Factors related to satisfaction with community-based home aging services in Shandong, China
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PROVIDER: S-EPMC10916510 | biostudies-literature | 2024 Jan
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Project description:BackgroundHome and community-based services are considered an appropriate and crucial caring method for older adults in China. However, the research examining demand for medical services in HCBS through machine learning techniques and national representative data has not yet been carried out. This study aimed to address the absence of a complete and unified demand assessment system for home and community-based services.MethodsThis was a cross-sectional study conducted on 15,312 older adults based on the Chinese Longitudinal Healthy Longevity Survey 2018. Models predicting demand were constructed using five machine-learning methods: Logistic regression, Logistic regression with LASSO regularization, Support Vector Machine, Random Forest, and Extreme Gradient Boosting (XGboost), and based on Andersen's behavioral model of health services use. Methods utilized 60% of older adults to develop the model, 20% of the samples to examine the performance of models, and the remaining 20% of cases to evaluate the robustness of the models. To investigate demand for medical services in HCBS, individual characteristics such as predisposing, enabling, need, and behavior factors constituted four combinations to determine the best model.ResultsRandom Forest and XGboost models produced the best results, in which both models were over 80% at specificity and produced robust results in the validation set. Andersen's behavioral model allowed for combining odds ratio and estimating the contribution of each variable of Random Forest and XGboost models. The three most critical features that affected older adults required medical services in HCBS were self-rated health, exercise, and education.ConclusionAndersen's behavioral model combined with machine learning techniques successfully constructed a model with reasonable predictors to predict older adults who may have a higher demand for medical services in HCBS. Furthermore, the model captured their critical characteristics. This method predicting demands could be valuable for the community and managers in arranging limited primary medical resources to promote healthy aging.
| S-EPMC10060662 | biostudies-literature
Project description:BACKGROUND:Community-based diabetes management is known to be an important strategy for global diabetes control. In China, community-based diabetes management care, including regular blood glucose tests and guidance on medicine use, dietary control, and physical exercise provided by primary health institutions (PHIs), as one of the key contents of the national essential public health services (EPHS), was implemented since 2009 when the new round of health system reform was initiated. This study aimed to investigate the utilization of community-based diabetes management care services, and explore the factors influencing utilization from both patients' and providers' points of view. METHODS:In total, 2520 type-2 diabetes mellitus (DM) patients registered for EPHS were selected from 63 PHIs in eight counties of Shandong province, China, using multi-stage stratified sampling. Of those, 2166 patients (response rate: 85.4%) completed face-to-face structured questionnaires on their utilization of community-based diabetes management care services. Further, 63 PHIs were surveyed on diabetes care delivery, and 444 primary healthcare providers were purposively sampled from those PHIs to measure their knowledge of diabetes management care delivery, using a self-developed questionnaire. Descriptive statistics were used to analyze the delivery and utilization of diabetes management care services. Multilevel logistic regression models were used to analyze the factors associated with patients' utilization of diabetes management services. RESULTS:All 63 PHIs reported that all the required four diabetes management services were provided through EPHS. However, only 49.6% of the patients reported they fully used these services, with no statistically significant difference between urban and rural patients. Patients who had higher knowledge of diabetes and better self-efficacy in controlling the condition, were more likely to fully utilize diabetes management care. A larger number of PHI health staff per 1000 population was associated with better utilization of care. CONCLUSION:Although community-based diabetes management services are well available to Chinese DM patients under the framework of EPHS, the actual utilization of diabetes management services among the patients was poor. The size of the PHI workforce, patients' knowledge and self-efficacy in controlling diabetes, were important predictors of utilization, and could be enhanced to improve control of diabetes.
| S-EPMC7212576 | biostudies-literature
Project description:ObjectivesThis study aims to examine trends in neighbourhood availability of community-based home visiting services (CHVS) (ie, coverage by local primary healthcare providers) over time and disparities in service availability according to individual characteristics using nationwide data of oldest-old individuals (age >80) in China.DesignRepeated, cross-sectional study.SettingThis study derived nationally representative data from the 2005-2018 Chinese Longitudinal Health Longevity Survey.ParticipantsA final analytical sample of 38 032 oldest-old individuals.Primary outcome measuresAvailability of CHVS was defined as having home visiting services in one's neighbourhood. Cochran-Armitage tests were used to test linear trends in the proportions of oldest-old with service availability. Weighted logistic regression models were used to examine variations in service availability across individual characteristics.ResultsOf 38 032 oldest-old individuals, availability of CHVS decreased from 9.7% in 2005 to 7.8% in 2008/2009, followed by continual increases to 33.7% in 2017/2018. These changes were similar between rural and urban oldest-old. After accounting for individual characteristics, in 2017/2018, compared with their counterparts, urban residents who had white-collar jobs before retirement and those residing in Western and Northeast China were less likely to have service availability. Oldest-old with disabilities, those living alone and those with low incomes did not report having greater availability of CHVS in either 2005 or 2017/2018.ConclusionsDespite the increasing service availability over the past 13 years, persistent geographical disparities in the availability of CHVS remain. As of 2017/2018, only one in three oldest-old in China reported having service availability, which raises concerns regarding continuity of care across different settings of services for those most in need, especially those living alone or with disabilities. National policies and targeting efforts are necessary to improve the availability of CHVS and reduce inequity in service availability for optimal long-term care to the oldest-old population in China.
| S-EPMC10083737 | biostudies-literature
Project description:ObjectivesThe aim of this study was to estimate and project the trend in long-term care (LTC) costs for home and community-based services as a percentage of gross domestic product in China between 2005 and 2050.DesignLongitudinal.Setting and participantsWe used 61,249 observations from 37,702 adults age ≥65 years from waves 2005, 2008, 2011, 2014, and 2018 of the Chinese Longitudinal Healthy Longevity Surveys.MethodsLTC costs for home and community-based services consisted of the monetary value of time spent on LTC and the direct LTC cost. We used the age-sex-residence-specific weights provided by the Chinese Longitudinal Healthy Longevity Surveys to estimate the LTC costs from 2005 to 2018. We used a component-based model to project LTC costs, in which the 2-part model was used to estimate the average LTC costs and the multi-state Markov model approach was used to project the future population by age, sex, and disability state.ResultsThe percentage of older adults with disabilities was projected to increase from 6.1% in 2005 to 7.5% in 2020 and 9.6% in 2050. The total LTC cost for home and community-based services were projected to increase from 0.3% of gross domestic product in 2005 to 0.7% in 2020 and to 6.4% in 2050.Conclusions and implicationsPolicymakers in China should take urgent actions to delay the onset of disabilities among older adults, which would curb the increasing LTC costs and maintain the sustainability of the LTC policies.
| S-EPMC10134410 | biostudies-literature
Project description:Community care is increasingly the mainstay of mental healthcare provision in many countries and patient satisfaction is an important barometer of quality of patient care. This paper explores the key factors associated with patient satisfaction with community mental health services in England and then compares providers' performance on patient satisfaction. Our analysis is based on patient-level responses from the community mental health survey, which is run annually by the Care Quality Commission (CQC) for the years 2010 to 2013. We perform a repeated cross-section analysis, identifying factors associated with patient satisfaction via a multi-level ordered probit model, including both patient- and provider-level variables. We identify hospital-specific effects via empirical Bayes estimation. Our analysis identifies a number of novel results. First, patient characteristics such as older age, being employed, and being able to work, are associated with higher satisfaction, while being female is associated with lower satisfaction. Service contact length, time since last visit, condition severity and admission to a mental health institution, are all associated with lower satisfaction. Second, treatment type affects satisfaction, with patients receiving talking therapies or being prescribed medications being more satisfied. Third, care continuity and involvement, as proxied by having a care plan, is associated with higher satisfaction. Fourth, seeing a health professional closer to the community improves satisfaction, with patients seeing a community-psychiatric nurse, a social worker or a mental-health support worker being more satisfied. Finally, our study identifies the need for service integration, with patients experiencing financial, accommodation, or physical health needs being less satisfied. At a provider level, we find a negative association between the percentage of occupied beds and satisfaction. We further identify significant provider-specific effects after accounting for observable differences in patient and provider characteristics which suggests significant differences in provider quality of care.
| S-EPMC6942033 | biostudies-literature
Project description:Well-child health care services are essential for maintaining optimum child health and development. This study's aim was to evaluate the quality of such services and identify factors affecting service quality from the perspective of well-child health care providers located in China's Hunan Province. To achieve this, a qualitative descriptive method was employed, with 22 well-child health care providers being recruited, using purposive sampling, from among the provinces' government community health centers. The participants completed individual semi-structured interviews lasting approximately 25-30 minutes that were designed to obtain their views on well-child health care administration in the province. Then, the interview transcripts were analyzed thematically. The main finding was that participants felt that the delivery of well-child health care services in Hunan Province is insufficient. Factors they mentioned as negatively affecting the delivery of such services included the region's fragmented primary health care system, inadequate attention to this issue from parents and community health care center managers, and a lack of specialized well-child care knowledge. Thus, currently, well-child health care is not being successfully implemented in Hunan Province; consequently, in order to successfully implement well-child health care in this region, community health care centers should invest more resources and funding, particularly into education programs for well-child health care providers.
| S-EPMC5779649 | biostudies-literature
Project description:ObjectiveMedicaid Home and Community-Based Services (HCBS) 1915(c) waivers are the largest provider of long-term services and supports for people with intellectual and developmental disabilities (IDDs). In this study, we explored how HCBS IDD waivers projected providing occupational therapy services in Fiscal Year (FY) 2015.MethodMedicaid HCBS IDD waivers across the nation gathered from the Centers for Medicare and Medicaid Services were qualitatively and quantitatively analyzed to determine how they projected providing occupational therapy services in terms of service expenditures and utilization.ResultsIn FY 2015, $14.13 million of spending was projected for occupational therapy services of 7,500 participants. However, there was large heterogeneity across states and services in terms of total projected spending, spending per participant, and reimbursement rates.ConclusionComparisons across states strengthen the profession's ability to assert the value of its services. These findings can help identify best practices and can advocate for the refinement of state occupational therapy programs.
| S-EPMC5807402 | biostudies-literature
Project description:BackgroundIn China, the mode of HIV transmission and the types and routes of drug use have changed in the past decade. HIV testing amongst drug users needs further improvement.MethodsInterviewer-administered questionnaires were used for data collection amongst 600 heterosexual drug users from the community and a municipal detention centre, where criminal suspects are supervised. Descriptive statistics, univariate analysis and multilevel logistic regression analysis were used to identify the factors associated with HIV testing amongst heterosexual drug users. All participants were screened HIV and sexually transmitted infections.ResultsAmongst 600 participants, 554 (92.3%) were methamphetamine users, and 155 (25.8%) underwent HIV testing in the past year. Multivariate analysis results revealed that drug users who were single (adjusted odds ratio(AOR) = 1.923, 95% confidence interval(CI) = 1.189-3.109), had less knowledge of HIV (AOR = 1.706, 95% CI = 1.074-2.711), used only one kind of drug (AOR = 2.649, 95% CI = 1.155-6.077), used drug via a non-injection route (AOR = 2.121, 95% CI = 1.103-4.078), did not receive free condoms (AOR = 2.307, 95% CI = 1.129-4.715) and who did not receive free publicity material from health workers in the past year (AOR = 2.828, 95% CI = 1.757-4.552) were less likely to undergo HIV testing. A total of 594 participants underwent HIV and syphilis screening in this survey. Amongst these participants, 2 (0.3%) were HIV antibody positive, and 88 (14.8%) showed positive results in both non-treponemal test (rapid plasma regain test) and treponemal test (Treponema pallidum particle agglutination test) for the first time.ConclusionsThe rate of HIV test uptake amongst heterosexual drug users in China remains low. Thus, more specific interventions are urgently needed to improve the utilisation of HIV testing amongst heterosexual drug users, particularly amongst non-injection drug users in China.
| S-EPMC6193625 | biostudies-literature
Project description:BackgroundThe viability of community-based health insurance programs depends on beneficiary satisfaction, and healthcare systems evaluate performance through patient reports and ratings to ensure effectiveness and service quality. To our knowledge, Ethiopia lacks national pooled data on the satisfaction of community-based health insurance beneficiaries and related factors. As a result, this review aimed to evaluate the level of beneficiaries' satisfaction with the scheme's services and associated factors in Ethiopia.MethodsDatabase searches on Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar were conducted on September 1st, 2022. Thirteen studies were chosen for review from the search results. Checklists from the Joan Briggs Institute were used to evaluate the risk of bias for the included studies. The data were extracted using a 2019 Microsoft Excel spreadsheet and analyzed using Stata 17. The odds ratios at p-values less than 0.05 with a 95% confidence interval were used to evaluate the effect estimates.ResultsThe pooled satisfaction of beneficiaries with community-based health insurance was found to be 66.0% (95% CI = 57-76%) and was found to be influenced by socio-demographic, health service-related, the scheme's related factors, and the beneficiaries' knowledge of it. The beneficiary satisfaction levels were highest in the Amhara region, at 69.0% (95% CI = 59-79%), followed by Southern Nations Nationalities and Peoples' Region (SNNPR) at 67.0% (95% CI = 40-94%), Oromia at 63.0% (95% CI = 58-68%), and Addis Ababa at 53.0% (95% CI = 45-62%).ConclusionEven though there was a moderate level of satisfaction, there are indications that the quality of health services and the coverage of the entire population lag behind, necessitating greater efforts to achieve universal health coverage.
| S-EPMC11487762 | biostudies-literature
Project description:ObjectivesTo determine the effect of home-based primary care (HBPC) for frail older adults, operating under Independence at Home (IAH) incentive alignment on long-term institutionalization (LTI).DesignCase-cohort study using HBPC site, Medicare administrative data, and National Health and Aging Trends Study (NHATS) benchmarks.SettingThree IAH-participating HBPC sites in Philadelphia, PA, Richmond, VA, and Washington, DC.ParticipantsHBPC integrated with long-term services and supports (LTSS) cases (n = 721) and concurrent comparison groups (HBPC not integrated with LTSS: n = 82; no HBPC: n = 573). Cases were eligible if enrolled at one of the three HBPC sites from 2012 to 2015. Independence at Home-qualified (IAH-Q) concurrent comparison groups were selected from Philadelphia, PA; Richmond, VA; and Washington, DC.InterventionHBPC integrated with LTSS under IAH demonstration incentives.MeasurementsMeasurements include LTI rate and mortality rates, community survival, and LTSS costs.ResultsThe LTI rate in the three HBPC programs (8%) was less than that of both concurrent comparison groups (IAH-Q beneficiaries not receiving HBPC, 16%; patients receiving HBPC but not in the IAH demonstration practices, 18%). LTI for patients at each HBPC site declined over the three study years (9.9%, 9.4%, and 4.9%, respectively). Costs of home- and community-based services (HCBS) were nonsignificantly lower among integrated care patients ($2151/mo; observed-to-expected ratio = .88 [.68-1.09]). LTI-free survival in the IAH HBPC group was 85% at 36 months, extending average community residence by 12.8 months compared with IAH-q participants in NHATS.ConclusionHBPC integrated with long-term support services delays LTI in frail, medically complex Medicare beneficiaries without increasing HCBS costs.
| S-EPMC6752197 | biostudies-literature