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Shen HC, Li CC, Yeh SCJ. Do hospitals attaining a public recognition for treating nurses fairly deliver better-quality health care? Evidence from cross-sectional analysis of California hospitals. J Adv Nurs 2024. [PMID: 38382902 DOI: 10.1111/jan.16123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024]
Abstract
AIM This study explored whether hospitals that allocate greater resources to their nursing staff provide better healthcare services than those that invest less in their nursing personnel. DESIGN Cross-sectional logistic and tobit analyses. METHODS We examined a sample of 314 California hospitals in 2017. We obtained a hospital's public recognition for treating nurses fairly between 2015 and 2017 from Nurse.org, the largest online community of nurses. We derived a hospital's healthcare quality in 2018 from the 2019-2020 Best Hospitals rankings released by U.S. News, a well-known media company publishing independent healthcare assessments periodically. RESULTS Our results showed that a nurse-friendly workplace was a crucial determinant of its overall healthcare quality. CONCLUSION AND IMPLICATIONS Healthcare administrators keen to enhance the quality of healthcare services should consider creating nurse-friendly workplaces. Furthermore, their evaluation of nurses' contributions to overall healthcare quality should not solely depend on the nurse-assessed quality of care, but rather comprise not only broad aspects of patient outcomes in primary care but also patient experiences, care-related factors and expert opinions. PATIENT OR PUBLIC CONTRIBUTION Our study helped address the overwhelmed healthcare system, whose long-running shortage of nurses has been exacerbated by the COVID-19 pandemic. Our work suggested that a hospital's investment in a nurse-friendly workplace can enhance its acquisition, retention and devotion of the nursing staff. This, in turn, can have profound impacts on its overall healthcare quality. WHAT ALREADY IS KNOWN Existing empirical evidence on the relation between nurse-friendly workplace and healthcare quality is limited and inconclusive. WHAT THIS PAPER ADDS We documented evidence that the quality of healthcare services provided by hospitals varies with their treatment of nursing staff. IMPLICATIONS FOR PRACTICE/POLICY Our results provided insights into key policies that have the potential to improve healthcare quality.
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Affiliation(s)
- Hsiu-Chu Shen
- Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chien-Ching Li
- Department of Health Systems Management, Rush University, Chicago, Illinois, USA
| | - Shu-Chuan Jennifer Yeh
- Department of Business Management, Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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Chou HC, Cheng SF, Jennifer Yeh SC, Tang PL. Effectiveness of a multicomponent activity and horticultural intervention for the hospitalized older adults: A randomized controlled trial: Effectiveness of Intervention for the Hospitalized Older Adults. Geriatr Nurs 2024; 55:112-118. [PMID: 37979470 DOI: 10.1016/j.gerinurse.2023.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
This study evaluated the effectiveness of different intervention programs in improving function among hospitalized older individuals using the Comprehensive Geriatric Assessment (CGA). A randomized controlled trial consisted of three groups: routine care, horticulture, and multicomponent activities (n = 32 each). Horticultural and multicomponent activity interventions showed beneficial effects on the CGA in hospitalized older individuals, particularly regarding cognitive function and quality-of-life. Additionally, horticultural activities significantly contributed to the perception of older adults' health status. We recommend to select older patients in geriatric wards with long-term hospitalization and adjust the frequency of activities or choose a single intervention program to provide long-term and effective intervention effects.
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Affiliation(s)
- Hsueh-Chih Chou
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC); Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (ROC)
| | - Su-Fen Cheng
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (ROC)
| | - Shu-Chuan Jennifer Yeh
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan (ROC)
| | - Pei-Ling Tang
- School of Nursing, Fooyin University, Kaohsiung, Taiwan (ROC).
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Yeh SCJ, Wang WC, Yu HC, Wu TY, Lo YY, Shi HY, Chou HC. Relationship between using cancer resource center services and patient outcomes. Support Care Cancer 2023; 31:706. [PMID: 37975908 DOI: 10.1007/s00520-023-08169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Psychological and social support are crucial in treating cancer. Cancer resource centers provide patients with cancer and their families with services that can help them through cancer treatment, ensure that patients receive adequate treatment, and reduce cancer-related stress. These centers offer various services, including medical guidance, health education, emotional assistance (e.g., consultations for cancer care), and access to resources such as financial aid and post recovery programs. In this study, we comprehensively analyzed how cancer resource centers assist patients with cancer and improve their clinical outcomes. METHODS The study participants comprised patients initially diagnosed with head and neck cancer or esophageal cancer. A total of 2442 patients from a medical center in Taiwan were included in the study. Data were analyzed through logistic regression and Cox proportional hazards regression. RESULTS The results indicate that unemployment, blue-collar work, and a lower education level were associated with higher utilization of cancer resource center services. The patients who were unemployed or engaged in blue-collar work had higher risks of mortality than did their white-collar counterparts. Patient education programs can significantly improve the survival probability of patients with cancer. On the basis of our evaluation of the utilization and benefits of services provided by cancer resource centers, we offer recommendations for improving the functioning of support systems for patients with cancer and provide suggestions for relevant future research. CONCLUSIONS We conclude that cancer resource centers provide substantial support for patients of low socioeconomic status and improve patients' survival.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Institute of Health Care Management & Department of Business Management, National Sun Yat-Sen University, 70 Lian Hai Road, Kaohsiung, 80424, Taiwan.
| | - Wen Chun Wang
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hsien-Chung Yu
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tzu-Yu Wu
- National Taiwan University Hospital Research Ethics Committee Office, Taipei, Taiwan
| | - Ying-Ying Lo
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsueh-Chih Chou
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Shi HY, Yeh SCJ, Chou HC, Wang WC. Long-term care insurance purchase decisions of registered nurses: Deep learning versus logistic regression models. Health Policy 2023; 129:104709. [PMID: 36725380 DOI: 10.1016/j.healthpol.2023.104709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/03/2022] [Accepted: 01/16/2023] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The purpose of this study was to use a deep learning model and a traditional statistical regression model to predict the long-term care insurance decisions of registered nurses. METHODS We Prospectively surveyed 1,373 registered nurses with a minimum of 2 years of full-time working experience at a large medical center in Taiwan: 615 who already owned long-term care insurance (LTCI), 332 who had no intention to purchase LTCI (group 1), and 426 who intended to purchase LTCI (group 2). RESULTS After inverse probability of treatment weighting (IPTW), no statistically significant differences were identified in the study characteristics of the two groups. All the performance indices for the deep neural network (DNN) model were significantly higher than those of the multiple logistic regression (MLR) model (P<0.001). The strongest predictor of an individual's long-term care insurance decision was their risk propensity score, followed by their caregiving responsibilities, whether they live with older adult relatives, their experiences of catastrophic illness, and their openness to experience. CONCLUSIONS The DNN model is useful for predicting long-term care insurance decisions. Its prediction accuracy can be increased through training with temporal data collected from registered nurses. Future research can explore designs for two-level or multilevel models that explain the contextual effects of the risk factors on long-term care insurance decisions.
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Affiliation(s)
- Hon-Yi Shi
- Institute of Health Care Management and Department of Business Management, National Sun Yat-sen University, No.70 Lian Hai Road, Kaohsiung 80424, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung, Taiwan; Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Institute of Health Care Management and Department of Business Management, National Sun Yat-sen University, No.70 Lian Hai Road, Kaohsiung 80424, Taiwan; Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Hsueh-Chih Chou
- Institute of Health Care Management and Department of Business Management, National Sun Yat-sen University, No.70 Lian Hai Road, Kaohsiung 80424, Taiwan; Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen Chun Wang
- Institute of Health Care Management and Department of Business Management, National Sun Yat-sen University, No.70 Lian Hai Road, Kaohsiung 80424, Taiwan
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Shih FC, Yeh SCJ, Hsu WL. Abusive supervision and employee well-being of nursing staff: Mediating role of occupational stress. J Adv Nurs 2023; 79:664-675. [PMID: 36511427 DOI: 10.1111/jan.15538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 10/18/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
AIM The study examined whether occupational stress mediated the relationship between abusive supervision and well-being of nursing staff. DESIGN A cross-sectional questionnaire survey was administered. METHODS Data were collected at three-time points between July 2020 and January 2021. A total of 313 valid responses were obtained from nurses working in a general hospital in Taiwan. The data were analysed using descriptive statistics, Pearson's correlation analysis and the bootstrap method. RESULTS Abusive supervision was positively associated with occupational stress (β = 0.288, SE = 0.069, 95% CI [0.152, 0.423]) and negatively associated with employee well-being, including psychological (β = -0.350, SE = 0.084, 95% CI [-0.515, -0.186]), physical (β = -0.301, SE = 0.080, 95% CI [-0.459, -0.143]) and social well-being (β = -0.422, SE = 0.121, 95% CI [-0.661, -0.183]). Occupational stress was negatively related to employee well-being. A mediation analysis with bootstrapping revealed that occupational stress mediated the relationship between abusive supervision and employee well-being, which included psychological (95% bootstrap CI [-0.183, -0.046]), physical (95% bootstrap CI [-0.212, -0.062]) and social well-being (95% bootstrap CI [-0.178, -0.040]). CONCLUSION Abusive supervision influences employee well-being. Occupational stress mediates the relationship between abusive supervision and employee well-being. To improve employee well-being, hospital administrators should develop policies for effectively managing nursing supervisors' abusive behaviour and subordinates' stress management. IMPACT Abusive supervision increased the occupational stress of employees and influenced their well-being. Thus, educational courses should be implemented to train supervisors to practice positive leadership and treat employees fairly. Promoting stress management among nursing staff may lead to the prompt reporting of abusive events and improved employee well-being. NO PATIENT OR PUBLIC CONTRIBUTION This study investigated the relationship between the abusive supervision and employee well-being of nursing employees. No patient or public contribution is involved in this study.
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Affiliation(s)
- Fang-Chi Shih
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Medical Affair Management Office, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Institute of Health Care Management & Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan.,Management Studies Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan.,Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wan-Ling Hsu
- Administration Center, E-Da Hospital, Kaohsiung, Taiwan
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Chen YC, Chung JH, Yeh YJ, Lou SJ, Lin HF, Lin CH, Hsien HH, Hung KW, Yeh SCJ, Shi HY. Predicting 30-Day Readmission for Stroke Using Machine Learning Algorithms: A Prospective Cohort Study. Front Neurol 2022; 13:875491. [PMID: 35860493 PMCID: PMC9289395 DOI: 10.3389/fneur.2022.875491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMachine learning algorithms for predicting 30-day stroke readmission are rarely discussed. The aims of this study were to identify significant predictors of 30-day readmission after stroke and to compare prediction accuracy and area under the receiver operating characteristic (AUROC) curve in five models: artificial neural network (ANN), K nearest neighbor (KNN), random forest (RF), support vector machine (SVM), naive Bayes classifier (NBC), and Cox regression (COX) models.MethodsThe subjects of this prospective cohort study were 1,476 patients with a history of admission for stroke to one of six hospitals between March, 2014, and September, 2019. A training dataset (n = 1,033) was used for model development, and a testing dataset (n = 443) was used for internal validation. Another 167 patients with stroke recruited from October, to December, 2019, were enrolled in the dataset for external validation. A feature importance analysis was also performed to identify the significance of the selected input variables.ResultsFor predicting 30-day readmission after stroke, the ANN model had significantly (P < 0.001) higher performance indices compared to the other models. According to the ANN model results, the best predictor of 30-day readmission was PAC followed by nasogastric tube insertion and stroke type (P < 0.05). Using a machine learning ANN model to obtain an accurate estimate of 30-day readmission for stroke and to identify risk factors may improve the precision and efficacy of management for these patients.ConclusionUsing a machine-learning ANN model to obtain an accurate estimate of 30-day readmission for stroke and to identify risk factors may improve the precision and efficacy of management for these patients. For stroke patients who are candidates for PAC rehabilitation, these predictors have practical applications in educating patients in the expected course of recovery and health outcomes.
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Affiliation(s)
- Yu-Ching Chen
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Jo-Hsuan Chung
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yu-Jo Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shi-Jer Lou
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Hsiu-Fen Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Neurology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ching-Huang Lin
- Division of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Hong-Hsi Hsien
- Department of Internal Medicine, St. Joseph Hospital, Kaohsiung, Taiwan
| | - Kuo-Wei Hung
- Division of Neurology, Department of Internal Medicine, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung, Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
- *Correspondence: Hon-Yi Shi
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Yeh SCJ, Wang WC, Wang YH, Wan T, Chou HC. How Followers’ Perception of Insider Status Influences the Relationship Between Servant Leadership and Work Attitude? IJOL 2022. [DOI: 10.33844/ijol.2022.60623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yen CC, Chan MH, Lin WC, Yeh SCJ. Protective Behaviors for COVID-19 Were Associated With Fewer Psychological Impacts on Nurses: A Cross-Sectional Study in Taiwan. INQUIRY 2022; 59:469580221096278. [PMID: 35532315 PMCID: PMC9092574 DOI: 10.1177/00469580221096278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The COVID-19 pandemic has increased psychological distress among
common people and has caused health care providers, such as nurses, to
experience tremendous stress. Methods: This prospective cross-sectional study
assessed the psychological impacts on nurses in a community hospital in Taiwan,
including major depressive disorder (MDD), posttraumatic stress (PTS), and
pessimism. According to transactional theory, coping strategies and personal
factors have psychological impacts. We hypothesized that behavioral responses to
COVID-19 (problem-focused coping) are more effective in reducing psychological
impacts than emotional responses to COVID-19 (emotion-focused coping).
Independent variables were the use of behavioral and emotional coping strategies
for COVID-19 and 3 personal factors, namely sleep disturbance, physical
component summary (PCS-12), and mental component summary (MCS-12) of the 12-Item
Short Form Health Survey (SF-12) obtained from the Medical Outcomes Study.
Dependent variables comprised 3 psychological impacts, namely MDD, PTS, and
pessimism. Results: We determined that behavioral coping strategies had
significant negative effects on PTS and pessimism; however, emotional coping
strategies had significantly positive effects on PTS and pessimism. Sleep
disturbance was significantly associated with increased MDD and pessimism.
PCS-12 had a significant negative effect on PTS, whereas MCS-12 was not
significantly associated with any of the 3 psychological impacts. Conclusions:
Nurses who adopted protective behavior against COVID-19, such as washing hands,
wearing masks, avoiding touching eyes, and mouth, and avoiding personal contact,
were associated with less posttraumatic stress and pessimism. Healthcare
providers should consider strategies for improving preventive behaviors to help
ease their worries and fears concerning COVID-19.
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Affiliation(s)
- Chia-Chi Yen
- Department of Nutrition, Institute of Biomedical Nutrition, Hungkuang University, Taichung, Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Superintendent’s Office, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Min-Ho Chan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Department of Anesthesia, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
| | - Wei-Chun Lin
- Department of Orthopedic, Kaohsiung Municipal Min-Sheng Hospital, Kaohsiung, Taiwan
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Lou SJ, Hou MF, Chang HT, Lee HH, Chiu CC, Yeh SCJ, Shi HY. Breast Cancer Surgery 10-Year Survival Prediction by Machine Learning: A Large Prospective Cohort Study. Biology (Basel) 2021; 11:biology11010047. [PMID: 35053045 PMCID: PMC8773427 DOI: 10.3390/biology11010047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/07/2023]
Abstract
Machine learning algorithms have proven to be effective for predicting survival after surgery, but their use for predicting 10-year survival after breast cancer surgery has not yet been discussed. This study compares the accuracy of predicting 10-year survival after breast cancer surgery in the following five models: a deep neural network (DNN), K nearest neighbor (KNN), support vector machine (SVM), naive Bayes classifier (NBC) and Cox regression (COX), and to optimize the weighting of significant predictors. The subjects recruited for this study were breast cancer patients who had received breast cancer surgery (ICD-9 cm 174-174.9) at one of three southern Taiwan medical centers during the 3-year period from June 2007, to June 2010. The registry data for the patients were randomly allocated to three datasets, one for training (n = 824), one for testing (n = 177), and one for validation (n = 177). Prediction performance comparisons revealed that all performance indices for the DNN model were significantly (p < 0.001) higher than in the other forecasting models. Notably, the best predictor of 10-year survival after breast cancer surgery was the preoperative Physical Component Summary score on the SF-36. The next best predictors were the preoperative Mental Component Summary score on the SF-36, postoperative recurrence, and tumor stage. The deep-learning DNN model is the most clinically useful method to predict and to identify risk factors for 10-year survival after breast cancer surgery. Future research should explore designs for two-level or multi-level models that provide information on the contextual effects of the risk factors on breast cancer survival.
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Affiliation(s)
- Shi-Jer Lou
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Ming-Feng Hou
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Surgery, Division of Breast Oncology and Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Center for Liquid Biopsy and Cohort Research, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Hong-Tai Chang
- Department of Surgery, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan;
| | - Hao-Hsien Lee
- Department of General Surgery, Chi Mei Medical Center, Liouying 73658, Taiwan;
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan;
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80420, Taiwan
| | - Hon-Yi Shi
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80420, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-7-3211101 (ext. 2648); Fax: +886-7-3137487
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Yeh SCJ, Chou HC, Chen SHS. Do Personality and Belief Influence the Ownership of Private Long-term Care Insurance? Innov Aging 2021. [PMCID: PMC8681453 DOI: 10.1093/geroni/igab046.3086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Consumer voices are often left out from assessments of nursing home (NH) quality. For this reason, consumer allegations and complaints against nursing homes were studied in relation to facility rates of nurse aide retention. Analyses involved means and frequencies, correlations, ANOVAs with Tukey correction to examine the independent and dependent variables (N=690). Four quartiles of retention were created. In the final models, medium, high, and extremely high retention facilities are compared to the low retention facilities. Negative binomial regressions were estimated on total, substantiated, and unsubstantiated counts of allegations and complaints. All regressions controlled for the same characteristics, including nurse aide empowerment, consistent assignment, administrator turnover, director of nursing turnover, average age of residents, and percent female. The correlation between retention and the dependent variables was negative and statistically significant (r=-0.11, p<.01). The ANOVAs showed that high retention NHs (61-72%) received significantly fewer allegations than low (0-48%) and medium (49-60%) retention NHs; they also received fewer unsubstantiated allegations, and fewer complaints, both substantiated and unsubstantiated. After controlling for other variables, each retention group was significantly related to having fewer allegations and complaints compared to the low retention NHs. Notably, high retention NHs received between 29 and 35% fewer allegations and complaints of all types. Unexpectedly, extremely high retention NHs had more allegations, complaints, and unsubstantiated allegations than high retention NHs. Policy and practice have a role to promote nurse aide retention, improve job quality, and ensure adequate support for this critical, in-demand workforce.
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Affiliation(s)
| | - Hsueh-Chih Chou
- Kaohsiung Veterans General Hospital, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan (Republic of China)
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Wang YC, Lee WY, Chou MY, Liang CK, Chen HF, Yeh SCJ, Yaung CL, Tsai KT, Huang JJ, Wang C, Lin YT, Lou SJ, Shi HY. Cost and Effectiveness of Long-Term Care Following Integrated Discharge Planning: A Prospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9111413. [PMID: 34828460 PMCID: PMC8621918 DOI: 10.3390/healthcare9111413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/12/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Little is known about the effects of seamless hospital discharge planning on long-term care (LTC) costs and effectiveness. This study evaluates the cost and effectiveness of the recently implemented policy from hospital to LTC between patients discharged under seamless transition and standard transition. A total of 49 elderly patients in the standard transition cohort and 119 in the seamless transition cohort were recruited from November 2016 to February 2018. Data collected from medical records included the Multimorbidity Frailty Index, Activities of Daily Living Scale, and Malnutrition Universal Screening Tool during hospitalization. Multiple linear regression and Cox regression models were used to explore risk factors for medical resource utilization and medical outcomes. After adjustment for effective predictors, the seamless cohort had lower direct medical costs, a shorter length of stay, a higher survival rate, and a lower unplanned readmission rate compared to the standard cohort. However, only mean total direct medical costs during hospitalization and 6 months after discharge were significantly (p < 0.001) lower in the seamless cohort (USD 6192) compared to the standard cohort (USD 8361). Additionally, the annual per-patient economic burden in the seamless cohort approximated USD 2.9–3.3 billion. Analysis of the economic burden of disability in the elderly population in Taiwan indicates that seamless transition planning can save approximately USD 3 billion in annual healthcare costs. Implementing this policy would achieve continuous improvement in LTC quality and reduce the financial burden of healthcare on the Taiwanese government.
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Affiliation(s)
- Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
| | - Wen-Ying Lee
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Administration, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan
| | - Ming-Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
- Department of Geriatric Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei 11221, Taiwan
- Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Hsueh-Fen Chen
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Chih-Liang Yaung
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan;
| | - Kang-Ting Tsai
- Department of Geriatrics and Center for Integrative Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Joh-Jong Huang
- Department of Health, Kaohsiung City Government, Kaohsiung 80251, Taiwan;
| | - Chi Wang
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan;
| | - Yu-Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung 81341, Taiwan; (Y.-C.W.); (M.-Y.C.); (C.-K.L.); (Y.-T.L.)
| | - Shi-Jer Lou
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Correspondence: (S.-J.L.); (H.-Y.S.); Tel.: +886-7-3211101 (ext. 2648) (H.-Y.S.)
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (W.-Y.L.); (H.-F.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40604, Taiwan
- Correspondence: (S.-J.L.); (H.-Y.S.); Tel.: +886-7-3211101 (ext. 2648) (H.-Y.S.)
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12
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Kuo YH, Chiu CC, Tseng LY, Wu CH, Chen MH, Fang YC, Tseng WC, Chen CH, Yeh SCJ, Shi HY. Long-Term Trends and Predictors of Medical Resource Utilization and Medical Outcomes in Inguinal Hernia Repair: A Nationwide Cohort Study. World J Surg 2021; 45:1771-1778. [PMID: 33660074 DOI: 10.1007/s00268-021-06012-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Few studies have comprehensively and systematically analyzed nationwide samples. This study purposed to explore temporal trends and predictors of medical resource utilization and medical outcomes in these patients to obtain data that can be used to improve healthcare policies and to support clinical and administrative decision-making. METHODS This study used nationwide population data contained in the Longitudinal Health Insurance Database of Taiwan. The 14,970 inguinal hernia repair patients were enrolled in this study (age range, 18-100 years) from 1997 to 2013 in Taiwan. After temporal trends analysis of demographic characteristics, clinical characteristics, and institutional characteristics, predictors of postoperative medical resource utilization and medical outcomes were evaluated through multiple linear regression analysis and Cox regression analysis. RESULTS The prevalence of inguinal hernia repair per 100,000 population significantly decreased from 195.38 in 1997 to 39.66 in 2013 (p < 0.05). Demographic characteristics, clinical characteristics, and institutional characteristics were significantly associated with postoperative medical resource utilization and medical outcomes (p < 0.05). Of these characteristics, both surgeon volume and hospital volume had the strongest association. CONCLUSIONS The inguinal hernia repair prevalence rate gradually decreased during the study period. Demographic characteristics, clinical characteristics, and institutional characteristics had strong associations with postoperative medical resource utilization and medical outcomes. Furthermore, hospital volume and surgeon volume had the strongest associations with postoperative medical resource utilization and medical outcomes. Additionally, providing the education needed to make the most advantageous medical decisions would be a great service not only to patients and their families, but also to the general population.
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Affiliation(s)
- Yi-Hung Kuo
- Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery and Medical Research Department, E-Da Cancer Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Li-Ya Tseng
- Department of Anesthesiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chien-Hung Wu
- Department of Emergency Medicine, Yunlin Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Yunlin, Taiwan
| | - Min Hui Chen
- Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yu-Chao Fang
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Wei-Chi Tseng
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chun-Hsiang Chen
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan.
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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13
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Chiu CC, Wang JJ, Hung CM, Lin HF, Hsien HH, Hung KW, Chiu HC, Jennifer Yeh SC, Shi HY. Impact of Multidisciplinary Stroke Post-Acute Care on Cost and Functional Status: A Prospective Study Based on Propensity Score Matching. Brain Sci 2021; 11:brainsci11020161. [PMID: 33530541 PMCID: PMC7912561 DOI: 10.3390/brainsci11020161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 02/07/2023] Open
Abstract
Few papers discuss how the economic burden of patients with stroke receiving rehabilitation courses is related to post-acute care (PAC) programs. This is the first study to explore the economic burden of stroke patients receiving PAC rehabilitation and to evaluate the impact of multidisciplinary PAC programs on cost and functional status simultaneously. A total of 910 patients with stroke between March 2014 and October 2018 were separated into a PAC group (at two medical centers) and a non-PAC group (at three regional hospitals and one district hospital) by using propensity score matching (1:1). A cost-illness approach was employed to identify the cost categories for analysis in this study according to various perspectives. Total direct medical cost in the per-diem-based PAC cohort was statistically lower than that in the fee-for-service-based non-PAC cohort (p < 0.001) and annual per-patient economic burden of stroke patients receiving PAC rehabilitation is approximately US $354.3 million (in 2019, NT $30.5 = US $1). Additionally, the PAC cohort had statistical improvement in functional status vis-à-vis the non-PAC cohort and total score of each functional status before rehabilitation and was also statistically significant with its total score after one-year rehabilitation training (p < 0.001). Early stroke rehabilitation is important for restoring health, confidence, and safe-care abilities in these patients. Compared to the current stroke rehabilitation system, PAC rehabilitation shortened the waiting time for transfer to the rehabilitation ward and it was indicated as an efficient policy for treatment of stroke in saving medical cost and improving functional status.
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Affiliation(s)
- Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan; (C.-C.C.); (C.-M.H.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
- Department of General Surgery, Chi Mei Medical Center, Liouying 73657, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan 71004, Taiwan;
| | - Chao-Ming Hung
- Department of General Surgery, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan; (C.-C.C.); (C.-M.H.)
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Hsiu-Fen Lin
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan;
| | - Hong-Hsi Hsien
- Department of Internal Medicine, St. Joseph Hospital, Kaohsiung 80288, Taiwan;
| | - Kuo-Wei Hung
- Division of Neurology, Department of Internal Medicine, Yuan’s General Hospital, Kaohsiung 80249, Taiwan;
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-C.C.); (S.-C.J.Y.)
- Institute of Hospital Management, Tsinghua University, Beijing 100084, China
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-C.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (H.-C.C.); (S.-C.J.Y.)
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-7-3211101 (ext. 2648); Fax: +886-7-3137487
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14
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Yeh SCJ, Wang WC, Chou HC, Chen SHS. Private Long-Term Care Insurance Decision: The Role of Income, Risk Propensity, Personality, and Life Experience. Healthcare (Basel) 2021; 9:healthcare9010102. [PMID: 33478041 PMCID: PMC7835807 DOI: 10.3390/healthcare9010102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 11/16/2022] Open
Abstract
The rising aging population contributes to increased caregiver burden and a greater need for long-term care services, thereby posing stronger financial burden. The current study aimed to examine the effect of income, risk-taking propensity, personality traits, and life experience on the ownership of and intention to own private long-term care insurance (LTCI). Primary data were collected from 1373 registered nurses with a minimum of two years of full-time working experience. Multinomial logistic regression was used to examine the relationships between ownership of LTCI and personal discretionary income, risk propensity, openness to experience, and life experience. Personal discretionary income was a crucial positive indicator in predicting ownership of LTCI. Higher risk-taking propensity was found to be negatively related to both currently own and future intention to own private LTCI. Participants who currently live with elders and who agree to caregiving responsibilities with government-provided cash allowance showed future intention to purchase LTCI. Little evidence was found for an association between life experience and future intention to own LTCI. Income, risk-taking propensity, and personality traits differ in their impact on ownership of and future intention to own LTCI. Our results provide policy makers with a better understanding of the forces driving demand in the private LTCI market, as well as the accompanying implications for public LTCI.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Department of Business Management, National Sun Yat-sen University, Kaohsiung City 804, Taiwan; (W.C.W.); (H.-C.C.)
- Correspondence:
| | - Wen Chun Wang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung City 804, Taiwan; (W.C.W.); (H.-C.C.)
| | - Hsueh-Chih Chou
- Department of Business Management, National Sun Yat-sen University, Kaohsiung City 804, Taiwan; (W.C.W.); (H.-C.C.)
- Kaohsiung Veterans General Hospital, Kaohsiung City 813, Taiwan;
| | - Shih-Hua Sarah Chen
- Kaohsiung Veterans General Hospital, Kaohsiung City 813, Taiwan;
- Division of Social Sciences, The University of Chicago, Chicago, IL 60637, USA
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15
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Yeh SCJ, Chen SHS, Yuan KS, Chou W, Wan TTH. Emotional Labor in Health Care: The Moderating Roles of Personality and the Mediating Role of Sleep on Job Performance and Satisfaction. Front Psychol 2021; 11:574898. [PMID: 33391089 PMCID: PMC7773755 DOI: 10.3389/fpsyg.2020.574898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022] Open
Abstract
The objective of this study is to investigate the effects of emotional labor on job performance and satisfaction, as well as to examine the mediating effect of sleep problems and the moderating effects of personality traits. A time-lagged study was conducted on 864 health professionals. Scales for emotional labor, sleep, personality traits, and job satisfaction were used and job performance data was obtained from records maintained by human resources. Structural equation modeling was performed to investigate the relations. Sleep problems only partially mediated the relationship between surface acting and job satisfaction but completely mediated the relationship between surface acting and job performance. Several personality traits were shown to moderate the relationship between surface acting and sleep problems. The effects were stronger for people with low agreeableness and high neuroticism. The relationship between high levels of deep acting and low levels of sleep problems was more pronounced in individuals with low extraversion. Supervisors should be conscious of emotional labor in the work context and provide necessary deep acting training to facilitate emotional regulation.
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Affiliation(s)
| | - Shih-Hua Sarah Chen
- Division of Social Science, University of Chicago, Chicago, IL, United States
| | - Kuo-Shu Yuan
- School of Business Administration, Huaqiao University, Quanzhou, China
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chong Shan University, Taichung, Taiwan
| | - Thomas T H Wan
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL, United States
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16
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Lou SJ, Hou MF, Chang HT, Chiu CC, Lee HH, Yeh SCJ, Shi HY. Machine Learning Algorithms to Predict Recurrence within 10 Years after Breast Cancer Surgery: A Prospective Cohort Study. Cancers (Basel) 2020; 12:cancers12123817. [PMID: 33348826 PMCID: PMC7765963 DOI: 10.3390/cancers12123817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023] Open
Abstract
No studies have discussed machine learning algorithms to predict recurrence within 10 years after breast cancer surgery. This study purposed to compare the accuracy of forecasting models to predict recurrence within 10 years after breast cancer surgery and to identify significant predictors of recurrence. Registry data for breast cancer surgery patients were allocated to a training dataset (n = 798) for model development, a testing dataset (n = 171) for internal validation, and a validating dataset (n = 171) for external validation. Global sensitivity analysis was then performed to evaluate the significance of the selected predictors. Demographic characteristics, clinical characteristics, quality of care, and preoperative quality of life were significantly associated with recurrence within 10 years after breast cancer surgery (p < 0.05). Artificial neural networks had the highest prediction performance indices. Additionally, the surgeon volume was the best predictor of recurrence within 10 years after breast cancer surgery, followed by hospital volume and tumor stage. Accurate recurrence within 10 years prediction by machine learning algorithms may improve precision in managing patients after breast cancer surgery and improve understanding of risk factors for recurrence within 10 years after breast cancer surgery.
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Affiliation(s)
- Shi-Jer Lou
- Graduate Institute of Technological and Vocational Education, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan;
| | - Ming-Feng Hou
- College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Hong-Tai Chang
- Department of Surgery, Kaohsiung Municipal United Hospital, Kaohsiung 80457, Taiwan;
| | - Chong-Chi Chiu
- Department of General Surgery, E-Da Cancer Hospital, I-Shou University, Kaohsiung 82445, Taiwan;
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Hao-Hsien Lee
- Department of General Surgery, Chi Mei Medical Center, Liouying, Tainan 73657, Taiwan;
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Business Management, National Sun Yat-sen University, Kaohsiung 80424, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung 40402, Taiwan
- Correspondence: ; Tel.: +886-7-321-1101 (ext. 2648); Fax: +886-7-313-7487
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17
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Chiou BL, Chen YF, Chen HY, Chen CY, Yeh SCJ, Shi HY. Effect of referral systems on costs and outcomes after hip fracture surgery in Taiwan. Int J Qual Health Care 2020; 32:649-657. [PMID: 32945841 DOI: 10.1093/intqhc/mzaa115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/01/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To explore the economic burdens of hip fracture surgery in patients referred to lower-level medical institutions and to evaluate how referral systems affect costs and outcomes of hip fracture surgery. DESIGN A nationwide population-based retrospective cohort study. SETTING All hospitals in Taiwan. PARTICIPANTS A total of 7500 patients who had received hip fracture surgery (International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic codes 820.0 ∼ 820.9 and procedure codes 79.15, 79.35, 81.52, 81.53) performed in 1997 to 2013. MAIN OUTCOME MEASURES Total costs including outpatient costs, inpatient costs and total medical costs and medical outcomes including 30-day readmission, 90-day readmission, infection, dislocation, revision and mortality. RESULTS The patients were referred to a lower medical institution after hip fracture surgery (downward referral group) and 3034 patients continued treatment at the same medical institution (non-referral group). Demographic characteristics, clinical characteristics and institutional characteristics were significantly associated with postoperative costs and outcomes (P < 0.05). On average, the annual healthcare cost was New Taiwan Dollars (NT$)2262 per patient lower in the downward referral group compared with the non-referral group. The annual economic burdens of the downward referral group approximated NT$241 million (2019 exchange rate, NT$30.5 = US$1). CONCLUSIONS Postoperative costs and outcomes of hip fracture surgery are related not only to demographic and clinical characteristics, but also to institutional characteristics. The advantages of downward referral after hip fracture surgery can save huge medical costs and provide a useful reference for healthcare authorities when drafting policies for the referral system.
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Affiliation(s)
- Bo-Lin Chiou
- Division of Physical Medicine & Rehabilitation, Yuan's General Hospital, No. 162 Cheng Kung 1st Road, Kaohsiung 80249, Taiwan
| | - Yu-Fu Chen
- Department of Medical Education & Research, Yuan's General Hospital, No. 162 Cheng Kung 1st Road, Kaohsiung 80249, Taiwan
| | - Hong-Yaw Chen
- Superintendent and Division of Gastrointestinal Surgery, Yuan's General Hospital, No. 162 Cheng Kung 1st Road, Kaohsiung 80249, Taiwan
| | - Cheng-Yen Chen
- Division of Orthopedic Surgery, Yuan's General Hospital, No. 162 Cheng Kung 1st Road, Kaohsiung 80249, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Department of Business Management, National Sun Yat-sen University, No. 70 Lien-hai Road, Kaohsiung 80424 Taiwan
| | - Hon-Yi Shi
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, No. 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan.,Department of Business Management, National Sun Yat-sen University, No. 70 Lien-hai Road, Kaohsiung 80424 Taiwan.,Deoartment of Medical Research, Kaohsiung Medical University Hospital, No. 100 Tzyou 1st Road, Kaohsiung 80756, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, No. 2 Yude Road, Taichung 40433, Taiwan
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18
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Lu CH, Fang CW, Chen HM, Fang YP, Fang CT, Huang YB, Chen CY, Liao KM, Yeh SCJ. Prescribing patterns of coronary artery aneurysm in Taiwan. BMC Cardiovasc Disord 2019; 19:188. [PMID: 31382884 PMCID: PMC6683534 DOI: 10.1186/s12872-019-1172-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/26/2019] [Indexed: 01/25/2023] Open
Abstract
Background Coronary artery aneurysm (CAA) is a rare disease, and there are limited data on prescribing patterns for CAA. The aim of our study was to investigate prescribing patterns for CAA in Taiwan via the National Health Insurance Research Database (NHIRD). Methods We included all CAA patients in Taiwan from 2005 to 2011. Data from 1 year before and after the CAA diagnosis were used to analyze examinations, comorbidities and prescribing patterns. Results A total of 1397 patients diagnosed with CAA were enrolled in our study. Most pediatric patients with CAA were diagnosed with Kawasaki disease (95.7%). In pediatric CAA patients, the utilization rates of aspirin and gamma globulins were 82.9 and 53.6%, respectively, after CAA diagnosis. Among the antithrombotic agents, aspirin was used most commonly, followed by dipyridamole (16.9%), heparin (5.8%) and warfarin (4.6%). In adult CAA patients, common comorbidities included hypertension (63.4%), hyperlipidemia (39.6%), and diabetes mellitus (26.1%). Coronary atherosclerosis was identified in 72.5% of adult patients after CAA diagnosis. Antithrombotic agents, particularly aspirin, clopidogrel and heparin, were prescribed more frequently after CAA diagnosis. Among the prescribed medications, aspirin (75.8%), β-blockers (48.3%), statins (47.6%), metformin (14.4%), sulfonylureas (14.4%) and isosorbide mononitrate (32.9%) were frequently observed in each category. Conclusions Kawasaki disease was the main cause of CAA in pediatric patients, and coronary artery disease was the most common comorbidity in adult CAA patients. The most commonly used antithrombic agent after CAA diagnosis was aspirin in both adult and pediatric patients.
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Affiliation(s)
- Chun-Hui Lu
- Division of Pharmacy, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chih-Wun Fang
- Division of Pharmacy, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Hao-Ming Chen
- Division of Pharmacy, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan.,Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
| | - Yi-Ping Fang
- School of Pharmacy, Kaohsiung Medical University, 100, Shiquan 1st Rd., Sanmin Dist.,, Kaohsiung City, 80708, Taiwan, Republic of China
| | - Chein-Tang Fang
- School of Pharmacy, Kaohsiung Medical University, 100, Shiquan 1st Rd., Sanmin Dist.,, Kaohsiung City, 80708, Taiwan, Republic of China
| | - Yaw-Bin Huang
- School of Pharmacy, Kaohsiung Medical University, 100, Shiquan 1st Rd., Sanmin Dist.,, Kaohsiung City, 80708, Taiwan, Republic of China.,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chung-Yu Chen
- School of Pharmacy, Kaohsiung Medical University, 100, Shiquan 1st Rd., Sanmin Dist.,, Kaohsiung City, 80708, Taiwan, Republic of China. .,Department of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. .,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, No.606, Jialixing, Jiali Dist., Tainan City, 72263, Taiwan, Republic of China.
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19
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Yeh SCJ, Yuan KS, Chen SHS, Lo YY, Chou HC, Huang S, Chiu HC, Wan TT. The moderating effect of leadership on the relationship between personality and performance. J Nurs Manag 2016; 24:869-883. [DOI: 10.1111/jonm.12391] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Institute of Health Care Management and Department of Business Management; National Sun Yat-Sen University; Kaohsiung Taiwan
| | - Kuo-Shu Yuan
- Department of Business Management; National Sun Yat-Sen University; Kaohsiung Taiwan
| | - Shih-Hua Sarah Chen
- Department of Economics; University of Illinois at Urbana-Champaign; Urbana Illinois USA
- University of Ottawa Heart Institute; Ottawa Ontario Canada
| | - Ying-Ying Lo
- Department of Healthcare Administration; I-Shou University; Kaohsiung Taiwan
| | - Hsueh-Chih Chou
- Department of Nursing; Kaohsiung Veterans General Hospital; Kaohsiung Taiwan
| | - Shan Huang
- Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics; Kaohsiung Medical University; Kaohsiung Taiwan
- Research Education and Epidemiology Center; Changhua Christian Hospital; Changhua Taiwan
| | - Thomas T.H. Wan
- Public Affairs, Health Management and Informatics and Medicine; University of Central Florida; Orlando Florida USA
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Chiu HC, Hsieh HM, Lin YC, Kuo SJ, Kao HY, Yeh SCJ, Chang WH, Hsiao PJ, Chen YS, Lin SL, Lo GH, Ker CG, Hung YH, Cheng HA, Chou TH, Chou SY, Wang JH, Wang CF. Patient assessment of diabetes care in a pay-for-performance program. Int J Qual Health Care 2016; 28:183-90. [PMID: 26819445 DOI: 10.1093/intqhc/mzv120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2015] [Indexed: 12/25/2022] Open
Affiliation(s)
- Herng-Chia Chiu
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan Research Education and Epidemiology Center, Changhua Christian Hospital, 135 Nan-Hsiao Street, Changhua 500-06, Taiwan
| | - Hui-Min Hsieh
- Department of Public Health, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Yi-Chieh Lin
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Shou-Jen Kuo
- Changhua Christian Hospital, 135 Nan-Hsiao Street, Changhua 500-06, Taiwan
| | - Hao-Yun Kao
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Shu-Chuan Jennifer Yeh
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan Department of Business Management, College of Management, National Sun Yat-sen University, 70 Lian Hai Road, Kaohsiung, 80424 Taiwan
| | - Wen-Hsin Chang
- MacKay Memorial Hospital, No. 92, Section 2, Zhongshan North Road, Zhongshan District, Taipei City 104, Taiwan
| | - Pi-Jung Hsiao
- College of Medicine, Kaohsiung Medical University, Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Shih-Chuan 1st Road, Kaohsiung 80708, Taiwan
| | - Yao-Shen Chen
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City 813, Taiwan
| | - Shoei-Loong Lin
- President Superintendent, Choninn Healthcare System, No. 196, Sec. 1, Wenhua Rd., BanqiaoDist. New Taipei City 22041, Taiwan
| | - Gin-Ho Lo
- E-DA Hospital; School of Medicine for International Students, I-Shou University 1 ,Yi-Da Road, Yanchao district, Kaohsiung, 82445 Taiwan
| | - Chen-Guo Ker
- Department of Surgery, Yuan's General Hospital, 162, Chen-Kong 1st Road, Kaohsiung 80249, Taiwan
| | - Yu-Han Hung
- Yuan's General Hospital, No. 162, Cheng gong 1st Road, Ling ya District, Kaohsiung City 80249, Taiwan
| | - Hsien-An Cheng
- Department of Neurology, Yuan's General Hospital, 162, Chen-Kun 1st Road, Kaohsiung 80249, Taiwan
| | - Tiang-Hong Chou
- Mennonite Christian Hospital, 44, Min-Chuan Road, Hualien 970, Taiwan
| | - Sze-Yuan Chou
- Cheng Ching General Hospital, 139 Ping Tien Street, Taichung, Taiwan
| | - Jao-Hsien Wang
- Department of Education and Research, Jiannren Hospital, 136 Nanyang Road, Kaohsiung 811, Taiwan
| | - Chien-Fu Wang
- Division of Physical Therapy, Taitung Christian Hospital, 350 Kai-Feng Street, Taitung City, Taitung County 950, Taiwan
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Chang MY, Yeh SCJ, Chu MC, Wu TM, Huang TH. Associations between Tai Chi Chung Program, Anxiety, and Cardiovascular Risk Factors. Am J Health Promot 2013; 28:16-22. [DOI: 10.4278/ajhp.120720-quan-356] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose. To examine the effects of a Tai Chi Chung (TCC) program, an efficiency approach, on anxiety and cardiovascular risk factors. Design. A quasi-experimental study. Setting. A community in Taipei City, Taiwan. Subjects. One hundred thirty-three adults aged 55 years and older. Intervention. Sixty-four participants (experimental group) attended a 60-minute Tai Chi exercise three times per week for 12 weeks, whereas 69 participants (control group) maintained their usual daily activities. Measures. Anxiety states, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and waist circumference (WC) were assessed at baseline, 6 weeks into the experiment, and 12 weeks into the experiment. Analysis. Generalized estimating equations were used to evaluate the changes. Results. Participants showed a greater drop in anxiety levels (β = −2.57, p = .001) and DBP (β = −7.02, p < .001) at the 12-week follow-up than did the controls. SBP significantly decreased in the 6-week follow-up and 12-week follow-up tests. The participants in the intervention achieved a greater drop in BMI at the 6-week and 12-week follow-up visits than the controls. The interventions demonstrated decreased average WC at the 6-week and 12-week follow-up visits as compared to the controls. Conclusion. The results highlight the long-term benefits of a TCC program in facilitating health promotion by reducing anxiety and risk factors for cardiovascular diseases.
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Yeh SCJ, Chang MY. The effect of Qigong on menopausal symptoms and quality of sleep for perimenopausal women: a preliminary observational study. J Altern Complement Med 2012; 18:567-75. [PMID: 22537466 DOI: 10.1089/acm.2011.0133] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The study objectives were to examine the effect of a 12-week 30-minute-a-day Ping Shuai Qigong exercise program on climacteric symptoms and sleep quality in perimenopausal women. DESIGN This was a prospective observational study. SETTINGS/LOCATION The subjects (N=70) from two communities were women aged 45 years and above who were experiencing menopausal symptoms. SUBJECTS Thirty-five (35) women from one community were assigned to a Ping Shuai Qigong intervention group, while 35 women from the other community were assigned to the control group. INTERVENTIONS This was a 12-week, 30-minute-a-day Ping Shuai Qigong program. OUTCOME MEASURES The Greene Climacteric Symptom scale and the Pittsburgh Sleep Quality Index were the outcome measures. METHODS Descriptive analysis and repeated-measures analysis of variance were used. RESULTS Pretest scores at baseline found no significant group differences in climacteric symptoms or sleep quality. Significant improvements in climacteric symptoms were found at 6 weeks and 12 weeks (t=4.07, p<0.001 and t=11.83, p<0.001) in the intervention group. They were also found to have significant improvements in sleep quality in those times (t=5.93, p<0.001 and t=10.58, p<0.001, respectively). CONCLUSIONS Ping Shuai Qigong improved climacteric symptoms and sleep quality in perimenopausal women at 6 weeks and 12 weeks. The longer a person practiced this form of meditative exercise, the greater the improvement in sleeping quality and climacteric symptoms.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Department of Business Management, Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung, Taiwan.
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Yeh SCJ, Huang CH, Chou HC, Wan TTH. The influence of facility ownership structure on individual responding to stress: a multilevel model. Health Serv Manage Res 2009; 22:62-70. [PMID: 19401499 DOI: 10.1258/hsmr.2008.008010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Few studies have investigated the effect of health-care facility ownership on the relationship between patient stressors and coping strategies. The purpose of this study was to investigate whether haemodialysis (HD) patient stressors and coping strategies differ by type of health-care facility ownership, and whether such ownership has a cross-level moderating effect between stressors and coping strategies. We used the Haemodialysis Stressor Scale and the Jalowiec Coping Scale; primary data were collected by interviewing 2642 HD patients 15 years or older on dialysis for at least three months from 27 HD centres. One-way analysis of variance and hierarchical linear modelling were used to attain the research purposes. HD patients from religious-based hospitals had higher stress related to their physical symptoms, dependency on medical staff, role ambiguity and blood vessel problems than those differently owned facilities. Patients in veterans and army (VA) hospitals had higher stress related to food and fluid restriction and dependency on medical staff than private centres. Patients in religious-based hospitals had significantly higher coping scores, followed by VA and private HD centres. Religion-based ownership might serve as a cross-level moderator for patients perceiving role ambiguity stress and using problem-oriented, support seeking and isolated thought-coping strategies.
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Yeh CH, Yeh SCJ. Effects of Ear Points' Pressing on Parameters Related to Obesity in Non-Obese Healthy and Obese Volunteers. J Altern Complement Med 2008; 14:309-14. [DOI: 10.1089/acm.2007.0678] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ching-Hui Yeh
- Department of Family Medicine, Zuoying Armed Force General Hospital, Kaohsiung, Taiwan, Republic of China
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan, Republic of China
| | - Shu-Chuan Jennifer Yeh
- Department of Business Management, National Sun Yat-Sen University, Kaohsiung, Taiwan, Republic of China
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Abstract
BACKGROUND Under the universal health insurance system in Taiwan, policy makers seek new approaches to balance rising costs and quality of care. One policy, Ambulatory Care Reimbursement, enacted in 2001 has effectively reduced patient numbers in clinics by cutting per patient reimbursement when a physician has seen over predetermined number of patients. PURPOSE To access the impact of this policy on physician satisfaction in regional hospitals and medical centers (MCs) from the point of view of their medical directors. METHODOLOGY We conducted a cross-sectional survey of medical directors from 25 MCs and 78 regional hospitals in Taiwan. The survey used a 5-point Likert scale to identify both impacts of reduced ambulatory care visits and physician satisfaction. We randomly selected 30% of all medical directors from both types of medical institutions. Of the 248 medical directors contacted, 142 replied. Excluding 5 incomplete responses, our final sample was 137. Response rates were roughly equivalent for MCs (54.67%) and regional hospitals (57.89%). FINDINGS Medical directors were typically male, aged 45.11 years, worked in MCs (60%), and were general practitioners (43.1%). Multiple regressions associated three independent predictors of physician satisfaction: physician-patient interaction (beta = .393, p = .001), mission (beta = .351, p = .007), and reduced health care expenditures (beta = .179, p = .014). Medical directors more often characterized the regulation of reducing number of visits as a means of encouraging MCs and regional hospitals to improve physician interaction with patients and, thus, associated it with greater patient satisfaction. Generally, directors did not believe that the regulation encouraged patients seeking care at other hospitals or that it resulted in reduced pay to physicians. PRACTICE IMPLICATION Reducing ambulatory care visits has promoted the physician-patient relationship and allowed many physicians attain their medical mission. Such regulation had influence on the physicians' satisfaction.
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Abstract
OBJECTIVES To investigate the stress related to undergoing hemodialysis (HD) and the relationship between these stresses and the coping strategies used by patients with end-stage renal disease. METHODS We used the Hemodialysis Stressor Scale and the Jalowiec Coping Scale to interview 2642 patients (mean age = 57 years; 53.5% female) receiving HD. The Hemodialysis Stressor Scale measures the level of stress related to stressor subscales: daily activity, physical condition, dependency on medical staff, fluid and food restriction, role ambiguity, blood vessel problems, and reproductive system functioning. The Jalowiec Coping Scale identifies the use of the following coping strategies: problem-oriented, emotion-oriented, support seeking, avoidance, and isolated thoughts. Data were analyzed using Hierarchical Linear Modeling. RESULTS Daily activity subscale scores were positively associated with using emotion-oriented, avoidance, and isolated thoughts as coping styles and negatively related to support seeking from professionals. The higher the perceived stress related to physical symptoms, dependency on medical staff, and blood vessel problems, the more the patients used emotion-oriented, support seeking, avoidance, and isolated thoughts to cope. Fluid and food restriction and role ambiguity subscales were found to be positively associated with emotion-oriented, avoidance, and isolated thoughts coping strategies. Reproductive system functioning was positively associated with emotion-oriented, avoidance, and isolated thoughts coping strategies. Patients on HD seldom use problem-oriented strategy to ease their stresses. Support seeking was another infrequently used coping strategy. CONCLUSIONS The most commonly used coping strategies in our patients were emotion-oriented, avoidance, and isolated thoughts. The choice of coping strategy depended on the types of stressor.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Beitou District, Taipei, Taiwan.
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Abstract
Using claims data from the Bureau of National Health Insurance (BNHI) in Taiwan and primary data collected from 940 patients who visited their physicians at out-patient clinics to complete questionnaire, we investigated the effects of the hospital volume control policy on the frequency of visits, medical expenses and patient satisfaction. We found that the volume control policy on ambulatory care decreased physician fees and increased both the number of visits and co-payments. However, it did not result in any change in the total medical expenses. A shift in ambulatory care expenditure from BNHI to patients did not improve patient satisfaction. While the patients were comfortable with the waiting line, they were not satisfied with the providers’ strategy of limiting quota of visits during a period of time.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Institute of Health Care Management, College of Management, National Sun Yat-Sen Univeristy, 70 Lian-Hai Road, Kaohsiung, Taiwan, 80424.
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Abstract
This study aimed to describe the characteristics of the elderly population living alone, and to examine how living alone relates to feeling lonely. Interviews were conducted with a stratified random sample of 4,859 elderly individuals living in Kaohsiung, Taiwan. Variables collected
included demographic information, living alone or not, activities of daily living (ADL), instrumental activities of daily living (IADL), Short Portable Mental Status Questionnaire (SPMSQ), chronic conditions, perceived social support, and a subjective measure of feeling lonely. Using logistic
regression, it was found that factors associated with living alone included gender, marital status, occupation, source of income, religion, and IADL. Living alone was, in turn, related to decreased levels of both perceived social support and feeling lonely after adjustment for potential confounders.
Managing retired life is important for adult elders, particularly for men. Lack of social support is common among the elderly community who live alone, which could well be a main reason for this group to feel lonely. As loneliness is linked to physical and mental health problems, increasing
social support and facilitating friendship should be factored into life-style management for communities of elderly.
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Abstract
Assessing functional status of residents in nursing homes is one way to evaluate the quality of care provided. The purpose of this study was to investigate whether rehabilitation interventions could lead to improved functional independence. A prospective study was carried out to examine the change in activities of daily living (ADL) of 310 residents aged 65 or above over a period of 6 months. About 41.3% (n = 128) received rehabilitation therapy. Functional improvement was observed in 30.6% of the participants. The corresponding figures for stabilization and functional decline were 45.2% and 24.2%, respectively. Using a multinomial logistic regression, we found that factors significantly associated with change in functional status included baseline ADL score, family visit, number of beds in the institution, and transfer to acute hospitals. After adjusting for these confounding variables, change in functional status of those who received rehabilitation and those who did not was not significantly different.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Institute of Health Care Management, National Sun Yat-Sen University, Kaohsiung, Taiwan, Republic of China.
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Abstract
BACKGROUND Social support is important in daily activities of the elderly. This study tests the hypothesis that there is an association between social support and cognitive function among the elderly in a community setting. METHODS Face-to-face interviews were conducted in a cross-sectional stratified random sample of 4,993 elderly (> or =65 years) city residents. Using multiple regression analysis, we investigated the influence of social support on cognitive function. RESULTS 12% were over 80 years old. 53.28% were men. 67.14% were married. Higher Short Portable Mental Status Questionnaire (SPMSQ) scores (higher score means better cognitive function) were associated with strong social support, as measured by marital status and perceived positive support from friends. Lower cognitive function was associated with older and with female respondents. Only instrumental activities of daily living (IADL) were statistically and negatively related to SPMSQ. Lower functional status was associated with lower cognitive function. Elders with grade school educations had lower SPMSQ scores than did elders with high school educations. CONCLUSIONS In Taiwan, higher cognitive function in community-living elderly was associated with increased social support. Life-style management should provide social activities for the elderly to promote a better quality of life.
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Institute of Human Resource Management, National Sun Yat-sen University, Kaohsiung, Taiwan
- Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yea-Ying Liu
- Institute of Human Resource Management, National Sun Yat-sen University, Kaohsiung, Taiwan
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan
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Affiliation(s)
- Shu-Chuan Jennifer Yeh
- Institute of Human Resource Management, National Sun Yat-sen University, 70 Lien-Hai Road, Kaohsiung, Taiwan 80424, ROC.
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