Health Services Research

Over the last decade state prisons have experienced unprecedented growth and many demographic changes. At the same time, courts are requiring states to provide mental health screening and treatment to prisoners. Findings from recent studies indicate that the prevalence of mental illness is higher in prisons than in the community, and comorbidity is common. Our ability to generalize from these studies is limited, however, because of major shifts in the demographic mix in prisons during the past decade. New studies on the prevalence of mental illness in prisons, which consider these recent changes would help planners allocate funds and staff to more effectively meet the needs of these individuals.

This study examines the effect of 13 strategic management activities on the financial performance of a national sample of 797 U.S. rural hospitals during the period of 1983-1988. Controlled for environment-market, geographic-region, and hospital-related variables, the results show almost no measurable effect of strategic adoption on rural hospital profitability and liquidity. Where statistically significant relationships existed, they were more often negative than positive. These findings were not expected; it was hypothesized that positive effects across a broad range of strategies would emerge, other things being equal. Discussed are possible explanations for these findings as well as their implication for a rural health policy relying on individual rural hospital strategic adaptation to environmental change.

Objectives
This study sought to explore perspectives of trans and gender diverse (TGD) people of ways to alleviate gender dysphoria in service provision and to develop a framework for application in health and other areas that can be used by researchers and service providers to design study protocols, assess organisations and enhance everyday practice in ways that are sensitive to TGD people’s experiences.

Methods
Data from a national Australian survey on TGD people conducted in 2018–2019 (n = 340) were used to develop a framework for alleviating dysphoria. Participants were asked an open-ended question on ways that body discomfort could be minimised in clinical encounters. Inductive thematic analysis was used to develop themes true to participant sentiment, which formed the basis for the development of a framework.

Results
The sample was overall young, with 60.6% aged 18–24, and a strong representation of gender diverse people (42.6%). The most important theme for participants was the context of the experience, which included the subthemes of the interpersonal qualities of service providers, language and pronouns, and practical aspects. Aspects of systems were also important, with education and awareness being particularly emphasised, followed by inclusive environments. Access to gender affirming medical and surgical procedures was rarely mentioned (2.6%). A minority of participants indicated that there was nothing that could be done to alleviate their gender dysphoria (4.4%).

Conclusions
The study proposes a framework that can help facilitate assessment of a service’s current practices, inform a practitioner’s daily practice and be used by researchers to appropriately design studies. The most important areas to address centre on the context of the immediate experience, which may be influenced through systems-level characteristics.

Nothing stands still. Technology evolves dramatically, customer needs keep changing, and new industries emerge. To forge ahead in this highly competitive landscape, businesses increasingly rely on service and service products to create and capture value. The Essentials of Services Marketing, Second Edition is written in response to this global transformation of our economies to services.

Research has it that developing countries face major challenges that are related to the provision of poor quality healthcare services which have been attributed to inadequate knowledge and skills compounded with low staff members. M&E in Kenya is weak with poor information and data sharing. Through HMIS, Kenya has streamlined its data collection whereby data flow channels have been defined and information sharing among stakeholders has been embraced. However, the existing M&E systems still have disjointed activities, numerous program-specific M&E structures and the existing M&E systems satisfying the reporting needs of donors. These challenges have created a weak culture of information use and demand. The objective of the study was to determine the effects of M&E human capacity on health service delivery. Descriptive research design was employed, a sample of 113 health facilities was sampled using LQAS sampling technique, primary data was collected using researcher designed questionnaires while secondary data was collected through review of relevant literature. Quantitative data was analysed using SPSS while qualitative data was analysed using qualitative content analysis and triangulated with quantitative data. The findings indicated that M&E human capacity could explain 84.4% of variability in health service delivery. The study recommended that capacities of existing M&E practitioners be developed and ensuring institutional memory where every trained M&E practitioner trains at least one other person. The researcher suggested areas for further research to include a similar study that compares the findings from public, private, NGO and FBO health facilities in both rural and urban areas.

BACKGROUND Practice-based research networks (PBRNs) are collaborations between clinical practitioners and academics. PBRNs aim to foster research in general practice through opportunities to learn more about how to undertake and participate in research, and assist in translating new knowledge into practice. Critically, PBRNs also offer clinicians the chance to contribute to research by posing questions of importance to quality clinical care. OBJECTIVE The objectives of this article are to describe why PRBNs are needed, the current situation regarding PBRNs in Australia, and why Australian general practice and patient outcomes could benefit from further investment in PBRNs. DISCUSSION PBRNs may assist by engaging more general practitioners (GPs) in the research process, thereby increasing the relevance of the research questions posed to the outcomes of the population GPs work within. Unlike similar countries (eg UK and The Netherlands), Australia no longer has any funding to support ...

This ethnographic study of interpretations of stress among hospital social workers reveals concrete ways in which institutional systems take form in the mundane actions and interpretations of individuals embedded in these systems. It also reveals how organizational cultures reflect and reinforce institutional conditions that have been negotiated in the interactions of individuals. Here, the institutional systems of medicine and social work come together in the everyday work of the social workers and result in two patterns of cultural dominance. Within these distinct types of culture emerge two forms of stress experience, including a dominant form, consistent with medical ideology, and a marginalized form, consistent with social work ideology. Some surprising patterns of interpretation emerge, including interpretations of ambiguity and burnout as normal, social, and desirable when the social work ideology is dominant. This institutional analysis of stress has theoretical, practical, and epistemological implications.

European policymakers have recently become increasingly committed to using Impact Assessment (IA) to inform policy decisions. Welcoming this development, the public health community has not yet paid sufficient attention to conceptual concerns about IA or to corporate efforts to shape the way in which IA is used. This essay is a thematic analysis of literature concerning IA and associated tools and a related assessment of the European Union's (EU) new 'integrated'IA tool. Eight key concerns regarding IA are identified from ...

Objective The aim of the present study was to describe, from the perspective of the healthcare funder, the cost components of the Australian Transition Care Program (TCP) and the healthcare resource use and costs for a group of transition care clients over a 6-month period following admission to the program. Methods A prospective cohort observational study of 351 consenting patients entering community-based transition care at six sites in two states in Australia from November 2009 to September 2010 was performed. Patients were followed up 6 months after admission to the TCP to ascertain current living status and hospital re-admissions over the follow-up period. Cost data were collected by transition care teams and from administrative data (hospital and Medicare records). Results The TCP provides a range of services with most costs attributed to provision of personal care support, case management, physiotherapy and occupational therapy. Most healthcare costs up to 6 months after tran...

Endophthalmitis, an ophthalmic condition characterized by an inflammation of the intraocular cavity, can have substantial implications for vision. However, little is known about the cost of treatment. The objective of this study was to estimate the direct medical cost of treatment for endophthalmitis in the United States. Retrospective data analysis using the 1997 through 2001 Medicare Beneficiary Encrypted Files. Beneficiaries who underwent cataract surgery were identified; baseline and clinical characteristics at the time of diagnosis were determined. Analyses stratified patients based on development of endophthalmitis in the year after surgery. Claims and reimbursements for cases (patients undergoing cataract extraction in whom endophthalmitis developed) and controls (patients who did not experience endophthalmitis) were determined and rates of resource use and costs were calculated from the perspective of Medicare. Annual Medicare payments and claims. A total of 417 beneficiaries with endophthalmitis occurring after cataract surgery were found; 139 558 had cataract surgery without subsequent endophthalmitis. Three fifths of beneficiaries were female and 89% were white. Ophthalmic claims and reimbursements were more than 1.45 times greater for cases than controls ($12 578 in higher claims and $3464 in higher reimbursements; P<0.0001). These findings demonstrate a substantial cost associated with endophthalmitis. With recent studies suggesting that prophylaxis is effective in preventing endophthalmitis, there is potential that inexpensive prophylaxis could result in cost and resource savings to Medicare.

Results of reliability and agreement studies are intended to provide information about the amount of error inherent in any diagnosis, score, or measurement. The level of reliability and agreement among users of scales, instruments, or classifications is widely unknown. Therefore, there is a need for rigorously conducted interrater and intrarater reliability and agreement studies. Information about sample selection, study design, and statistical analysis is often incomplete. Because of inadequate reporting, interpretation and synthesis of study results are often difficult. Widely accepted criteria, standards, or guidelines for reporting reliability and agreement in the health care and medical field are lacking. The objective was to develop guidelines for reporting reliability and agreement studies. Eight experts in reliability and agreement investigation developed guidelines for reporting. Fifteen issues that should be addressed when reliability and agreement are reported are proposed. The issues correspond to the headings usually used in publications. The proposed guidelines intend to improve the quality of reporting.

Anxiety Uncertainty Management (AUM) theory (Gudykunst, 2004) suggests that both anxiety and uncertainty are key factors that influence cross-cultural engagement within health services. The current study employed an experimental design to test AUM theory within a health context, specifically the impact of high or low perceived predictability and high or low anxiety on willingness to interact within a health care interaction. Additionally, the study assessed the unique contribution of state and trait anxiety, ethnocentrism and attitudes towards seeking psychological help, on participants’ ratings of willingness to interact within a health setting to better understand health help-seeking behaviour. Results indicate that an anxiety provoking situation is a significant predictor of willingness to interact,with high anxiety leading to less willingness to interact, a finding enhanced when perceived predictability of a health professional was also low. This finding supports the application of AUM theory to the health setting. A heightened anxiety provoking situation was also found to have a direct effect on the perceived predictability of an intercultural health interaction partner. Despite previous research indicating the importance of help seeking behaviour and cultural attitudes in negatively influencing engagement with health services, the current study found that state anxiety was a more significant indicator of willingness to interact in a cross-cultural health interaction than these other indicators.

A new reimbursement system for general hospitals in Israel was introduced in July 1990. The new system specified that for 15 selected procedures, hospitals would be paid by the insurers prospectively, rather than by the traditional per-diem arrangement. The rates were determined by the Ministry of Health. Henceforth, the number of selected procedures has increased and by now 40 procedures are included. In line with the ever-lasting interest in the effect of financial incentives on suppliers of medical care, the purpose of this paper is to examine the first-year effect of this change on the volume of activity, length of stay, quality of care, and hospitals' real income. We focused on five selected procedures (cholecystectomy, hysterectomy, hip replacement, operations on lens and heart surgeries) performed in the four largest Israeli medical centers (Sheba, Sorasky, Rambam, and Hadassah). The analysis includes more than 17,000 hospitalizations occurring during two years prior to t...