1
|
Chen H, Xia Y, Qin Q, Cheng J, Xiong C. Spatial equity and factors associated with intensive care unit bed allocation in China. Arch Public Health 2024; 82:169. [PMID: 39343936 PMCID: PMC11439290 DOI: 10.1186/s13690-024-01402-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 09/18/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND At present, unequal allocation of medical resources represents a major problem for medical service management in China and many other countries. Equity of intensive care unit (ICU) bed allocation is essential for timely and equitable access to medical care for critically ill patients. This study analysed the equity of ICU bed allocation in 31 provincial regions in China, and the associated factors, to provide a theoretical basis for improvement in the allocation of ICU beds. METHODS The equity of ICU bed allocation was investigated in 31 provincial regions in China in 2021. The Gini coefficient combined with Lorenz curves were used to analyse the current status of ICU bed allocation by both population and service area. The spatial heterogeneity and aggregation of ICU bed density were analysed using the Global Moran's index. The spatial distribution pattern was visualized via LISA maps using the Local Moran's index. Three grey correlation models were constructed to assess the key factors influencing ICU bed density. Finally, robustness analysis was performed to test the reliability of the results. RESULTS The allocation of ICU beds in China was highly inequitable by service area (Gini = 0.68) and showed better balance by population distribution (Gini = 0.14). The distribution of ICU beds by service area was highly spatially clustered (Global Moran's I = 0.22). The bed utilization rate exhibited the strongest association with ICU bed density by population. Registered nurses per 10,000 square kilometres was the strongest factor affecting ICU bed density by service area. CONCLUSIONS The allocation of ICU beds by population is better than by service area; the allocation by service area is less equitable in China. These findings emphasise the need to implement better measures to reduce ICU bed equity differences between regions and balance and coordinate medical resources. Service area size, bed utilization, the number of registered nurses and other key factors should be considered when performing regional health planning for ICU bed supply. This will increase the equitable access to critical medical services for all populations.
Collapse
Affiliation(s)
- Huihui Chen
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Ying Xia
- Department of Nursing, School of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Qiang Qin
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Jing Cheng
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China
| | - Change Xiong
- School of Public Health, Wuhan University of Science and Technology, Wuhan, China.
| |
Collapse
|
2
|
He YT, Zhang YC, Wu RK, Huang W, Wang RN, He LX, Li B, Zhang YL. Dynamic evolution and spatial difference of public health service supply in economically developed provinces of China: typical evidence from Guangdong Province. BMC Health Serv Res 2024; 24:23. [PMID: 38178099 PMCID: PMC10768127 DOI: 10.1186/s12913-023-10444-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE The outbreak of the COVID-19 pandemic has drawn attention from all sectors of society to the level of public health services. This study aims to investigate the level of public health service supply in the four major regions of Guangdong Province, providing a basis for optimizing health resource allocation. METHODS This article uses the entropy method and panel data of 21 prefecture-level cities in Guangdong Province from 2005 to 2021 to construct the evaluation index system of public health service supply and calculate its supply index. On this basis, the standard deviation ellipse method, kernel density estimation, and Markov chain are used to analyze the spatiotemporal evolution trend of the public health service supply level in Guangdong Province. The Dagum Gini coefficient and panel regression model are further used to analyze the relative differences and the key influencing factors of difference formation. Finally, the threshold effect model is used to explore the action mechanism of the key factors. RESULTS Overall, the level of public health service supply in Guangdong Province is on an upward trend. Among them, polarization and gradient effects are observed in the Pearl River Delta and Eastern Guangdong regions; the balance of public health service supply in Western Guangdong and Northern Mountainous areas has improved. During the observation period, the level of public health services in Guangdong Province shifted towards a higher level with a smaller probability of leapfrogging transition, and regions with a high level of supply demonstrated a positive spillover effect. The overall difference, intra-regional difference and inter-regional difference in the level of public health service supply in Guangdong Province during the observation period showed different evolutionary trends, and spatial differences still exist. These differences are more significantly positively affected by factors such as the level of regional economic development, the degree of fiscal decentralization, and the urbanization rate. Under different economic development threshold values, the degree of fiscal decentralization and urbanization rate both have a double threshold effect on the role of public health service supply level. CONCLUSION The overall level of public health service supply in Guangdong Province has improved, but spatial differences still exist. Key factors influencing these differences include the level of regional economic development, the degree of fiscal decentralization, and the urbanization rate, all of which exhibit threshold effects. It is suggested that, in view of the actual situation of each region, efforts should be made to build and maintain their own advantages, enhance the spatial linkage of public health service supply, and consider the threshold effects of key factors in order to optimize the allocation of health resources.
Collapse
Affiliation(s)
- Yan-Ting He
- School of Health Management, Southern Medical University, Guangzhou510515, China
| | - Yue-Chi Zhang
- School of Social & Political Sciences, College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Rang-Ke Wu
- School of Foreign Studies, Southern Medical University, Guangzhou510515, China
| | - Wen Huang
- The Fifth Affiliate Hospital of Southern Medical University, Guangzhou510515, China
| | - Ruo-Nan Wang
- School of Health Management, Southern Medical University, Guangzhou510515, China
| | - Luo-Xuan He
- School of Health Management, Southern Medical University, Guangzhou510515, China
| | - Bei Li
- School of Health Management, Southern Medical University, Guangzhou510515, China.
| | - Yi-Li Zhang
- School of Health Management, Southern Medical University, Guangzhou510515, China.
| |
Collapse
|
3
|
Chen B, Jin F. Spatial distribution, regional differences, and dynamic evolution of the medical and health services supply in China. Front Public Health 2022; 10:1020402. [PMID: 36211684 PMCID: PMC9540227 DOI: 10.3389/fpubh.2022.1020402] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/31/2022] [Indexed: 01/28/2023] Open
Abstract
The imbalance of medical and health services supply (MHSS) is a significant public health concern as regional economic development disparities widen in China. Based on the provincial panel data of medical and health services, this paper constructed an evaluation index system and used the two-stage nested entropy method to measure the MHSS level of 31 provinces in China from 2005 to 2020. Then we used the standard deviation ellipse, Dagum Gini coefficient, β convergence model, kernel density estimation and Markov chain to investigate the spatial distribution, regional differences, and dynamic evolution of MHSS. According to the results of these analysis, the conclusions are drawn as follows: (1) In general, the MHSS level in China showed a significant up-ward trend from 2005 to 2020. However, the MHSS level among different provinces showed a non-equilibrium characteristic. (2) Regional comparison shows that the eastern region had the highest level, and the central region had the lowest level. The eastern and central regions presented polarization, while the western region showed unremarkable gradient effect. (3) During the period, the overall regional differences, intra-regional differences, and inter-regional differences of MHSS level all showed convergence. (4) The economic development, urbanization rate, fiscal self-sufficiency rate, and foreign direct investment had significant impacts on the convergence. (5) The provinces with high levels had the positive spillover effect. The findings of this paper provide theoretical supports for optimizing the allocation of health resources and improving the equity of MHSS.
Collapse
Affiliation(s)
| | - Fulei Jin
- School of Economics, Shandong University of Finance and Economics, Jinan, China
| |
Collapse
|
4
|
Alexander GL, Galambos C, Rantz M, Shumate S, Vogelsmeier A, Popejoy L, Crecelius C. Value Propositions for Health Information Exchange Toward Improving Nursing Home Hospital Readmission Rates. J Gerontol Nurs 2022; 48:15-20. [PMID: 34978491 DOI: 10.3928/00989134-20211207-03] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The importance of health information technology use in nursing home (NH) care delivery is a major topic in research exploring methods to improve resident care. Topics of interest include how technology investments, infrastructure, and work-force development lead to better methods of nursing care delivery and outcomes. Value propositions, including perceived benefits, incentives, and system changes recognized by end-users, are important resources to inform NH leaders, policymakers, and stakeholders about technology. The purpose of the current research was to identify and disseminate value propositions from a community of stakeholders using a health information exchange (HIE). Researchers used a nominal group process, including 49 individual stakeholders participating in a national demonstration project to reduce avoidable hospitalizations in NHs. Stakeholders identified 41 total anticipated changes from using HIE. Ten stakeholder types were perceived to have experienced the highest impact from HIE in areas related to resident admissions, communication, and efficiency of care delivery. [Journal of Gerontological Nursing, 48(1), 15-20.].
Collapse
|
5
|
Henning-Smith C, Cross D, Rahman A. Challenges to Admitting Residents: Perspectives from Rural Nursing Home Administrators and Staff. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2021; 58:469580211005191. [PMID: 33769114 PMCID: PMC8743937 DOI: 10.1177/00469580211005191] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rural residents are older, on average, than urban residents, with more underlying health conditions and higher rates of disability. Rural nursing homes face unique challenges admitting medically-complex patients and meeting their needs throughout their stay. These challenges may be amplified for certain health conditions. Greater geographic distances also strain transitional care coordination practices with health system referral hubs in urban areas. In this study, we assess perceptions of difficulty rural nursing homes encounter in admitting and serving individuals with dementia, obesity, mental and behavioral health conditions, and medically complex conditions. Using a survey of nursing home administrators located in non-metropolitan counties across the U.S. (n = 209), we assessed the self-reported degree of difficulty identified in serving each of the 4 type of conditions, coupled with qualitative analysis of open-ended questions identifying specific challenges. Rural nursing homes have capacity constraints owing to lower population density, limited financial resources, and unique challenges recruiting and retaining workforce to rural areas. Nursing home administrators reported the most challenges to providing high-quality care to residents with mental and behavioral health challenges, followed by obesity. For specific challenges, administrators focused primarily on staffing concerns, as well as space and equipment needs. Rural nursing home administrators identified challenges related to specific conditions and capacity constraints. To ensure appropriate and high-quality nursing home placement for rural residents, and to minimize the disruption of transitions into nursing home settings, more attention is needed on addressing the constraints identified by rural nursing home administrators in this study.
Collapse
Affiliation(s)
| | - Dori Cross
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Adrita Rahman
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| |
Collapse
|
6
|
Alexander GL, Powell KR, Deroche CB. An evaluation of telehealth expansion in U.S. nursing homes. J Am Med Inform Assoc 2021; 28:342-348. [PMID: 33164054 PMCID: PMC7883984 DOI: 10.1093/jamia/ocaa253] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/24/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This research brief contains results from a national survey about telehealth use reported in a random sample of U.S. nursing homes. METHODS AND MATERIALS The sample includes nursing homes (N = 664) that completed surveys about information technology maturity, including telehealth use, beginning January 1, 2019, and ending August 4, 2020. A pre/post design was employed to examine differences in nursing home telehealth use for nursing homes completing surveys prior to and after telehealth expansion, on March 6, 2020. We calculated a cumulative telehealth score using survey data from 6 questions about extent of nursing home telehealth use (score range 0-42). We calculated proportions of nursing homes using telehealth and used logistic regression to look for differences in nursing homes based on organizational characteristics and odds ratios. RESULTS Significant relationships were found between nursing home characteristics and telehealth use, and specifically, larger metropolitan homes reported greater telehealth use. Ownership had little effect on telehealth use. Nursing homes postexpansion used telehealth applications for resident evaluation 11.24 times more (P < .01) than did nursing homes pre-expansion. DISCUSSION Administrators completing our survey reported a wide range of telehealth use, including approximately 16% having no telehealth use and 5% having the maximum amount of telehealth use. Mean telehealth use scores reported by the majority of these nursing homes is on the lower end of the range. CONCLUSIONS One solution for the current pandemic is to encourage the proliferation of telehealth with continued relaxed regulations, which can reduce isolation and preserve limited resources (eg, personal protective equipment) while maintaining proper distancing parameters.
Collapse
Affiliation(s)
| | - Kimberly R Powell
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | | |
Collapse
|
7
|
Alexander GL, Georgiou A, Siette J, Madsen R, Livingstone A, Westbrook J, Deroche C. Exploring information technology (IT) sophistication in New South Wales residential aged care facilities. AUST HEALTH REV 2020; 44:288-296. [DOI: 10.1071/ah18260] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 02/04/2019] [Indexed: 11/23/2022]
Abstract
Objective
The aim of this study was to determine baseline information technology (IT) sophistication in New South Wales (NSW), Australia, residential aged care facilities.
Method
IT sophistication measures IT capabilities, extent of IT use and IT integration in two domains, resident care and clinical support. A survey was administered to all NSW residential aged care facilities (n = 876) between February and May 2017. A 15% response rate was achieved (130/876). Facilities were organised by organisational type, total residential places and remoteness. Using post-stratification weights, estimates of IT sophistication scores for NSW were determined. Regression was used to examine whether there was a linear relationship between IT sophistication and the ratio of residents receiving high care.
Results
Participating facilities were similar to other NSW facilities in residential places and remoteness, but different in organisational type. IT sophistication was highest in IT capabilities and integration in resident care. IT sophistication was lowest in clinical support. Respondents had a mean of 1.2 years of IT experience. IT sophistication varied among aged care facilities. There was a linear relationship (P < 0.05) with the proportion of high-care residents and total IT sophistication
Conclusion
Routine reports of IT sophistication in aged care are not available. If data were available, determining the influence of IT sophistication on the quality care for residential aged care would be possible.
What is known about the topic?
Aged care settings that deliver care to the older population need to be contemporary in their approach to delivering high-quality and safe care. Health IT holds great potential for improving the quality and safety of care of older residents in aged care facilities.
What does this paper add?
This report provides a baseline assessment of IT capabilities, extent of IT use and IT integration, called IT sophistication, among aged care facilities with variable characteristics.
What are implications for practitioners?
Increasing IT sophistication has the potential to improve the quality of care delivered by aged care staff.
Collapse
|
8
|
Clement JP, Khushalani J, Baernholdt M. Urban-Rural Differences in Skilled Nursing Facility Rehospitalization Rates. J Am Med Dir Assoc 2018; 19:902-906. [DOI: 10.1016/j.jamda.2018.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/26/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
|
9
|
Abstract
OBJECTIVE Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making. METHODS This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015. The constant comparative method (CCM) of joint coding was used for data analysis. RESULTS Nine RNs from six LTC facilities participated in the study. The RN practice environment includes two essential RN information management aspects: information resources and information spaces. Ten commonly used information resources by RNs included: (1) RN-personal notes; (2) facility-specific templates/forms; (3) nursing processes/tasks; (4) paper-based resident profile; (5) daily care plans; (6) RN-notebooks; (7) medication administration records (MARs); (8) reporting software application (RAI-MDS); (9) people (care providers); and (10) references (i.e., books). Nurses used a combination of shared information spaces, such as the Nurses Station or RN-notebook, and personal information spaces, such as personal notebooks or "sticky" notes. Four essential RN information management functions were identified: collection, classification, storage, and distribution. Six sets of information were necessary to perform RN care tasks and communication, including: (1) admission, discharge, and transfer (ADT); (2) assessment; (3) care plan; (4) intervention (with two subsets: medication and care procedure); (5) report; and (6) reference. Based on the RN information management system requirements, a graphic information flow model was constructed. CONCLUSION This baseline study identified key components of a current LTC nursing information management system. The information flow model may assist health information technology (HIT) developers to consolidate the design of HIT solutions for LTC, and serve as a communication tool between nurses and information technology (IT) staff to refine requirements and support further LTC HIT research.
Collapse
Affiliation(s)
- Quan Wei
- Alberta Health Services, Calgary, Alberta, Canada
| | - Karen L Courtney
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| |
Collapse
|
10
|
Borders TF. Recognition of the Inaugural "Article of the Year," Rural Health Research Methods, Information Technology, and Veterans' Health Care. J Rural Health 2017; 33:237-238. [PMID: 28678416 DOI: 10.1111/jrh.12252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Tyrone F Borders
- Department of Health Management and Policy, College of Public Health, University of Kentucky, Lexington, Kentucky
| |
Collapse
|