The research, published in BMC Health Services Research, examined Prehospital Assessment Units, or PAUs, which are paramedic-staffed units designed to strengthen acute care pathways by assessing patients before a decision is made about hospital conveyance. The model sits squarely within a broader international trend toward non-conveyance, in which emergency medical services are asked not merely to transport patients but to evaluate them at the scene, treat what can be treated, and connect people with the right level of care, which is sometimes no hospital visit at all. Sustainable implementation of such services, the Danish team argued, depends on cooperation across sectors that have historically operated in separate silos.

To capture how the model is landing on the ground, the researchers used a convergent parallel mixed-methods design, running quantitative questionnaires and qualitative focus groups simultaneously and then integrating the results. Data were collected between April and August 2024 across the emergency medical services, hospital emergency departments, general practice, and municipal acute care in the Region of Southern Denmark. The questionnaire drew on previously published and validated outcome measures, while the qualitative material was analysed using Reflexive Thematic Analysis, a technique in which researchers systematically code narratives and construct themes that interpret shared experiences rather than simply counting them.

The numbers tell a strikingly positive story. Of 231 healthcare professionals who responded to the questionnaire, a response rate of 51.7 percent, 166 were included after prespecified exclusions. On a one-to-five scale, the median score for the Acceptability of Intervention Measure was a perfect 5.00, with an interquartile range of 4.00 to 5.00, meaning that at least three quarters of respondents rated acceptability at four or above. The Intervention Appropriateness Measure yielded a median of 4.13, and the Feasibility of Intervention Measure a median of 4.25, with interquartile ranges of 4.00 to 5.00 and 3.75 to 5.00 respectively. In plain terms, the clinicians who interact with PAUs overwhelmingly regard them as acceptable, largely appropriate, and broadly workable.

Numbers alone, however, cannot explain why a service succeeds or stalls, and this is where the qualitative arm of the study earns its keep. Three focus groups involving 18 participants drawn from across the acute care spectrum captured cross-sector experiences in depth. The thematic analysis generated three themes: the contested work of patient selection, integration in acute care, and building understanding through shared narratives. Together, these themes map the social and organisational terrain on which the PAU model either flourishes or frays, revealing that a service can be well liked in principle while still generating friction at its operational edges.

The first theme, patient selection, points to what may be the model’s most consequential challenge. Deciding which patients can be safely assessed and left at home, and which genuinely need an emergency department, is inherently contested work, and the qualitative accounts suggest that boundaries around this decision are not always clear. When frontline staff in different parts of the system disagree about who belongs in a PAU’s remit, consistency suffers, and the researchers identified this variability as a negative implementation determinant, a factor that may hinder uniform delivery of the service across settings and shifts.

The second theme, integration in acute care, extends that concern to the institutional level. A prehospital assessment unit does not operate in a vacuum; its value depends on how smoothly it slots into emergency departments, general practice, and municipal acute care. The study found evidence of role negotiation, with professionals working out where PAU staff fit within established hierarchies and workflows. Accounts of this negotiation, alongside variability in feasibility scores, revealed further negative determinants rooted in contextual factors and unclear boundaries between services. These are not failures of the model so much as growing pains of a system learning to share responsibility for acutely ill patients across traditional dividing lines.

The third theme, however, offers a genuine cause for optimism. Shared narratives, the stories professionals tell each other about the service, emerged as a powerful engine of understanding. Qualitative narratives reinforced the quantitative findings, legitimising the PAUs and highlighting their contribution across sectors. When emergency department physicians, general practitioners, municipal staff, and paramedics exchange experiences of the unit in action, abstract scepticism gives way to concrete appreciation of what the service can and cannot do. The researchers identified this cross-sector contribution and the role of shared experience as positive implementation determinants, suggesting that communication itself is an intervention worth investing in.

The methodological machinery behind these conclusions deserves attention. By using a joint display to align quantitative ratings with qualitative determinants, the researchers could check whether the numbers and the narratives told the same story, and largely they did. The high acceptability scores were corroborated by qualitative accounts that legitimised the service, while the spread in feasibility scores was echoed by focus group discussions of selection disputes and integration struggles. This convergence strengthens confidence that the findings reflect real professional experience rather than artefacts of either surveys or interviews. The study was classified as a quality assurance initiative under Danish legislation, exempt from formal ethical review, with informed consent obtained from all participants and data handling compliant with the General Data Protection Regulation.

For health systems everywhere grappling with emergency department overcrowding and ageing populations, the Danish experience carries a clear message. Paramedic-staffed prehospital assessment units can earn the trust of the clinicians around them, and that trust is measurable, with median acceptability scores at the top of the scale. But acceptance is only the first hurdle. The contested work of deciding who can be safely left at home, and the institutional work of weaving a new service into the fabric of acute care, will determine whether such models deliver consistent benefits or uneven ones. The authors conclude that healthcare professionals reported predominantly positive experiences of the PAU model, while the challenges they identified reflect contextual factors and unclear boundaries that may hinder consistent implementation. In other words, the idea has won the argument; now comes the harder task of winning the workflow.

Subject of Research: Implementation of paramedic-staffed prehospital assessment units in acute care

Article Title: Healthcare professionals’ experiences of implementing paramedic-staffed prehospital assessment units in acute care: a mixed-methods study

Article References: Healthcare professionals’ experiences of implementing paramedic-staffed prehospital assessment units in acute care: a mixed-methods study. (n.d.). https://doi.org/10.1186/s12913-026-15764-9

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15764-9

Keywords: prehospital care, paramedics, non-conveyance, emergency medical services, acute care, implementation science, mixed methods, acceptability, feasibility, patient selection, health services research, Denmark

Researchers led by Andrea L. Nevedal of the VA Center for Clinical Management Research at VA Ann Arbor Healthcare System and colleagues, including senior author Donna M. Zulman of VA Palo Alto and Stanford University, interviewed 25 veterans between July and October 2024. All participants had endorsed at least one social risk, such as food insecurity or financial strain, in a national survey administered across the Department of Veterans Affairs between March and June 2024, and all had agreed to a follow-up interview. Rather than asking a simple yes-or-no question about comfort with screening, the team structured their semi-structured interviews around the Theoretical Framework of Acceptability, a rigorous model that describes seven distinct determinants of whether patients judge a health care intervention to be acceptable: affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. The analysis used rapid directed content analysis, an approach designed to distill themes quickly while preserving fidelity to the guiding framework.

The headline finding is strikingly positive. Veterans in the study found social risk and needs screening to be acceptable, and many framed it in terms of duty and reciprocity. The ethicality determinant aligned with a core value the researchers describe as serving those who served: veterans viewed the VA’s interest in housing, food, and financial stability as consistent with the institution’s mission, provided staff explain how such questions belong in health care at all. That conditional is crucial. Veterans told the researchers they feel comfortable disclosing needs only when staff make clear that screening is an integral part of VA health care rather than an administrative intrusion. Without that framing, the same questions could feel invasive or bureaucratic.

Perceived burden, one of the framework’s seven determinants, was low, but again with a condition attached: screening must not interfere with the goals veterans bring to a health care visit. This is a technical point with real implementation consequences. When a patient arrives for a diabetes management appointment or a mental health session, additional questionnaires compete for limited visit time. The study suggests that screening tools embedded seamlessly into existing workflows, rather than layered on top of them, preserve the goodwill that makes disclosure possible. Similarly, veterans’ affective attitudes toward screening were dependent on what happened afterward. Screening that leads to resource receipt generates positive emotional responses; screening that leads nowhere risks breeding cynicism.

One of the most consequential findings concerns information risk. Opportunity costs did not outweigh screening benefits in the aggregate, but veterans worried that sensitive information could be used against them. This concern has particular resonance in the VA context, where disability compensation and eligibility are tied to documented conditions and histories. Patients who fear that disclosing food insecurity or financial strain might somehow jeopardize benefits have a rational incentive to underreport, and underreporting would quietly dismantle the entire screening enterprise. The study’s implication is that trust-building measures, including transparent explanations of how data are stored, who sees them, and how they relate to clinical care, are not optional extras but structural requirements for valid screening programs.

Intervention coherence, the degree to which patients understand how an intervention works, emerged as another area ripe for improvement. Veterans wanted clarification on how social risks actually impact health. This may sound like a communication detail, but the science behind it is substantive. A large body of literature links social determinants such as housing instability, food insecurity, and social isolation to measurable outcomes including cardiovascular disease, hospital utilization, and mortality, and organizations from the National Academies of Sciences, Engineering, and Medicine to the American College of Physicians and the American Heart Association have issued position statements urging clinical integration of social care. The Joint Commission has even established a National Patient Safety Goal aimed at improving health care equity. Veterans asking how a missed meal connects to a chronic disease diagnosis are asking a question the field has spent a decade learning to answer, and clinics that can answer it credibly are more likely to earn honest responses.

Perceived effectiveness was the final hinge. Veterans anticipated that screening would be worthwhile if the VA provided timely and appropriate resources in response to disclosed needs. Prior research has documented exactly why this matters. A systematic review in Health Equity found that social needs screening and interventions in clinical settings show variable effects on utilization, cost, and clinical outcomes, and commentators in JAMA Network Open have warned that screening is increasing faster than the infrastructure to act on results. A screening program that identifies needs without referral capacity is not merely ineffective; it can actively erode the patient trust that the VA study identifies as the foundation of acceptability. Prior qualitative work with primary care patients and caregivers, including studies in American Journal of Preventive Medicine and Journal of the American Board of Family Medicine, has reached consistent conclusions across populations: patients accept social screening when it comes with a credible pathway to help.

The study’s practical recommendations distill into three design principles. First, explain the purpose of screening and its relevance to health, so veterans understand why a clinician is asking about rent alongside blood pressure. Second, offer appropriate resources in response to disclosed needs, closing the loop between identification and action. Third, designate a point of contact and provide multiple avenues to access support, a recommendation aimed at the self-efficacy determinant of the framework. When patients know who to talk to and can reach help by phone, in person, or digitally, the psychological cost of acting on a disclosed need drops. Related VA programs, such as the Assessing Circumstances and Offering Resources for Needs, or ACORN, screening and referral initiative described in earlier work in the same journal, suggest the health system is already building toward these mechanisms.

Methodologically, the study is notable for its disciplined use of theory. By anchoring each interview and each analytic code to a named determinant of acceptability, the researchers converted a diffuse question, do patients like this?, into a structured map of the cognitive and emotional responses that determine program viability. The team applied purposeful sampling and information-power principles to guide sample size, and followed consensus-based standards for rigor in rapid qualitative analysis. The authors note the limits inherent in the design: participants were veterans who had already endorsed social risks on a national survey, meaning the findings speak most directly to the population screening programs are intended to reach, and anonymized quotations rather than full datasets were shared to protect confidentiality. The study was approved by the VA Central Institutional Review Board, and the views expressed are those of the authors, not necessarily the Department of Veterans Affairs.

The broader significance of this work extends well beyond the VA. Health systems nationwide are now embedding social risk screening into electronic health records, quality measures, and even accreditation standards, sometimes faster than evidence about patient receptivity can accumulate. This study supplies that evidence from a population that is often assumed to be guarded about personal hardship, and the verdict is encouraging: veterans welcome these conversations when they are explained honestly, embedded respectfully, and answered with real help. The title phrase the researchers borrowed from a participant, that screening would be a burden off my back, captures the essential insight. Patients do not experience questions about social hardship as the burden; the hardship itself is the burden, and a health system that asks, listens, and responds can genuinely lift it.

Subject of Research: Veterans' acceptability of social risk and needs screening in the Veterans Affairs health system

Article Title: “It Would be a Burden off My Back”: Veterans’ Perceptions of Social Risk and Needs Screening Acceptability

Article References: “It Would be a Burden off My Back”: Veterans’ Perceptions of Social Risk and Needs Screening Acceptability. (n.d.). https://doi.org/10.1007/s11606-026-10805-9

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10805-9

Keywords: veterans, social risk screening, social determinants of health, health-related social needs, Veterans Affairs, qualitative research, acceptability, food insecurity, patient-centered care, health equity, Theoretical Framework of Acceptability, Journal of General Internal Medicine

RESSA was developed by the Global Commission on Evidence to Address Societal Challenges, an international initiative convened to strengthen the use of evidence in decision-making at every level of government. The tool is not designed to evaluate a single policy decision. Instead, it assesses the entire evidence support system of a country or jurisdiction: the institutions, networks, processes and products that together determine whether policymakers have timely access to high-quality research when they need it. As evidence-informed policy-making has gained prominence worldwide, the commission and its partners have argued that such systems deserve the same scrutiny as the policies they inform. Until now, however, systematic process evaluations of system-level assessment methodologies have been scarce, particularly in the complex, politically charged environments where they are most needed.

The Irish assessment provided an ideal test case. It involved an unusually broad coalition of national institutions: the Department of Health, the Health Research Board, Evidence Synthesis Ireland, Cochrane Ireland and the Global Commission on Evidence itself. Researchers led from the University of Galway, including Marie Tierney and Declan Devane, conducted the process evaluation alongside the RESSA itself, asking three linked questions. Was the assessment delivered as intended? Did the stakeholders involved find it acceptable? And what did their experiences reveal about how such assessments should be run in future?

Methodologically, the study was a qualitative process evaluation with quantitative elements, framed by the Medical Research Council’s guidance on evaluating complex interventions. Three participant groups were recruited: key informants from the Department of Health and affiliated organisations, members of the project’s Oversight Group, and the RESSA lead who carried out the assessment. Delivery fidelity was measured in two ways. The research team qualitatively explored the RESSA lead’s preparedness for the task, and quantitatively compared the delivered assessment against the published RESSA protocol, checking whether each specified component had been implemented as written. Qualitative interviews were analysed using a hybrid inductive-deductive thematic approach anchored in pre-specified process evaluation domains, while acceptability findings were interpreted through the Theoretical Framework of Acceptability, a validated model covering constructs such as affective attitude, burden, perceived effectiveness and ethicality. Reporting followed the Consolidated Criteria for Reporting Qualitative Research, and the study received ethics approval from the University of Galway Research Ethics Committee in March 2024, with written informed consent obtained from all participants.

The headline result is striking in its simplicity. The RESSA was delivered with complete fidelity: all eight protocol components were implemented exactly as specified, a score of eight out of eight, or one hundred percent. In the world of complex interventions, where implementation drift is the norm rather than the exception, such perfect adherence to a published protocol is noteworthy. It suggests that the RESSA methodology, despite operating in the messy reality of a national policy environment, is specified clearly enough to be reproduced faithfully by a trained assessor. Equally important, the assessment proved acceptable to stakeholders across all three participant groups, indicating that the process did not feel extractive, opaque or burdensome to those whose system was being examined.

Beneath those headline findings, however, the qualitative analysis surfaced three cross-cutting themes that the researchers argue are essential to understanding how such assessments actually succeed. The first concerns internal advocacy and governance structures. Stakeholders’ engagement with the assessment, its implementation and its potential impact were shaped by whether champions inside the organisations involved could advocate for the process and whether governance arrangements gave it legitimacy and traction. An assessment of an evidence system, in other words, is not a neutral technical exercise dropped into a vacuum; it lands in an institutional landscape where sponsorship, authority and accountability determine whether its findings are absorbed or ignored.

The second theme centred on communication. Clear, sustained communication supported stakeholder understanding of what the RESSA was and why it was being conducted, fostered engagement throughout the process, and influenced the assessment’s potential to drive change. This may sound obvious, but in practice system-level assessments involve many actors with different expectations, vocabularies and levels of familiarity with evidence terminology. Misalignment at any point can erode trust and blunt the assessment’s usefulness. The third theme concerned relational dynamics: the patterns of trust, collaboration and interpersonal connection among stakeholders were described as central to successful implementation. Where relationships were strong, the assessment could surface candid information about how the evidence system worked; where they were fragile, the process risked becoming superficial.

Taken together, these findings carry a message that extends well beyond Ireland. The researchers conclude that the RESSA can be implemented with high delivery fidelity and in a manner acceptable to stakeholders within complex policy environments, which is precisely the context in which such tools must function. But they also conclude that successful implementation depends not only on methodological fidelity. Organisational context, governance structures, communication practices and stakeholder relationships all shape whether an assessment of an evidence support system delivers meaningful insight. For countries considering a RESSA, the practical implication is that preparation should extend beyond training the assessor and assembling documents: it should include mapping internal advocates, establishing clear governance, and investing deliberately in communication and relationship-building from the outset.

The study also fills a methodological gap. Process evaluation is well established for clinical and public health interventions, but it has rarely been applied to system-level assessment methodologies in the policy sphere. By demonstrating that fidelity can be measured against a published protocol, that acceptability can be systematically assessed using an established theoretical framework, and that qualitative themes can be rigorously derived and reported, the Irish team has provided a template that others can adapt. The authors offer practical recommendations to support the adaptation of RESSA-style assessments across diverse policy settings, from ministries of health in high-income countries to evidence units in low- and middle-income contexts where the Global Commission on Evidence has focused much of its attention.

There are, of course, limits to what a single process evaluation can establish. The study examined one assessment in one jurisdiction, with a small number of participant groups, and the findings about relationships and governance are context-dependent by nature. The research team was also transparent about competing interests: several authors are employed by the Health Research Board, which funded the work, and by the Department of Health, although the design, analysis and decision to publish were led independently by the research team. Even so, the study’s core contribution stands. It shows that the invisible infrastructure connecting research to health policy can be examined systematically, and that when it is, the most important variables may be human ones. As governments worldwide commit to evidence-informed decision-making, the Irish experience suggests that the tools to audit that commitment now exist, and that using them well requires as much attention to trust and communication as to protocol and method.

Subject of Research: Process evaluation of the RESSA methodology for assessing evidence support systems in Irish health policy-making

Article Title: Process evaluation of the Rapid Evidence Support System Assessment (RESSA) methodology for health policy-making in Ireland

Article References: Tierney, M., Byrne, P., Whelan, B., Burke, N. N., Creely, C., Gill, C., Horgan, M., Lavis, J. N., Maguire, T., O’Neill, J., Toomey, E., Waddell, K., & Devane, D. (2026). Process evaluation of the Rapid Evidence Support System Assessment (RESSA) methodology for health policy-making in Ireland. Health Research Policy and Systems. https://doi.org/10.1186/s12961-026-01533-x

Image Credits: AI Generated

DOI: 10.1186/s12961-026-01533-x

Keywords: RESSA, evidence-informed policy-making, health policy, Ireland, process evaluation, delivery fidelity, acceptability, knowledge translation, evidence support systems, Global Commission on Evidence, Health Research Board, governance