1
|
Tomaiuolo R, Banfi G. From volume to value: a watershed moment for the clinical laboratory. Clin Chem Lab Med 2024; 62:593-596. [PMID: 37775150 DOI: 10.1515/cclm-2023-0870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
The clinical laboratory is often evaluated for the volume of testing. However, it is undeniable that laboratory tests affect clinical decision-making and are included in many clinical guidelines, meaning their contribution to determining clinical outcomes. Therefore, the clinical laboratory professional has the task of enhancing laboratory tests by optimizing the request and reporting phase and addressing patient outcomes. This opinion paper, presenting practical examples of managing value-based health care in the clinical laboratory context, underlines the need to shift towards value-based management to optimize outcome-based health care.
Collapse
Affiliation(s)
- Rossella Tomaiuolo
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Giuseppe Banfi
- Vita-Salute San Raffaele University, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| |
Collapse
|
2
|
Dearing J, Masquillier C, van Olmen J, Zieff SG, Liu A, Rollins A. Reciprocal coproduction as a basis for the diffusion of global health innovations. BMJ Glob Health 2023; 8:e013134. [PMID: 37793816 PMCID: PMC10551926 DOI: 10.1136/bmjgh-2023-013134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Global health reciprocal innovations originate in low-income and middle-income countries as well as high-income countries before their developers communicate about them with potential adopters in other countries as a transnational team. While communication technology has enabled a more rapid and broader sharing of information about innovations to prevent disease and improve health, innovations of various types have spread among countries, at all levels of income, for many centuries. In this article, we introduce the idea of reciprocal coproduction as a basis for the international sharing of information about innovations that exhibit potential for improving global health. Reciprocal coproduction occurs through two relational team-based processes: developer-led reinvention of an innovation so that it retains its desirable causal effects and implementer-led adaptation of that innovation so that it is compatible with new contexts into which it is introduced. Drawing on research and our own experiences across a range of health issues, we discuss common barriers to reciprocal coproduction and the diffusion of reciprocal innovations. We conclude with lessons drawn from dissemination and implementation science about the effective translation of reciprocal innovations from country to country so that researchers, policy-makers and social entrepreneurs can best ensure equity, accelerate adoptions and heighten the likelihood that global health reciprocal innovations will make a positive difference in health.
Collapse
Affiliation(s)
- James Dearing
- Department of Communication, Michigan State University, East Lansing, Michigan, USA
| | | | - Josefien van Olmen
- Department of Primary and Interdisciplinary Care, University of Antwerp, Antwerpen, Belgium
| | - Susan G Zieff
- Department of Kinesiology, San Francisco State University, San Francisco, California, USA
| | - Albert Liu
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Angela Rollins
- Department of Psychology, Indiana University Purdue University at Indianapolis, Indianapolis, Indiana, USA
| |
Collapse
|
3
|
Andersson T, Linnéusson G, Holmén M, Kjellsdotter A. Nurturing innovative culture in a healthcare organisation - Lessons from a Swedish case study. J Health Organ Manag 2023; 37:17-33. [PMID: 36815697 PMCID: PMC10430797 DOI: 10.1108/jhom-05-2021-0181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/28/2022] [Accepted: 12/20/2022] [Indexed: 02/24/2023]
Abstract
PURPOSE Healthcare organisations are often described as less innovative than other organisations, since organisational culture works against innovations. In this paper, the authors ask whether it has to be that way or whether is possible to nurture an innovative culture in a healthcare organisation. The aim of this paper is to describe and analyse nurturing an innovative culture within a healthcare organisation and how culture can support innovations in such a healthcare organisation. DESIGN/METHODOLOGY/APPROACH Based on a qualitative case study of a healthcare unit that changed, within a few years, from having no innovations to repeatedly generating innovations, the authors describe important aspects of how innovative culture can be nurtured in healthcare. Data were analysed using inductive and deductive analysis steps. FINDINGS The study shows that it is possible to nurture an innovative culture in a healthcare organisation. Relationships and competences beyond healthcare, empowering structures and signalling the importance of innovation work with resources all proved to be important. All are aspects that a manager can influence. In this case, the manager's role in nurturing innovative culture was very important. PRACTICAL IMPLICATIONS This study highlights that an innovative culture can be nurtured in healthcare organisations and that managers can play a key role in such a process. ORIGINALITY/VALUE The paper describes and analyses an innovative culture in a healthcare unit and identifies important conditions and strategies for nurturing innovative culture in healthcare organisations.
Collapse
Affiliation(s)
- Thomas Andersson
- School of Business
,
University of Skövde
, Skövde,
Sweden
- Faculty of Theology, Diaconia and Leadership,
VID Specialized University
, Oslo,
Norway
| | - Gary Linnéusson
- School of Engineering,
Jönköping University
, Jönköping,
Sweden
| | - Maria Holmén
- Innovation Platform,
Region Västra Götaland
, Gothenburg,
Sweden
| | - Anna Kjellsdotter
- Research and Development Centre
,
Skaraborg Hospital
, Skövde,
Sweden
| |
Collapse
|
4
|
Turjamaa R, Vaismoradi M, Kangasniemi M. Older home care clients' experiences of digitalisation: A qualitative study of experiences of the use of robot for medicines management. Scand J Caring Sci 2022; 37:561-570. [PMID: 36574259 DOI: 10.1111/scs.13141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/18/2022] [Accepted: 12/11/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Home-living older people with multiple medications are a key target group for medication robots. However, our understanding of how robots for medicines management work in older people's daily lives is limited. AIM The aim of this study was to describe older home care clients' experiences of the implementation and use of a robot for medicines management at home. DESIGN A qualitative interview study. METHODS Data were collected during spring and autumn 2021 using semi-structured individual interviews with older home care clients (n = 38). The data were analysed using inductive content analysis. RESULTS The older home care clients had positive experiences with the use of technology for the medication process, but they also faced challenges in their daily life activities. Implementation and use of the robot required open-mindedness, satisfaction with the implementation, and the opportunity to practice the use of the robot with a nurse. However, the current design and size of the robot for medicines management in home care still need development, given that our research participants did not feel included in the robot development process. CONCLUSION The use of digital solutions will increase older people's home care. Therefore, there is a need to deepen our understanding of the implementation and use of digital solutions to prevent digital challenges and to provide a more comprehensive picture of this phenomenon. In addition, research focusing on whether the use of the robot affects medication administration incidents and medication adherence should be conducted to improve the safety of medicines management.
Collapse
Affiliation(s)
- Riitta Turjamaa
- Unit of Continuous Learning Savonia University of Applied Sciences Kuopio Finland
| | | | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, Satakunta Regional Hospital Turku University Pori Finland
| |
Collapse
|
5
|
Perry LM, Morken V, Peipert JD, Yanez B, Garcia SF, Barnard C, Hirschhorn LR, Linder JA, Jordan N, Ackermann RT, Harris A, Kircher S, Mohindra N, Aggarwal V, Frazier R, Coughlin A, Bedjeti K, Weitzel M, Nelson EC, Elwyn G, Van Citters AD, O'Connor M, Cella D. Patient-Reported Outcome Dashboards Within the Electronic Health Record to Support Shared Decision-making: Protocol for Co-design and Clinical Evaluation With Patients With Advanced Cancer and Chronic Kidney Disease. JMIR Res Protoc 2022; 11:e38461. [PMID: 36129747 PMCID: PMC9536520 DOI: 10.2196/38461] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/18/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported outcomes-symptoms, treatment side effects, and health-related quality of life-are important to consider in chronic illness care. The increasing availability of health IT to collect patient-reported outcomes and integrate results within the electronic health record provides an unprecedented opportunity to support patients' symptom monitoring, shared decision-making, and effective use of the health care system. OBJECTIVE The objectives of this study are to co-design a dashboard that displays patient-reported outcomes along with other clinical data (eg, laboratory tests, medications, and appointments) within an electronic health record and conduct a longitudinal demonstration trial to evaluate whether the dashboard is associated with improved shared decision-making and disease management outcomes. METHODS Co-design teams comprising study investigators, patients with advanced cancer or chronic kidney disease, their care partners, and their clinicians will collaborate to develop the dashboard. Investigators will work with clinic staff to implement the co-designed dashboard for clinical testing during a demonstration trial. The primary outcome of the demonstration trial is whether the quality of shared decision-making increases from baseline to the 3-month follow-up. Secondary outcomes include longitudinal changes in satisfaction with care, self-efficacy in managing treatments and symptoms, health-related quality of life, and use of costly and potentially avoidable health care services. Implementation outcomes (ie, fidelity, appropriateness, acceptability, feasibility, reach, adoption, and sustainability) during the co-design process and demonstration trial will also be collected and summarized. RESULTS The dashboard co-design process was completed in May 2020, and data collection for the demonstration trial is anticipated to be completed by the end of July 2022. The results will be disseminated in at least one manuscript per study objective. CONCLUSIONS This protocol combines stakeholder engagement, health care coproduction frameworks, and health IT to develop a clinically feasible model of person-centered care delivery. The results will inform our current understanding of how best to integrate patient-reported outcome measures into clinical workflows to improve outcomes and reduce the burden of chronic disease on patients and health care systems. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/38461.
Collapse
Affiliation(s)
- Laura M Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Victoria Morken
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - John D Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Cynthia Barnard
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Lisa R Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert J Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jeffrey A Linder
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Neil Jordan
- Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, IL, United States
| | - Ronald T Ackermann
- Division of General Internal Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Alexandra Harris
- Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sheetal Kircher
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Nisha Mohindra
- Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Vikram Aggarwal
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rebecca Frazier
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Ava Coughlin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Melissa Weitzel
- Northwestern Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Division of Nephrology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Eugene C Nelson
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Mary O'Connor
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Robert H Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| |
Collapse
|
6
|
Blom MC, Khalid M, Van-Lettow B, Hutink H, Larsson S, Huff S, Ingvar M. Harmonization of the ICHOM Quality Measures to Enable Health Outcomes Measurement in Multimorbid Patients. Front Digit Health 2021; 2:606246. [PMID: 34713068 PMCID: PMC8521789 DOI: 10.3389/fdgth.2020.606246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/13/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: To update the sets of patient-centric outcomes measures (“standard-sets”) developed by the not-for-profit organization ICHOM to become more readily applicable in patients with multimorbidity and to facilitate their implementation in health information systems. To that end we set out to (i) harmonize measures previously defined separately for different conditions, (ii) create clinical information models from the measures, and (iii) restructure the annotation to make the sets machine-readable. Materials and Methods: First, we harmonized the semantic meaning of individual measures across all the 28 standard-sets published to date, in a harmonized measure repository. Second, measures corresponding to four conditions (Breast cancer, Cataracts, Inflammatory bowel disease and Heart failure) were expressed as logical models and mapped to reference terminologies in a pilot study. Results: The harmonization of semantic meaning resulted in a consolidation of measures used across the standard-sets by 15%, from 3,178 to 2,712. These were all converted into a machine-readable format. 61% of the measures in the 4 pilot sets were bound to existing concepts in either SNOMED CT or LOINC. Discussion: The harmonization of ICHOM measures across conditions is expected to increase the applicability of ICHOM standard-sets to multi-morbid patients, as well as facilitate their implementation in health information systems. Conclusion: Harmonizing the ICHOM measures and making them machine-readable is expected to expedite the global adoption of systematic and interoperable outcomes measurement. In turn, we hope that the improved transparency on health outcomes that follows will let health systems across the globe learn from each other to the ultimate benefit of patients.
Collapse
Affiliation(s)
| | - Mona Khalid
- International Consortium for Health Outcome Measurement, London, United Kingdom
| | | | | | | | - Stan Huff
- University of Utah Department of Biomedical Informatics, Intermountain Health Care, Salt Lake City, UT, United States
| | - Martin Ingvar
- Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.,Department of Clinical Neuroradiology, Karolinska University Hospital, Solna, Sweden
| |
Collapse
|
7
|
Savarese M, Sapienza M, Acquati GM, Nurchis MC, Riccardi MT, Mastrilli V, D’Elia R, Graps EA, Graffigna G, Damiani G. Educational Interventions for Promoting Food Literacy and Patient Engagement in Preventing Complications of Type 2 Diabetes: A Systematic Review. J Pers Med 2021; 11:jpm11080795. [PMID: 34442439 PMCID: PMC8399193 DOI: 10.3390/jpm11080795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 01/02/2023] Open
Abstract
The present review aims to map the current literature on educational interventions to promote food literacy in type 2 diabetes, with a particular focus on the concept of patient engagement. The systematic review was implemented on five databases with no restrictions on the publication year. The studies selected for the review were focused on patients with type 2 diabetes, ranging from 2003 to 2021 and published in 13 countries (44% USA). Thirty-three articles were analyzed. Twenty-seven articles targeted singular patients; fifteen articles conceptualized patient engagement as self-management. In seven articles, the provider is a multidisciplinary team. Twenty articles did not report a theoretical framework in the intervention development, and eleven did not use an intervention material. Twenty-six articles did not use a technology proxy. Outcome categories were narratively mapped into four areas: clinical, psychological, behavioral, and literacy. To date, most of the interventions are heterogeneous in the adopted methodology, measures, and outcomes considered. More attention should be given to the psychosocial characterization of patient engagement as well as the technological support. High-quality, randomized controlled trials and longitudinal studies are lacking and need to be conducted to verify the efficacy of these insights.
Collapse
Affiliation(s)
- M. Savarese
- EngageMinds HUB–Consumer Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy; (M.S.); (G.G.)
- Faculty of Agriculture Food and Environmental Sciences, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
| | - M. Sapienza
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
| | - G. M. Acquati
- Faculty of Psychology, Università Cattolica del Sacro Cuore, 20123 Milano, Italy;
| | - M. C. Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A.Gemelli IRCCS, Largo A.Gemelli 8, 00168 Rome, Italy;
| | - M. T. Riccardi
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
- Correspondence: ; Tel.: +39-06-3015-4396
| | - V. Mastrilli
- Ministero Della Salute, Direzione Generale della Prevenzione, Ufficio 8-Promozione Salute e Prevenzione Controllo Malattie Cronico-Degenerative, 20123 Milano, Italy; (V.M.); (R.D.)
| | - R. D’Elia
- Ministero Della Salute, Direzione Generale della Prevenzione, Ufficio 8-Promozione Salute e Prevenzione Controllo Malattie Cronico-Degenerative, 20123 Milano, Italy; (V.M.); (R.D.)
| | - E. A. Graps
- A.Re.S.S. Puglia-Agenzia Regionale Strategica per la Salute ed il Sociale Area Valutazione e Ricerca, 20123 Milano, Italy;
| | - G. Graffigna
- EngageMinds HUB–Consumer Food & Health Engagement Research Center, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy; (M.S.); (G.G.)
- Faculty of Agriculture Food and Environmental Sciences, Università Cattolica del Sacro Cuore, 20123 Milano, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Largo A.Gemelli 1, 20123 Milano, Italy
| | - G. Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (M.S.); (G.D.)
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A.Gemelli IRCCS, Largo A.Gemelli 8, 00168 Rome, Italy;
| |
Collapse
|
8
|
Hager A, Lindblad S, Brommels M, Salomonsson S, Wannheden C. Sharing Patient-Controlled Real-World Data Through the Application of the Theory of Commons: Action Research Case Study. J Med Internet Res 2021; 23:e16842. [PMID: 33464212 PMCID: PMC7854041 DOI: 10.2196/16842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/15/2020] [Accepted: 12/17/2020] [Indexed: 12/25/2022] Open
Abstract
Background Technological advances have radically changed the opportunities for individuals with chronic conditions to practice self-care and to coproduce health care and research. Digital technologies enable patients to perform tasks traditionally carried out by health care professionals in a more convenient way, at lower costs, and without compromising quality. Patients may also share real-world data with other stakeholders to promote individual and population health. However, there is a need for legal frameworks that enable patient privacy and control in such sharing of real-world data. We believe that this need could be met by the conceptualization of patient-controlled real-world data as knowledge commons, which is a resource shared by a group of people. Objective This study aimed to propose a conceptual model that describes how patient-controlled real-world data can be shared effectively in chronic care management, in a way that supports individual and population health, while respecting personal data privacy and control. Methods An action research approach was used to develop a solution to enable patients, in a self-determined way, to share patient-controlled data to other settings. We chose the context of cystic fibrosis (CF) care in Sweden, where coproduction between patients, their families, and health care professionals is critical in the introduction of new drugs. The first author, who is a lawyer and parent of children with CF, was a driver in the change process. All coauthors collaborated in the analysis. We collected primary and secondary data reflecting changes during the time period from 2012 to 2020, and performed a qualitative content analysis guided by the knowledge commons framework. Results Through a series of changes, a national system for enabling patients to share patient-controlled real-world data to different stakeholders in CF care was implemented. The case analysis resulted in a conceptual model consisting of the following three knowledge commons arenas that contributed to patient-controlled real-world data collection, use, and sharing: (1) patient world arena involving the private sphere of patients and families; (2) clinical microsystem arena involving the professional sphere at frontline health care clinics; and (3) round table arena involving multiple stakeholders from different settings. Based on the specification of property rights, as presented in our model, the patient can keep control over personal health information and may grant use rights to other stakeholders. Conclusions Health information exchanges for sharing patient-controlled real-world data are pivotal to enable patients, health care professionals, health care funders, researchers, authorities, and the industry to coproduce high-quality care and to introduce and follow-up novel health technologies. Our model proposes how technical and legal structures that protect the integrity and self-determination of patients can be implemented, which may be applicable in other chronic care settings as well.
Collapse
Affiliation(s)
| | | | - Mats Brommels
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Stina Salomonsson
- Center for Observational and Real World Evidence, Merck Sharp and Dohme, Stockholm, Sweden
| | - Carolina Wannheden
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
9
|
Pitkänen LJ, Leskelä RL, Tolkki H, Torkki P. A Value-Based Steering Model for Healthcare. FRONTIERS IN HEALTH SERVICES 2021; 1:709271. [PMID: 36926492 PMCID: PMC10012620 DOI: 10.3389/frhs.2021.709271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022]
Abstract
This article aims to answer how a commissioning body can steer health services based on value in an environment where the commissioner is responsible for the health services of a population with varying health service needs. In this design science study, we constructed a value-based steering model consisting of three parts: (1) the principles of steering; (2) the steering process; and (3) Value Steering Canvas, a concrete tool for steering. The study is based on Finland, a tax-funded healthcare system, where healthcare is a public service. The results can be applied in any system where there is a commissioner and a service provider, whether they are two separate organizations or not. We conclude that steering can be done based on value. The commissioning body can start using value-based steering without changes in legislation or in the present service system. Further research is needed to test the model in practice.
Collapse
Affiliation(s)
- Laura J Pitkänen
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Helena Tolkki
- Nordic Healthcare Group, Helsinki, Finland.,Faculty of Management and Business, Tampere University, Tampere, Finland
| | - Paulus Torkki
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| |
Collapse
|
10
|
Stöcker JK, Vonk MC, van den Hoogen FHJ, Nijhuis-van der Sanden MWG, Spierings J, Staal JB, Satink T, van den Ende CHM. Room for improvement in non-pharmacological systemic sclerosis care? - a cross-sectional online survey of 650 patients. BMC Rheumatol 2020; 4:43. [PMID: 32760879 PMCID: PMC7393838 DOI: 10.1186/s41927-020-00142-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 05/28/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND/ OBJECTIVE To gain insight in the use of current systemic sclerosis (SSc) care provided by health professionals from the patient perspective. We focused on referral reasons, treatment goals, the alignment with unmet care needs, and outcome satisfaction. METHODS Dutch SSc patients from 13 participating rheumatology departments were invited to complete an online survey. Descriptive statistics were used to describe current use of non-pharmacological care and outcome satisfaction. Reasons for referral and treatment goals were encoded in International Classification of Function and Disability (ICF) terms. RESULTS We included 650 patients (mean (standard deviation [SD]) age, 59.4 (11.4) years. 50% had contact with a health professional in the past year; 76.3% since disease onset. Physiotherapists were the most frequently visited in the past year (40.0%), followed by dental hygienists (11.4%) and podiatrists (9.2%). The three most common referral reasons were pain, joint mobility and cardiovascular functions. Fatigue, Raynaud's phenomenon, physical limitations, reduced hand function and joint problems were mentioned by more than 25% of all respondents as unmet needs. The proportion of patients treated in the past year by a health professional who were satisfied with knowledge and expertise of their health professionals was 74.4%; 73% reported improved daily activities and better coping with complaints. However, 48.9% perceived that the collaboration between rheumatologist and health professional was never or only sometimes sufficient. CONCLUSION Despite the high outcome satisfaction and good accessibility of health professionals, there are obstacles in the access to non-pharmacological care and communication barriers between health professionals and rheumatologists.
Collapse
Affiliation(s)
- Juliane K Stöcker
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Madelon C Vonk
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ton Satink
- Research Group Neuro Rehabilitation, HAN University of Applied Sciences, Nijmegen, The Netherlands
- European Masters of Science in Occupational Therapy, HvA University of Applied Sciences, Amsterdam, The Netherlands
| | - Cornelia H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
11
|
Lyles CR, Nelson EC, Frampton S, Dykes PC, Cemballi AG, Sarkar U. Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices. Ann Intern Med 2020; 172:S123-S129. [PMID: 32479176 PMCID: PMC7800164 DOI: 10.7326/m19-0876] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with EHR data through patient portals, These studies mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Interventions that used one-on-one patient training were associated with the highest portal use. Patients with limited health or digital literacy faced challenges to portal use. Clinicians reported a lack of workflows to support patient use of portals in routine practice. These studies suggest that achieving higher rates of patient engagement through EHR portals will require paying more attention to the needs of diverse patients and systematically measuring usability as well as scope of content. Future work should incorporate implementation science approaches and directly address the key role of clinicians and staff in promoting portal use.
Collapse
Affiliation(s)
- Courtney R Lyles
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| | - Eugene C Nelson
- Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (E.C.N.)
| | | | - Patricia C Dykes
- Center for Patient Safety, Research, and Practice, Brigham and Women's Hospital, Boston, Massachusetts (P.C.D.)
| | - Anupama G Cemballi
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| | - Urmimala Sarkar
- UCSF Department of Medicine, Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, California (C.R.L., A.G.C., U.S.)
| |
Collapse
|
12
|
Challenges to the Application of Integrated, Personalized Care for Patients with COPD-A Vision for the Role of Clinical Information. J Clin Med 2020; 9:jcm9051311. [PMID: 32370150 PMCID: PMC7290491 DOI: 10.3390/jcm9051311] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/10/2023] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a complex disease defined by airflow limitation and characterized by a spectrum of treatable and untreatable pulmonary and extra-pulmonary disease characteristics. Nonpharmacological management related to physical activity, physical capacity, body composition, breathing and energy-saving techniques, coping strategies, and self-management is as important as its pharmacological management. Most patients with COPD carry other chronic diagnoses and this poses a key challenge, as it lowers the quality of life, increases mortality, and impacts healthcare consumption. A personalized, multi-, and interprofessional approach is key. Today, healthcare is poorly organized to meet this complexity with the isolation between care levels, logic silos of the different healthcare professions, and lack of continuity of care along the patient’s journey with the healthcare system. In order to meet the criteria for integrated, personalized care for COPD, the structural capabilities of healthcare to support a comprehensive approach and continuity of care needs improvement. COPD is preeminently a disease that requires a transition from a reactive single-specialty approach to a proactive interprofessional approach. In this study, we discuss the issues that need to be addressed when moving from current health care practice to a person-centered model where the care processes and information are aligned to the individual personal needs of the patient.
Collapse
|
13
|
Szanton SL, Han HR, Campbell J, Reynolds N, Dennison-Himmelfarb CR, Perrin N, Davidson PM. Shifting paradigms to build resilience among patients and families experiencing multiple chronic conditions. J Clin Nurs 2019; 29:3591-3594. [PMID: 31856340 PMCID: PMC7540462 DOI: 10.1111/jocn.15145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/11/2019] [Indexed: 12/26/2022]
Affiliation(s)
- Sarah L Szanton
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Hae-Ra Han
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Nancy Reynolds
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | | - Nancy Perrin
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | | |
Collapse
|
14
|
von Thiele Schwarz U, Aarons GA, Hasson H. The Value Equation: Three complementary propositions for reconciling fidelity and adaptation in evidence-based practice implementation. BMC Health Serv Res 2019; 19:868. [PMID: 31752846 PMCID: PMC6873662 DOI: 10.1186/s12913-019-4668-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 10/21/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There has long been debate about the balance between fidelity to evidence-based interventions (EBIs) and the need for adaptation for specific contexts or particular patients. The debate is relevant to virtually all clinical areas. This paper synthesises arguments from both fidelity and adaptation perspectives to provide a comprehensive understanding of the challenges involved, and proposes a theoretical and practical approach for how fidelity and adaptation can optimally be managed. DISCUSSION There are convincing arguments in support of both fidelity and adaptations, representing the perspectives of intervention developers and internal validity on the one hand and users and external validity on the other. Instead of characterizing fidelity and adaptation as mutually exclusive, we propose that they may better be conceptualized as complimentary, representing two synergistic perspectives that can increase the relevance of research, and provide a practical way to approach the goal of optimizing patient outcomes. The theoretical approach proposed, the "Value Equation," provides a method for reconciling the fidelity and adaptation debate by putting it in relation to the value (V) that is produced. The equation involves three terms: intervention (IN), context (C), and implementation strategies (IS). Fidelity and adaptation determine how these terms are balanced and, in turn, the end product - the value it produces for patients, providers, organizations, and systems. The Value Equation summarizes three central propositions: 1) The end product of implementation efforts should emphasize overall value rather than only the intervention effects, 2) implementation strategies can be construed as a method to create fit between EBIs and context, and 3) transparency is vital; not only for the intervention but for all of the four terms of the equation. There are merits to arguments for both fidelity and adaptation. We propose a theoretical approach, a Value Equation, to reconciling the fidelity and adaptation debate. Although there are complexities in the equation and the propositions, we suggest that the Value Equation be used in developing and testing hypotheses that can help implementation science move toward a more granular understanding of the roles of fidelity and adaptation in the implementation process, and ultimately sustainability of practices that provide value to stakeholders.
Collapse
Affiliation(s)
- Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23 Västerås, Sweden
- Medical Management Centre, LIME, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Gregory A. Aarons
- Child and Adolescent Services Research Center, 3665 Kearny Villya Rd, Suie 200N, San Diego, CA 92123 USA
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, San Diego, CA 92093-0812 USA
- UC San Diego Dissemination and Implementation Science Center (UCSD-DISC), 9500 Gilman Drive (0990), La Jolla, CA 92093-0990 USA
| | - Henna Hasson
- Medical Management Centre, LIME, Karolinska Institutet, 171 77 Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| |
Collapse
|
15
|
De Regge M, Decoene E, Eeckloo K, Van Hecke A. Development and Evaluation of an Integrated Digital Patient Platform During Oncology Treatment. J Patient Exp 2019; 7:53-61. [PMID: 32128372 PMCID: PMC7036686 DOI: 10.1177/2374373518825142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Patient platforms are seen as promising technologies in an integrated care approach to
involve cancer patients in their own health care and to support them in managing their
personal health information. However, few digital platforms have been codesigned with
patients and caregivers. Objective: To develop, implement, and evaluate the feasibility and applicability of a digital
oncology platform (DOP) for patients with cancer. Method: A mixed-method study was used, employing a survey, interviews, and logged data from
caregivers and patients. The DOP was designed in cooperation with Information Technology
(IT) staff, caregivers, and patients. Results: The DOP was actively used by half of the patients. These active patients were positive
about the DOP. Caregivers acknowledged the added value but also indicate that additional
workload was involved. Oncology nurse specialists are the users of the platform. General
practitioners have indicated their interest in the platform. Conclusion: Thanks to the codesign process, the DOP could be tailored to the expectations of the
end users. This study provides insight into which DOP functionalities the patients were
interested in and includes further recommendations for implementation.
Collapse
Affiliation(s)
- Melissa De Regge
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium.,Department of Management, Innovation and Entrepreneurship, Faculty of Economics and Business Administration, Ghent University, Ghent, Belgium
| | - Elsie Decoene
- Cancer Center, Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Strategic Policy Cell, Ghent University Hospital, Ghent, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.,Nursing Department, Ghent University Hospital, Ghent, Belgium
| |
Collapse
|
16
|
Abstract
IN BRIEF This study examined the relationship between patient commitment and A1C. Patients completed the Altarum Consumer Engagement (ACE) measure. Multiple A1C values were extracted from medical records for 273 military beneficiaries. Effects were analyzed with generalized linear models. The ACE Commitment subscale was significantly inversely related to A1C trends. Low-commitment patients were more likely to have a high A1C. High-commitment patients were 16% more likely to have an A1C <7.0%; this likelihood increased to 65% over time. The ACE Commitment domain may be a useful clinical tool. Increasing patients' commitment to managing diabetes may improve their A1C over time.
Collapse
Affiliation(s)
- Jana Wardian
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center (WHASC), Lackland, TX
| | | | - Chris Duke
- Center for Consumer Choice in Health Care, Altarum Institute, Ann Arbor, MI
| | - Tom J. Sauerwein
- Diabetes Center of Excellence, Wilford Hall Ambulatory Surgical Center (WHASC), Lackland, TX
| |
Collapse
|
17
|
Evaluating hospital websites in Kuwait to improve consumer engagement and access to health information: a cross-sectional analytical study. BMC Med Inform Decis Mak 2018; 18:82. [PMID: 30249244 PMCID: PMC6154923 DOI: 10.1186/s12911-018-0660-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/04/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Current advances in information and communication technology have made accessing and obtaining health-related information easier than ever before. Today, many hospital websites use a patient-centric approach to promote engagement and encourage learning for better health-related decision making. However, little is known about the current state of hospital websites in the State of Kuwait. This study aims to evaluate hospital websites in Kuwait and offer recommendations to improve patient engagement and access to health information. METHODS This study employs a cross-sectional analytical approach to evaluate hospital websites in Kuwait in 2017. The websites of hospitals that provide in-patient services were identified through a structured search. Only active websites that were available in either English or Arabic were considered. The evaluation of the websites involved a combination of automated and expert- based evaluation methods and was performed across four dimensions: Accessibility, Usability, Presence, and Content. RESULTS Nine hospitals met the inclusion criteria. Most of the websites fell short in all four dimensions. None of the websites passed the accessibility guidelines. The usability of websites varied between hospitals. Overall, the majority of hospitals in Kuwait have rudimentary online presence and their websites require careful reassessment with respect to design, content, and user experience. The websites focus primarily on promoting services provided by the hospital rather than engaging and communicating with patients or providing evidence-based information. CONCLUSIONS Healthcare organization and website developers should follow best-practices to improve their websites taking into consideration the quality, readability, objectivity, coverage and currency of the information as well as the design of their websites. Hospitals should leverage social media to gain outreach and better engagement with consumers. The websites should be offered in additional languages commonly spoken by people living in Kuwait. Efforts should be made to ensure that health information on hospital websites are evidence-based and checked by healthcare professionals.
Collapse
|
18
|
Kamal AH, Kirkland KB, Meier DE, Morgan TS, Nelson EC, Pantilat SZ. A Person-Centered, Registry-Based Learning Health System for Palliative Care: A Path to Coproducing Better Outcomes, Experience, Value, and Science. J Palliat Med 2017; 21:S61-S67. [PMID: 29091509 DOI: 10.1089/jpm.2017.0354] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Palliative care offers an approach to the care of people with serious illness that focuses on quality of life and aligning care with individual and family goals, and values in the context of what is medically achievable. OBJECTIVE Measurement of the impact of palliative care is critical for determining what works for which patients in what settings, to learn, improve care, and ensure access to high value care for people with serious illness. METHODS A learning health system that includes patients and families partnering with clinicians and care teams, is directly linked to a registry to support networks for improvement and research, and offers an ideal framework for measuring what matters to a range of stakeholders interested in improving care for this population. MEASUREMENTS Measurement focuses on the individual patient and family experience as the fundamental outcome of interest around which all care delivery is organized. RESULTS We describe an approach to codesigning and implementing a palliative care registry that functions as a learning health system, by combining patient and family inputs and clinical data to support person-centered care, quality improvement, accountability, transparency, and scientific research. DISCUSSION The potential for a palliative care learning health system that, by design, brings together enriched information environments to support coproduction of healthcare and facilitated peer networks to support patients and families, collaborative clinician networks to support palliative care program improvement, and collaboratories to support research and the application of research to benefit individual patients is immense.
Collapse
Affiliation(s)
- Arif H Kamal
- 1 Duke Cancer Institute and the Fuqua School of Business, Duke University , Durham, North Carolina
| | - Kathryn B Kirkland
- 2 Dartmouth Hitchcock Health and The Dartmouth Institute for Health Policy and Clinical Practice , Lebanon , New Hampshire
| | - Diane E Meier
- 3 Center to Advance Palliative Care , Icahn School of Medicine at Mount Sinai Hospital, New York, New York
| | - Tamara S Morgan
- 4 The Dartmouth Institute for Health Policy and Clinical Practice , Lebanon , New Hampshire
| | - Eugene C Nelson
- 4 The Dartmouth Institute for Health Policy and Clinical Practice , Lebanon , New Hampshire
| | - Steven Z Pantilat
- 5 Palliative Care Program, Division of Hospital Medicine , UCSF, San Francisco, California
| |
Collapse
|