Qualitative study measuring the usability of the International Cardiac Rehabilitation Registry

Design, development and evaluation of registry software for upper limb disabilities

Upper limb disabilities, if not managed, controlled and treated, significantly affect the physical and mental condition, daily activities and quality of life. Registries can help control and manage and even treat these disabilities by collecting clinical-management data of upper limb disabilities. Therefore, the aim of this study is to design, develop and evaluate a registry system for upper limb disabilities in terms of usability. By having identified data elements in the exploratory phase, we developed our registry software using hypertext preprocessor (PHP) programming language in XAMPP software, version 8.1.10. The content and interface validity of the pre-final version were assessed by 13 experts in the field of medical informatics and health information management. The registry has capabilities to create user profiles, record patient history, clinical records, independence in daily activities, mental health, and treatment processes. It can also generate statistical reports. Participants evaluated the registry's usability as "good" across different dimensions. The registry can help understand upper limb disabilities, improve care, reduce costs and errors, determine incidence and prevalence, evaluate prevention and treatment, and support research and policymaking. The registry can serve as a model for designing registries for other body disabilities.

Human Factors and Organizational Issues in Health Informatics: Review of Recent Developments and Advances

OBJECTIVE

In this paper we focus on a review of key articles published in the past two years (2022 and 2023) in the areas of human factors and organizational issues in health informatics.

METHODS

We reviewed manuscripts that were published in primary human factors, human factors engineering and health informatics journals. This involved conducting a series of searches using PubMed, Web of Science, and Google Scholar for articles related to human factors in healthcare published in 2022 and 2023.

RESULTS

The range of applications that have been designed and analyzed using human factors approaches has been rapidly expanding, including increased number of articles around topics such as the following: AI in healthcare, patient-centered design, usability of mHealth, organizational issues, and work around ensuring system safety. This includes study of applications designed for use by both patients and health providers applying both qualitative and quantitative approaches to user requirements, user-centered system design and human factors analysis and evaluation.

CONCLUSION

The importance of human factors is becoming recognized as new forms of health technology appear. A multi-level perspective on human factors, that considers human factors at multiple levels, from the individual user to the complex social and organizational context, was described to consider the range and diversity of human factors approaches in healthcare. Such an approach will be needed to drive the design and evaluation of useful and usable healthcare information technologies.

Promoting cardiac rehabilitation program quality in low-resource settings: Needs assessment and evaluation of the International Council of Cardiovascular Prevention and Rehabilitation's registry quality improvement supports

BACKGROUND

Cardiac rehabilitation (CR) registries have the potential to support quality improvement (QImp). This study investigated the QImp needs of International CR Registry-participating programs and their evaluation of its' supports.

METHODS

ICRR offers comparative outcome dashboards and QImp sessions, among other features. In this qualitative study, ICRR data stewards from the 17 active on-boarded CR programs were invited to a focus group held in November 2023 via Teams; stewards not sufficiently-proficient in English were invited to provide written input. Deductive-thematic analysis using NVIVO was undertaken by 2 researchers; member-checking ensued.

RESULTS

Nine participated, and four provided input, from eight countries. Three themes emerged; saturation was achieved. First, QImp facilitators included training, institutional requirements, dedicated staff, resources in academic centres and ICRR features. Second, QImp barriers included staffing issues, the global nature of the ICRR, and structural challenges in low-resource settings. Finally, ICRR supports for QImp included didactic webinars, hearing from other programs, 1-1 support offered and assessing minimum Certification standards.

CONCLUSION

ICRR-participating programs are satisfied with QImp supports but encounter challenges, including related to language, staffing and other resources. CR registries should be leveraged and optimized to support CR programs to assess and improve their care quality.

Development and Evaluation of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) Program Certification for Low-Resource Settings

Background

Cardiac rehabilitation (CR) is a proven model of secondary prevention, but new sites, providing quality care, are needed in low-resource settings. This study (1) described the development of International Council of Cardiovascular Prevention and Rehabilitation's (ICCPR) Program Certification and (2a) tested its implementation, considering (b) appropriateness of quality standards for these settings.

Methods

The Steering Committee finalized 13 standards, requiring 70% be met. They are assessed initially through International CR Registry (ICRR) program survey and patient data; if Certification appears possible, a two-hour virtual site assessment is arranged to corroborate. Standard operating procedures for Assessor training were developed. A multi-method pilot study was then undertaken with a quantitative (description of quality indicators) and qualitative (focus groups on MS Teams) component. ICRR sites with post-program data by April 2022 were invited to participate. Two team members independently analyzed focus group transcripts, using a deductive-thematic approach with NVIVO.

Results

Five CR programs from the Eastern Mediterranean, South-East Asian and American regions participated. Upon application, with some data cleaning, initially four programs were eligible to proceed to virtual site assessment. Ultimately, all five programs were certified, each meeting a minimum of 12/13 standards (peak MET increase and program completion rate were not met by some centres). Four themes resulted from the two focus groups of 13 site data stewards: motivation and benefits (eg, international recognition, additional program resources), logistics (eg, communication, cost, site visit process), the standards and their assessment (eg, balance of rigor and feasibility), and suggestions for improvement (eg, website).

Conclusion

ICCPR's Program Certification has been demonstrated to be feasible, rigorous, and acceptable. Standards are attainable in low-resource settings. Certified programs reap benefits including additional resources. This first international Certification is suitable for low-resource settings, to complement that from the American and European CR Societies.

Pilot testing of the International Council of Cardiovascular Prevention and Rehabilitation Registry

The International Council of Cardiovascular Prevention and Rehabilitation developed an International Cardiac Rehabilitation (CR) Registry (ICRR) to support CR programs in low-resource settings to optimize care provision and patient outcomes. This study assessed implementation of the ICRR, site data steward experience with on-boarding and data entry, and patient acceptability. Multimethod observational pilot involves (I) analysis of ICRR data from three centers (Iran, Pakistan, and Qatar) from inception to May 2022, (II) focus group with on-boarded site data stewards (also from Mexico and India), and (III) semistructured interviews with participating patients. Five hundred sixty-seven patients were entered. Based on volumes at each program, 85.6% of patients were entered in ICRR. 99.3% patients approached consented to participate. The average time to enter data at pre- and follow-up assessments by source was 6.8-12.6 min. Of 22 variables preprogram, completion was 89.5%. Among patients with any follow-up data, of four program-reported variables, completion was 99.0% in program completers and 51.5% in none; of 10 patient-reported variables, completion was 97.0% in program completers and 84.8% in none. The proportion of patients with any follow-up data was 84.8% in program completers, with 43.6% of noncompleters having any data entered other than completion status. Twelve data stewards participated in the focus group. Main themes were valuable on-boarding process, data entry, process of engaging patients, and benefits of participation. Thirteen patients were interviewed. Themes were good understanding of the registry, positive experience providing data, and value of lay summary and eagerness for annual assessment. Feasibility and data quality of ICRR were demonstrated.