Hospital Pricing Following Integration with Physician Practices

The past decade has witnessed a new wave of hospital-physician integration, with the fraction of hospitals owning any office-based physician practice increasing from 28% in 2009 to 53% in 2015 nationwide. We offer one of the first hospital-level longitudinal analyses in examining how hospital-physician integration affects hospital prices in the modern healthcare environment. We find a robust 3–5% increase in hospital prices following integration. There is little indication that hospital quality is commensurately higher or that patient mix has changed following integration. Our supplementary analyses point to stronger bargaining leverage and foreclosure of rival hospitals as potential mechanisms for the estimated price effects.     

Percepción de profesionales de la salud sobre la intervención grupal socioeducativa con mujeres que presentan síntomas somáticos sin causa orgánica

ObjectiveTo know the perception and opinion of primary care health professionals on the impact of non-medicalizing group educational intervention (GRUSE) with women who present somatic symptoms without organic cause.DesignQualitative phenomenological study.SettingPrimary care health centers in Andalusia, during 2017 and 2018.Participants and/or contextsTwenty-four health professionals, selected according to their level of involvement in the GRUSE strategy (socio-educational groups).MethodA qualitative methodology is applied, through the phenomenological method. The technique used to collect the information is the discussion group, and a content analysis is carried out on it. The software Atlas.ti 8.0 is used as a support resource for the analysis.ResultsHealth professionals highlight group work as a means of achieving change, and point to the importance of intervention as a non-medicalizing strategy. They perceive that the participants obtain some benefits: the improvement of their personal well-being, the increase of their self-esteem and self-determination, and the generation of social networks, benefits that also affect their immediate surroundings.ConclusionsIn the opinion of the professionals, the strategy has positive effects on women and does not mean an increase in resources for the health system. In addition, they express the importance of provide women with tools to cope with daily life problems derivates mostly from gender mandates of a patriarchal society.     

IMXQB-80: A Quillaja brasiliensis saponin-based nanoadjuvant enhances Zika virus specific immune responses in mice

Vaccine adjuvants are compounds that enhance/prolong the immune response to a co-administered antigen. Saponins have been widely used as adjuvants for many years in several vaccines – especially for intracellular pathogens – including the recent and somewhat revolutionary malaria and shingles vaccines. In view of the immunoadjuvant potential of Q. brasiliensis saponins, the present study aimed to characterize the QB-80 saponin-rich fraction and a nanoadjuvant prepared with QB-80 and lipids (IMXQB-80). In addition, the performance of such adjuvants was examined in experimental inactivated vaccines against Zika virus (ZIKV). Analysis of QB-80 by DI-ESI-ToF by negative ion electrospray revealed over 29 saponins that could be assigned to known structures existing in their congener Q. saponaria, including the well-studied QS-21 and QS-7. The QB-80 saponins were a micrOTOF able to self-assembly with lipids in ISCOM-like nanoparticles with diameters of approximately 43 nm, here named IMXQB-80. Toxicity assays revealed that QB-80 saponins did present some haemolytical and cytotoxic potentials; however, these were abrogated in IMXQB-80 nanoparticles. Regarding the adjuvant activity, QB-80 and IMXQB-80 significantly enhanced serum levels of anti-Zika virus IgG and subtypes (IgG1, IgG2b, IgG2c) as well as neutralized antibodies when compared to an unadjuvanted vaccine. Furthermore, the nanoadjuvant IMXQB-80 was as effective as QB-80 in stimulating immune responses, yet requiring fourfold less saponins to induce the equivalent stimuli, and with less toxicity. These findings reveal that the saponin fraction QB-80, and particularly the IMXQB-80 nanoadjuvant, are safe and capable of potentializing immune responses when used as adjuvants in experimental ZIKV vaccines.     

National decision-making for the introduction of new vaccines: A systematic review, 2010–2020

BackgroundCompeting priorities make using a transparent and evidence-based approach important when deciding to recommend new vaccines. We conducted a literature review to document the processes and frameworks for national decision-making on new vaccine introductions and explored which key features have evolved since 2010.MethodsWe searched literature published on policymaking related to vaccine introduction from March 2010 to August 2020 in six databases. We screened articles for eligibility with the following exclusion criteria: non-human or hypothetical vaccines, the sole focus on economic evaluation or decision to adopt rather than policy decision-making. We employed nine broad categories of criteria from the 2012 review for categorization and abstracted data on the country, income level, vaccine, and other relevant criteria.ResultsOf the 3808 unique references screened, 116 met eligibility criteria and were classified as: a) framework of vaccine adoption decision-making (27), b) studies that analyse empirical data on or examples of vaccine adoption decision-making (45), c) theoretical and empirical articles that provide insights into the vaccine policymaking process (44 + 17 already included in the previous categories). Commonly reported criteria for decision-making were the burden of disease; vaccine efficacy/effectiveness, safety; impact on health and non-health outcomes; economic evaluation and cost-effectiveness of alternative interventions. Programmatic and acceptability aspects were not as often considered. Most (50; 82%) of the 61 articles describing the process of vaccine introduction policymaking highlighted the role of country, regional, or global evidence-informed recommendations and a robust national governance as enabling factors for vaccine adoption.ConclusionsThe literature on vaccine adoption decision-making has expanded since 2010. We found that policymakers and expert advisory committee members (e.g., National Immunization Technical Advisory Group [NITAG]) increasingly value the interventions based on economic evaluations. The results of this review could guide discussions on evidence-informed immunization decision-making among country, sub-regional, and regional stakeholders.     

Qualité des supports de communication de crise lors de la pandémie de la COVID-19 au Grand Maghreb

ObjectiveTo objectively assess the quality of “crisis communication” media, during the COVID-19 pandemic, in the three Greater Maghreb countries (Tunisia, Algeria, Morocco).MethodsA compliance audit for press releases and epidemiological bulletins was analyzed against a quality benchmark, which had been specifically designed by the authors. This framework, made up of five dimensions and 50 items, graded (0/1), was applied by two researchers in preventive medicine. Multiplying the scores by a coefficient of two resulted in a partial score of 20 points for each dimension and a total score of 100 points for the checklist taken as a whole. The quality of the communication media was considered to be good when exceeding the thresholds of 15/20 for the different dimensions and 75/100 for the entire grid.ResultsA total of 141 information media were included in this audit (Tunisia: 60; Algeria: 60; Morocco: 21). The overall median quality score for these media was only 56/100 (IIQ: [46–58]), without major variability between countries. The most appreciated dimension was “maintaining the confidence of the population”, with an overall median score of 14/20 (12/20 for epidemiological bulletins and 16/20 for press releases). The most poorly rated dimension was “strengthening community participation”, with a median score of only 4/20 (6/20 for epidemiological bulletins and 4/20 for press releases).ConclusionThe quality of the Maghreb crisis communication media during COVID-19 was insufficient in most of its dimensions and items, particularly from a psychosocial standpoint. Reinforcement of the capacities of communication officers to develop information material and supports during health crises is indispensable and should be considered as an urgent matter.     

全球各国疾控体系研究热点分析

目的 分析2000—2019年全球各国疾控体系的研究热点和变化趋势,为我国疾控体系的改革与完善提供循证依据。方法 基于Web of Science数据库,系统筛选2000年1月—2019年12月疾控体系相关的研究文献,运用CiteSpace 5.6.R5软件进行文献分析。结果 共收集有效文献9 878篇,过去二十年间疾控体系相关研究呈现总体递增趋势;预防、风险、体制、监督和联合等是疾控体系研究的高频词汇;不同阶段疾控体系研究关注的主题不同,2000—2006年间更关注疾控体系的职能定位和疾病防控,2006—2009年间更关注疾控体系自身诸如标准、监督等相关问题的研究,2009—2019年间更关注疾控体系运行模式和社会化形象的研究;研究热点聚类可归为儿童疾病预防、医疗救治、政策支持、检验能力建设、信息化管理和多学科联合防控6个部分。结论 我国疾控体系发展应更多关注机构定位和管理、人才建设方面,借鉴全国各国疾控体系的先进经验,进一步加强疾控体系防控能力建设。     

我国空中医疗急救发展现状与体系构建建议

目的 探讨我国空中医疗急救发展现状及体系构建策略。方法 基于现有资料分析我国空中医疗急救发展现状、模式、问题与挑战。结果 近年来我国通航企业及飞行器数量发展迅速,但是存在总体不足、多数通航企业规模较小等问题。空中急救网络主要有航空公司主导、医院或急救中心主导、通航企业-医院联合和政府主导4种发展模式;各模式均为自由发展,距离国家规划的目标尚远;现有体系内要素分散、结构不完整,大范围的空中急救网络尚未形成。结论 我国地形复杂,建成覆盖面广、运行模式统一的空中医疗急救网络困难较大,建议全国范围内构建多个主体共同参与的多元化区域性空中急救体系,而在青藏高原及周边区域优先构建公益性空中医疗急救体系。     

四川省十年新医改历程与成效研究

本研究系统地梳理了四川省新医改的发展历程,总结出四川省十年新医改取得的医疗保障体系建立健全、卫生筹资结构日趋合理、公共卫生服务水平持续增强、医疗卫生资源大幅增加、医疗服务能力进一步加强、医药费用涨幅得到有效控制、药品供应保障机制逐步健全、居民健康水平持续改善等成效。下一步应推进政府治理体系和治理能力现代化,系统、整体、协同推进医改;以医疗卫生领域供给侧改革为主线,建立优质高效的医疗卫生服务体系;深入推进重点领域改革,为健康四川建设奠定健康基础。     

河南省二级医院护士医院伦理氛围感知与隐性缺勤的相关性研究

目的 探讨河南省二级医院护士医院伦理氛围感知与隐性缺勤的现状及相关性。方法 采取多阶段分层随机抽样的方法在河南省抽取二级医院护士594名,采用一般资料调查表、医院伦理氛围量表、斯坦福隐性缺勤量表进行调查,采用相关性分析和多元线性回归分析探究护士医院伦理氛围感知与隐形缺勤之间的关系。结果 护士医院伦理氛围总分为(4.36±0.43)分,隐形缺勤为（14.83±4.76）分;不同科室、聘任方式、夜班数、科室工作年限以及饮食是否规律的护士隐形缺勤得分差异具有统计学意义（P＜0.05）;医院伦理氛围总分与隐性缺勤呈负相关(r = - 0.348,P＜0.001),各维度与隐性缺勤呈负相关（P＜0.001）;回归分析结果显示在去除混杂因素（科室工作年限、是否饮食规律、科室）后,医院伦理氛围可负向预测护士隐形缺勤（β = - 0.296,P＜0.001）。结论 医院伦理氛围可能是二级医院护士隐性缺勤的独立危险因素,医院管理者应关注护士对医院伦理氛围感知情况的变化,以降低隐性缺勤。     

药品零加成政策对慢性心力衰竭患者次均住院费用变化影响结构分析

目的 分析药品零加成政策对于慢性心衰住院费用的影响和结构变动趋势,为推进医改的实施和加强医院内部管理提供依据。方法 收集上海某医院2016—2019年慢性心衰患者住院费用,采用结构变动度法和灰色关联度法分析各项费用的结构变动情况及其与总费用的关联程度。 结果 2016—2019年住院费用总结构变动度为24.49%;药费及耗材费呈下降趋势,诊断费及综合服务费上升;药费结构变动贡献率最大（34.75%）,其次是诊断费（31.24%）,两项累积贡献率达65.99%;与次均住院费用关联度从高到低前三项为诊断费（0.86）、药费（0.79）和耗材费（0.72）。 结论 样本医院药品零加成政策的实施取得显著的成效。今后医院应建立合理评估机制,进一步控制药费及耗材费,加强诊断费的监督管理,优化医疗费用结构。