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Schlieter H, Kählig M, Hickmann E, Fürstenau D, Sunyaev A, Richter P, Breitschwerdt R, Thielscher C, Gersch M, Maaß W, Reuter-Oppermann M, Wiese L. [Digital health applications (DiGA) in the area of tension between progress and criticism : Discussion paper from the "Digital health" specialist group of the German Informatics Society]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:107-114. [PMID: 38086924 PMCID: PMC10776708 DOI: 10.1007/s00103-023-03804-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 11/07/2023] [Indexed: 01/10/2024]
Abstract
Since December 2019, digital health applications (DiGA) have been included in standard care in Germany and are therefore reimbursed by the statutory health insurance funds to support patients in the treatment of diseases or impairments. There are 48 registered DiGA listed in the directory of the Federal Institute of Drugs and Medical Devices (BfArM), mainly in the areas of mental health; hormones and metabolism; and muscles, bones, and joints. In this article, the "Digital Health" specialist group of the German Informatics Society describes the current developments around DiGA as well as the current sentiment on topics such as user-centricity, patient and practitioner acceptance, and innovation potential. In summary, over the past three years, DiGA have experienced a positive development, characterized by a gradually increasing availability of various DiGA and coverage areas as well as prescription numbers. Nevertheless, significant regulatory adjustments are still required in some areas to establish DiGA as a well-established instrument in long-term routine healthcare. Key challenges include user-centeredness and the sustainable use of the applications.
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Affiliation(s)
- Hannes Schlieter
- Forschungsgruppe Digital Health, Fakultät Wirtschaftswissenschaften, Technische Universität Dresden, Dresden, Sachsen, Deutschland
| | - Maren Kählig
- Forschungsgruppe Digital Health, Fakultät Wirtschaftswissenschaften, Technische Universität Dresden, Dresden, Sachsen, Deutschland.
| | - Emily Hickmann
- Forschungsgruppe Digital Health, Fakultät Wirtschaftswissenschaften, Technische Universität Dresden, Dresden, Sachsen, Deutschland
| | - Daniel Fürstenau
- Department of Business IT, IT University of Copenhagen, Kopenhagen, Dänemark
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ali Sunyaev
- Institut für Angewandte Informatik und Formale Beschreibungsverfahren, Karlsruher Institut für Technologie, Karlsruhe, Baden-Württemberg, Deutschland
| | - Peggy Richter
- Forschungsgruppe Digital Health, Fakultät Wirtschaftswissenschaften, Technische Universität Dresden, Dresden, Sachsen, Deutschland
| | - Rüdiger Breitschwerdt
- Professur für Wirtschaftsinformatik und Medizinische Informatik, Wilhelm Büchner Hochschule, Darmstadt, Hessen, Deutschland
| | - Christian Thielscher
- KompetenzCentrum für Medizinoekonomie, FOM Hochschule, Essen, Nordrhein-Westfalen, Deutschland
| | - Martin Gersch
- Fachbereich Wirtschaftswissenschaften, Freie Universität Berlin, Berlin, Deutschland
| | - Wolfgang Maaß
- Lehrstuhl für Betriebswirtschaftslehre, insbesondere Wirtschaftsinformatik, German Research Center for Artificial Intelligence Universität Saarland, Saarbrücken, Saarland, Deutschland
| | - Melanie Reuter-Oppermann
- Faculty of Behavioural, Management and Social Sciences, Center for Healthcare Operations Improvement and Research, University of Twente, Enschede, Niederlande
| | - Lena Wiese
- Fraunhofer Institute for Toxicology and Experimental Medicine ITEM, Leader Research Group Bioinformatics, Hannover, Niedersachsen, Deutschland
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Rønn C, Wieland A, Lehrer C, Márton A, LaRoche J, Specker A, Leroy P, Fürstenau D. Circular Business Model for Digital Health Solutions: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e47874. [PMID: 37999949 DOI: 10.2196/47874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/11/2023] [Accepted: 10/14/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND The circular economy reshapes the linear "take, make, and dispose" approach and evolves around minimizing waste and recapturing resources in a closed-loop system. The health sector accounts for 4.6% of global greenhouse gas emissions and has, over the decades, been built to rely on single-use devices and deal with high volumes of medical waste. With the increase in the adoption of digital health solutions in the health care industry, leading the industry into a new paradigm of how we provide health care, a focus must be put on the amount of waste that will follow. Digital health solutions will shape health care through the use of technology and lead to improved patient care, but they will also make medical waste more complex to deal with due to the e-waste component. Therefore, a transformation of the health care industry to a circular economy is a crucial cornerstone in decreasing the impact on the environment. OBJECTIVE This study aims to address the lack of direction in the current literature on circular business models. It will consider micro, meso, and macro factors that would impact the operational validity of circular models using the digital health solutions ePaper label (medical packaging), smart wearable sensor (health monitoring devices), smart pill box (medication management), and endo-cutter (surgical equipment) as examples. METHODS The study will systematically perform a scoping review through a database and snowball search. We will analyze and classify the studies from a predetermined set of categories and then summarize them into an evidence map. Based on the review, the study will develop a 2D framework for businesses to follow or for future research to take a standpoint from. RESULTS Preliminarily, the review has analyzed 26 studies in total. The results are close to equally distributed among the micro (8/26, 31%), meso (10/26, 38%), and macro (8/26, 31%) levels. Circular economy studies emphasize several circular practices such as recycling (17/26, 65%), reusing (18/26, 69%), reducing (15/26, 58%), and remanufacturing (8/26, 31%). The value proposition in the examined business model is mostly dominated by stand-alone products (18/26, 69%) compared to product as a service (7/26, 27%), involving stakeholders such as health care professionals or hospitals (20/26, 77%), manufacturers (11/26, 42%), and consumers (9/26, 35%). All studies encompass societal (12/26, 46%), economic (23/26, 88%), and environmental (24/26, 92%) viewpoints. CONCLUSIONS The study argues that each digital health solution would have to be accessed individually to find the optimal business model to follow. This is due to their differing life cycles and complexity. The manufacturer will need a layered value proposition, implementing several business models dependent on their respective product portfolios. The need to incorporate several business models implies an ecosystem perspective that is relevant to consider. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47874.
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Affiliation(s)
- Camille Rønn
- Department of Business IT, IT University of Copenhagen, Copenhagen, Denmark
| | - Andreas Wieland
- Department of Operations Management, Copenhagen Business School, Copenhagen, Denmark
| | - Christiane Lehrer
- Department of Digitalization, Copenhagen Business School, Copenhagen, Denmark
| | - Attila Márton
- Department of Digitalization, Copenhagen Business School, Copenhagen, Denmark
| | - Jason LaRoche
- Janssen Biologics, The Janssen Pharmaceutical Companies of Johnson & Johnson, Leiden, Netherlands
| | | | - Pascal Leroy
- Waste Electrical and Electronic Equipment Forum, Brussels, Belgium
| | - Daniel Fürstenau
- Department of Business IT, IT University of Copenhagen, Copenhagen, Denmark
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Kopka M, Scatturin L, Napierala H, Fürstenau D, Feufel MA, Balzer F, Schmieding ML. Characteristics of Users and Nonusers of Symptom Checkers in Germany: Cross-Sectional Survey Study. J Med Internet Res 2023; 25:e46231. [PMID: 37338970 DOI: 10.2196/46231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/12/2023] [Accepted: 05/03/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Previous studies have revealed that users of symptom checkers (SCs, apps that support self-diagnosis and self-triage) are predominantly female, are younger than average, and have higher levels of formal education. Little data are available for Germany, and no study has so far compared usage patterns with people's awareness of SCs and the perception of usefulness. OBJECTIVE We explored the sociodemographic and individual characteristics that are associated with the awareness, usage, and perceived usefulness of SCs in the German population. METHODS We conducted a cross-sectional online survey among 1084 German residents in July 2022 regarding personal characteristics and people's awareness and usage of SCs. Using random sampling from a commercial panel, we collected participant responses stratified by gender, state of residence, income, and age to reflect the German population. We analyzed the collected data exploratively. RESULTS Of all respondents, 16.3% (177/1084) were aware of SCs and 6.5% (71/1084) had used them before. Those aware of SCs were younger (mean 38.8, SD 14.6 years, vs mean 48.3, SD 15.7 years), were more often female (107/177, 60.5%, vs 453/907, 49.9%), and had higher formal education levels (eg, 72/177, 40.7%, vs 238/907, 26.2%, with a university/college degree) than those unaware. The same observation applied to users compared to nonusers. It disappeared, however, when comparing users to nonusers who were aware of SCs. Among users, 40.8% (29/71) considered these tools useful. Those considering them useful reported higher self-efficacy (mean 4.21, SD 0.66, vs mean 3.63, SD 0.81, on a scale of 1-5) and a higher net household income (mean EUR 2591.63, SD EUR 1103.96 [mean US $2798.96, SD US $1192.28], vs mean EUR 1626.60, SD EUR 649.05 [mean US $1756.73, SD US $700.97]) than those who considered them not useful. More women considered SCs unhelpful (13/44, 29.5%) compared to men (4/26, 15.4%). CONCLUSIONS Concurring with studies from other countries, our findings show associations between sociodemographic characteristics and SC usage in a German sample: users were on average younger, of higher socioeconomic status, and more commonly female compared to nonusers. However, usage cannot be explained by sociodemographic differences alone. It rather seems that sociodemographics explain who is or is not aware of the technology, but those who are aware of SCs are equally likely to use them, independently of sociodemographic differences. Although in some groups (eg, people with anxiety disorder), more participants reported to know and use SCs, they tended to perceive them as less useful. In other groups (eg, male participants), fewer respondents were aware of SCs, but those who used them perceived them to be more useful. Thus, SCs should be designed to fit specific user needs, and strategies should be developed to help reach individuals who could benefit but are not aware of SCs yet.
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Affiliation(s)
- Marvin Kopka
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Lennart Scatturin
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hendrik Napierala
- Institute of General Practice and Family Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Business IT, IT University of Copenhagen, København, Denmark
| | - Markus A Feufel
- Division of Ergonomics, Department of Psychology and Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Malte L Schmieding
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Marbin D, Gutwinski S, Lech S, Fürstenau D, Kokwaro L, Krüger H, Schindel D, Schreiter S. Use of digital technologies by users of psychiatric inpatient services in Berlin, Germany: a cross-sectional patient survey. BMJ Open 2023; 13:e067311. [PMID: 36944459 PMCID: PMC10032388 DOI: 10.1136/bmjopen-2022-067311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
UNLABELLED Few studies and almost exclusively from the USA have recently investigated mobile phone and computer use among users of psychiatric services, which is of high relevance regarding the increasing development of digital health applications and services. OBJECTIVE, DESIGN AND SETTING In a cross-sectional patient survey, we examined (a) rates and purposes of mobile phone, computer, internet and social media use, and (b) the role of social and clinical predictors on rates of utilisation among psychiatric inpatients in Berlin, Germany. PARTICIPANTS AND RESULTS Descriptive analyses showed that among 496 participants, 84.9% owned a mobile phone and 59.3% a smartphone. Among 493 participants, 68.4% used a computer regularly. Multivariate logistic regression models revealed being homeless, diagnosis of a psychotic illness, being of older age and a lower level of education to be significant predictors for not owning a mobile phone, not using a computer regularly or having a social media account, respectively. CONCLUSIONS Users of psychiatric services may have access to mobile phones and computers, although rates are lower than in the general population. However, key barriers that need to be addressed regarding the development of and engagement with digital health interventions are factors of social exclusion like marginalised housing as well as clinical aspects like psychotic illness.
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Affiliation(s)
- Derin Marbin
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Psychiatrische Universitätsklinik der Charité im St Hedwig-Krankenhaus, Berlin, Germany
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Psychiatrische Universitätsklinik der Charité im St Hedwig-Krankenhaus, Berlin, Germany
| | - Sonia Lech
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Digitalization, Copenhagen Business School, Copenhagen, Denmark
| | - Linda Kokwaro
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Helena Krüger
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniel Schindel
- Institute for Medical Sociology and Rehabilitation Science, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Fürstenau D, Baiyere A, Schewina K, Schulte-Althoff M, Rothe H. Extended Generativity Theory on Digital Platforms. Information Systems Research 2023. [DOI: 10.1287/isre.2023.1209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
The assumption that generativity engenders unbounded growth has acquired an almost taken-for-granted position in information systems and management literature. Against this premise, we examine the relationship between generativity and user base growth in the context of a digital platform. To do this, we synthesize the literature on generativity into two views, social interaction (expansion of ecosystem boundaries) and product view (expansion of product boundaries), that jointly and individually relate to user base growth. Both views help us explain how opening a platform relates to the emergence and resolution of conflicting expectations in a platform ecosystem that result in new functions and expanded use. We adopt a panel vector autoregressive approach combining data from six large transaction platforms that engaged with open-source developer communities. We found that the dominant narrative of generativity engendering growth, although generally supported by our analysis, obscures the fact that the inverse is also true; that is, growth can lead to expansion of product boundaries (inverse generativity) and that generativity can be bounded; that is, growth can stabilize ecosystem boundaries (bounded generativity). Against this background, we propose an extended generativity theory that presents generativity and growth in an integrative view and raises awareness about the limitations of the “unbounded growth” claim. We conclude that there is value in separating the two views of generativity conceptually and analytically, along with their relationship to user base growth, and we call for research on the pathways through which generativity produces growth. History: Ola Henfridsson, Senior Editor; Robert Wayne Gregory, Associate Editor. Supplemental Material: The online appendix is available at https://doi.org/10.1287/isre.2023.1209 .
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Affiliation(s)
- Daniel Fürstenau
- Department of Business IT, IT University of Copenhagen, 2300 Copenhagen, Denmark
| | - Abayomi Baiyere
- Smith School of Business, Queen’s University, Kingston, Ontario K7L 3N6, Canada
- Department of Digitalization, Copenhagen Business School, 2000 Frederiksberg, Denmark
| | - Kai Schewina
- School of Business & Economics, Freie Universität Berlin, 12435 Berlin, Germany
| | - Matthias Schulte-Althoff
- School of Business & Economics, Freie Universität Berlin, 12435 Berlin, Germany
- Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Hannes Rothe
- Department of Information Systems and Supply Chain Management, ICN Business School, 10117 Berlin, Germany
- Institute for Computer Science and Business Information Systems, University of Duisburg-Essen, Essen 45141, Germany
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Vogel A, Guinemer C, Fürstenau D. Patients' and healthcare professionals' perceived facilitators and barriers for shared decision-making for frail and elderly patients in perioperative care: a scoping review. BMC Health Serv Res 2023; 23:197. [PMID: 36829131 PMCID: PMC9960423 DOI: 10.1186/s12913-023-09120-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/27/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) in perioperative care, is an organizational approach to instituting sharing of information and decision-making around surgery. It aims at enabling patient autonomy and patient-centered care. Frail and elderly patients suffering from multiple health conditions and increased surgical vulnerability might particularly benefit from SDM. However, little is known about the facilitators and barriers to implementing SDM in perioperative care for the specific needs of frail and elderly patients. Our objective is twofold: First, we aim at collecting, analyzing, categorizing, and communicating facilitators and barriers. Second, we aim at collecting and mapping conceptual approaches and methods employed in determining and analyzing these facilitators and barriers. METHODS The search strategy focused on peer-reviewed studies. We employed a taxonomy which is based on the SPIDER framework and added the items general article information, stakeholder, barriers/facilitators, category, subcategory, and setting/contextual information. This taxonomy is based on preceding reviews. The scoping review is reported under the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews. Based on the databases MEDLINE, Embase, CINAHL, and Web of Science, we screened 984 articles, identified, and reviewed 13 original studies. RESULTS Within this review, two primary facilitators concerning patients' willingness to participate in SDM emerged: Patients want to be informed on their medical condition and procedures. Patients prefer sharing decisions with healthcare professionals, compared to decision-making solely by patients or decision-making solely by healthcare professionals. Communication issues and asymmetric power relationships between patients and clinical healthcare professionals are barriers to SDM. Regarding the methodological approaches, the evaluation of the conceptual approaches demonstrates that the selected articles lack employing a distinct theoretical framework. Second, the selected studies mainly used surveys and interviews, observational studies, like ethnographic or video-based studies are absent. CONCLUSION Diverging findings perceived by patients or clinical healthcare professionals were identified. These imply that SDM research related to elderly and frail patients should become more encompassing by employing research that incorporates theory-based qualitative analysis, and observational studies of SDM consultations for understanding practices by patients and clinical healthcare professionals. Observational studies are particularly relevant as these were not conducted. TRIAL REGISTRATION https://osf.io/8fjnb/.
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Affiliation(s)
- Amyn Vogel
- School of Business & Economics, Department of Information Systems, Freie Universität Berlin, Berlin, Germany.
| | - Camille Guinemer
- grid.6363.00000 0001 2218 4662Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Fürstenau
- grid.6363.00000 0001 2218 4662Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany ,grid.32190.390000 0004 0620 5453Department of Business IT, IT University of Copenhagen, Copenhagen, Denmark
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7
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Vorderwülbecke G, Spies C, von Heymann C, Kruppa J, Fürstenau D, Kaufner L, Werner S, Höft M, Balzer F. [The costs of preoperative anemia in hip joint revision surgery]. Anaesthesiologie 2023; 72:13-20. [PMID: 36378326 PMCID: PMC9852200 DOI: 10.1007/s00101-022-01211-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 08/09/2022] [Accepted: 09/06/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anemia is highly prevalent in patients before hip joint revision surgery (HJRS) and is associated with an increased complication rate. This paper is the first to investigate costs, real diagnosis-related group (DRG) revenues and case coverage of preoperative anemia in elective HJRS. METHODS Medical data, transfusions, costs, and revenues of all patients undergoing HJRS at two campuses of the Charité -Universitätsmedizin Berlin between 2010 and 2017 were used for subgroup analyses and linear regressions. RESULTS Of 1187 patients included 354 (29.8%) showed preoperative anemia. A total of 565 (47.6%) patients were transfused with a clear predominance of anemic patients (72.6% vs. 37.0%, p < 0.001). Costs (12,318€ [9027;20,044€] vs. 8948€ [7501;11,339€], p < 0.001) and revenues (11,788€ [8992;16,298€] vs. 9611€ [8332;10,719€], p < 0.001) were higher for preoperatively anemic patients and the coverage was deficient (-1170€ [-4467;1238€] vs. 591€ [-1441;2103€], p < 0.001). In anemic patients, case contribution margins decreased with increasing transfusion rates (p ≤ 0.001). Comorbidities had no significant economic impact. CONCLUSION Preoperative anemia and perioperative transfusions in HJRS are associated with increased treatment costs and a financial undercoverage for healthcare providers and health insurance companies. Concepts for the treatment of preoperative anemia (e.g. patient blood management) could reduce treatment costs in the medium term.
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Affiliation(s)
- Gerald Vorderwülbecke
- grid.6363.00000 0001 2218 4662Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Deutschland
| | - Claudia Spies
- grid.6363.00000 0001 2218 4662Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Deutschland
| | - Christian von Heymann
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Deutschland. .,Klinik für Anästhesie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Vivantes Klinikum im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Deutschland.
| | - Jochen Kruppa
- grid.6363.00000 0001 2218 4662Institut für Biometrie und Klinische Epidemiologie, Charité – Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Deutschland
| | - Daniel Fürstenau
- grid.4655.20000 0004 0417 0154Department of Digitalization, Copenhagen Business School, Copenhagen, Dänemark ,grid.7468.d0000 0001 2248 7639Institut für Medizinische Informatik, Charité – Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Deutschland
| | - Lutz Kaufner
- grid.6363.00000 0001 2218 4662Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Deutschland
| | - Sven Werner
- grid.6363.00000 0001 2218 4662Geschäftsbereich Unternehmenscontrolling – Klinikcontrolling, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Moritz Höft
- grid.6363.00000 0001 2218 4662Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité – Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Deutschland
| | - Felix Balzer
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Deutschland. .,Institut für Medizinische Informatik, Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Deutschland.
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Mosch L, Fürstenau D, Brandt J, Wagnitz J, Klopfenstein SAI, Poncette AS, Balzer F. The medical profession transformed by artificial intelligence: Qualitative study. Digit Health 2022; 8:20552076221143903. [PMID: 36532112 PMCID: PMC9756357 DOI: 10.1177/20552076221143903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Healthcaare delivery will change through the increasing use of artificial intelligence (AI). Physicians are likely to be among the professions most affected, though to what extent is not yet clear. OBJECTIVE We analyzed physicians' and AI experts' stances towards AI-induced changes. This concerned (1) physicians' tasks, (2) job replacement risk, and (3) implications for the ways of working, including human-AI interaction, changes in job profiles, and hierarchical and cross-professional collaboration patterns. METHODS We adopted an exploratory, qualitative research approach, using semi-structured interviews with 24 experts in the fields of AI and medicine, medical informatics, digital medicine, and medical education and training. Thematic analysis of the interview transcripts was performed. RESULTS Specialized tasks currently performed by physicians in all areas of medicine would likely be taken over by AI, including bureaucratic tasks, clinical decision support, and research. However, the concern that physicians will be replaced by an AI system is unfounded, according to experts; AI systems today would be designed only for a specific use case and could not replace the human factor in the patient-physician relationship. Nevertheless, the job profile and professional role of physicians would be transformed as a result of new forms of human-AI collaboration and shifts to higher-value activities. AI could spur novel, more interprofessional teams in medical practice and research and, eventually, democratization and de-hierarchization. CONCLUSIONS The study highlights changes in job profiles of physicians and outlines demands for new categories of medical professionals considering AI-induced changes of work. Physicians should redefine their self-image and assume more responsibility in the age of AI-supported medicine. There is a need for the development of scenarios and concepts for future job profiles in the health professions as well as their education and training.
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Affiliation(s)
- Lina Mosch
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany,Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Lina Mosch, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Charitéplatz 1, 10117 Berlin, Germany
| | - Daniel Fürstenau
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany,Department of Business IT, IT University of Copenhagen, København, Denmark
| | - Jenny Brandt
- Universitätsmedizin Mainz, corporate member of Johannes Gutenberg University, Mainz, Germany
| | - Jasper Wagnitz
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Sophie AI Klopfenstein
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany,Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Akira-Sebastian Poncette
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany,Department of Anesthesiology and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Balzer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
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Sunyaev A, Fürstenau D, Davidson E. Correction to: Call for Papers, Issue 3/2024. Bus Inf Syst Eng 2022. [DOI: 10.1007/s12599-022-00774-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Sunyaev A, Fürstenau D, Davison E. Call for Papers, Issue 3/2024. Bus Inf Syst Eng 2022. [DOI: 10.1007/s12599-022-00763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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11
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Rehfeld S, Schulte-Althoff M, Schreiber F, Fürstenau D, Näher AF, Hauss A, Köhler C, Balzer F. The Prediction of Fall Circumstances Among Patients in Clinical Care - A Retrospective Observational Study. Stud Health Technol Inform 2022; 294:575-576. [PMID: 35612151 DOI: 10.3233/shti220530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Standardized fall risk scores have not proven to reliably predict falls in clinical settings. Machine Learning offers the potential to increase the accuracy of such predictions, possibly vastly improving care for patients at high fall risks. We developed a boosting algorithm to predict both recurrent falls and the severity of fall injuries. The model was trained on a dataset including extensive information on fall events of patients who had been admitted to Charité - Universitätsmedizin Berlin between August 2016 and July 2020. The data were recorded according to the German expert standard for fall documentation. Predictive power scores were calculated to define optimal feature sets. With an accuracy of 74% for recurrent falls and 86% for injury severity, boosting demonstrated the best overall predictive performance of all models assessed. Given that our data contain initially rated risk scores, our results demonstrate that well trained ML algorithms possibly provide tools to substantially reduce fall risks in clinical care settings.
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Affiliation(s)
- Sven Rehfeld
- Department of Information Systems, Freie Universität Berlin, Germany
| | | | - Fabian Schreiber
- Institute of Medical Informatics, Charité - Universitätsmedizin, Germany
| | - Daniel Fürstenau
- Department of Information Systems, Freie Universität Berlin, Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin, Germany
- Department of Digitalization, Copenhagen Business School, Denmark
| | - Anatol-Fiete Näher
- Institute of Medical Informatics, Charité - Universitätsmedizin, Germany
- Data Management Unit, Robert Koch Institute, Germany
| | - Armin Hauss
- Institute of Medical Informatics, Charité - Universitätsmedizin, Germany
| | - Charlotte Köhler
- Department of Information Systems, Freie Universität Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin, Germany
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Fürstenau D, Haneke H, Spies C, Walz T, Schewina K, Höft M, Mörgeli R, Balzer F. Tackling the frailty burden with an integrative value-based approach: results from a mixed-methods study. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Aim
The purpose of this paper is to investigate the implementation of value-based care principles in the context of frailty in the perioperative process, highlighting the importance of an integrative perspective considering medical and patient-centric outcomes as well as costs.
Subject and methods
This mixed-methods study employs a sequential design. Qualitative observational data were used to identify needs and barriers for implementing value-based principles, and quantitative methods were subsequently used to demonstrate the value of employing such an approach using data gathered from n = 952 patients. Propensity score matching was applied to identify the frailty-associated costs of the inpatient setting for n = 381 non-frail and n = 381 (pre-)frail patients, in particular considering patient-centric outcomes.
Results
The qualitative analysis identified three main challenges when implementing value-based principles in the context of perioperative care and frailty, namely challenges related to the cost, patient-centric, and integrative perspectives. In addressing these shortcomings, a quantitative analysis of a propensity score-matched sample of patients undergoing surgery shows additional frailty-associated costs of 3583.01 [1654.92; 5511.04] EUR for (pre-)frail patients and the influence of individual patient-centric attributes. Effect size Cohen’s d was 0.26.
Conclusion
The results demonstrate that frailty should be considered from an integrative perspective, taking cost, patient-centered outcomes, and medical outcomes into account simultaneously. The results also show the value of a research design which uses qualitative data for the identification of needs and barriers, as well as quantitative data for demonstrating the usefulness of the conceived value-based approach to perioperative care delivery.
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Seibert K, Domhoff D, Bruch D, Schulte-Althoff M, Fürstenau D, Biessmann F, Wolf-Ostermann K. Application Scenarios for Artificial Intelligence in Nursing Care: Rapid Review. J Med Internet Res 2021; 23:e26522. [PMID: 34847057 PMCID: PMC8669587 DOI: 10.2196/26522] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/21/2021] [Accepted: 10/08/2021] [Indexed: 12/23/2022] Open
Abstract
Background Artificial intelligence (AI) holds the promise of supporting nurses’ clinical decision-making in complex care situations or conducting tasks that are remote from direct patient interaction, such as documentation processes. There has been an increase in the research and development of AI applications for nursing care, but there is a persistent lack of an extensive overview covering the evidence base for promising application scenarios. Objective This study synthesizes literature on application scenarios for AI in nursing care settings as well as highlights adjacent aspects in the ethical, legal, and social discourse surrounding the application of AI in nursing care. Methods Following a rapid review design, PubMed, CINAHL, Association for Computing Machinery Digital Library, Institute of Electrical and Electronics Engineers Xplore, Digital Bibliography & Library Project, and Association for Information Systems Library, as well as the libraries of leading AI conferences, were searched in June 2020. Publications of original quantitative and qualitative research, systematic reviews, discussion papers, and essays on the ethical, legal, and social implications published in English were included. Eligible studies were analyzed on the basis of predetermined selection criteria. Results The titles and abstracts of 7016 publications and 704 full texts were screened, and 292 publications were included. Hospitals were the most prominent study setting, followed by independent living at home; fewer application scenarios were identified for nursing homes or home care. Most studies used machine learning algorithms, whereas expert or hybrid systems were entailed in less than every 10th publication. The application context of focusing on image and signal processing with tracking, monitoring, or the classification of activity and health followed by care coordination and communication, as well as fall detection, was the main purpose of AI applications. Few studies have reported the effects of AI applications on clinical or organizational outcomes, lacking particularly in data gathered outside laboratory conditions. In addition to technological requirements, the reporting and inclusion of certain requirements capture more overarching topics, such as data privacy, safety, and technology acceptance. Ethical, legal, and social implications reflect the discourse on technology use in health care but have mostly not been discussed in meaningful and potentially encompassing detail. Conclusions The results highlight the potential for the application of AI systems in different nursing care settings. Considering the lack of findings on the effectiveness and application of AI systems in real-world scenarios, future research should reflect on a more nursing care–specific perspective toward objectives, outcomes, and benefits. We identify that, crucially, an advancement in technological-societal discourse that surrounds the ethical and legal implications of AI applications in nursing care is a necessary next step. Further, we outline the need for greater participation among all of the stakeholders involved.
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Affiliation(s)
- Kathrin Seibert
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dominik Domhoff
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
| | - Dominik Bruch
- Auf- und Umbruch im Gesundheitswesen UG, Bonn, Germany
| | - Matthias Schulte-Althoff
- School of Business and Economics, Department of Information Systems, Freie Universität Berlin, Einstein Center Digital Future, Berlin, Germany
| | - Daniel Fürstenau
- Department of Digitalization, Copenhagen Business School, Frederiksberg, Denmark.,Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Biessmann
- Faculty VI - Informatics and Media, Beuth University of Applied Sciences, Einstein Center Digital Future, Berlin, Germany
| | - Karin Wolf-Ostermann
- Institute of Public Health and Nursing Research, High Profile Area Health Sciences, University of Bremen, Bremen, Germany
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Guinemer C, Boeker M, Fürstenau D, Poncette AS, Weiss B, Mörgeli R, Balzer F. Telemedicine in Intensive Care Units: Scoping Review. J Med Internet Res 2021; 23:e32264. [PMID: 34730547 PMCID: PMC8600441 DOI: 10.2196/32264] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/03/2021] [Accepted: 09/18/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The role of telemedicine in intensive care has been increasing steadily. Tele-intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. OBJECTIVE This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. METHODS A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. RESULTS A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. CONCLUSIONS The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/19695.
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Affiliation(s)
- Camille Guinemer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Boeker
- Intelligence and Informatics in Medicine, Medical Center rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Digitalization, Copenhagen Business School, Copenhagen, Denmark
| | - Akira-Sebastian Poncette
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Björn Weiss
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rudolf Mörgeli
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Balzer
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Vogel A, Balzer F, Fürstenau D. The social construction of the patient-physician relationship in the clinical encounter: Media frames on shared decision making in Germany. Soc Sci Med 2021; 289:114420. [PMID: 34607053 DOI: 10.1016/j.socscimed.2021.114420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 11/28/2022]
Abstract
The literature on healthcare management has noted that shared decision-making (SDM) - a practice of organizing joint decisions between healthcare professionals and patients - should improve healthcare outcomes through patient engagement and autonomy, fostering patient-centeredness. While SDM projects are implemented across Europe and the US, the diffusion of the practice remains partial, and its' conceptualization scattered. Healthcare management literature explores SDM on the underlying assumption that its limited diffusion results from an information problem, implying objective criteria and rational behavior. The purpose of this research is to study the social construction of SDM within the clinical setting and the underlying rationales using the case of one of the largest healthcare markets worldwide - Germany. To capture the complexity of SDM, a frame analysis is conducted on its medial representations. News media is both influential in shaping public opinion, as well as in generating public discourse. This analysis enables one to elaborate different facets of the construct of SDM, to capture inherent patterns of facilitating and obstructing aspects and to explore consequences for the diffusion of SDM. Three facilitating and three obstructive frames on the implementation of SDM were identified. The polarities of these frames range from the questioning of one's decision-making authority to the perception of individual competence and decision-making agency. Moreover, this study reflects on how physicians' and patients' role for SDM is conceived.
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Affiliation(s)
- Amyn Vogel
- Freie Universität Berlin, School of Business & Economics, Department of Information Systems, Germany.
| | - Felix Balzer
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Daniel Fürstenau
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Digitalization, Copenhagen Business School, Denmark.
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von Briel F, Recker J, Selander L, Jarvenpaa SL, Hukal P, Yoo Y, Lehmann J, Chan Y, Rothe H, Alpar P, Fürstenau D, Wurm B. Researching Digital Entrepreneurship: Current Issues and Suggestions for Future Directions. CAIS 2021. [DOI: 10.17705/1cais.04833] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Affiliation(s)
- Daniel Fürstenau
- Department of Information Systems, School of Business and Economics, Freie Universität Berlin, 14195 Berlin, Germany
- Einstein Center Digital Future, 10117 Berlin, Germany
| | - Abayomi Baiyere
- Department of Digitalization, Copenhagen Business School, 2000 Frederiksberg, Denmark
- University of Turku, 20500 Turku, Finland
| | - Natalia Kliewer
- Department of Information Systems, School of Business and Economics, Freie Universität Berlin, 14195 Berlin, Germany
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Fürstenau D, Spies C, Gersch M, Vogel A, Mörgeli R, Poncette AS, Müller-Werdan U, Balzer F. Sharing Frailty-related information in perioperative care: an analysis from a temporal perspective. BMC Health Serv Res 2019; 19:105. [PMID: 30732604 PMCID: PMC6367783 DOI: 10.1186/s12913-019-3890-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 01/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Especially patients older than 65 years undergoing surgery are prone to develop frailty-related complications that may go far beyond the index hospitalization (e.g., cognitive impairment following postoperative delirium). However, aging-relevant information are currently not fully integrated into hospitals' perioperative processes. METHODS We introduce a temporal perspective, which focuses on the social construction of time, to better understand existing barriers to the exchange of frailty-related data, targeting complexity research. Our chosen context is perioperative care provided by a tertiary hospital in Germany that has implemented a special track for patients over 65 years old undergoing elective surgery. The research followed a participatory modelling approach between domain and modelling experts with the goal of creating a feedback loop model of the relevant system relationships and dynamics. RESULTS The results of the study show how disparate temporal regimes, understood as frameworks for organizing actions in the light of time constraints, time pressure, and deadlines, across different clinical, ambulant, and geriatric care sectors create disincentives to cooperate in frailty-related data exchanges. Moreover, we find that shifting baselines, meaning continuous increases in cost and time pressure in individual sectors, may unintentionally reinforce - rather than discourage - disparate temporal regimes. CONCLUSIONS Together, these results may (1) help to increase awareness of the importance of frailty-related data exchanges, and (2) impel efforts aiming to transform treatment processes to go beyond sectoral boundaries, taking into account the potential benefits for frail patients arising from integrated care processes using information technology.
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Affiliation(s)
- Daniel Fürstenau
- Department of Information Systems, Freie Universität Berlin, School of Business & Economics, Garystr. 21, 14195, Berlin, Germany.,Einstein Center Digital Future, Wilhelmstraße 67, 10117, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Gersch
- Department of Information Systems, Freie Universität Berlin, School of Business & Economics, Garystr. 21, 14195, Berlin, Germany
| | - Amyn Vogel
- Department of Information Systems, Freie Universität Berlin, School of Business & Economics, Garystr. 21, 14195, Berlin, Germany
| | - Rudolf Mörgeli
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Akira-Sebastian Poncette
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Einstein Center Digital Future, Wilhelmstraße 67, 10117, Berlin, Germany
| | - Ursula Müller-Werdan
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Geriatric Research Group, Reinickendorfer Str. 61, 13347, Berlin, Germany
| | - Felix Balzer
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Einstein Center Digital Future, Wilhelmstraße 67, 10117, Berlin, Germany.
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