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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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