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Sustainability
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Sustainable Healthcare: How to Assess and Improve Healthcare Structures' Sustainability
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Sustainable Healthcare: How to Assess and Improve Healthcare Structures' Sustainability

A special issue of Sustainability (ISSN 2071-1050). This special issue belongs to the section "Health, Well-Being and Sustainability".

Deadline for manuscript submissions: closed (30 June 2024) | Viewed by 17770

Special Issue Editors

Prof. Dr. Francisco Ródenas Rigla

E-Mail Website
Guest Editor
Polibienestar Research Institute, University of Valencia, 46022 Valencia, Spain
Interests: sustainability of welfare systems; analysis of public policies; long-term care; aging and ICT; sociospatial stratification and inequality
Prof. Dr. Jordi Garcés Ferrer

E-Mail Website
Guest Editor
Polibienestar Research Institute, University of Valencia, 46022 Valencia, Spain
Interests: social policy; long-term care; social innovation; ageing
Dr. Ascensión Doñate-Martínez

E-Mail Website
Guest Editor
Polibienestar Research Institute, University of Valencia, 46022 Valencia, Spain
Interests: wellbeing; chronic conditions; palliative care; public policies
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue of Sustainability focuses on a fundamental topic in today’s society, as demonstrated by the COVID-19 pandemic: the sustainability of healthcare systems. The pandemic highlighted the weaknesses of the health system, subjecting it to harsh stress tests. In the global health crisis, the older population and chronic patients have been the focus of the attention of health systems as they are high-risk groups, highlighting the need to improve the structures and protocols aimed at the most vulnerable. Health and care systems have been working under pressure during these last few months, significantly affecting their effectiveness and efficacy. All these aspects must act as a red flag to point out the value of healthcare systems to approach citizens’ wellbeing and to protect this crucial aspect for the current and future sustainability of Welfare States.  

Demographic change, with the aging of societies, and epidemiological change, with an increase in chronic diseases, is unquestionable globally. Among the consequences of these changes is the increase in multimorbidity and fragility, which means an increase in demand for health and social services. This scenario involves complexity in the management and organization of care, which require a structural and functional adaptation of the available health resources if we want to conserve them and make them sustainable. However, the effects of decision making in the medium- and long-term in health systems pose a great challenge without the help of technology, that is, without the use of computational tools and mathematical models. This is not a new challenge—scientists from different areas of knowledge have questioned the feasibility and sustainability of health systems for several decades. In this context, it is important to highlight the link between social and technical sciences for the advancement and implementation of current knowledge in this field.

Today’s global health crisis, derived from the COVID-19 pandemic, forces us to consider what is necessary to renew our systems and maintain them, without conditioning the response of future societies. In this Special Issue, we hope to find papers that raise responses to the challenge of sustainability of healthcare, in particular those aimed at the most vulnerable populations, such as older patients and/or those with chronic diseases, from different approaches. We are particularly interested, from an interdisciplinary and inter-institutional point of view, in the use of AI and algorithms in the field of care management, computational simulation of new care scenarios, the proposal of models to improve care for patients with chronic diseases, the development of tools for early identification, risk detection and screening, or the organization and integration of palliative care in daily clinical practice as well as end-of-life care.

Prof. Dr. Francisco Ródenas Rigla
Prof. Dr. Jordi Garcés Ferrer
Dr. Ascensión Doñate-Martínez
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. Sustainability is an international peer-reviewed open access semimonthly 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 2400 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

  • sustainable healthcare
  • long-term care
  • chronic diseases
  • older population
  • ICT applied to healthcare

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Published Papers (6 papers)

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21 pages, 5499 KiB  
Article
Advancing Sustainable Healthcare Technology Management: Developing a Comprehensive Risk Assessment Framework with a Fuzzy Analytical Hierarchy Process, Integrating External and Internal Factors in the Gulf Region
by Tasneem Mahmoud, Wamadeva Balachandran and Saleh Altayyar
Sustainability 2024, 16(18), 8197; https://doi.org/10.3390/su16188197 - 20 Sep 2024
Viewed by 1110
Abstract
In the context of healthcare technology management (HTM) in Saudi Arabia and the Gulf region, this study addresses a significant gap by exploring both external and internal risk factors affecting HTM performance. Previous studies have primarily focused on modeling or predicting failures in [...] Read more.
In the context of healthcare technology management (HTM) in Saudi Arabia and the Gulf region, this study addresses a significant gap by exploring both external and internal risk factors affecting HTM performance. Previous studies have primarily focused on modeling or predicting failures in medical devices, mostly examining internal (endogenous) factors that impact device performance and the development of optimal service strategies. However, a comprehensive investigation of external (exogenous) factors has been notably absent. This research introduced a novel hierarchical risk management framework designed to accommodate a broad array of healthcare technologies, not limited to just medical devices. It significantly advanced the field by thoroughly investigating and validating a comprehensive set of 53 risk factors and assessed their influence on HTM. Additionally, this study embraced the perspective of enterprise risk management (ERM) and expanded it to identify and incorporate a wider range of risk factors, offering a more holistic and strategic approach to risk assessment in healthcare technology management. The findings revealed that several previously underexplored external and internal factors significantly impacted HTM performance. Notably, the Fuzzy AHP survey identified “design risk” under facility and environmental risks as the highest risk for HTM in this region. Furthermore, this study revealed that three out of the top ten risks were related to “facility and internal environmental” factors, six were related to technological endogenous factors, and only one was related to managerial factors. This distribution underscores the critical areas for intervention and the need for robust facility and technology management strategies. In conclusion, this research not only fills a critical void by providing a robust framework for healthcare technology risk assessment but also broadens the scope of risk analysis to include a wider array of technologies, thereby enhancing the efficacy and safety of healthcare interventions in the region. Additionally, the proposed hierarchy provides insights into the underlying risk factors for healthcare technology management, with potential applications extending beyond the regional context to a global scale. Moreover, the equation we proposed offers a novel perspective on the key risk factors involved in healthcare technology management, presenting insights with far-reaching implications applicable not only regionally but also on a global level. This framework also supports sustainability goals by encouraging the efficient and responsible utilization and management of healthcare technologies, essential for ensuring the long-term economic and environmental sustainability of medical technology use. This research is of an exploratory nature, with the findings from the Fuzzy AHP analysis being most applicable to the specific geographic regions examined. Additional research is required to validate these results and to confirm the trends observed in various other regions and contexts. Full article
(This article belongs to the Special Issue Sustainable Healthcare: How to Assess and Improve Healthcare Structures' Sustainability)
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13 pages, 1585 KiB  
Article
Disability in Older People and Socio-Economic Deprivation in Italy: Effects on the Care Burden and System Resources
by Georgia Casanova and Roberto Lillini
Sustainability 2022, 14(1), 205; https://doi.org/10.3390/su14010205 - 26 Dec 2021
Cited by 6 | Viewed by 3084
Abstract
The sustainability of European Long-Term Care systems faces the demographic and socio-economic circumstances, mainly the increasing ageing of the population, with its chronic disease conditions, and the simultaneous economic general crises, exacerbated by the recent COVID-19 pandemic. Beyond the increase in general rate [...] Read more.
The sustainability of European Long-Term Care systems faces the demographic and socio-economic circumstances, mainly the increasing ageing of the population, with its chronic disease conditions, and the simultaneous economic general crises, exacerbated by the recent COVID-19 pandemic. Beyond the increase in general rate of relative poverty, there is a higher risk of poverty among elderly and families in a high demand of care, especially if situations of Activities Daily Living (ADL) disability are present. Italian welfare, which is based on family care regimes and regional strategies, and is oriented to private or public care, is a relevant case study with which to analyze such a relationship. This paper aims to study the relationship between ADL disability and the socio-economic deprivation of families, that is, household poverty. Variables came from the ISTAT Health for All Italian Database and the INAIL Disability Allowance Database. A pool of statistical methods, based on bivariate and multivariate analyses, from bivariate correlation, through multiple linear regression to principal component factor analysis, were used to reduce the number of the variables and compute the indicators. The multivariate analysis underlines how ADL disability impacts on a household’s poverty, confirming the existence of statistical correlation between them. Moreover, the study identifies and measures two answer capability models to cope with household poverty. The answer capability of the formal system is the main tool for reducing poverty due to one family member’s ADL disability. Integration and collaboration between the formal system and family capabilities remains the main solution. Full article
(This article belongs to the Special Issue Sustainable Healthcare: How to Assess and Improve Healthcare Structures' Sustainability)
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11 pages, 302 KiB  
Article
A Classification System for Decision-Making in the Management of Patients with Chronic Conditions
by Francisco Ródenas-Rigla, David Conesa, Antonio López-Quílez and Estrella Durá-Ferrandis
Sustainability 2021, 13(23), 13176; https://doi.org/10.3390/su132313176 - 28 Nov 2021
Viewed by 2016
Abstract
Patients with chronic diseases are frequent users of healthcare services. The systematic use of stratification tools and predictive models for this group of patients can be useful for health professionals in decision-making processes. The aim of this study was to design two new [...] Read more.
Patients with chronic diseases are frequent users of healthcare services. The systematic use of stratification tools and predictive models for this group of patients can be useful for health professionals in decision-making processes. The aim of this study was to design two new classifier systems for detecting the risk of hospital admission for elderly patients with chronic conditions. In this retrospective cohort study, a set of variables related to hospital admission for patients with chronic conditions was obtained through focus groups, a health database analysis and statistical processing. To predict the probability of admission from the set of predictor variables, a logistic regression within the framework of Generalized Linear Models was used. The target population consisted of patients aged 65 years or older treated in February 2016 at the Primary Health Care Centre of Burjassot (Spain). This sample was selected through the consecutive sampling of the patient quotas of the physicians who participated in the study (1000 patients). The result was two classification systems, with reasonable values of 0.722 and 0.744 for the area under the ROC curve. The proposed classifier systems could facilitate a change in the current patient management models and make them more proactive. Full article
(This article belongs to the Special Issue Sustainable Healthcare: How to Assess and Improve Healthcare Structures' Sustainability)
11 pages, 695 KiB  
Article
Responsive and Minimalist App Based on Explainable AI to Assess Palliative Care Needs during Bedside Consultations on Older Patients
by Vicent Blanes-Selva, Ascensión Doñate-Martínez, Gordon Linklater, Jorge Garcés-Ferrer and Juan M. García-Gómez
Sustainability 2021, 13(17), 9844; https://doi.org/10.3390/su13179844 - 2 Sep 2021
Cited by 2 | Viewed by 2917
Abstract
Palliative care is an alternative to standard care for gravely ill patients that has demonstrated many clinical benefits in cost-effective interventions. It is expected to grow in demand soon, so it is necessary to detect those patients who may benefit from these programs [...] Read more.
Palliative care is an alternative to standard care for gravely ill patients that has demonstrated many clinical benefits in cost-effective interventions. It is expected to grow in demand soon, so it is necessary to detect those patients who may benefit from these programs using a personalised objective criterion at the correct time. Our goal was to develop a responsive and minimalist web application embedding a 1-year mortality explainable predictive model to assess palliative care at bedside consultation. A 1-year mortality predictive model has been trained. We ranked the input variables and evaluated models with an increasing number of variables. We selected the model with the seven most relevant variables. Finally, we created a responsive, minimalist and explainable app to support bedside decision making for older palliative care. The selected variables are age, medication, Charlson, Barthel, urea, RDW-SD and metastatic tumour. The predictive model achieved an AUC ROC of 0.83 [CI: 0.82, 0.84]. A Shapley value graph was used for explainability. The app allows identifying patients in need of palliative care using the bad prognosis criterion, which can be a useful, easy and quick tool to support healthcare professionals in obtaining a fast recommendation in order to allocate health resources efficiently. Full article
(This article belongs to the Special Issue Sustainable Healthcare: How to Assess and Improve Healthcare Structures' Sustainability)
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8 pages, 919 KiB  
Article
Living Longer with Disability: Economic Implications for Healthcare Sustainability
by Alessandro Danovi, Stefano Olgiati and Alessandro D’Amico
Sustainability 2021, 13(8), 4467; https://doi.org/10.3390/su13084467 - 16 Apr 2021
Cited by 5 | Viewed by 2333
Abstract
This work focuses on the economic implications of the relationship between life expectancy, the number of years lost to disability and per-capita total health expenditure. The primary goal of the paper is to identify and plot the correlation between healthcare expenditure and the [...] Read more.
This work focuses on the economic implications of the relationship between life expectancy, the number of years lost to disability and per-capita total health expenditure. The primary goal of the paper is to identify and plot the correlation between healthcare expenditure and the global increase in life expectancy, in order to assess if, and how, the way longer average lifespans are achieved affects healthcare sustainability. Datasets regarding the United States, the European Union and the five largest emerging healthcare systems (i.e., Brazil, the Russian Federation, India, China and South Africa) were obtained from the Institute for Health Metrics and Evaluation and the WHO Health Expenditure Statistics Repository. All analysis was performed on 2017 data. The results of the analysis showed the number of years lost to disability to be a linear function of life expectancy at birth (male R2 = 0.61; female R2 = 0.47), and per-capita total health expenditure to be an exponential function of the number of years lost to disability (male R2 = 0.60; female R2 = 0.65). This implies that improving life expectancy via social policies bears negative consequences in terms of healthcare sustainability, unless the number of years lost to disability is reduced too. Further studies should narrow the sample of countries and causes of years lost due to disability, to better inform future policy efforts. Full article
(This article belongs to the Special Issue Sustainable Healthcare: How to Assess and Improve Healthcare Structures' Sustainability)
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12 pages, 260 KiB  
Perspective
Empowering Sustainable Healthcare: The Role of Health Literacy
by Patrizio Zanobini, Marco Del Riccio, Chiara Lorini and Guglielmo Bonaccorsi
Sustainability 2024, 16(10), 3964; https://doi.org/10.3390/su16103964 - 9 May 2024
Cited by 5 | Viewed by 3875
Abstract
The imperative of sustainability in healthcare is becoming more pressing due to global health crises, climate change, and the rising burden of chronic diseases. Sustainability in healthcare involves social, economic, and environmental dimensions, each important for equitable and robust healthcare delivery. Health literacy [...] Read more.
The imperative of sustainability in healthcare is becoming more pressing due to global health crises, climate change, and the rising burden of chronic diseases. Sustainability in healthcare involves social, economic, and environmental dimensions, each important for equitable and robust healthcare delivery. Health literacy may play a central role in embracing all three dimensions, bridging the gap between complex health information and individuals’ capability to understand and use it effectively: In fact, as a factor influencing the link between adverse social and economic conditions and subsequent health issues, health literacy could represent a practical target for mitigating health disparities within various demographic groups, thereby enhancing social sustainability. Furthermore, when people possess a solid understanding of their health conditions and the necessary steps for health management, they can contribute to a reduction in generated healthcare costs. Finally, health literacy and environmental health literacy equips individuals and communities with the knowledge and skills to understand how environmental factors affect health and empowers them to take proactive measures to protect the environment, potentially reducing the environmental impact of healthcare services. Therefore, integrating health literacy into education curricula and healthcare professional training is crucial for promoting sustainability. Despite some known barriers to the advancement and improvement of health literacy, such as limited awareness of its importance, the collaboration between academia, healthcare institutions, and community organizations is a path to follow to overcome these challenges. Full article
(This article belongs to the Special Issue Sustainable Healthcare: How to Assess and Improve Healthcare Structures' Sustainability)
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