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Healthcare and Health: Measures and Evaluation

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 35591

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Prof. Domenica Matranga

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Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
Interests: statistical modeling; data envelopment analysis; congestion analysis; multilevel Modeling; Bayesian modelling; additive Bayesian networks; structural equation modeling; healthcare efficiency evaluation; socioeconomic health inequality; noncommunicable diseases; elderly; active aging
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Prof. Filippa Bono

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Department of Economics, Business and Statistics (SEAS), University of Palermo, 90100 Palermo, Italy
Interests: multidimensional analysis; data envelopment analysis; multilevel models; efficiency analysis; health inequality; concentration index; European Commission; socioeconomic inequality
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Ms. Laura Maniscalco

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Department of Biomedicine, Neuroscience and Advanced Diagnostics (BI.N.D.), University of Palermo, 90100 Palermo, Italy
Interests: statistical modeling; additive Bayesian networks; logistic regression with Firth’s penalty; structural equation modeling; socioeconomic health inequality; noncommunicable diseases; elderly; active aging; social network; appropriateness of drugs and diagnostics exam prescriptions; mental disorders
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Special Issue Information

Dear Colleagues,

Healthcare evaluation is an essential tool to assess the quality, importance, value, or adherence of a service or process or structure and comprises rigorous quality measurement methods. Circumscribing healthcare evaluation is challenging as it comprises the assessment of structures, process, output, and outcomes. The choice of measures and methods depends on the evaluation framework used as well as on their objectives. The evaluation of healthcare services and treatments can be addressed to measure the organizational efficacy and clinical effectiveness of diagnostic and therapeutic care pathways and protocols. Specifically, we would be delighted to receive papers investigating the impact of the current pandemics on all wards' organizational efficiency with particular insight into COVID-19 wards.

Reducing inequality in health remains one of the European Union's burning issues, and it is also an ambitious goal for each civil society. Inequality in health is influenced by socioeconomic, cultural, legal, political, and structural factors. Nowadays, the COVID-19 pandemic has widened health inequalities, limiting access to care for people with other chronic diseases, such as oncologic or cardiopathic patients.

A valid evaluation depends on the quality of data and methods used for assessment, and it addresses the successful strategies and policies of national authorities and regions implemented to reduce health inequalities. Temporal and territorial data analyses on health inequalities can help in successful strategies.

In attempts to address disparities in health and healthcare, there is a need for more research exploring sampling methods, statistical models, surveys, dataset construction, data correction, policy implication, output or outcome definitions, and what is necessary to understand and improve health status and healthcare. This issue will have a broad focus on the impact of health quality, care, wellbeing, waste resources, measures and statistical methods, and cost control.

We welcome original research papers using different study designs and systematic reviews, impact analyses, and meta-analyses.

Prof. Domenica Matranga
Prof. Filippa Bono
Ms. Laura Maniscalco
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Patient satisfaction
Efficiency
Data envelopment analysis
Stochastic frontiers
Good and bad outputs
Healthcare indicators
Responsiveness
Waiting lists
Care humanization
Diagnostic and therapeutic care pathways
Equitable
Patient-centered care
Policy evaluation
Health-related quality of life
Health outcome
Performance indicators
Resilience
Study design
Standardization
Time series models
COVID-19
Pandemics

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Published Papers (9 papers)

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Research

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12 pages, 1335 KiB

Open AccessArticle

A Cohort Study on Diabetic Undocumented Migrants in Italy: Can Charitable Organizations Contribute to Higher Adherence?

by Elisabetta Listorti, Aleksandra Torbica, Silvano G. Cella, Gianfrancesco Fiorini, Giovanni Corrao and Matteo Franchi

Int. J. Environ. Res. Public Health 2023, 20(4), 2794; https://doi.org/10.3390/ijerph20042794 - 4 Feb 2023

Cited by 1 | Viewed by 1753

Abstract

The increasing presence of documented and undocumented migrants increases the commitment of the Italian National Health Service to their health needs, following its founding principle of equity. In particular, chronic diseases, such as diabetes, represent a crucial area where patients’ health is affected by their adherence to care pathways, for which the recent literature has reported alarming low levels. In the case of migrants, obstacles to adherence, such as language or organizational barriers, could be overcome thanks also to charitable organizations providing healthcare services. In this study, we aimed to compare the adherence among documented and undocumented migrants who received healthcare services in Milan, Italy, either from the National Health Service (NHS) or from a charitable organization. We identified a cohort of newly taken into care diabetic patients composed of two groups: (i) documented migrants that attend the NHS; and (ii) undocumented migrants that attend a charity. Information was tracked by merging two datasets: the regional healthcare information system of Lombardy, and a unique dataset that collects data on specialistic visits and pharmaceutical prescriptions for all people visiting one of the most prominent charitable organizations in Italy. The annual diabetologist visit was used as the measure of adherence. The probability of being adherent was compared among the two groups by using a multivariate log-binomial regression model, considering a set of personal characteristics that may impact health behaviors. The cohort comprised 6429 subjects. The percentage of adherence was 52% among the documented migrants, and 74% among the undocumented. Regression results confirmed this pattern: undocumented patients have an increased probability of being adherent by 1.19 times (95% CI: 1.12 to 1.26) compared to documented ones. Our study revealed the potentiality of charitable organizations in guaranteeing continuity of care to undocumented migrants. We argue that this mechanism would benefit from central coordination by the government. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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29 pages, 2728 KiB

Open AccessArticle

How to Engage Health Care Workers in the Evaluation of Hospitals: Development and Validation of BSC-HCW1—A Cross-Sectional Study

by Faten Amer, Sahar Hammoud, Haitham Khatatbeh, Huda Alfatafta, Abdulsalam Alkaiyat, Abdulnaser Ibrahim Nour, Dóra Endrei and Imre Boncz

Int. J. Environ. Res. Public Health 2022, 19(15), 9096; https://doi.org/10.3390/ijerph19159096 - 26 Jul 2022

Cited by 4 | Viewed by 3287

Abstract

Organizations worldwide utilize the balanced scorecard (BSC) for their performance evaluation (PE). This research aims to provide a tool that engages health care workers (HCWs) in BSC implementation (BSC-HCW1). Additionally, it seeks to translate and validate it at Palestinian hospitals. In a cross-sectional study, 454 questionnaires were retrieved from 14 hospitals. The composite reliability (CR), interitem correlation (IIC), and corrected item total correlation (CITC) were evaluated. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used. In both EFA and CFA, the scale demonstrated a good level of model fit. All the items had loadings greater than 0.50. All factors passed the discriminant validity. Although certain factors’ convergent validity was less than 0.50, their CR, IIC, and CITC were adequate. The final best fit model had nine factors and 28 items in CFA. The BSC-HCW1 is the first self-administered questionnaire to engage HCWs in assessing the BSC dimensions following all applicable rules and regulations. The findings revealed that this instrument’s psychometric characteristics were adequate. Therefore, the BSC-HCW1 can be utilized to evaluate BSC perspectives and dimensions. It will help managers highlight which BSC dimension predicts HCW satisfaction and loyalty and examine differences depending on HCWs’ and hospital characteristics. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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13 pages, 1623 KiB

Open AccessArticle

COVID-19 Phenotypes and Comorbidity: A Data-Driven, Pattern Recognition Approach Using National Representative Data from the United States

by George D. Vavougios, Vasileios T. Stavrou, Christoforos Konstantatos, Pavlos-Christoforos Sinigalias, Sotirios G. Zarogiannis, Konstantinos Kolomvatsos, George Stamoulis and Konstantinos I. Gourgoulianis

Int. J. Environ. Res. Public Health 2022, 19(8), 4630; https://doi.org/10.3390/ijerph19084630 - 12 Apr 2022

Cited by 1 | Viewed by 2161

Abstract

The aim of our study was to determine COVID-19 syndromic phenotypes in a data-driven manner using the survey results based on survey results from Carnegie Mellon University’s Delphi Group. Monthly survey results (>1 million responders per month; 320,326 responders with a certain COVID-19 test status and disease duration <30 days were included in this study) were used sequentially in identifying and validating COVID-19 syndromic phenotypes. Logistic Regression-weighted multiple correspondence analysis (LRW-MCA) was used as a preprocessing procedure, in order to weigh and transform symptoms recorded by the survey to eigenspace coordinates, capturing a total variance of >75%. These scores, along with symptom duration, were subsequently used by the Two Step Clustering algorithm to produce symptom clusters. Post-hoc logistic regression models adjusting for age, gender, and comorbidities and confirmatory linear principal components analyses were used to further explore the data. Model creation, based on August’s 66,165 included responders, was subsequently validated in data from March–December 2020. Five validated COVID-19 syndromes were identified in August: 1. Afebrile (0%), Non-Coughing (0%), Oligosymptomatic (ANCOS); 2. Febrile (100%) Multisymptomatic (FMS); 3. Afebrile (0%) Coughing (100%) Oligosymptomatic (ACOS); 4. Oligosymptomatic with additional self-described symptoms (100%; OSDS); 5. Olfaction/Gustatory Impairment Predominant (100%; OGIP). Our findings indicate that the COVID-19 spectrum may be undetectable when applying current disease definitions focusing on respiratory symptoms alone. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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13 pages, 1309 KiB

Open AccessArticle

Nighttime Sleep Awakening Frequency and Its Consistency Predict Future Academic Performance in College Students

by Ghee Wee Ho, Zhenzhi Yang, Linna Xing, Ken Kang-Too Tsang, Huada Daniel Ruan and Yu Li

Int. J. Environ. Res. Public Health 2022, 19(5), 2933; https://doi.org/10.3390/ijerph19052933 - 2 Mar 2022

Cited by 2 | Viewed by 5902

Abstract

Although the relationship between sleep and academic performance has been extensively examined, how sleep predicts future academic performance (e.g., 2–3 years) remains to be further investigated. Using wearable smartwatches and a self-report questionnaire, we tracked sleep activities of 45 college students over a period of approximately half a month to see whether their sleep activities predicted their academic performance, which was estimated by grade point average (GPA). Results showed that both nighttime sleep awakening frequency and its consistency in the tracking period were not significantly correlated with the GPA for the courses taken in the sleep tracking semester (current GPA). However, both nighttime sleep awakening frequency and its consistency inversely predicted the GPA for the rest of the courses taken after that semester (future GPA). Moreover, students with more difficulty staying awake throughout the day obtained lower current and future GPAs, and students with higher inconsistency of sleep quality obtained lower future GPA. Together, these findings highlight the importance of nighttime sleep awakening frequency and consistency in predicting future academic performance, and emphasize the necessity of assessing the consistency of sleep measures in future studies. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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14 pages, 744 KiB

Open AccessArticle

Inequality in Healthcare Utilization in Italy: How Important Are Barriers to Access?

by Domenica Matranga and Laura Maniscalco

Int. J. Environ. Res. Public Health 2022, 19(3), 1697; https://doi.org/10.3390/ijerph19031697 - 1 Feb 2022

Cited by 17 | Viewed by 3648

Abstract

With the ageing population, equitable access to medical care has proven to be paramount for the effective and efficient management of all diseases. Healthcare access can be hindered by cost barriers for drugs or exams, long waiting lists or difficult access to the place where the needed healthcare service is provided. The aim of this paper is to investigate whether the probability of facing one of these barriers varies among individuals with different socio-economic status and care needs, controlling for geographical variability. Methods. The sample for this study included 9629 interviews with Italian individuals, aged 15 and over, from the second wave (2015) of the European Health Interview Survey, which was conducted in all EU Member States. To model barriers to healthcare, two-level variance components of logistic regression models with a nested structure given by the four Italian macro-areas were considered. Results. Of the barriers considered in this study, only two were found to be significantly associated with healthcare utilization. Specifically, they are long waiting lists for specialist service accessibility (adjOR = 1.20, 95% CI (1.07; 1.35)) and very expensive exams for dental visit accessibility (adjOR = 0.84, 95% CI (0.73; 0.96)). Another important result was the evidence of an increasing north–south gradient for all of the considered barriers. Conclusion. In Italy, healthcare access is generally guaranteed for all of the services, except for specialist and dental visits that face a waiting time and financial barriers. However, barriers to healthcare were differentiated by income and sex. The north–south gradient for healthcare utilization could be explained through the existing differences in organizational characteristics of the several regional healthcare services throughout Italy. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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12 pages, 3149 KiB

Open AccessArticle

Processing Cycle Efficiency to Monitor the Performance of an Intelligent Tube Preparation System for Phlebotomy Services

by Ming-Feng Wu, Jen-Ying Li, Yu-Hsuan Lin, Wei-Chang Huang, Chi-Chih He and Jiunn-Min Wang

Int. J. Environ. Res. Public Health 2021, 18(17), 9386; https://doi.org/10.3390/ijerph18179386 - 6 Sep 2021

Cited by 1 | Viewed by 2789

Abstract

Background: The waiting time (WT) for a phlebotomy is directly related to patient satisfaction with a health service. However, the processing time varies widely depending on the type of patients. Monitoring of the WT alone may not enable an effective evaluation of the lean performance of the medical staff for patients with different characteristics. The objective of this study was to use process cycle efficiency (PCE) to assess the performance of an intelligent tube preparation system (ITPS) which automatically labeled test tubes and conducted patient rerouting for phlebotomy services, and to interpret the WT during peak hours. Methods: Three time periods were used. The baseline period was from 1 July to 31 July 2014. Phase 1 was after the establishment of the ITPS, with patients ≥80 years old being rerouted. In phase 2, patients ≥78 years old were rerouted. Those data were recorded with a calling system and ITPS, respectively. Results: PCE was significantly improved from 12.9% at baseline to 51.1% (p < 0.001) in phase 1 and 53.0% (p < 0.001) in phase 2. The WT of 16.9 min at baseline was reduced to 3.8 min in phase 1 (p < 0.001), and 3.6 min in phase 2 (p < 0.001). Moreover, the results showed that a WT < 10 min was consistent with a PCE ≥ 25%. Conclusions: Establishing an ITPS for phlebotomy can significantly increase PCE and shorten the WT. Furthermore, the PCE ≥ 25% could be a good assessment reference for the management of appropriate human resources for phlebotomy services, although it is a complex parameter. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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14 pages, 911 KiB

Open AccessArticle

The Research on Patient Satisfaction with Remote Healthcare Prior to and during the COVID-19 Pandemic

by Liliana Hawrysz, Grażyna Gierszewska and Agnieszka Bitkowska

Int. J. Environ. Res. Public Health 2021, 18(10), 5338; https://doi.org/10.3390/ijerph18105338 - 17 May 2021

Cited by 31 | Viewed by 7925

Abstract

The issue of research on patient satisfaction with healthcare services took on a completely new dimension due to the COVID-19 pandemic and the developing telehealth services. This results from the fact that during the pandemic, remote healthcare was often the only possible form of care provision to the patient. The COVID-19 pandemic has substantially accelerated the implementation of remote healthcare in healthcare institutions and made it an essential tool for providing healthcare services. The objective of the literature review was to study the research on patient satisfaction with remote healthcare services prior to and during the pandemic. The study featured a literature review of electronic databases, such as: Medline, ProQuest, PubMED, Ebsco, Google Scholar, WoS. The identified empirical papers were classified in two groups concerning the research on patient satisfaction prior to and during the COVID-19 pandemic, and were divided and descriptively synthesised. Certain limitations to the methodical quality of the research were demonstrated as result of the conducted analyses. It was also ascertained that researchers lack clarity on the method of defining and measuring satisfaction prior to and during the COVID-19 pandemic. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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9 pages, 526 KiB

Open AccessArticle

Postoperative Vomiting Following Laparoscopic Cholecystectomy Is Associated with Intraoperative Fluid Administration: A Retrospective Cohort Study

by Chia-Yu Hsieh, Yan-Yuen Poon, Ting-Yu Ke, Min-Hsien Chiang, Yan-Yi Li, Peng-Neng Tsai and Shao-Chun Wu

Int. J. Environ. Res. Public Health 2021, 18(10), 5305; https://doi.org/10.3390/ijerph18105305 - 17 May 2021

Cited by 10 | Viewed by 3403

Abstract

Potential risk factors for postoperative vomiting (POV) are important for daily anesthesia practice. To identify the risk factors associated with POV we retrospectively reviewed 553 adult patients who underwent scheduled simple laparoscopic cholecystectomy under sevoflurane-based general anesthesia between January and December 2018. Patients who experienced POV were predominantly women, had lower body weight, and higher ASA (American Society of Anesthesiologists) physical status. The POV group showed female sex predominance, lower body weight, and higher ASA physical status, with a significant difference when compared with the non-POV group. In univariate analysis, female sex and Apfel scores of 2, 3, and 4 were associated with a higher POV incidence. Age > 70 years, higher body weight, and ASA physical status III were associated with a lower POV incidence. In multivariate logistic regression, sex, age, Apfel score, and intraoperative crystalloid infusion rate were POV predictive factors. Receiver operating characteristic analysis showed a negative association between the intraoperative crystalloid infusion rate and POV occurrence with an area under the curve of 0.73 (p = 0.001). The cutoff intraoperative crystalloid infusion rate was 2 mL/kg/h with 82% sensitivity and 49% specificity (≥2 mL/kg/h was associated with a lower POV incidence vs. <2 mL/kg/h (OR, 95% CI; 0.52 [0.33–0.83])). To decrease POV in these patients, identifying high-risk factors and an intraoperative crystalloid administration of ≥2 mL/kg/h should be considered in patients undergoing LC under sevoflurane-based general anesthesia. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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Review

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18 pages, 2699 KiB

Open AccessReview

The Impact of the COVID-19 Pandemic on Hospital Services for Patients with Cardiac Diseases: A Scoping Review

by Mats de Lange, Ana Sofia Carvalho, Óscar Brito Fernandes, Hester Lingsma, Niek Klazinga and Dionne Kringos

Int. J. Environ. Res. Public Health 2022, 19(6), 3172; https://doi.org/10.3390/ijerph19063172 - 8 Mar 2022

Cited by 10 | Viewed by 3270

Abstract

This study aims to assess the impact of the COVID-19 pandemic on hospital cardiac care, as assessed by performance indicators. Scoping review methodology: performance indicators were extracted to inform on changes in care during January–June 2020. Database searches yielded 6277 articles, of which 838 met the inclusion criteria. After full-text screening, 94 articles were included and 1637 indicators were retrieved. Most of the indicators that provided information on changes in the number of admissions (n = 118, 88%) signaled a decrease in admissions; 88% (n = 15) of the indicators showed patients’ delayed presentation and 40% (n = 54) showed patients in a worse clinical condition. A reduction in diagnostic and treatment procedures was signaled by 95% (n = 18) and 81% (n = 64) of the indicators, respectively. Length of stay decreased in 58% (n = 21) of the indicators, acute coronary syndromes treatment times increased in 61% (n = 65) of the indicators, and outpatient activity decreased in 94% (n = 17) of the indicators related to outpatient care. Telehealth utilization increased in 100% (n = 6). Outcomes worsened in 40% (n = 35) of the indicators, and mortality rates increased in 52% (n = 31). All phases of the pathway were affected. This information could support the planning of care during the ongoing pandemic and in future events. Full article

(This article belongs to the Special Issue Healthcare and Health: Measures and Evaluation)

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