Co-designing, measuring, and optimizing innovations and solutions within complex adaptive health systems

Human-centred AI for emergency cardiac care: Evaluating RAPIDx AI with PROLIFERATE_AI

BACKGROUND

Chest pain diagnosis in emergency care is hindered by overlapping cardiac and non-cardiac symptoms, causing diagnostic uncertainty. Artificial Intelligence, such as RAPIDx AI, aims to enhance accuracy through clinical and biochemical data integration, but its adoption relies on addressing usability, explainability, and seamless workflow integration without disrupting care.

OBJECTIVE

Evaluate RAPIDx AI's integration into clinical workflows, address usability barriers, and optimise its adoption in emergencies.

METHODS

The PROLIFERATE_AI framework was implemented across 12 EDs (July 2022-January 2024) with 39 participants: 15 experts co-designed a survey via Expert Knowledge Elicitation (EKE), applied to 24 ED clinicians to assess RAPIDx AI usability and adoption. Bayesian inference, using priors, estimated comprehension, emotional engagement, usage, and preference, while Monte Carlo simulations quantified uncertainty and variability, generating posterior means and 95% bootstrapped confidence intervals. Qualitative thematic analysis identified barriers and optimisation needs, with data triangulated through the PROLIFERATE_AI scoring system to rate RAPIDx AI's performance by user roles and demographics.

RESULTS

Registrars exhibited the highest comprehension (median: 0.466, 95 % CI: 0.41-0.51) and preference (median: 0.458, 95 % CI: 0.41-0.48), while residents/interns scored the lowest in comprehension (median: 0.198, 95 % CI: 0.17-0.26) and emotional engagement (median: 0.112, 95 % CI: 0.09-0.14). Registered nurses showed strong emotional engagement (median: 0.379, 95 % CI: 0.35-0.45). Novice users faced usability and workflow integration barriers, while experienced clinicians suggested automation and streamlined workflows. RAPIDx AI scored "Good Impact," excelling with trained users but requiring targeted refinements for novices.

CONCLUSION

RAPIDx AI enhances diagnostic accuracy and efficiency for experienced users, but usability challenges for novices highlight the need for targeted training and interface refinements. The PROLIFERATE_AI framework offers a robust methodology for evaluating and scaling AI solutions, addressing the evolving needs of sociotechnical systems.

Integrating Remote Monitoring Into the Pregnancy Care: Perspectives of Pregnant Women and Healthcare Professionals

Remote monitoring has been proposed to provide new opportunities to monitor pregnancy in the home environment and reduce the number of follow-up visits to the maternity clinic. Still, the integration of remote monitoring into the pregnancy care process has not been achieved. This descriptive qualitative study aimed to explore pregnant women's and healthcare professionals' perceptions of integrating remote monitoring into pregnancy monitoring process. A convenience sample of 10 pregnant women and 11 healthcare professionals participated in the focus group interviews. The data were analyzed with reflexive thematic analysis. The results comprised a four-step pregnancy monitoring process organizing the issues to consider when integrating remote monitoring into these steps. According to pregnant women and healthcare professionals, remote pregnancy monitoring should allow a holistic assessment to ensure the well-being of the pregnant woman and the fetus. Clear criteria for monitoring should guide the adaptation of monitoring to the identified monitoring needs. Ideally, remote monitoring could enable more personalized maternity care, supporting the monitoring-related decision-making of both pregnant women and healthcare professionals and facilitating the early detection of pregnancy complications. However, integration of remote monitoring would require significant restructuring of current pregnancy care processes.

The ILC Maine statement: Time for the fundamental care [r]evolution

AIM

The aim of this study was to present the third position statement from the International Learning Collaborative (ILC). The ILC is the foremost global organization dedicated to transforming fundamental care. Internationally, fundamental care is reported to be poorly delivered, delayed or missed, negatively impacting patients, their families/carers and healthcare staff and systems. Overcoming this global challenge requires profound transformation in how our healthcare systems value, deliver and evaluate fundamental care. This transformation will take both evolutionary and revolutionary guises. In this position statement, we argue how this [r]evolutionary transformation for fundamental care can and must be created within clinical practice.

DESIGN

Position paper.

METHODS

This position statement stems from the ILC's annual conference and Leadership Program held in Portland, Maine, USA, in June 2023. The statement draws on the discussions between participants and the authors' subsequent reflections and synthesis of these discussions and ideas. The conference and Leadership Program involved participants (n = 209) from 13 countries working primarily within clinical practice.

RESULTS

The statement focuses on what must occur to transform how fundamental care is valued, prioritized and delivered within clinical practice settings globally. To ensure demonstrable change, the statement comprises four action-oriented strategies that must be systematically owned by healthcare staff and leaders and embedded in our healthcare organizations and systems: Address non-nursing tasks: reclaim and protect time to provide high-value fundamental care. Accentuate the positive: change from deficit-based to affirmative language when describing fundamental care. Access evidence and assess impact: demonstrate transformation in fundamental care by generating relevant indicators and impact measures and rigorously synthesizing existing research. Advocate for interprofessional collaboration: support high-quality, transdisciplinary fundamental care delivery via strong nursing leadership.

CONCLUSION

The ILC Maine Statement calls for ongoing action - [r]evolution - from healthcare leaders and staff within clinical practice to prioritize fundamental care throughout healthcare systems globally.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

We outline four action-oriented strategies that can be embedded within clinical practice to substantially transform how fundamental care is delivered. Specific actions to support these strategies are outlined, providing healthcare leaders and staff a road map to continue the transformation of fundamental care within our healthcare systems.

IMPACT

Fundamental care affects everyone across their life course, regardless of care context, clinical condition, age and/or the presence of disability. This position statement represents a call to action to healthcare leaders and staff working specifically in clinical practice, urging them to take up the leadership challenge of transforming how fundamental care is delivered and experience globally.

PATIENT OR PUBLIC CONTRIBUTION

Patients, service users and caregivers were involved in the ILC annual conference, thus contributing to the discussions that shaped this position statement. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The strategies and actions outlined in this position statement are relevant to all clinical settings globally, providing practical strategies and actions that can be employed to enhance fundamental care for all patients and their families/carers. By outlining the importance of both evolutionary and revolutionary change, we identify ways in which healthcare systems globally can begin making the necessary steps towards radical fundamental care transformation, regardless of where they are in the change journey.

Artificial intelligence and big data from digital health applications: publication trends and analysis

PURPOSE

The integration of big data with artificial intelligence in the field of digital health has brought a new dimension to healthcare service delivery. AI technologies that provide value by using big data obtained in the provision of health services are being added to each passing day. There are also some problems related to the use of AI technologies in health service delivery. In this respect, it is aimed to understand the use of digital health, AI and big data technologies in healthcare services and to analyze the developments and trends in the sector.

DESIGN/METHODOLOGY/APPROACH

In this research, 191 studies published between 2016 and 2023 on digital health, AI and its sub-branches and big data were analyzed using VOSviewer and Rstudio Bibliometrix programs for bibliometric analysis. We summarized the type, year, countries, journals and categories of publications; matched the most cited publications and authors; explored scientific collaborative relationships between authors and determined the evolution of research over the years through keyword analysis and factor analysis of publications. The content of the publications is briefly summarized.

FINDINGS

The data obtained showed that significant progress has been made in studies on the use of AI technologies and big data in the field of health, but research in the field is still ongoing and has not yet reached saturation.

RESEARCH LIMITATIONS/IMPLICATIONS

Although the bibliometric analysis study conducted has comprehensively covered the literature, a single database has been utilized and limited to some keywords in order to reach the most appropriate publications on the subject.

PRACTICAL IMPLICATIONS

The analysis has addressed important issues regarding the use of developing digital technologies in health services and is thought to form a basis for future researchers.

ORIGINALITY/VALUE

In today's world, where significant developments are taking place in the field of health, it is necessary to closely follow the development of digital technologies in the health sector and analyze the current situation in order to guide both stakeholders and those who will work in this field.

Insights on Excellence: A Guide to the Commission on Magnet as It Considers the Future

As the Commission on Magnet ® considers updates to the Magnet Recognition Program ® , a new lens is suggested to both conceptualize and structure the program for more relevant metrics of excellence going forward. By focusing on exemplars of excellence that demonstrate a more outward view and the foundational role of nurses in advancing the health of society, the construct of excellence becomes more impactful and reflective of the real value of nurses and their role in these endeavors.

The Caring Life Course Theory: Opening new frontiers in care-A cardiac rehabilitation example

AIM(S)

To operationalize the Caring Life Course Theory (CLCT) as a framework for improving cardiac rehabilitation (CR) engagement and informing ways to address disparities in rural, low socio-economic areas.

METHODS

A secondary analysis of data collected from 15 CR programmes to identify CR patterns through the CLCT lens using a mixed-methods approach. All analytical processes were conducted in NVivo, coding qualitative data through thematic analysis based on CLCT constructs. Relationships among these constructs were quantitatively assessed using Jaccard coefficients and hierarchical clustering via dendrogram analysis to identify related clusters.

RESULTS

A strong interconnectedness among constructs: 'care from others', 'capability', 'care network' and 'care provision' (coefficient = 1) highlights their entangled crucial role in CR. However, significant conceptual disparities between 'care biography' and 'fundamental care' (coefficient = 0.4) and between 'self-care' and 'care biography' (coefficient = 0.384615) indicate a need for more aligned and personalized care approaches within CR.

CONCLUSION

The CLCT provides a comprehensive theoretical and practical framework to address disparities in CR, facilitating a personalized approach to enhance engagement in rural and underserved regions.

IMPLICATIONS

Integrating CLCT into CR programme designs could effectively address participation challenges, demonstrating the theory's utility in developing targeted, accessible care interventions/solutions.

IMPACT

Explored the challenge of low CR engagement in rural, low socio-economic settings. Uncovered care provision, transitions and individual care biographies' relevance for CR engagement. Demonstrated the potential of CLCT to inform/transform CR services for underserved populations, impacting practices and outcomes.

REPORTING METHOD

EQUATOR-MMR-RHS.

PATIENT CONTRIBUTION

A consumer co-researcher contributed to all study phases.

Care biography: A concept analysis

In this article, we investigate how the concept of Care Biography and related concepts are understood and operationalised and describe how it can be applied to advancing our understanding and practice of holistic and person-centred care. Walker and Avant's eight-step concept analysis method was conducted involving multiple database searches, with potential or actual applications of Care Biography identified based on multiple discussions among all authors. Our findings demonstrate Care Biography to be a novel overarching concept derived from the conjunction of multiple other concepts and applicable across multiple care settings. Concepts related to Care Biography exist but were more narrowly defined and mainly applied in intensive care, aged care, and palliative care settings. They are associated with the themes of Meaningfulness and Existential Coping, Empathy and Understanding, Promoting Positive Relationships, Social and Cultural Contexts, and Self-Care, which we used to inform and refine our concept analysis of Care Biography. In Conclusion, the concept of Care Biography, can provide a deeper understanding of a person and their care needs, facilitate integrated and personalised care, empower people to be in control of their care throughout their life, and help promote ethical standards of care.

The SCOPE framework - implementing ideals of responsible research assessment

Background

Research and researchers are heavily evaluated, and over the past decade it has become widely acknowledged that the consequences of evaluating the research enterprise and particularly individual researchers are considerable. This has resulted in the publishing of several guidelines and principles to support moving towards more responsible research assessment (RRA). To ensure that research evaluation is meaningful, responsible, and effective the International Network of Research Management Societies (INORMS) Research Evaluation Group created the SCOPE framework enabling evaluators to deliver on existing principles of RRA. SCOPE bridges the gap between principles and their implementation by providing a structured five-stage framework by which evaluations can be designed and implemented, as well as evaluated.

Methods

SCOPE is a step-by-step process designed to help plan, design, and conduct research evaluations as well as check effectiveness of existing evaluations. In this article, four case studies are presented to show how SCOPE has been used in practice to provide value-based research evaluation.

Results

This article situates SCOPE within the international work towards more meaningful and robust research evaluation practices and shows through the four case studies how it can be used by different organisations to develop evaluations at different levels of granularity and in different settings.

Conclusions

The article demonstrates that the SCOPE framework is rooted firmly in the existing literature. In addition, it is argued that it does not simply translate existing principles of RRA into practice, but provides additional considerations not always addressed in existing RRA principles and practices thus playing a specific role in the delivery of RRA. Furthermore, the use cases show the value of SCOPE across a range of settings, including different institutional types, sizes, and missions.