Journal of health services research & policy
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J Health Serv Res Policy · Jan 2015
A qualitative study of systemic influences on paramedic decision making: care transitions and patient safety.
Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors. ⋯ Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department).
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J Health Serv Res Policy · Jan 2015
Association between market concentration of hospitals and patient health gain following hip replacement surgery.
To assess the association between market concentration of hospitals (as a proxy for competition) and patient-reported health gains after elective primary hip replacement surgery. ⋯ Hospital market concentration (as a proxy for competition) appears to have no significant influence (at the 5% level) on the outcome of elective primary hip replacement. The generalizability of this finding needs to be investigated.
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J Health Serv Res Policy · Jan 2015
Comparison of the carbon footprint of different patient diets in a Spanish hospital.
Mitigating climate change requires management strategies to reduce greenhouse gas emissions in any sector, including the health system. Carbon footprint calculations should play a key role in quantifying and communicating these emissions. Food is among the categories with low accuracy because the carbon footprint for food is still under development. We aimed to quantify the carbon footprint of different diets. ⋯ Hospital diets contribute to the carbon footprint of a hospital. The type of diet has a significant impact on the greenhouse gas emissions. A Mediterranean diet is associated with lower environmental impact than diets with more meat, in particular red meat.
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J Health Serv Res Policy · Jan 2015
Why public trust in health care systems matters and deserves greater research attention.
Considering the underlying importance of trust, there is too little research into the understanding, protection and recovery of trust in health care systems, not only for the effective functioning of health care systems but also for society in general. Several researchers have pointed towards a contemporary crisis of trust in health care systems and there have been many examples that show the severe effects of mistrust. More research into public trust in health care systems could contribute to improving efficiency while protecting the health of the public.
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J Health Serv Res Policy · Oct 2014
ReviewEnvironmental sustainability in hospitals - a systematic review and research agenda.
Hospitals are significant contributors to natural resource depletion and environmental change. Our objective was to establish the extent to which hospital environmental sustainability has been studied and the key issues that emerge for policy, practice and research. ⋯ There remain significant gaps in the evidence base on hospital sustainability. Assessments of environmental impacts and natural resource use are beginning to be produced, both at the level of individual hospitals and at the health system level. These are an important start, but in many areas do not yet provide sufficiently detailed information to guide decision-making. There are many areas where the interests of patients and the environment coincide, but others where tensions exist. Rising resource costs and climate change mitigation measures are likely to create an increasing stimulus for research on hospital sustainability. Such research will benefit from inter-disciplinary coordination across research funders and countries.