A Method for Assessing the Fairness of Health Resource Allocation Based on Geographical Grid

The assessment of the fairness of health resource allocation is an important part of the study for the fairness of social development.The data used in most of the existing assessment methods comes from statistical yearbooks or field survey sampling.These statistics are generally based on administrative areas and are difficult to support a fine-grained evaluation model.In response to these problems,the evaluation method proposed in this paper is based on the query statistics of the geographic grid of the target area,which are more accurate and efficient.Based on the query statistics of hot words in the geographic grids,this paper adopts the maximum likelihood estimation method to estimate the population in the grid region.Then,according to the statistical yearbook data of Hunan province,the estimated number and actual number of hospitals in each grid are analyzed and compared to measure the fairness of health resource allocation in the target region.Experiments show that the geographical grid population assessment based on hot words is more accurate and close to the actual value.The estimated average error is only about 17.8 percent.This method can assess the fairness of health resource allocation in any scale,and is innovative in data acquisition and evaluation methods.

Health resource utilization and the economic burden of patients with wet age-related macular degeneration in Thailand

AIM: To determine healthcare resource utilization and the economic burden associated with wet age-related macular degeneration(AMD) in Thailand ·METHODS: This study included patients diagnosed with wet AMD that were 60 years old or older,and had best corrected visual acuity(BCVA) measured at least two times during the follow-up period. We excluded patients having other eye diseases. Two separate sub-studies were conducted. The first sub-study was a retrospective cohort study; electronic medical charts were reviewed to estimate the direct medical costs. The second sub-study was a cross-sectional survey estimating the direct non-medical costs based on face-to-face interviews using a structured questionnaire. For the first sub-study,direct medical costs,including the cost of drugs,laboratory,procedures,and other treatments were obtained. For the second sub-study,direct non-medical costs,e.g. transportation,food,accessories,home renovation,and caregiver costs,were obtained from face-to-face interviews with patients and/ or caregivers. ·RESULTS: For the first sub-study,sixty-four medical records were reviewed. The annual average number of medical visits was 11.1 ±6.0. The average direct medical costs were $3 604 ±4 530 per year. No statistically-significant differences of the average direct medical costs among the BCVA groups were detected(P =0.98). Drug costs accounted for 77% of total direct medical costs. For direct non-medical costs,67 patients were included. Forty-eight patients(71.6%) required the accompaniment of a person during the out-patient visit. Seventeen patients(25.4%) required a caregiver at home. The average direct non-medical cost was $2 927 ±6 560 per year. There were no statistically-significant differences in the average costs among the BCVA groups(P =0.74). Care-giver cost accounted for 87% of direct non-medical costs.·CONCLUSION: Our study indicates that wet AMD is associated with a substantial economic burden,especially concerning drug and care-giver costs.

How University Athletics Can Impact Mental Health among Student Athletes at the University of Evansville

In recent years, the NCAA student athlete population in the United States has surpassed 500,000, and is continuing to rise each year [1]. These student athletes work their entire lives academically and athletically to reach the ultimate goal: competing in university athletics. However, when these athletes reach university, they are met with non-stop training, homework, exams, and evolving social lives. We have conducted a study at the University of Evansville evaluating how participation in university athletics may impact mental health status among these student athletes, as well as measuring players’ awareness of accessible mental health resources. Over fifty percent of participants reported experiencing at least one mental health condition while competing in their sport;eighty percent reported having knowledge of the mental health resources available to them on campus, however, nearly thirty percent of those knowledgeable reported not knowing how to access these resources. This has indicated a gap in awareness and utilization of mental health resources among student athletes at the University of Evansville.

The Place of Human Resource Management in Lagos State Healthcare Delivery: A Statistical Overview

Background: Behind every great system is an organized team;this is especially true in the healthcare industry, where a dedicated human resources team can effectively recruit employees, train staff, and implement safety measures in the workplace. The importance of human resources in the healthcare industry cannot be overstated, with benefits ranging from providing an orderly and effectively run facility to equipping staff with the most accurate and up-to-date training. Proper human resources management is critical in providing high-quality health care. A refocus on human resources management in healthcare requires more research to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes and access to health care worldwide. Methods: This study leveraged NOI Polls census data on Health Facility Assessment for Lagos State. One thousand two hundred fifty-six health care facilities were assessed in Lagos State;numbers of Health workers were documented alongside their area of specialization. Also, demographic characterizations of the facilities, such as LGA, Ownership type, Facility Level Care, and Category of the facility, were also documented. Descriptive statistics alongside cross tabulation was done to present the various area of specialization of the health workers. Multiple response analysis was done to understand the distribution of human resources across the health facilities. At the same time, Chi-square and correlation tests were conducted to test the independence of various categories recorded while understanding the relationships among selected specialties. Results: The study revealed that Nurses were the most common health specialist in the Lagos State health facilities. At the same time, Gynecologists and General surgeons are the two medical specialists mostly common in health facilities. Midwives are the second most common health specialist working full time, while Generalist medical doctors make up the top three health specialists working full time. Nurses and Midwives had the highest number in Lagos State, while Pulmonologists were currently the lowest human resource available in Lagos State health care system. It was also noted that health facility distribution across Lagos’s urban and rural areas was even. In contrast, distribution based on other factors such as ownership type, Facility level of care, and facility category was slightly skewed. Conclusion: The distribution of health workers in health facility across LGA in Lagos State depend on Ownership type, Facility level of care, and category of the facility.

Healthcare Worker-Related Factors Contributing to Tuberculosis Treatment Non-Adherence among Patients in Kisumu East Sub-County

Background: Treatment non-adherence poses significant risks to health outcomes and impedes the health system’s efficiency, hence curtailing progress towards the end Tuberculosis (TB) strategy under SDG 3.3. Despite interventions to address TB treatment non-adherence, Kenya still reports high TB treatment non-adherence rates of 35% and consequently poor treatment outcome rates. Health Care Workers (HCWs) play a critical role in linking the population to health services, yet little is known of their influence on patients’ TB treatment non-adherence in Kenya. Objective: To analyze HCW-related factors associated with TB treatment non-adherence among patients in Kisumu East Sub-County. Methods: Health facility-based analytical cross-sectional mixed-method study. A Semi-structured questionnaire on treatment adherence and patients’ perceptions of HCWs during the clinic visit was administered to 102 consenting adult (out of a total census of 107 adults) drug-susceptible TB patients. 12 purposively selected HCWs by rank from 6 health facilities participated in Key Informant Interview sessions. Medication adherence was measured using the Morisky Medication Adherence Scale and then expressed as a dichotomous variable. Quantitative analysis utilized STATA version 15.1 while qualitative deductive thematic analysis was done using NVIVO version 14. Results: TB treatment non-adherence rate of 26% (CI: 18% - 36%) was recorded. Overall, patients who felt supported in dealing with the illness were 8 times more likely to adhere to treatment compared to those who were not (aOR = 7.947, 95% CI: 2.214 - 28.527, p = 0.001). Key HCW related factors influencing adherence to treatment included: friendliness (cOR = 4.31, 95% CI: 1.514 - 12.284, p = 0.006), respect (cOR = 6.679, 95% CI: 2.239 - 19.923, p = 0.001) and non-discriminatory service (cOR = 0.1478, 95% CI: 0.047 - 0.464, p = 0.001), communication [adequacy of consultation time (cOR = 6.563, 95% CI: 2.467 - 17.458, p = 0.001) and patients’ involvement in their health decisions (cOR = 3.02 95% CI: 1.061 - 8.592, p = 0.038)] and education and counselling (cOR = 4.371, 95% CI: 1.725 - 11.075, p = 0.002). Conclusion: The study results underline importance of patient-centered consultation for TB patients and targeted education and counselling for improved treatment adherence.

Role of social distancing in tackling COVID-19 during the first wave of pandemic in Nordic region:Evidence from daily deaths,infections and needed hospital resources

Objectives:To measure the effect of social distancing on reducing daily deaths,infections and hospital resources needed for coronavirus disease 2019(COVID-19)patients during the first wave of the pandemic in Nordic countries.Methods:The observations of social distancing,daily deaths,infections along with the needed hospital resources for COVID-19 patient hospitalizations including the numbers of all hospital beds,beds needed in ICUs and infection wards,nursing staffs needed in ICUs and infection wards were collected from the Institute for Health Metrics and Evaluation(IHME)by the University of Washington.The observations of social distancing were based on the reduction in human contact relative to background levels for each location quantified by cell phone mobility data collected from IHME.The weighted data per 100,000 population gathered in a 40-day period of the first wave of the pandemic in Denmark,Finland,Iceland,Norway and Sweden.Statistical technique of panel data analysis is used to measure the associations between social distancing and COVID-19 indicators in long-run.Results:Results of dynamic long-run models confirm that a 1%rise in social distancing by reducing human contacts may decline daily deaths,daily infections,all hospital beds needed,beds/nurses needed in ICUs and beds/nurses needed in infection wards due COVID-19 pandemic by 1.13%,15.26%,1.10%,1.17%and 1.89%,respectively.Moreover,results of error correction models verify that if the equilibriums between these series are disrupted by a sudden change in social distancing,the lengths of restoring back to equilibrium are 67,62,40,22 and 49 days for daily deaths,daily infections,all hospital beds needed,nurses/beds needed in ICUs and nurses/beds needed in infection wards,respectively.Conclusion:Proper social distancing was a successful policy for tackling COVID-19 with falling mortality and infection rates as well as the needed hospital resources for patient hospitalizations in Nordic countries.The results alert governments of the need for continuously implementing social distancing policies while using vaccines to prevent national lockdowns and reduce the burden of patient hospitalizations.

Limited Focus on the Use of Health Care by Elderly Migrants——A Literature Review

Our premise for this literature review is the global demographic change caused by the world’s population living longer and becoming older, and extensive international migration leading to multicultural societies. Increasing age leads to health problems, often long-term or chronic, requiring investments in health care. Worse health and dissimilarities in pattern of morbidity/ mortality have been found in foreign-compared to Swedish-born persons, so it is reasonable to assume that this affects use of health care. The exploratory review focuses on elderly migrants’ (>65 years) use of healthcare. The databases Pub Med, EBSCO, CINAHL and ERIC were searched in 2000-2013. A limited number of studies were found;few had a comparative approach, most were from the USA, and focused on migrants from the former Soviet Union or countries in South-East Asia. A range of factors were identified that influence patterns of health care use: language fluency, ability to communicate, self-reported health status, prevalence of chronic disease, physical distance from care provision, availability of transport to reach care, cost of care, the health insurance system, cultural norms and values regarding different forms of care, level of education, and length of residence in the host country. Most studies treated health care from a general perspective and collected data from community and hospital settings, without analysing usage separately. Some studies indicated elderly migrants making use of health care less than other groups but the pattern is not unambiguous: other studies show that there is an overuse of health care. It is therefore difficult to show any particular pattern, or possible differences in use, regarding community versus in-patient care. Studies focusing on migrants’ actual use of health care are few and further research is needed, especially because elderly people form the largest group of users of health care and will be even larger in the future.

2011—2020年我国卫生资源配置的地区差异和动态演进

目的分析我国2011—2020年卫生资源配置的地区差异及动态演进趋势,为提升卫生资源效率、促进优质卫生资源均衡发展提供参考依据。方法基于2011—2020年面板数据,采用熵值法对卫生资源配置水平进行综合测度,基于自然断点分级法评价卫生资源配置空间均衡性,使用泰尔指数测算卫生资源配置地区差异程度及来源与构成,通过核密度估计法探讨卫生资源配置动态演进趋势。结果观察期内,我国卫生资源配置综合水平由1.810增至1.972,中密度、次高密度、次低密度区范围扩大6.45%。较观察初期,卫生资源配置受西部地区影响的总体差异涨幅约为1.36%,区域间差异占比约为51.38%。在动态演进过程中卫生资源配置非均衡性呈轻微缩小趋势,各区域形成两极或多极化特征。结论我国卫生资源配置渐趋均衡,而区域间差异仍是我国卫生资源配置总体差异的主要来源。

“十四五”时期我国卫生健康事业发展展望

“十四五”时期,我国卫生健康事业步入新的历史阶段。在这一时期,公共卫生能力建设应成为发展重点,通过优化医疗卫生资源配置,实现大健康观下的医防结合。推动以医疗为中心的医疗联合体转变为以预防和健康管理为中心的健康联合体,使医疗保险为公众的健康结果而非医疗卫生服务买单。完善健康服务体系,实现健康联合体内部上下联动。建立以健康结果为导向的医疗保险支付方式,倒逼服务供给侧改革,推动医疗保险基金形成战略性购买机制。充分发挥信息时代互联互通的优势,深化健康大数据的治理与应用,助力公众健康管理。

京津冀中医药卫生资源配置现状及效率

目的了解实行京津冀一体化发展以来京津冀中医药卫生资源的配置情况,为京津冀中医药协同发展提供参考建议。方法对2015—2018年京津冀中医药卫生资源数据进行描述性分析,用数据包络分析评价2018年京津冀中医药卫生资源的配置效率。结果北京市每万常住人口中医医疗卫生机构数、每万常住人口卫生技术人员数、每万常住人口实有床位数均处于三地最高水平。河北省中医药卫生资源的增幅较大,中医医院的服务量增长较快。北京市的中医药卫生资源配置弱有效,天津市、河北省的中医药卫生资源配置无效。结论北京市的中医药卫生资源相对丰富。河北省的中医药卫生资源及中医药卫生服务发展较好。在京津冀中医药协同发展的背景下,应将北京市的非首都功能向河北省疏解,河北省应加强中医药人才建设。

2013—2019 年广东省儿科医疗服务变化状况

目的分析广东省儿科医疗卫生资源配置和儿科医师诊疗负担现状及趋势,为优化儿科资源配置、完善儿科服务体系提供依据。方法收集2013—2019年广东省开设儿科服务机构数、儿科执业(助理)医师数、每千0~14岁儿童医师数、医师日均负担诊疗量等数据,进行统计学描述及对比分析。结果2013—2019年,广东省开设儿科服务的医疗机构数由1885家下降至1831家。儿科医师由0.9万人增长至1.3万人,每千0~14岁儿童医师数由0.59人增长至0.72人;床位数由3.1万张增加至4.2万张,每千0~14岁儿童床位数由1.98张增加至2.23张;儿科门急诊人次由6161.0万人次增加至7110.2万人次,儿科出院人次由169.5万人次增长至218.1万人次。儿科医师日均负担诊疗量由26.5人次下降至21.0人次,2019年儿科医师比全省医师日均负担诊疗量多8.8人次;儿科医师年均负担住院量由182.9人次下降至162.0人次,高于全省医师的平均水平(62.1人次)。结论广东省儿科机构数逐年减少,儿科医师、床位及其人均占有量逐年提高,儿科门诊住院服务需求持续增长,儿科医师工作负荷有所下降,但仍然高于医师的平均水平。需采取相应措施进一步完善儿科医疗服务体系,增加儿科卫生资源配置,满足日益增长的儿科医疗服务需求。

基于集聚度和集中指数的广西区域卫生资源配置公平性分析

目的分析“十三五”期间广西区域卫生资源分布情况及配置公平性,为优化广西区域卫生资源配置提供参考。方法综合运用集聚度和集中指数,从人口、地理分布和经济状况评价广西区域卫生资源配置的公平性。结果“十三五”规划收官时,广西各地医疗卫生资源集聚度为0.41~2.47,50%的地区卫生资源集聚度大于1(达到公平区间),卫生资源集聚度与人口集聚度的比值为0.67~1.66,67.86%地区比值小于1(公平性不足),南宁、北海、柳州、桂林等经济发达地区的配置公平性优于百色、贺州、河池、来宾、崇左等经济欠发达地区。2020年末,卫生技术人员、执业(助理)医师、注册护士、实有床位4项指标的集中指数分别为0.134、0.150、0.144、0.082,全区各项指标的集中曲线较2015年均出现不同程度的回升,且都分布于45°标准线下方。“十三五”期间,广西各地卫生资源集聚度及其与人口集聚度的比值分布跨度较大,区域卫生资源配置公平性存在较大差异。从总体上看,卫生资源按地理配置的公平性优于按人口配置的公平性。结论2020年末,广西卫生技术人员、执业(助理)医师、注册护士、实有床位4项资源的集中指数均出现下降,说明4项资源配置的公平性有所提升。人力资源配置公平性仍然欠佳,卫生从业人员不足问题依然突出。广西卫生资源倾向分布于经济水平较好的地区。建议加大欠发达地区的医疗卫生建设支出,因地制宜优化地区卫生资源配置,多管齐下推动卫生人力资源公平发展,以促进广西区域卫生资源合理配置。

Rate and yield of repeat upper endoscopy in patients with dyspepsia

AIM: To determine the rate and yield of repeat esophagogastroduodenoscopy (EGD) for dyspepsia in clinical practice,whether second opinions drive its use,and whether it is performed at the expense of colorectal cancer screening.METHODS: We performed a retrospective cohort study of all patients who underwent repeat EGD for dyspepsia from 1996 to 2006 at the University of California,San Francisco endoscopy service.RESULTS: Of 24 780 EGDs,5460 (22%) were performed for dyspepsia in 4873 patients.Of these,451 patients (9.3%) underwent repeat EGD for dyspepsia at a median 1.7 (interquartile range,0.8-3.1) years after initial EGD.Signif icant f indings possibly related to dyspepsia were more likely at initial (29%) vs repeat EGD (18%) [odds ratio (OR),1.45;95% confidence interval (CI): 1.20-1.75,P < 0.0001],and at repeat EGD if the initial EGD had reported such f indings (26%) than if it had not (14%) (OR,1.32;95% CI: 1.08-1.62,P = 0.0015).The same endoscopist performed the repeat and initial EGD in 77% of cases.Of patients aged 50 years or older,286/311 (92%) underwent lower endoscopy.CONCLUSION: Repeat EGD for dyspepsia occurred at a low but substantial rate,with lower yield than initial EGD.Optimizing endoscopy use remains a public health priority.

山东省基层妇幼保健机构资源效率的空间分布

目的 研究山东省县(区、市)级妇幼保健机构资源效率的空间分布特征及聚集性,为妇幼保健机构资源效率的提升提供科学依据。方法 用ArcGIS 10.5软件进行Moran’s Ⅰ空间自相关分析和Getis-Ord G~*热点分析。结果 目前,山东省还有13家(占9.42%)基层妇幼保健机构没有开展门诊服务,41家(占29.71%)未开展住院服务。山东省基层妇幼保健机构的日均住院工作负担和床位使用率呈空间正相关(Moran’s Ⅰ=0.194,P=0.001;Moran’s Ⅰ=0.223,P < 0.001)。Getis-Ord Gi~*热点分析显示,日均门急诊工作负担、日均住院工作负担和床位使用率均存在热点和冷点聚集区域。其中,热点区域主要分布在临沂、潍坊和烟台等市,冷点区域主要分布在济南市、青岛市、东营市和菏泽市。结论 山东省基层妇幼保健机构的资源使用效率指标具有空间异质性,应密切关注冷热点区域,分类指导、统筹规划,提高妇幼保健资源的利用效率。

Thirty-day readmission in patients with heart failure with preserved ejection fraction:Insights from the nationwide readmission database

BACKGROUND There are rising numbers of patients who have heart failure with preserved ejection fraction(HFpEF).Poorly understood pathophysiology of heart failure with preserved and reduced ejection fraction and due to a sparsity of studies,the management of HFpEF is challenging.AIM To determine the hospital readmission rate within 30 d of acute or acute on chronic heart failure with preserved ejection fraction and its effect on mortality and burden on health care in the United States.METHODS We performed a retrospective study using the Agency for Health-care Research and Quality Health-care Cost and Utilization Project,Nationwide Readmissions Database for the year 2017.We collected data on hospital readmissions of 60514 adults hospitalized for acute or acute on chronic HFpEF.The primary outcome was the rate of all-cause readmission within 30 d of discharge.Secondary outcomes were cause of readmission,mortality rate in readmitted and index patients,length of stay,total hospitalization costs and charges.Independent risk factors for readmission were identified using Cox regression analysis.RESULTS The thirty day readmission rate was 21%.Approximately 9.17%of readmissions were in the setting of acute on chronic diastolic heart failure.Hypertensive chronic kidney disease with heart failure(1245;9.7%)was the most common readmission diagnosis.Readmitted patients had higher in-hospital mortality(7.9%vs 2.9%,P=0.000).Our study showed that Medicaid insurance,higher Charlson co-morbidity score,patient admitted to a teaching hospital and longer hospital stay were significant variables associated with higher readmission rates.Lower readmission rate was found in residents of small metropolitan or micropolitan areas,older age,female gender,and private insurance or no insurance were associated with lower risk of readmission.CONCLUSION We found that patients hospitalized for acute or acute on chronic HFpEF,the thirty day readmission rate was 21%.Readmission cases had a higher mortality rate and increased healthcare resource utilization.The most common cause of readmission was cardio-renal syndrome.

Associations between measures of pediatric human resources and the under-five mortality rate: a nationwide study in China in 2014

Background To quantify the associations between the under-five mortality rate(U5MR)and measures of pediatric human resources,including pediatricians per thousand children(PPTC)and the geographical distribution of pediatricians.Methods We analyzed data from a national survey in 2015-2016 in 2636 counties,accounting for 31 mainland provinces of China.We evaluated the associations between measures of pediatric human resources and the risk of a high U5MR(>18 deaths per 1000 live births)using logistic regression and restricted cubic spline regression models with adjustments for potential confounders.PPTC and pediatricians per 10,000 km^(2) were categorized into quartiles.The highest quartiles were used as reference.Results The median values of PPTC and pediatricians per 10,000 km^(2) were 0.35(0.20-0.70)and 150(50-500),respectively.Compared to the counties with the highest PPTC(≥0.7),those with the lowest PPTC(<0.2)had a 52% higher risk of a high U5MR,with an L-shaped relationship.An inverted J-shaped relationship was found that the risk of a high U5MR was 3.74[95%confidence interval(CI)2.55-5.48],3.07(95% CI 2.11-4.47),and 2.25 times(95% CI 1.52-3.31)higher in counties with<50,50-149,and 150-499 pediatricians per 10,000 km^(2),respectively,than in counties with≥500 physicians per 10,000 km^(2).The joint association analyses show a stronger association with the risk of a high U5MR in geographical pediatrician density than PPTC.Conclusion Both population and geographical pediatrician density should be considered when planning child health care services,even in areas with high numbers of PPTC.