1
|
Husain A, Cohen E, Dubrowski R, Jamieson T, Kurahashi AM, Lokuge B, Rapoport A, Saunders S, Stasiulis E, Stinson J, Subramaniam S, Wegier P, Barwick M. A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study. J Med Internet Res 2021; 23:e25505. [PMID: 33656445 PMCID: PMC8294640 DOI: 10.2196/25505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/24/2020] [Accepted: 01/22/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. OBJECTIVE The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. METHODS The study was a hybrid type II mixed methods design to simultaneously evaluate Loop's clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. RESULTS We recruited 25 initiating health care providers across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop's potential value for engaging the patient and caregiver, and for improving communication within the patient's circle of care, Loop's relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. CONCLUSIONS Fundamental structural and implementation challenges persist toward realizing Loop's potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication.
Collapse
Affiliation(s)
- Amna Husain
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada.,Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Eyal Cohen
- Pediatric Medicine and Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Raluca Dubrowski
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Trevor Jamieson
- Department of Medicine, Unity Health Toronto, Toronto, ON, Canada
| | | | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Adam Rapoport
- Pediatric Advanced Care Team, The Hospital for Sick Children, Toronto, ON, Canada.,Emily's House Children's Hospice, Toronto, ON, Canada
| | - Stephanie Saunders
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada.,School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Elaine Stasiulis
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | - Melanie Barwick
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Flohr L, Beaudry S, Johnson KT, West N, Burns CM, Ansermino JM, Dumont GA, Wensley D, Skippen P, Gorges M. Clinician-Driven Design of VitalPAD-An Intelligent Monitoring and Communication Device to Improve Patient Safety in the Intensive Care Unit. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:3000114. [PMID: 29552425 PMCID: PMC5853765 DOI: 10.1109/jtehm.2018.2812162] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/19/2018] [Accepted: 02/12/2018] [Indexed: 01/22/2023]
Abstract
The pediatric intensive care unit (ICU) is a complex environment, in which a multidisciplinary team of clinicians (registered nurses, respiratory therapists, and physicians) continually observe and evaluate patient information. Data are provided by multiple, and often physically separated sources, cognitive workload is high, and team communication can be challenging. Our aim is to combine information from multiple monitoring and therapeutic devices in a mobile application, the VitalPAD, to improve the efficiency of clinical decision-making, communication, and thereby patient safety. We observed individual ICU clinicians, multidisciplinary rounds, and handover procedures for 54 h to identify data needs, workflow, and existing cognitive aid use and limitations. A prototype was developed using an iterative participatory design approach; usability testing, including general and task-specific feedback, was obtained from 15 clinicians. Features included map overviews of the ICU showing clinician assignment, patient status, and respiratory support; patient vital signs; a photo-documentation option for arterial blood gas results; and team communication and reminder functions. Clinicians reported the prototype to be an intuitive display of vital parameters and relevant alerts and reminders, as well as a user-friendly communication tool. Future work includes implementation of a prototype, which will be evaluated under simulation and real-world conditions, with the aim of providing ICU staff with a monitoring device that will improve their daily work, communication, and decision-making capacity. Mobile monitoring of vital signs and therapy parameters might help improve patient safety in wards with single-patient rooms and likely has applications in many acute and critical care settings.
Collapse
Affiliation(s)
- Luisa Flohr
- Faculty of MedicineThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Shaylene Beaudry
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - K Taneille Johnson
- Faculty of MedicineThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Nicholas West
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada
| | - Catherine M Burns
- Department of Systems Design EngineeringUniversity of WaterlooWaterlooONN2L 3G1Canada
| | - J Mark Ansermino
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada.,BC Children's Hospital Research InstituteVancouverBCV5Z 4H4Canada
| | - Guy A Dumont
- Department of Electrical and Computer EngineeringThe University of British ColumbaVancouverBCV6T 1Z4Canada
| | - David Wensley
- Department of PediatricsThe University of British ColumbaVancouverBCV6H 3V4Canada
| | - Peter Skippen
- Department of PediatricsThe University of British ColumbaVancouverBCV6H 3V4Canada
| | - Matthias Gorges
- Department of AnesthesiologyPharmacology and TherapeuticsThe University of British ColumbaVancouverBCV6T 1Z3Canada.,BC Children's Hospital Research InstituteVancouverBCV5Z 4H4Canada
| |
Collapse
|
3
|
Voruganti T, Husain A, Grunfeld E, Webster F. Disruption or innovation? A qualitative descriptive study on the use of electronic patient-physician communication in patients with advanced cancer. Support Care Cancer 2018; 26:2785-2792. [DOI: 10.1007/s00520-018-4103-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 02/11/2018] [Indexed: 12/30/2022]
|
4
|
Daneshvar H, Anderson S, Williams R, Mozaffar H. How Can Social Media Lead to Co-Production (Co-Delivery) of New Services for the Elderly Population? A Qualitative Study. JMIR Hum Factors 2018; 5:e5. [PMID: 29434014 PMCID: PMC5826974 DOI: 10.2196/humanfactors.7856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/05/2017] [Accepted: 10/03/2017] [Indexed: 11/21/2022] Open
Abstract
Background The future of health care services in the European Union faces the triple challenges of aging, fiscal restriction, and inclusion. Co-production offers ways to manage informal care resources to help them cater for the growing needs of elderly people. Social media (SM) is seen as a critical enabler for co-production. Objective The objective of this study was to investigate how SM—private Facebook groups, forums, Twitter, and blogging—acts as an enabler of co-production in health and care by facilitating its four underlying principles: equality, diversity, accessibility, and reciprocity. Methods We used normalization process theory as our theoretical framework to design this study. We conducted a qualitative study and collected data through 20 semistructured interviews and observation of the activities of 10 online groups and individuals. We then used thematic analysis and drew on principles of co-production (equality, diversity, accessibility, and reciprocity) as a deductive coding framework to analyze our findings. Results Our findings point to distinct patterns of feature use by different people involved in care of elderly people. This diversity makes possible the principles of co-production by offering equality among users, enabling diversity of use, making experiences accessible, and encouraging reciprocity in the sharing of knowledge and mutual support. We also identified that explication of common resources may lead to new forms of competition and conflicts. These conflicts require better management to enhance the coordination of the common pool of resources. Conclusions SM uses afford new forms of organizing and collective engagement between patients, carers, and professionals, which leads to change in health and care communication and coordination.
Collapse
Affiliation(s)
- Hadi Daneshvar
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Stuart Anderson
- School of Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh, United Kingdom
| | - Hajar Mozaffar
- Business School, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
5
|
Kurahashi AM, Stinson JN, van Wyk M, Luca S, Jamieson T, Weinstein P, Cafazzo JA, Lokuge B, Cohen E, Rapoport A, Husain A. The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System. JMIR Hum Factors 2018; 5:e2. [PMID: 29317386 PMCID: PMC5780614 DOI: 10.2196/humanfactors.7882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/27/2017] [Accepted: 11/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system's uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. OBJECTIVE This study aimed to report end users' perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. METHODS Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. RESULTS Participants enjoyed testing Loop and were able to use the core functions-composing, posting, and reading messages-with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. CONCLUSIONS Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness.
Collapse
Affiliation(s)
- Allison M Kurahashi
- The Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Margaret van Wyk
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Stephanie Luca
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Trevor Jamieson
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada.,Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Weinstein
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Healthcare Human Factors, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| | - Bhadra Lokuge
- The Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Adam Rapoport
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada.,Emily's House Children's Hospice, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Amna Husain
- The Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
6
|
Voruganti T, Grunfeld E, Jamieson T, Kurahashi AM, Lokuge B, Krzyzanowska MK, Mamdani M, Moineddin R, Husain A. My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer. J Med Internet Res 2017; 19:e219. [PMID: 28720558 PMCID: PMC5539387 DOI: 10.2196/jmir.7421] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/05/2017] [Accepted: 05/26/2017] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. OBJECTIVE The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. METHODS We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ≥3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. RESULTS Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. CONCLUSIONS The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. TRIAL REGISTRATION ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb).
Collapse
Affiliation(s)
- Teja Voruganti
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eva Grunfeld
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Trevor Jamieson
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Allison M Kurahashi
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Bhadra Lokuge
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| | - Monika K Krzyzanowska
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Muhammad Mamdani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Centre for Healthcare Analytics Research and Training, St. Michael's Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Amna Husain
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, Toronto, ON, Canada
| |
Collapse
|
7
|
Orlowski S, Lawn S, Matthews B, Venning A, Jones G, Winsall M, Antezana G, Bidargaddi N, Musiat P. People, processes, and systems: An observational study of the role of technology in rural youth mental health services. Int J Ment Health Nurs 2017; 26:259-272. [PMID: 27878940 DOI: 10.1111/inm.12262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2016] [Indexed: 11/27/2022]
Abstract
The merits of technology-based mental health service reform have been widely debated among academics, practitioners, and policy makers. The design of new technologies must first be predicated on a detailed appreciation of how the mental health system works before it can be improved or changed through the introduction of new products and services. Further work is required to better understand the nature of face-to-face mental health work and to translate this knowledge to computer scientists and system designers responsible for creating technology-based solutions. Intensive observation of day-to-day work within two rural youth mental health services in South Australia, Australia, was undertaken to understand how technology could be designed and implemented to enhance young people's engagement with services and improve their experience of help seeking. Data were analysed through a lens of complexity theory. Results highlight the variety of professional roles and services that can comprise the mental health system. The level of interconnectedness evident in the system contrasted with high levels of service self-organization and disjointed information flow. A mental health professional's work was guided by two main constructs: risk and engagement. Most clients presented with a profile of disability, disadvantage, and isolation, so complex client presentations and decision-making were core practices. Clients (and frequently, their families) engaged with services in a crisis-dependent manner, characterized by multiple disengagements and re-engagements over time. While significant opportunities exist to integrate technology into existing youth mental health services, technologies for this space must be usable for a broad range of medical, psychological and cognitive disability, social disadvantage, and accommodate repeat cycles of engagement/disengagement over time.
Collapse
Affiliation(s)
- Simone Orlowski
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Ben Matthews
- School of Information Technology and Electrical Engineering, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Venning
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Gabrielle Jones
- Country and Outback Health, Port Augusta, South Australia, Australia
| | - Megan Winsall
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Gaston Antezana
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Niranjan Bidargaddi
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia.,Young and Well Cooperative Research Centre, Melbourne, Victoria, Australia
| | - Peter Musiat
- Institute of Psychiatry, King's College London, London, UK
| |
Collapse
|
8
|
Randhawa GS, Ahern DK, Hesse BW. Information technology-enabled team-based, patient-centered care: The example of depression screening and management in cancer care. HEALTH POLICY AND TECHNOLOGY 2017; 6:67-71. [PMID: 28948138 PMCID: PMC5609681 DOI: 10.1016/j.hlpt.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The existing healthcare delivery systems across the world need to be redesigned to ensure high-quality care is delivered to all patients. This redesign needs to ensure care is knowledge-based, patient-centered and systems-minded. The rapid advances in the capabilities of information and communication technology and its recent rapid adoption in healthcare delivery have ensured this technology will play a vital role in the redesign of the healthcare delivery system. This commentary highlights promising new developments in health information technology (IT) that can support patient engagement and self-management as well as team-based, patient-centered care. Collaborative care is an effective approach to screen and treat depression in cancer patients and it is a good example of the benefits of team-based and patient-centered care. However, this approach was developed prior to the widespread adoption and use of health IT. We provide examples to illustrate how health IT can improve prevention and treatment of depression in cancer patients. We found several knowledge gaps that limit our ability to realize the full potential of health IT in the context of cancer and comorbid depression care. These gaps need to be filled to improve patient engagement; enhance the reach and effectiveness of collaborative care and web-based programs to prevent and treat depression in cancer patients. We also identify knowledge gaps in health IT design and implementation. Filling these gaps will help shape policies that enable clinical teams to deliver high-quality cancer care globally.
Collapse
Affiliation(s)
- Gurvaneet S Randhawa
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, 3E442, Bethesda, MD 20892-9761, United States
| | - David K Ahern
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
- Program in Behavioral Informatics and eHealth, Brigham & Women's Hospital, United States
| | - Bradford W Hesse
- Health Communications and Informatics Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, United States
| |
Collapse
|
9
|
Abraham J, Kannampallil TG, Patel VL, Patel B, Almoosa KF. Impact of Structured Rounding Tools on Time Allocation During Multidisciplinary Rounds: An Observational Study. JMIR Hum Factors 2016; 3:e29. [PMID: 27940423 PMCID: PMC5182443 DOI: 10.2196/humanfactors.6642] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/23/2016] [Accepted: 11/29/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Recent research has shown evidence of disproportionate time allocation for patient communication during multidisciplinary rounds (MDRs). Studies have shown that patients discussed later during rounds receive lesser time. OBJECTIVE The aim of our study was to investigate whether disproportionate time allocation effects persist with the use of structured rounding tools. METHODS Using audio recordings of rounds (N=82 patients), we compared time allocation and communication breakdowns between a problem-based Subjective, Objective, Assessment, and Plan (SOAP) and a system-based Handoff Intervention Tool (HAND-IT) rounding tools. RESULTS We found no significant linear dependence of the order of patient presentation on the time spent or on communication breakdowns for both structured tools. However, for the problem-based tool, there was a significant linear relationship between the time spent on discussing a patient and the number of communication breakdowns (P<.05)--with an average of 1.04 additional breakdowns with every 120 seconds in discussion. CONCLUSIONS The use of structured rounding tools potentially mitigates disproportionate time allocation and communication breakdowns during rounds, with the more structured HAND-IT, almost completely eliminating such effects. These results have potential implications for planning, prioritization, and training for time management during MDRs.
Collapse
Affiliation(s)
- Joanna Abraham
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, IL, United States
| | - Thomas G Kannampallil
- Department of Family Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Vimla L Patel
- Center for Cognitive Studies in Medicine and Public Health, New York Academy of Medicine, New York, NY, United States
| | - Bela Patel
- Division of Critical Care Medicine, Department of Internal Medicine, University of Texas Health Science Center, Houston, TX, United States
| | | |
Collapse
|