reducing fear-driven silence, and supporting open communication to strengthen patient safety practices. Organizational strategies that encourage reporting, ensure supportive leadership, and address shift-related fatigue may improve safety outcomes.
IntroductionOrganization-wide culture change programs (OWCCP) implement initiatives across multiple sites, services, and work groups. Yet, there is considerable variability in sustaining OWCCP in healthcare. This study aimed to identify the factors that organizational leaders perceive as influencing the embedding of OWCCP across clinical and non-clinical services and settings in healthcare.MethodData was collected through semi-structured interviews with 21 organizational healthcare leaders in clinical and non-clinical settings. Reflexive thematic analysis was employed to analyze data and identify key themes from the interview transcripts.ResultsThis study demonstrated the unique application of Normalization Process Theory (NPT) in a non-clinical setting and defined 12 key factors that influence the embedding of OWCCP in healthcare. The influencing factors included (1) Program governance - measurement and reporting; leadership; defined roles and accountability; process and systems; (2) People factors - resources; training; perceived benefits; and (3) Contextual factors - external environment; communications; stakeholder engagement; adaptive program; and alignment with organizational culture.ConclusionThis study demonstrated the unique application of NPT in a non-clinical setting and defined key factors that influence the embedding of OWCCP in clinical and non-clinical settings in healthcare.
In an ageing society, the demand for medical care is rising in many developed countries. However, medical resources such as doctors and nurses are limited, and healthcare systems vary significantly across nations, making a universal solution elusive. In Japan, small and medium-sized hospitals face staffing shortages, necessitating improvements in management capabilities. While research has been conducted on hospital operations and marketing separately, studies integrating marketing and operations for small hospitals are scarce. This study examines a case of a small rural hospital, revealing that bed occupancy rates are crucial for aligning marketing and operations. It identifies the bed occupancy rate as a key performance indicator (KPI) that connects these two domains.
In today's world of intense competition, patient loyalty has become a critical factor for hospitals to sustain their existence and gain competitive advantage. The present study aims to reveal the mediating role of corporate reputation in the effect of patient-physician communication on patient loyalty. The research data were obtained from individuals residing in & Idot;stanbul, T & uuml;rkiye, who received services from private hospitals in the last year and were 18 years of age and over, through an online survey. The research results indicated that patient-physician communication positively affected corporate reputation. It indicated that patient-physician communication and corporate reputation positively affected patient loyalty. It also showed that corporate reputation had a mediating role in the effect of patient-physician communication on patient loyalty. As a consequence, the present study exhibited that patient-physician communication and corporate reputation are predictor factors of patient loyalty.
Objective To explore the potential value of a modified ROX index incorporating heart rate (HR-ROX) for early risk stratification of extubation failure in patients with pneumonia-induced acute respiratory failure receiving HFNC after extubation. Methods This retrospective, single-center observational study included patients admitted to the ICU with pneumonia-induced acute respiratory failure who required endotracheal intubation and received HFNC immediately after extubation. According to reintubation within 72 h, patients were classified into extubation success (n = 57) and failure (n = 43) groups. ROX index and heart rate were recorded at predefined time points before and after extubation. The HR-ROX index was calculated as ROX divided by heart rate and multiplied by 100. Receiver operating characteristic (ROC) analysis was used to assess discriminatory performance. Results HR-ROX demonstrated moderate discriminatory performance at multiple post-extubation time points. The AUROC values of HR-ROX at 6 and 12 h were 0.76 and 0.77, respectively. In exploratory multivariable logistic regression adjusting for age, SOFA score, and APACHE II score, lower HR-ROX at 6 h remained independently associated with extubation failure (OR 2.61, 95% CI 1.42-4.77, P < 0.001). Conclusion HR-ROX may provide modest incremental value for early risk stratification of extubation failure in pneumonia-induced respiratory failure patients receiving HFNC after extubation.
This study aims to determine the prevalence and associated sociodemographic factors of metabolic syndrome among healthcare workers (HCWs) in a government medical research institute in Klang Valley, with a focus on gender-specific differences. A cross-sectional study was carried out in 2023, involving 990 healthcare workers. Metabolic syndromes were defined based on the 'Harmonised' criteria, and any individual exhibited at least three of the standard five risk factors. Descriptive analysis, bivariate and multivariable logistic regression were conducted using IBM SPSS version 25.0. The overall prevalence of metabolic syndrome was 19.5%, higher in males (25.3%) compared to females (17.4%), P = 0.007. The multivariable logistic regression analysis identified lower education (aOR = 2.31, 95% CI: 1.47, 3.64), age 35 and above (aOR = 1.59, 95% CI: 1.09, 2.33), and male HCWs (aOR = 1.52, 95% CI: 1.02, 2.26) as the most significant factors associated with metabolic syndrome among HCWs. Gender-specific findings showed that the significant factors for metabolic syndrome among female HCWs were older age, lower education, and family history of hypertension. Metabolic syndrome is prevalent among HCWs in this study and reveals significant gender differences for prevalence and the associated factors. These findings highlight the importance of gender-specific strategies in addressing metabolic health risks.
Substance use disorder (SUD) is a major public health concern among U.S. adolescents. The patient-centered medical home (PCMH), emphasizing coordinated, comprehensive, and continuous primary care tailored to patient needs, has emerged as a promising model for integrating behavioral health. Yet, little is known about its association with adolescent SUD. This study examined the relationship between PCMH receipt and SUD among adolescents (N = 30,629; ages 10-17) from the combined 2018-2019 National Survey of Children's Health. Propensity score matching using a 1:1 nearest neighbor algorithm was applied to reduce potential selection bias between adolescents who reported receipt of PCMH and those who did not. A weighted logistic regression was conducted in the matched sample, adjusting for covariates guided by the Andersen Model of Healthcare Utilization. A balanced matched sample containing 25,576 participants was achieved (imbalance test: chi(2) = 7.09, d.f. = 6, p = 0.312), suggesting that potential selection bias was reduced. Adolescents reporting PCMH receipt had significantly lower odds of current SUD status (OR = 0.46, p < 0.01). Findings highlight the behavioral health benefits of PCMH and its relevance for early SUD prevention. Primary care providers may play a crucial role through screening and coordinated care. Efforts to address implementation barriers are warranted to improve adolescent behavioral health outcomes.
Objective: This study explores the role of General Practitioners (GPs) in managing patients' medication information in Norwegian municipalities, focusing on their responsibilities and interactions with other healthcare professionals. It also examines how GPs' roles are perceived by nurses and physicians in municipal healthcare to identify areas to improve medication information sharing. Methods: A qualitative approach was employed, involving semi-structured interviews with GPs (n = 2), a medical doctor (n = 1), and nurses (n = 5) in a Norwegian municipality implementing the Shared Medication List (SML). Data were analyzed using reflexive thematic analysis. Findings: The analysis revealed three main themes: (1) Lack of information sharing infrastructure, highlighting fragmented digital systems hindering accurate medication management. (2) Division of labour and responsibility, with GPs often acting as intermediaries between healthcare professions. (3) Expectations of the SML, with professionals anticipating improved information sharing but expressing concern about changing responsibility for updating the medication list. Concerns were also raised about maintaining GPs' primary role in ensuring medication accuracy and preventing errors. Conclusion: GPs currently play a critical intermediary role in medication information management within a fragmented digital infrastructure. While the SML is expected to improve information sharing, unresolved issues related to responsibility and workflow remain key concerns prior to implementation.
This study examines the convergence hypothesis of the maternal mortality rate (MMR), which posits that countries with higher MMR are converging with the lower MMR countries, using UNICEF data from 2000 to 2017. Specifically, this study examines two types of convergence. First, it examines stochastic conditional convergence in MMR by testing the stationarity property of regional MMR gaps relative to global MMR. Specifically, the MMR gap is defined as the difference between a region's maternal mortality rate and the world MMR. If this gap is stationary, shocks to maternal mortality are temporary, and the region exhibits stochastic conditional convergence towards the global MMR. Conversely, a non-stationary MMR gap indicates persistent divergence. Stationarity test results indicate no convergence, except in Sub-Saharan Africa and Eastern and Southern Africa. Secondly, this study aims to investigate the club convergence, which refers to the phenomenon where countries do not all converge to a single steady state but rather form distinct 'convergence clubs'. The Phillips & Sul [Transition Modelling and Econometric Convergence Tests. Econometrica. 2007;75:1771-1855. https://doi.org/10.1111/j.1468-0262.2007.00811.x] approach is applied to examine club convergence. The results show no evidence of overall convergence for the full sample; rather, two convergence clubs are noted. Our findings suggest that the African region needs stronger health systems to maintain low MMR levels.
BackgroundPrivate Emergency Medical Services (EMS) workers play a critical role in providing pre-hospital care during medical emergencies. This study assessed the key daily stressors faced by such EMS personnel and their sense of coherence (SOC).MethodsAn exploratory qualitative approach was used in this study using semi-structured ono-on-one interviews with current employees of an EMS agency that provides 911 services. After the interviews, the participants were administered a survey to assess their SOC. Both Paramedics and Emergency Medical Technicians (EMT) were invited to participate.ResultsWe identified five overarching categories of stressors: (1) Management and Workplace Culture, (2) Structural Support and Resources, (3) Job Tasks and Physical Barriers, (4) Mental Health Challenges and Resources, and (5) Co-Worker Interactions and Team Dynamics. The cumulative effect of these stressors significantly impacted EMS workers' SOC. Many reported feeling unsupported by management, inadequate staffing, physical exhaustion, and insufficient mental health resources. Survey data corroborated these findings, with 100% of respondents feeling unfairly treated, and 88% reporting low self-worth.ConclusionThe findings highlight the significant challenges faced by EMS personnel and the critical need for improved organizational support and resources to enhance their SOC and overall well-being.
This study investigates the impact of key Customer Relationship Management (CRM) elements on the resilience of hospital networks. The research identified dimensions of organizational resilience through qualitative analysis of Delphi method interviews using MAXQDA24 software. Subsequently, Structural Equation Modeling (SEM) with Partial Least Squares (PLS) in SmartPLS3 was employed to test the proposed model. The findings reveal that CRM has a positive and significant impact on organizational capabilities, which in turn positively influences risk management. Risk management significantly enhances hospital resilience. Key elements such as customer knowledge management, CRM-based technology, innovation, adaptability, and flexibility were identified as crucial. The results demonstrate that improving CRM and organizational capabilities can indirectly boost hospital network resilience by strengthening risk and crisis management practices. The study proposes a comprehensive model to enhance resilience, offering valuable insights for managers and policymakers to improve hospital performance during crises.
The anticipated sales volume of pharmaceuticals displayed noticeable patterns. Based on the observed patterns, it is recommended that pharmaceutical companies consider adapting their distribution and logistics strategies in order to effectively meet market demands during periods of increased demand. Seasonal variations have an impact on the pharmaceutical supply chain, which exert a significant impact on various stages ranging from manufacturing to distribution. The present research uses the ORGNF (Optimized Random Forest Gradient Boosting Nelder Fusion) model to forecast the demand for pharmaceutical medications in 2024. With an RMSE of 5.70 and an R2 score of 73.79%, this model outperformed individual models. According to the data, we observed a direct relationship between the need for seasonal medicine and the rates of disease recurrence, with observable spikes in demand happening during particular months. Surprisingly, the sales of medications used to treat common ailments had little impact on the sales of other types of drugs, offering strong proof of the market's ability to meet demand on its own. With the use of professional marketing, the pharmaceutical business is able to maximize budget allocation.
