A state of war has the potential to profoundly disrupt routine, essential ambulatory hospital services, negatively impacting both acute hospitalizations and continuity of care. During June 2025, a war ignited between Israel and Iran, causing multiple casualties and substantial damage to essential healthcare facilities. This study examined the impact of the war on ambulatory visit volumes at Israel’s largest tertiary medical center and assessed the contribution of telemedicine encounters to mitigating conflict-related disruptions. This is a retrospective analysis of ambulatory service data collected at Sheba Tel HaShomer Medical Center between June 13 and June 24, 2025, compared to the corresponding period in the previous years (2021–2024), with a focus on the methodologies and managerial decisions implemented. We conducted an interrupted time series analysis using annual outpatient data from matched dates in 2021–2025. We modeled the proportion of visits delivered via telemedicine using segmented linear regression, incorporating calendar year as a continuous time variable and an indicator marking the onset of the 2025 regional war to estimate the immediate change in telemedicine use, adjusted for pre-war trends. Between June 13 and 24, 2025, Sheba Medical Center conducted 53,158 ambulatory visits, of which 9,478 (17.8
Israel’s community water fluoridation policy, mandatory from 2002 until its halt in 2014, provides a natural experiment to assess fluoridation’s impact on pediatric oral health. This retrospective study analyzed digital dental records of 12-year-old children (2014–2022) to assess changes in caries experience following community water fluoridation cessation. We examined the Decayed, Missing, and Filled Teeth index, focusing on its Missing-and-Filled (MF) component, across socioeconomic status groups, gender, and fluoridation status (fluoridated vs. non-fluoridated). Differences were assessed using one-way Welch ANOVA and post-hoc Games-Howell tests. The MF index increased significantly after fluoridation ended, especially in low-SES populations. Twelve-year-olds in low-SES communities without fluoridated water had more than double the caries experience of those in high-SES communities (mean MF 0.82 vs. 0.40; p < 0.05). Fluoridated communities showed a considerably narrower SES gap. SES had a large effect on caries outcomes (partial η²≈0.34), and the absence of fluoridation was associated with a modest but significant increase in MF (partial η²≈0.01). Females exhibited higher MF rates than males, with gender disparities more pronounced in non-fluoridated groups. Cessation of CWF was associated with a rise in caries and widened SES and gender disparities, underscoring fluoridation’s value in promoting oral health equity. CWF remains a foundational public health measure, one that is unequaled in its ability to deliver effective, safe, equitable, and cost-saving caries prevention to entire populations. Reinstating mandatory community water fluoridation is essential to reverse the widening oral health disparities that disproportionately affect low-SES children and females. Policymakers must prioritize this measure to restore health equity and protect vulnerable populations who rely on this passive preventive intervention.
Adolescents often navigate complex psychological, behavioral, and identity-related challenges, yet many do not seek the mental health support they need. Sexual minority youth face additional identity-based barriers that further hinder access to care. A sample of 1,129 Israeli adolescents aged 16–18 (M = 17.42, SD = 1.03), including 30
Israel faces a growing need for medical professionals due to population growth and aging, yet the number of licensed physicians per capita remains below the OECD average. The gap is particularly evident in the number of medical specialists. One factor contributing to this shortage may be the delay between medical licensure and the commencement of residency training. The objective of this study was to assess the extent to which delays in the commencement of residency programs occur, to identify and analyze barriers that delay the start of residency training among newly licensed physicians in Israel, and to explore possible solutions to optimize this process. This mixed-methods study included a quantitative analysis of administrative datasets from the Israeli Ministry of Health (n = 18,480), and qualitative analysis based on 31 semi-structured interviews conducted with department heads, residents, and residency candidates between January and August 2023. Despite a steady increase in the number of licensed physicians, the median time between licensure and the start of residency has remained constant at approximately four months. According to interviewees’ accounts in the study, delays were often associated with inconsistent and opaque admission processes, regional disparities in hospital demand, and mismatched expectations between candidates and departments, and could in part be explained by the absence of a centralized residency allocation system. Factors such as elective choices during internship and geographic location further influenced the timeline. Interviewees did not commonly report postponing residency for personal reasons. Delays in residency placement, compounded by inefficient workforce allocation, may reduce the effective capacity of the healthcare system. A more transparent and structured national framework - similar to those in the US, Canada, and Spain - could help streamline the process and reduce inefficiencies. Policy recommendations include improved data transparency, standardization of admission criteria, and better support for hospitals in peripheral regions. Establishing a unified, annual data reporting system on the physician workforce is a necessary prerequisite for any effective reform or national workforce planning.
Social media has evolved significantly as a platform for healthcare communication, education, and consultation, especially following the COVID-19 pandemic. While these platforms are increasingly used for medical advice, they operate largely outside formal health policy frameworks, creating a growing “informal layer” of healthcare. A cross-sectional observational study was conducted using an anonymous online questionnaire distributed to the “Ask an M.D.” group members from April to July 2023. Demographic characteristics, consultation patterns, motivations for using the platform, and comparisons between users from central and peripheral regions of Israel were analyzed, to identify potential disparities in digital health access. Of approximately 19,000 members who viewed the survey, 1,508 responded (8
Abstract Background Dental unit waterlines (DUWLs) are susceptible to microbial contamination because of biofilm formation within their complex water delivery systems. Although the US CDC and several professional organizations recommend maintaining dental treatment water at potable water quality, Israel currently lacks specific national standards and regulatory requirements for monitoring and maintaining DUWLs. This study assessed the prevalence of Legionella and other microbial contaminants in DUWLs across dental clinics in central Israel and examined factors associated with contamination to inform patient and dental stuff safety and national policy development. Methods This survey included 52 randomly selected dental clinics, with 359 water samples collected from DUWL components and water sources. Samples were tested for Legionella spp., Legionella pneumophila , Pseudomonas aeruginosa , and heterotrophic plate count (HPC). Water quality indicators - residual chlorine and turbidity were also measured. Statistical analyses were used to explore associations between microbial and common water quality and clinic characteristics. Results Of the clinics tested, 94% exhibited at least one abnormal water quality result. Legionella exceeded the threshold in 74% of samples, Pseudomonas in 25%, and HPC in 53%. Contamination was most frequent in turbine and syringe connectors. Low chlorine levels and high turbidity were significantly associated with increased microbial counts. Legionella pneumophila concentrations above 2,500 GU/L were found in 19% of Legionella -positive samples. No consistent effect of dental chair age or clinic operating frequency was observed. Conclusions The widespread microbial contamination identified in Israeli dental unit waterlines represents a potential patient and occupational health concern and highlights an important regulatory gap in the oversight of dental water quality. These findings support the need to develop national standards for DUWL monitoring, maintenance, and treatment, together with routine surveillance and regulatory oversight, to improve patient safety and ensure safe dental care environments.
As populations age, changing living conditions and declining self-advocacy often create barriers to essential care. Mobile Geriatric Teams (MGTs) offer a potential solution by providing assessments within a patient’s regular environment, potentially reaching underdiagnosed and undertreated individuals who struggle to access routine healthcare. The aim of this study was to evaluate the clinical impact and reach of MGTs in the Northern District of Israel. Specifically, we aimed to assess the extent of MGT-initiated Comprehensive Geriatric Assessments and compare therapeutic and diagnostic outcomes between patients seen by MGTs and those receiving standard community-based geriatric consultations. This is a retrospective, data-based study serving as a proof-of-concept evaluation for MGT implementation in Israel. The intervention was implemented in MHS between January 1, 2020, and December 31, 2023, and data were collected 3 and 6 months after the MGT appointment. Group comparisons were conducted using chi-square tests, Fisher’s exact tests, and Wilcoxon rank-sum tests. In addition, we performed matched logistic regression models. A total of 8,152 individuals were included in the study; 4,348 were assessed by MGTs. The MGT group participants were slightly older and had a higher proportion of males and a lower SES category than the comparison group. The MGTs group had fewer diagnoses of mild cognitive impairment, dementia, and depression, compared to the comparison group. They also had more diagnoses of orthostatic hypotension, and they were more likely to be assessed for fall risk. The MGT group was also prescribed fewer medications in the months following the assessment. After the MGT intervention, we report an increase in primary care visits in the relevant population in the district where it was implemented, while the comparison group did not have a corresponding trend. In this study, we demonstrated that MGTs can reach a specific subpopulation of the elderly who might not otherwise undergo a geriatric assessment, primarily males, those of low SES, and possibly those with less urgent health concerns. These findings highlight the complementary role of MGTs in increasing accessibility, promoting equity, and addressing unmet needs in populations less likely to seek care on their own.
Emergency medical services (EMS) in conflict-affected settings face compounding operational demands, making organizational resilience (OR) a critical institutional asset. Israel’s EMS have operated under ongoing security pressures for decades, intensified dramatically following the 7 October 2023 attacks. Despite growing recognition of OR as a measurable and modifiable property, longitudinal interventional evidence in pre-hospital settings remains sparse. This study reports the development and three-time-point evaluation of a targeted intervention program designed to enhance OR within Israeli EMS. A three-time-point quasi-longitudinal interventional study was conducted within a single EMS: T1 (pre-intervention baseline; n = 196), T2 (post-intervention; n = 205), and T3 (six-month follow-up; n = 172). OR was measured using the validated seven-domain Organizational Resilience Questionnaire (ORQ). The 70-hour intervention - comprising structured training (30 h, 4 weeks) and organizational embedding (40 h, 24 weeks) - was delivered by internal Resilience Trustees. OR changes were examined using one-way ANOVA with Bonferroni-corrected comparisons (Cohen’s d) and independent-samples t-tests (α*=0.005). Sequential multivariable regression (pooled n = 573) and ANCOVA identified independent OR predictors and examined OR changes after covariate adjustment. Composite OR increased significantly from T1 to T2 (Δ=+0.20; p = 0.018; d = 0.27), with a Bonferroni-corrected significant gain in situational awareness (Δ=+0.25; p < 0.001), with additional gains in adaptive capacity (Δ=+0.21; p = 0.006) and learning processes (Δ=+0.23; p = 0.006) reaching conventional but not Bonferroni-corrected significance. OR continued to rise at six-month follow-up (T1 mean = 3.86; T2 mean = 4.06; T3 mean = 4.09; Δ T1→T3 = + 0.23; p = 0.007; d = 0.32). The time effect remained significant after full covariate adjustment (ANCOVA: F = 7.41; p = 0.001; ηp²=0.026), with paramedics showing greater gains (+ 0.27) than other staff (+ 0.05; Time × Profession: p = 0.046). Transformational leadership, employee well-being, and technological advancement were the dominant OR predictors (pooled R²=0.770; β = 0.458, 0.274, 0.208, respectively; all p < 0.001). A structured, domain-targeted OR program was associated with significant, domain-coherent resilience gains that progressively consolidated under protracted conflict conditions. The ORQ and the Resilience Trustee model — for which the present study provides preliminary effectiveness evidence — together offer a promising framework for OR strengthening in EMS organizations confronting chronic operational disruption, with implications for national and global emergency health policy.
Abstract Background Arabs in Israel, comprising about 21% of the population, are recognized as an indigenous minority with full citizenship rights, yet they face persistent structural disadvantages compared to Jewish citizens. These disparities are evident across socioeconomic, educational, employment, and health domains. High poverty rates, particularly among women, children, and the older adults, are aggravated by limited governmental investment in infrastructure, education, and health services. Arab women’s labor force participation remains notably low due to systemic barriers. Extensive evidence links socioeconomic status with health outcomes and behaviors. This study examines how sociodemographic factors and health knowledge are associated with economic status, self-rated health, and health behaviors among Arabs in Israel. Methods This cross-sectional study utilized data from the 2015–2016 Health and Environment Survey among Arabs in Israel (HESPI). Employing a three-stage stratified cluster sampling of over 2,000 households, face-to-face interviews gathered socio-demographic, economic, and health-related data. The final sample included 2,041 adults representing diverse socioeconomic and geographic groups within Arab communities. Results Approximately half of participants lived below the poverty line (51.7%). Those with lower economic status exhibited poorer self-rated health (p<.001, d = 0.22), higher prevalence of chronic illness (p=.009, d = 0.13), and lower engagement in physical activity (p<.001, d = 0.29), while smoking and BMI did not significantly differ by economic status. Family size moderated the relationships between economic status and both chronic illness (p<.001, 95%CI = 1.33, 2.19) and SRH (p<.001, 95%CI = -0.33, -0.13), indicating that smaller families are less likely to experience these negative effects of low economic status. Educational attainment slightly moderated the link between economic status and physical activity (p=.016, η2 = 0.003). Regression analyses revealed that gender, age, education, and health knowledge were significantly associated with health outcomes and behaviors (R2 = 0.10 to R2 = 0.43), with health knowledge mediating several of these associations. Conclusions The findings indicate that poverty is associated with poorer health outcomes and behaviors among Arabs in Israel. Smaller family size and higher education may mitigate the negative effects of poverty, and health knowledge plays a mediating role for health outcomes and behaviors. Findings suggest that socioeconomic empowerment and higher education are important in promoting health equity.
Abstract Background Monitoring developmental milestones is essential for identifying at-risk populations and for guiding effective intervention programs. Our previous report examined milestone attainment among Israeli children from 2016 to 2020. Using a similar methodology, this study analyzes trends in developmental milestone attainment in the Israeli population from 2019 to 2024, with primary focus on 2019 to 2023 because of changes in evaluation policy. This follow-up report complements the earlier analysis by providing updated estimates for the post-COVID period and enabling assessment of temporal trends and potential changes in socioeconomic and regional disparities that could not be evaluated previously. Methods The dataset included over 1 million children with more than 5 million developmental assessments conducted at Maternal and Child Health Clinics (MCHCs) across Israel. These assessments were used to calculate failure rates across four developmental domains: language, social, gross motor, and fine motor skills, along with parental concern about child development. Data were stratified by maternal characteristics, such as age, education, employment, and marital status, and by family sociodemographic factors, including ethnicity, degree of Haredi observance and socioeconomic status. We applied multivariable logistic regression to estimate associations between sociodemographic factors and the odds of failure to attain milestones, while controlling for confounding. Results A mild overall increase in milestone failure rates was observed from 2019 to 2023. Disparities based on maternal characteristics, particularly lower education, divorce status, unemployment, advanced maternal age, and immigration background, widened notably during periods of national disruption (COVID-19 and the war). In contrast, gaps associated with ethnicity and socioeconomic status remained stable or narrowed. Parental concern increased across most groups, particularly among Bedouin parents, suggesting growing awareness. Conclusions Maternal-level characteristics were strongly associated with elevated developmental risk from 2019 to 2023, and may be particularly sensitive to national crises. The findings underscore the importance of strengthening parental awareness, prioritizing early identification of high-risk families, and maintaining access to developmental services during emergencies. The study’s insights can support decision-makers in education, health, welfare, and local authorities in developing evidence-based strategies to promote equity and resilience in early childhood development systems.
BACKGROUND:In 2023 Israeli Arabs (i.e., Arab Palestinian citizens of Israel) constituted 22% of Israel's working-age population. In that same year, Israeli Arabs constituted 25% of Israel's employed physicians of working age - up significantly from 8% in 2010. The objectives of this study were to: 1) assess whether, and to what extent, there is an Arab-Jewish income differential among Israeli physicians; 2) assess the extent to which any such differential can be attributed to Arab-Jewish differences in the demographic, geographic, and/or work-related characteristics of the medical workforce; and 3) explore the policy implications of the key findings. METHODS:The analysis utilized the Central Bureau of Statistics' 2022 Population and Housing Census, which included data on 7,089 physicians, of whom 1,333 were Arab and 5,756 were Jewish or other (hereafter "Jewish"). The main income variable examined was "Total annual gross income from work". RESULTS:In 2022, the average annual physician income for Arab physicians was 26% less than for Jewish physicians (NIS 358 thousand vs. NIS 483 thousand). Arab physicians were more likely to be under age 40 (71% v. 28%), male (77% v. 52%), residents of the North region (48% v. 7%), in non-supervisory roles (87% v. 75%), and generalists or family practitioners (33% v. 22%). Controlling for age and sex, via regression analysis, reduced the income differential to 1%. This major reduction was due to Arab physicians being markedly younger than Jewish physicians. Further controlling for regional distribution and work characteristics (managerial status, specialty status/type, and months worked) did not change the ethnicity differential, but did markedly reduce the coefficients of the age variables. CONCLUSIONS:The 2022 Arab-Jewish income differential among physicians was due predominantly to differences in age composition. The differential could potentially shrink in the decades ahead, as more Arab physicians reach the ages at which physician incomes are at their highest. However, as part of the effect of age on income is mediated by work characteristics, the extent to which the wage gap will shrink will depend in part on the extent to which Arab physicians will secure prestigious residency training slots and managerial positions. Health system leaders can play an important role in promoting such developments. In particular, steps should be taken to increase the representativeness of Arabs in Israeli medical schools.
BACKGROUND:Specialty choice plays a central role in shaping physicians' careers and influences the distribution and sustainability of the healthcare workforce. In Israel, persistent shortages in specific specialties and geographic regions highlight the need to better understand the motivations guiding specialty preferences. Identifying latent motivational dimensions provides a broad perspective on the interplay between multidimensional factors shaping specialty choice. METHODS:A cross-sectional survey was conducted among Israeli medical students in their final year and medical interns between July 2024 and January 2025. Participants completed an online questionnaire including demographic characteristics and motivational factors influencing specialty choice using 5-point Likert-scale items. Exploratory factor analysis based on polychoric correlations was performed to identify latent motivational dimensions. Factor associations with demographic characteristics and intended specialty were examined using proportional-odds ordinal logistic regression. RESULTS:A total of 527 trainees participated. Exploratory factor analysis identified three motivational dimensions: Interpersonal Factors, Career and Academic Development, and Lifestyle Aspects. All factors demonstrated acceptable internal consistency. No sex-based differences were observed for lifestyle or career and academic motivations, while women rated interpersonal considerations higher than men. Career and academic development motivations were stronger among trainees who studied abroad and among graduates compared with final-year students. Specialty-specific analyses showed that candidates intending surgical or obstetrics and gynecology specialties placed the greatest emphasis on career and academic development, while lifestyle considerations were more prominent among those aiming for pediatrics and psychiatry. Interpersonal motivations did not differ significantly across specialties. CONCLUSIONS:Specialty choice among Israeli medical trainees is shaped by distinct but interrelated motivational dimensions with important workforce implications. The shared importance of lifestyle considerations across sexes suggests that improvements in work-life balance may enhance recruitment across a wider range of specialties. Specialty-specific differences in career and academic motivations highlight the potential value of structured exposure during medical school rotations to research activity and academic career pathways, particularly in fields perceived as offering limited academic opportunities. Aligning training environments with trainee motivations may support recruitment to specialties in distress and contribute to long-term workforce sustainability.
BACKGROUND:National quality indicators play a crucial role in monitoring hospital performance and fostering accountability. However, standardized indicators often fail to capture the intricate realities of clinical practice. To mitigate this limitation, Israel's National Program for Quality Indicators for general, geriatric, and psychiatric hospitals has implemented an individual appeals process, enabling hospitals to request case-based exclusions from indicator calculations when performance deviations arise from factors beyond their control. After three years of this initiative, our goal is to investigate the experiences of hospital Quality Managers (QMs) with the individual appeals track, aiming to inform enhancements to the national quality indicators program. METHODS:A qualitative, phenomenological study was conducted using semi-structured interviews with ten QMs from general, geriatric, and psychiatric hospitals. Interviews were analyzed using thematic, textual, and content analysis. RESULTS:Three core themes emerged: (1) Knowledge and familiarity gaps - most QMs relied on experiential learning rather than formal training or Ministry guidelines; (2) Communication gaps - strong collaboration existed within hospitals and with supervising nurses, but limited dialogue and feedback occurred with higher Ministry levels or across institutions; (3) Recognition gaps - QMs perceived acceptance of appeals as professional validation, while rejections often evoked frustration and a sense of underappreciating. CONCLUSIONS:QMs' experiences highlight systemic gaps in training, communication, and recognition that influence the perceived legitimacy and effectiveness of the individual appeals track. Strengthening structured onboarding, establishing transparent two-way communication, and embedding formal recognition mechanisms could enhance motivation, professional confidence, and the program's credibility. POLICY IMPLICATIONS:Institutionalizing the appeals process as a formal policy tool supported by standardized training, inter-hospital learning forums, and routine feedback loops can transform it from a technical exception mechanism into a strategic platform for continuous quality improvement and policy learning within Israel's healthcare system.
Abstract Background In 2019, a Universal Health Coverage reform of dental services for older adults was implemented in Israel, in order to improve their access to dental care, reduce financial obstacles and decrease inequalities in service utilization. This study aims to examine changes in dental care among elderly over the first 6 years of the reform. Methods Analysis of the utilization reports submitted by the HMOs to the Ministry of Health between the years 2019 (the beginning of the reform) to 2024. The reports included number of patients treated by type of treatments each year. Results During the first six years, the number of treated patients in the framework of the reform increased from 46.6 thousand to 129.4 thousand. During the years 2019 to 2024 there was a significant increase in preventive and first aid treatments (2.7 and 2.2-fold, respectively). Maintenance and surgical treatments increased moderately (1.8 and 1.6-fold, respectively),as well as rehabilitative treatments for 80 + age group and check-ups (1.5 and 1.4-fold, respectively). Conclusions During the first six years of the dental treatment reform, there was a notable increase of older adults who received dental treatments at HMOs clinics.
Abstract Background Financial pressures on health systems have increased in recent years. Voluntary health insurance (VHI) could, in principle, fill in the gaps in public coverage and funding. However, there is little evidence on realized access to VHI-funded care – who uses it and for what services, especially in countries with high VHI ownership, such as Israel. Our study assesses gaps in VHI uptake and utilization across the Israeli population. Methods Two consecutive cross-sectional data were collected through two national surveys among the adult population (aged 22+) conducted in 2012 and again in 2022, with respective response rates of 61% (N= 2,330) and 52% (N = 2,536). Bivariate analyses (ꭓ2) estimated the differences between population groups in the rates of VHI ownership and utilization of services at least once during the two years preceding the survey, while multivariable logistic regressions estimated the corresponding odds ratios. Findings VHI ownership rates remained high (around 83%) in both surveys but varied across subgroups. Arabs, residents of peripheral areas, and those in the lowest income quintile had lower ownership rates and lower likelihood of owning it. Overall, VHI self-reported utilization stood at 66% in 2022, lower than 76% in 2012. Visits to specialists were the only service category with increased utilization (from 20% to 28%). In 2022, VHI owners with lower incomes, lower education, and those residing in peripheral areas were also less likely to report utilizing VHI. Yet, Arabs and ultra-Orthodox Jews were more likely to report utilizing VHI. Those reporting poor health were also more likely to report utilizing VHI. Discussion and conclusions Our study examines VHI ownership trends and gaps in utilization of VHI-funded services in Israeli populations. The regressive nature of VHI premiums and disproportionately higher utilization by owners with higher socioeconomic status highlights the limitations of VHI as a sustainable and equitable financing policy tool for healthcare to policymakers. This unequal coverage demonstrates that VHI is not a full substitute for public funds, potentially indicating access barriers, while showing that fewer insured are benefiting from coverage. Its role should be clearly defined to ensure it complements public healthcare coverage.
BACKGROUND:Israel established the Medical Volunteers for Israel (MVFI) registry to rapidly recruit, license, and integrate international physicians into its health system during emergencies. This study evaluates the registry's design, implementation, and operational outcomes. METHODS:A narrative synthesis of registry data was conducted using the MFVI dataset from October 2023 to August 2025. Quantitative analysis characterized physician demographics, specialty distribution, licensing status, and deployment outcomes. A standardized review of hospital needs assessment and licensing protocols was performed to detail the system's replicability. RESULTS:The registry enrolled 7,032 international physicians from over 50 countries, with 59% originating from the United States. High-demand specialties included anesthesiology (23% of deployed), emergency medicine (23%), and trauma surgery (12%). Of those registered, 453 physicians were successfully deployed to fill acute staffing gaps. Deployment occurred through a novel, hospital-specific temporary licensing mechanism that bypassed the traditional multi-month observation requirements for senior physicians entering the Israeli workforce. The process, designed to be efficient and similar to that for temporary licenses for visiting specialists, was intended to accelerate approvals and reduce bureaucracy. Although it was finalized before Oct 7, 2023, for earthquake preparedness, recruitment, and final approval occurred only after that date. CONCLUSIONS:The MFVI registry demonstrates that a government-led, need-based integration of international medical personnel is an effective strategy for sustaining healthcare operations during emergencies. While successful in bridging staffing gaps, the model requires robust pre-deployment orientation to overcome language and system barriers. By embedding expertise directly into national infrastructure, this approach offers a scalable alternative to traditional parallel aid models such as emergency medical teams and field hospitals.
Abstract Background Healthcare teams encounter adverse events and medical errors, and inadequate awareness and support can leave these teams vulnerable as “second victims” (SV). The objectives of our study were to assess healthcare professionals’ understanding of the SV concept, evaluate the existing support systems in place, and identify the types of support mechanisms they consider most desirable. Methods In February 2024, the SV Experience and Support online survey was administered to healthcare workers in hospitals owned by Clalit Health Services, Israel. The survey focused on emotional responses following involvement in medical errors, perceived support from supervisors, and the availability of organizational resources. Statistical analysis was performed using SPSS statistical software. A Likert scale was used, where 1 represented “strongly disagree” and 6 represented “strongly agree.” Results The survey was sent to 6,645 physicians and 11,855 nurses. A total of 483 physicians and 1,359 nurses participated in the survey (7.2% and 11.4% response rate, respectively). Both physicians and nurses reported high emotional stress (Mean scores: 4.89 ± 1.17 and 5.16 ± 1.06, respectively, p < 0.001) and embarrassment (Mean scores: 4.76 ± 1.16 and 4.94 ± 1.22, respectively, p < 0.001) following errors, with a notable desire for peer support (51.6%). Sleep disturbances also highlighted the adverse events’ somatic burden and impact (Mean scores: 3.96 ± 1.49 and 4.22 ± 1.50, respectively, p = 0.002). The most desired support path was having a colleague to discuss the event (p < 0.001). Conclusions Healthcare workers face a significant risk of becoming SV after unexpected medical events, and peer support is preferred. Program directors should therefore prioritize structured peer support initiatives, alongside robust formal systems and open communication, in accordance with workers’ preferences. Addressing gaps in resource awareness and refining managerial approaches is essential.
Abstract Background Decision fatigue, based on Baumeister’s “Strength Model of Self-Control”, suggests that the quality of decision-making declines with the accumulation of decisions over time. This phenomenon, previously observed in various professional fields, may impact military physicians who make critical and organizational decisions. We aimed to assess how decision-making changes throughout the workday among military physicians in a clinic setting. Methods A retrospective observational analysis was conducted using a database of 2 million medical encounters from the military medical record system between 2015 and 2019. Decision outcomes were tracked for exemptions from specific duties granted, sick leave issued, days of sick leave, emergency department referrals, antibiotic prescriptions for upper respiratory tract infections and spinal X-ray referrals for low back pain – in accordance with appointment time and physician employment type. Results Findings showed a decrease in specific-duty exemptions granted by physicians until lunchtime, a peak post-lunch and a subsequent decline in the afternoon (p < 0.001). Referrals to the emergency department increased through the morning, dipped post-lunch and rose again by day’s end (p < 0.001). Sick leave issuance and the number of days granted both declined as the day progressed, with the steepest decline in the afternoon (p < 0.001). Rates of antibiotic prescription for URTIs and spinal X-ray referrals for LBP did not vary significantly throughout the day. Civilian physicians tended to issue more sick leave, exemptions and referrals than regular duty physicians, though both groups demonstrated similar trends throughout the day. Conclusions This study highlights the influence of decision fatigue on clinical decision-making among military physicians, showing a time-based decline in granting sick leave and specific-duty exemptions, with an increase in emergency referrals towards the end of the workday. These might have system-wide implications such as overutilization of healthcare, and increased health expenditure. Recognizing and addressing decision fatigue is important to mitigate its effects.
BACKGROUND:Digital emergency care applications offer potential to reduce delays, enhance triage, and improve care coordination, yet evidence remains limited on their real-world implementation at scale. Maccabi Healthcare Services developed Maccabi-RED, a mobile application allowing patients to request urgent community-based care as an alternative to hospital emergency department visits. This study examines the implementation and utilization of Maccabi-RED during 2020-2023, aiming to describe demographic and clinical characteristics of patients initiating emergency care requests, identify factors associated with request approval and successful routing to community-based care and examine healthcare utilization patterns following app-initiated requests. METHODS:This retrospective study analyzed de-identified electronic health record data from Maccabi Healthcare Services, including all patient-initiated emergency care requests through the Maccabi-RED application between January 2020 and December 2023. The study included 94,795 requests from 77,508 patients. We extracted demographic and clinical variables and examine patterns of subsequent healthcare utilization in the week following app-initiated emergency care requests, comparing approved versus non-approved requests. RESULTS:During the study period, 51.6% of requests were approved, resulting in urgent community clinic appointments. Service utilization increased substantially from 11,058 requests in 2020 to 36,532 in 2023. Approved requests were more common among older patients and those with chronic conditions. Emergency type strongly influenced approval rates, with foreign body cases showing substantially higher approval odds than orthopedic cases. Geographic, ethnic, and socioeconomic disparities in approval rates were observed. In adjusted analyses, approved requests were associated with lower 7-day healthcare utilization, including fewer primary care physician visits and reduced odds of hospital emergency department and emergency medical center visits. CONCLUSIONS:The Maccabi-RED application demonstrates feasibility of scaling patient-initiated digital emergency routing, with potential to reduce downstream acute care utilization. However, observed approval disparities across age groups, geographic regions, and socioeconomic strata indicate that digital maturity alone does not guarantee equitable access. These findings underscore the importance of embedding equity considerations in system design, monitoring protocols, and capacity planning. Future development, including artificial intelligence-enabled decision support, should prioritize transparency and algorithmic fairness to improve performance without amplifying existing health inequities.
BACKGROUND:Israel is advancing large genetic and longitudinal studies in personalized medicine through national digital health initiatives. MIDGAM, the Israeli national biobank established in 2014, provides the core biosample and data infrastructure enabling this research. We investigated the willingness to donate samples and linked clinical data for research purposes, and examined preferences regarding the receipt of research-derived information, including incidental findings. METHODS:A structured, self-administered questionnaire was distributed electronically to a representative sample of the Israeli population. Participants were asked about their willingness to donate biosamples and linked data, and their opinions regarding receiving results including incidental findings. The data were analyzed by sociodemographic and health characteristics. RESULTS:The survey included 1,607 respondents. 52% were willing to donate biosamples, and 40% were also willing to link them with their medical records and to receive incidental results (84.6% of those willing to donate). Individuals most willing to donate and receive research findings, were non-Ultra-Orthodox Jewish, secular, male, aged 30 to 49 years with post-secondary/academic education and above-average income. Additionally, respondents characterized by better general health, being physically active, and absence of chronic or severe illness were more willing to donate biosamples. The main barriers to biosample donation were concerns about data leakage, privacy violations and lack of understanding of the donation purpose. CONCLUSION:Israel's biosample donation landscape mirrors global patterns, with notable sectorial and demographic disparities. Higher socioeconomic status and health engagement increase willingness to donate, while privacy concerns and the perceived burden of continued involvement reduce participation.
